Questions and Answers
What percentage of oral cancers are squamous cell carcinomas (SCC)?
What are the three anatomical locations included in the term "oral"?
What is the primary type of cancer affecting the oral region, as mentioned in the text?
What percentage of lip vermilion squamous cell carcinomas occur on the lower lip?
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What is a possible risk factor for lip vermilion SCC mentioned in the text?
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In the context of TNM staging for OSCC, what does "T1" represent?
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Which of the following N categories in the TNM staging system indicates involvement of bilateral or contralateral lymph nodes?
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What is a characteristic of OSCC in individuals with light skin?
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What is the difference in the TNM staging system for HPV-positive and HPV-negative OSCC?
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What is the maximum size of a lymph node that would be categorized as N2b in the TNM staging system?
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Which of the following is a possible complication of OSCC that could lead to difficulty swallowing?
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What does the term "mets" refer to in the context of OSCC?
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Which of the following terms is most associated with an abnormal, red, velvety patch of tissue in the oral cavity?
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What is a key characteristic of oral squamous cell carcinoma (SCC) in younger patients?
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What does the term 'exophytic' describe in the context of oral lesions?
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Which of the following is a characteristic of leukoplakia?
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What is the significance of erythroleukoplakia in the oral cavity?
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What is the name of the specific type of cancer that is mentioned in the text as a potential complication of oral lichen planus?
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What is a key difference between erythroleukoplakia and leukoplakia?
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Which of the following anatomical subsites has a better prognosis than the others?
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What is the most common presenting morphology of Oral SCC?
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Which of the following is NOT an intrinsic factor contributing to Oral SCC etiology?
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Which of these factors is a known risk factor for Oral SCC?
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What is the typical presentation of an Erythroplakic Oral SCC?
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What is the primary difference between endophytic and exophytic Oral SCC?
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Which of these is an oncogenic virus known to be associated with Oral SCC?
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What is the significance of the retromolar trigone?
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Which of these is a potential clinical feature of Oral SCC?
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Study Notes
Learning Objectives
- Understand epidemiology, etiopathogenesis, clinical features, staging, management, and prognosis of epithelial malignancies in the oral and head/neck regions.
- Compare squamous cell carcinomas (SCC) in the oral cavity versus the oropharynx.
- Discuss oral health concerns and side effects of antineoplastic therapy.
Oral Cancer Overview
- Approximately 95% of oral cancers are squamous cell carcinomas (SCC).
Terminology
- "Oral" includes:
- Lip vermilion
- Oral cavity proper
- Oropharynx
Anatomy
- Oral Cavity Subsites:
- Hard palate, anterior two-thirds of tongue, labial mucosa, buccal mucosa, floor of mouth, alveolar ridge/gingiva, retromolar trigone.
- Oropharynx Subsites:
- Soft palate, posterior one-third (base) of tongue, palatine tonsils, palatoglossal folds, valleculae, posterior pharyngeal wall.
Epidemiology
- Oral SCC is more prevalent in males than females.
- Risk for developing oral SCC increases with age.
Etiology
- Extrinsic Risk Factors:
- Tobacco, alcohol, betel quid, sunlight exposure (lip vermilion), x-irradiation.
- Microbiome dysbiosis and infections (e.g., syphilis, oncogenic viruses like HPV16).
- Intrinsic Risk Factors:
- Nutritional deficiencies (iron, vitamin A), immunosuppression, and genetic mutations (TP53, RB1, CDKN2A, RAS, MYC, EGFR, PIK3CA).
Clinical Features
- Morphological types of Oral SCC:
- Exophytic: Grows outward from mucosa.
- Endophytic: Grows into tissue, often forming a broad base.
- Leukoplakic: White patches.
- Erythroplakic: Red lesions or mixed red and white.
- Symptoms may include pain, induration, destruction of underlying bone, and paresthesia.
High-Risk Sites for Oral SCC
- Particularly high-risk areas include:
- Tongue (especially posterior lateral and ventral surfaces)
- Floor of mouth
- Other sites: gingiva, buccal mucosa, labial mucosa, hard palate.
Lip Vermilion SCC
- Approximately 90% of cases occur on the lower lip, often due to chronic UV light exposure.
- Typically presents in light-skinned individuals; growth is relatively slow.
- Metastases occur later, often when the tumor size exceeds 3-6 cm with a depth of invasion >10 mm.
TNM Staging for Oropharyngeal SCC
- HPV-positive oropharyngeal SCC uses specific criteria for staging based on primary tumor size, regional lymph node involvement, and distant metastasis.
- TNM categories indicate various classifications based on tumor size, regional nodes (ipsilateral, contralateral, bilateral), and distant metastases.
- Staging for HPV-negative oropharyngeal SCC follows similar but distinct classification criteria.
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