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{{Oral cancer}}
{{Oral cancer}}
{{CMG}};{{AE}} {{Simrat}}
{{CMG}}; {{AE}} {{SSW}}, {{Simrat}}; {{GRR}} {{Nat}}
==Overview==
==Overview==
Oral cancer can be classified into several subtypes based on histology such as squamous cell carcinoma, verrucous carcinoma, minor salivary gland carcinoma, lymphomas, benign oral cancer and oropharyngeal tumors, leukoplakia, and erythroplakia.  
Oral cancer can be classified into three types based on the potential to spread to other parts of the body such as [[malignant]] [[tumors]],[[ precancerous]] conditions, and [[Benign tumor|benign tumors]]. Most common type of [[Malignant tumors|malignant tumor]] of the [[mouth]] is [[squamous cell carcinoma]]. [[Squamous cell carcinoma]] is further classified based on [[macroscopic]] and [[microscopic]] features. About 5% of oral cavity cancers are rare [[malignant tumors]] that start in different types of [[Cells (biology)|cells]] in the oral cavity. These include [[salivary gland cancer]], [[melanoma]], [[bone]] and [[soft tissue]] [[sarcomas]], [[Lymphomas]] and [[Plasmacytoma|extramedullary plasmacytomas]], [[Hodgkin lymphoma]], and [[non-Hodgkin lymphoma]] [[metastatic cancer]].
==Classification==
==Classification==
Oral cancer can be classified into several subtypes based on histology:
===(i) Malignant tumors of the oral cavity===
*Squamous cell carcinoma
* [[Malignant tumors|Malignant tumors]] of the oral cavity are [[cancerous]] growths that have the potential to spread ([[metastasize]]) to other parts of the body.  
Squamous cell carcinoma account for more than 90% of cancers that occur in the oral cavity and oropharynx. 
* The [[oral cavity]] is lined with [[squamous]] [[epithelium]], which is formed by flat, scale-like [[Cells (biology)|cells]] called [[Squamous cell|squamous cells]].
*Verrucous carcinoma
* The most common oral cavity cancer starts in these cells and is called [[squamous cell carcinoma]] (SCC).
*Minor salivary gland carcinomas
**Adenoid cystic carcinoma
**Mucoepidermoid carcinoma
**Polymorphous low-grade adenocarcinoma.
*Lymphomas
**Oral cancers that develop in lymph tissue, are known as lymphomas.
***Hodgkin lymphoma
***Non-Hodgkin lymphoma
*Benign oral cavity and oropharyngeal tumors
Several types of non-cancerous tumors and tumor-like conditions can arise in the oral cavity and oropharynx.
*Leukoplakia and erythroplakia
A premalignant (or precancerous) lesion is defined as "a benign, morphologically altered tissue that has a greater than normal risk of malignant transformation." There are several different types of premalignant lesion that occur in the mouth. Some oral cancers begin as white patches (leukoplakia), red patches (erythroplakia) or mixed red and white patches (erythroleukoplakia or "speckled leukoplakia").  


====Squamous Cell Carcinoma====
*[[Squamous cell carcinomas]] (SCC) make up 95% of all oral cavity cancers. They are classified based on [[macroscopic]] or [[microscopic]] features.
**'''Macroscopic features:'''
**Can be seen without a microscope
**Squamous cell carcinomas are described as following based on [[macroscopic]] features:
::*Infiltrative – [[Cancer]] is growing into deep layers of the [[oral cavity]]
::*Exophytic – [[Cancer]] is growing outwards from the surface of the [[oral cavity]]
::*Verrucous– [[Cancer]] has a wart-like appearance
::*Ulcerated– [[Cancer]] appears as an open [[sore]]
::*Flat – [[Cancer]] appears as an abnormal area in the lining of the [[oral cavity]]
:*'''Microscopic features:'''
:*[[Squamous cell carcinomas]] (SCC) are further divided into the following types based on [[microscopic]] features:
::*Classical or conventional SCC: Most cancers of the [[oral cavity]] are classical or conventional [[squamous cell carcinoma]]. This type of SCC starts in the [[squamous epithelium]] that lines the [[oral cavity]] and occurs most often on the [[lower lip]], [[tongue]] and floor of the [[mouth]].
::*Variants of SCC: These [[squamous cell carcinomas]] have distinct [[microscopic]] features that make them look and behave differently from classical SCC.
:::*[[Verrucous carcinoma]]
:::*Basaloid SCC
:::*[[Papillary]] SCC
:::*Spindle cell carcinoma (SpCC)
:::*Acantholytic SCC
:::*[[Adenosquamous carcinoma]]
:::*[[Lymphoepithelioma|Lymphoepithelial carcinoma]]


