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{{Oral cancer}}
{{Oral cancer}}
{{CMG}};{{AE}} {{SSW}},{{Simrat}}
{{CMG}}; {{AE}} {{SSW}}, {{Simrat}}; {{GRR}} {{Nat}}
==Overview==
==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.
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]]. 
 
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.  
==Classification==
==Classification==
===Malignant tumors of the oral cavity===
===(i) Malignant tumors of the oral cavity===
* Malignant tumours of the oral cavity are cancerous growths that have the potential to spread ([[metastasize]]) to other parts of the body.  
* [[Malignant tumors|Malignant tumors]] of the oral cavity are [[cancerous]] growths that have the potential to spread ([[metastasize]]) to other parts of the body.  
* The oral cavity is lined with [[squamous]] [[epithelium]], which is formed by flat, scale-like cells called squamous cells.
* The [[oral cavity]] is lined with [[squamous]] [[epithelium]], which is formed by flat, scale-like [[Cells (biology)|cells]] called [[Squamous cell|squamous cells]].
* The most common oral cavity cancer starts in these cells and is called [[squamous cell carcinoma]] (SCC).
* The most common oral cavity cancer starts in these cells and is called [[squamous cell carcinoma]] (SCC).


====Squamous Cell Carcinoma====
====Squamous Cell Carcinoma====
*Squamous cell carcinoma (SCC) tumors make up 95% of all oral cavity cancers. They are classified based on macroscopic or microscopic features.
*[[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. Cancers are described as:
**'''Macroscopic features:'''
::*Infiltrative – Cancer is growing into the deeper layers of the oral cavity.
**Can be seen without a microscope
::*Exophytic – Cancer is growing outwards from the surface of the oral cavity.
**Squamous cell carcinomas are described as following based on [[macroscopic]] features:
::*Verrucous– Cancer has a wart-like appearance.
::*Infiltrative – [[Cancer]] is growing into deep layers of the [[oral cavity]]
::*Ulcerated– Cancer appears as an open sore.
::*Exophytic – [[Cancer]] is growing outwards from the surface of the [[oral cavity]]
::*Flat – Cancer appears as an abnormal area in the lining of the oral cavity.
::*Verrucous– [[Cancer]] has a wart-like appearance
:*Based on their microscopic features, squamous cell carcinomas are divided into 2 types:
::*Ulcerated– [[Cancer]] appears as an open [[sore]]
::*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.
::*Flat – [[Cancer]] appears as an abnormal area in the lining of the [[oral cavity]]
::*Variants of SCC: These squamous cell carcinomas have distinct microscopic features that make them look and behave differently from classical SCC.
:*'''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]]
:::*[[Verrucous carcinoma]]
:::*Basaloid SCC
:::*Basaloid SCC
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:::*Spindle cell carcinoma (SpCC)
:::*Spindle cell carcinoma (SpCC)
:::*Acantholytic SCC
:::*Acantholytic SCC
:::*Adenosquamous carcinoma
:::*[[Adenosquamous carcinoma]]
:::*Lymphoepithelial carcinoma
:::*[[Lymphoepithelioma|Lymphoepithelial carcinoma]]


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


===Benign tumors and conditions of the oral cavity===
===(iii) Benign tumors and conditions of the oral cavity===
*Benign Tumors: There are many different types of benign oral cavity tumors.
*'''Benign tumors:''' There are many different types of benign oral cavity tumors.
**Hyperplasias
**[[Hyperplasia]]
**[[Papillomas]]
**[[Papillomas]]
**[[Pleomorphic adenoma]]
**[[Pleomorphic adenoma]]
**Soft tissue tumors
**[[Soft tissue]] tumors
***[[Lymphangioma]]
***[[Lymphangioma]]
***[[Hemangioma]]
***[[Hemangioma]]
***[[Neurofibroma]]
***[[Neurofibroma]]
***[[Lipoma]]
***[[Lipoma]]
*Benign odontogenic tumors and cysts
*[[Benign]] odontogenic [[tumors]] and cysts
**[[Osteoma]]
**[[Osteoma]]
**Ossifying [[fibroma]]
**Ossifying [[fibroma]]
*Benign conditions
*[[Benign]] conditions
**[[Candidiasis]] (thrush)
**[[Candidiasis]] ([[Oral candidiasis|thrush]])
**[[Aphthous ulcers]] (canker sores)
**[[Aphthous ulcers]] ([[canker sores]])
**Recurrent [[herpes labialis]] (cold sores)
**Recurrent [[herpes labialis]] ([[cold sores]])
**[[Erythema migrans]] (geographic tongue)
**[[Erythema migrans]] ([[geographic tongue]])
**Hairy tongue
**Hairy tongue
**[[Lichen planus]]
**[[Lichen planus]]
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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 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>
{| class="wikitable"
{| class="wikitable"
! colspan="2" |TNM Staging for Lip and Oral Cavity Cancers#
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |TNM Staging for Lip and Oral Cavity Cancers#
|-
|-
| colspan="2" |'''Tumor'''
| colspan="2" |'''Tumor'''
|-
|-
|TX
|TX
|Primary tumor cannot be assessed.
|[[Primary tumor]] cannot be assessed
|-
|-
|T0
|T0
|Primary tumor cannot be assessed.
|[[Primary tumor]] cannot be assessed
|-
|-
|Tis
|Tis
|Carcinoma in situ
|[[Carcinoma in situ]]
|-
|-
|T1
|T1
|Tumor <2 cm or less in greatest dimension
|[[Tumor]] <2 cm or less in greatest dimension
|-
|-
|T2
|T2
|Tumor more than 2 cm but not more than 4 cm in greatest dimension
|[[Tumor]] more than 2 cm but not more than 4 cm in greatest dimension
|-
|-
|T3
|T3
|Tumor more than 4 cm in greatest dimension
|[[Tumor]] more than 4 cm in greatest dimension
|-
|-
|T4 (lip)
|T4 (lip)
|Tumor invades through cortical bone, inferior alveolar nerve, floor of the mouth, or skin of the face (e.g., chin or nose).
|[[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)
|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).
|[[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
|T4b
|Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid canal.
|[[Tumor]] invades masticator space, [[pterygoid]] plates, or skull base and/or encases [[internal carotid]] canal
|-
|-
| colspan="2" |'''Regional Lymph Nodes (N)'''
| colspan="2" |'''Regional Lymph Nodes (N)'''
|-
|-
|NX
|NX
|Regional lymph nodes cannot be assessed
|Regional [[lymph nodes]] cannot be assessed
|-
|-
|N0
|N0
|No regional lymph node metastasis
|No regional [[lymph node]] [[metastasis]]
|-
|-
|N1
|N1
|Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
|[[Metastasis]] in a single [[ipsilateral]] [[lymph node]], 3 cm or less in greatest dimension
|-
|-
|N2a
|N2a
|Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension
|[[Metastasis]] in a single [[ipsilateral]] [[lymph node]], more than 3 cm but not more than 6 cm in greatest dimension
|-
|-
|N2b
|N2b
|Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension
|[[Metastasis]] in multiple [[ipsilateral]] [[lymph nodes]], none more than 6 cm in greatest dimension
|-
|-
|N2c
|N2c
|Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
|[[Metastasis]] in bilateral or [[contralateral]] [[lymph nodes]], none more than 6 cm in greatest dimension
|-
|-
|N3