====Rare malignant tumors====
*About 5% of oral cavity cancers are rare, [[malignant tumors]] that start in different types of [[Cells (biology)|cells]] in the [[oral cavity]].
**[[Salivary gland cancer]]
**[[Melanoma]]
**[[Bone]] and [[soft tissue]] [[sarcomas]]
**[[Lymphomas]] and extramedullary [[Plasmacytoma|plasmacytomas]]
**[[Hodgkin lymphoma]]
**[[Non-Hodgkin lymphoma]]
**[[Metastatic cancer]]
===(ii) Pre-cancerous lesions of the oral cavity===
* Several types of non-cancerous [[tumors]] and [[tumor]]-like conditions can arise in the [[oral cavity]] and [[oropharynx]].
* A pre-malignant (or precancerous) lesion is defined as a [[benign]], morphologically-altered tissue that has a greater than normal risk of becoming [[malignant]].
* There are several different types of pre-malignant lesions that occur in the [[mouth]].
* Some oral cancers begin as white patches ([[leukoplakia]]), red patches ([[erythroplakia]]), or mixed red and white patches (erythroleukoplakia or "speckled leukoplakia").
* The most common pre-cancerous conditions of the [[oral cavity]] are:
** [[Leukoplakia]]
** [[Erythroplakia]]
**Erythroleukoplakia
**Proliferative verrucous [[leukoplakia]] (PVL)
**[[Oral]] [[submucous]] [[fibrosis]]


===(iii) Benign tumors and conditions of the oral cavity===
*'''Benign tumors:''' There are many different types of benign oral cavity tumors.
**[[Hyperplasia]]
**[[Papillomas]]
**[[Pleomorphic adenoma]]
**[[Soft tissue]] tumors
***[[Lymphangioma]]
***[[Hemangioma]]
***[[Neurofibroma]]
***[[Lipoma]]
*[[Benign]] odontogenic [[tumors]] and cysts
**[[Osteoma]]
**Ossifying [[fibroma]]
*[[Benign]] conditions
**[[Candidiasis]] ([[Oral candidiasis|thrush]])
**[[Aphthous ulcers]] ([[canker sores]])
**Recurrent [[herpes labialis]] ([[cold sores]])
**[[Erythema migrans]] ([[geographic tongue]])
**Hairy tongue
**[[Lichen planus]]
**Frictional [[hyperkeratosis]]
**[[Mucocele]]


 
== TNM Classification of oral cavity carcinoma ==
 
The TNM classification of oral cavity carcinoma is as follows:<ref>{{cite book | last = Sobin | first = L. H. | title = TNM classification of malignant tumours | publisher = Wiley-Blackwell | location = Chichester, West Sussex, UK Hoboken, NJ | year = 2009 | isbn = 9781444332414 }}</ref>
 
 
The process used to find out if cancer has spread within the oral cavity or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnose oral cavity cancer are also used to stage the disease.
*The following stages are used for lip and oral cavity cancer:
**Stage 0 (Carcinoma in Situ)
**Stage I
**Stage II
**Stage III
**Stage IV
 
{| class="wikitable"
{| class="wikitable"
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |TNM Staging for Lip and Oral Cavity Cancers#
|-
| colspan="2" |'''Tumor'''
|-
|TX
|[[Primary tumor]] cannot be assessed
|-
|T0
|[[Primary tumor]] cannot be assessed
|-
|Tis
|[[Carcinoma in situ]]
|-
|T1
|[[Tumor]] <2 cm or less in greatest dimension
|-
|T2
|[[Tumor]] more than 2 cm but not more than 4 cm in greatest dimension
|-
|T3
|[[Tumor]] more than 4 cm in greatest dimension
|-
|T4 (lip)
|[[Tumor]] invades through cortical bone, [[inferior alveolar nerve]], floor of the mouth, or [[skin]] of the face (e.g., chin or nose)
|-
|T4a (oral cavity)
|[[Tumor]] invades adjacent structures (e.g., through cortical bone into deep [extrinsic] [[muscle]] of the [[tongue]] [[[genioglossus]], [[hyoglossus]], [[palatoglossus]], and [[styloglossus]]], [[maxillary sinus]], or [[skin]] of the [[face]])
|-
|T4b
|[[Tumor]] invades masticator space, [[pterygoid]] plates, or skull base and/or encases [[internal carotid]] canal
|-
| colspan="2" |'''Regional Lymph Nodes (N)'''
|-
|NX
|Regional [[lymph nodes]] cannot be assessed
|-
|N0
|No regional [[lymph node]] [[metastasis]]
|-
|N1
|[[Metastasis]] in a single [[ipsilateral]] [[lymph node]], 3 cm or less in greatest dimension
|-
|N2a
|[[Metastasis]] in a single [[ipsilateral]] [[lymph node]], more than 3 cm but not more than 6 cm in greatest dimension
|-
|N2b
|[[Metastasis]] in multiple [[ipsilateral]] [[lymph nodes]], none more than 6 cm in greatest dimension
|-
|N2c
|[[Metastasis]] in bilateral or [[contralateral]] [[lymph nodes]], none more than 6 cm in greatest dimension
|-
|N3
|[[Metastasis]] in a [[lymph node]] more than 6 cm in greatest dimension
|-
| colspan="2" |'''Distant Metastasis (M)'''
|-
|MX
|Distant [[metastasis]] cannot be assessed
|-
|-
! Name
|M0
! Description
|No distant [[metastasis]]
|-
|-
|Stage 0
|M1
|In stage 0, abnormal cells are found in the lining of the lips and oral cavity. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
|Distant [[metastasis]]
|-
|-
| Stage I
| colspan="2" |M = Distant [[metastasis]]; N = regional [[Lymph node|lymph nodes]]; T= [[primary tumor]]; Tis = [[carcinoma in situ]].
 
<nowiki>#</nowiki> = Staging system of the American Joint Committee on Cancer.
|In stage I, cancer has formed and the tumor is 2 centimeters or smaller. Cancer has not spread to the lymph nodes.
|}
{| class="wikitable"
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Staging of Oral Squamous Cell Carcinoma
|-
|'''Stage'''
|'''Description'''
|-
|0
|Tis, N0, M0
|-
|-
| Stage II
|I
|In stage II, the tumor is larger than 2 centimeters but not larger than 4 centimeters, and cancer has not spread to the lymph nodes.
|T1, N0, M0
|-
|-
| Stage III
|II
|In stage III, the tumor:
|T2, N0, M0
may be any size and has spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the tumor; or
is larger than 4 centimeters.
|-
|-
| Stage IV
|III
| Stage IV is divided into stages IVA, IVB, and IVC.
|T3, N0, M0
T1, N1, M0
 
T2, N1, M0
 
T3, N1, M0
|-
|-
| Stage IVA
|IVA
|In stage IVA, the tumor:
|T4a, N0, M0
T4a, N1, M0


*has spread through tissue in the lip or oral cavity into nearby tissue and/or bone (jaw, tongue, floor of mouth, maxillary sinus, or skin on the chin or nose);cancer may have spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the tumor; or
T1, N2, M0
*is any size or has spread through tissue in the lip or oral cavity into nearby tissue and/or bone (jaw, tongue, floor of mouth, maxillary sinus, or skin on the chin or nose), and cancer has spread:
 
**to one lymph node on the same side of the neck as the tumor and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or
T2, N2, M0
**to more than one lymph node on the same side of the neck as the tumor and the lymph nodes are not larger than 6 centimeters; or
 
**to lymph nodes on the opposite side of the neck as the tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters.
T3, N2, M0
 
T4a, N2, M0
|-
|IVB
|Any T, N3, M0
T4b, any N, M0
|-
|-
| Stage IVB
|IVC
|In stage IVB, the tumor:
|Any T, any N, M1
*may be any size and has spread to one or more lymph nodes that are larger than 6 centimeters; or
*has spread further into the muscles or bones in the oral cavity, or to the base of the skull and/or the carotid artery. Cancer may have spread to one or more lymph nodes anywhere in the neck.
|-
|-
| Stage IVC
| colspan="2" |M = Distant [[metastasis]]; N = regional [[lymph nodes]]; T = [[primary tumor]]; Tis = [[carcinoma in situ]].
|In stage IVC, the tumor has spread beyond the lip or oral cavity to distant parts of the body, such as the lungs. The tumor may be any size and may have spread to the lymph nodes.
|}
|}


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Latest revision as of 12:49, 11 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sargun Singh Walia M.B.B.S.[2], Simrat Sarai, M.D. [3]; Grammar Reviewer: Natalie Harpenau, B.S.[4]

Overview

Oral cancer can be classified into three types based on the potential to spread to other parts of the body such as malignant tumors,precancerous conditions, and benign tumors. Most common type of malignant tumor of the mouth is squamous cell carcinoma. Squamous cell carcinoma is further classified based on macroscopic and microscopic features. About 5% of oral cavity cancers are rare malignant tumors that start in different types of cells in the oral cavity. These include salivary gland cancer, melanoma, bone and soft tissue sarcomas, Lymphomas and extramedullary plasmacytomas, Hodgkin lymphoma, and non-Hodgkin lymphoma metastatic cancer.

Classification

(i) Malignant tumors of the oral cavity

Squamous Cell Carcinoma

Rare malignant tumors

(ii) Pre-cancerous lesions of the oral cavity

(iii) Benign tumors and conditions of the oral cavity

TNM Classification of oral cavity carcinoma

The TNM classification of oral cavity carcinoma is as follows:[1]

TNM Staging for Lip and Oral Cavity Cancers#
Tumor
TX Primary tumor cannot be assessed
T0 Primary tumor cannot be assessed
Tis Carcinoma in situ
T1 Tumor <2 cm or less in greatest dimension
T2 Tumor more than 2 cm but not more than 4 cm in greatest dimension
T3 Tumor more than 4 cm in greatest dimension
T4 (lip) Tumor invades through cortical bone, inferior alveolar nerve, floor of the mouth, or skin of the face (e.g., chin or nose)
T4a (oral cavity) Tumor invades adjacent structures (e.g., through cortical bone into deep [extrinsic] muscle of the tongue [[[genioglossus]], hyoglossus, palatoglossus, and styloglossus], maxillary sinus, or skin of the face)
T4b Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid canal
Regional Lymph Nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
N2a Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension
N2b Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension
N2c Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
N3 Metastasis in a lymph node more than 6 cm in greatest dimension
Distant Metastasis (M)
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
M = Distant metastasis; N = regional lymph nodes; T= primary tumor; Tis = carcinoma in situ.

# = Staging system of the American Joint Committee on Cancer.

Staging of Oral Squamous Cell Carcinoma
Stage Description
0 Tis, N0, M0
I T1, N0, M0
II T2, N0, M0
III T3, N0, M0

T1, N1, M0

T2, N1, M0

T3, N1, M0

IVA T4a, N0, M0

T4a, N1, M0

T1, N2, M0

T2, N2, M0

T3, N2, M0

T4a, N2, M0

IVB Any T, N3, M0

T4b, any N, M0

IVC Any T, any N, M1
M = Distant metastasis; N = regional lymph nodes; T = primary tumor; Tis = carcinoma in situ.

References

  1. ↑ Sobin, L. H. (2009). TNM classification of malignant tumours. Chichester, West Sussex, UK Hoboken, NJ: Wiley-Blackwell. ISBN 9781444332414.


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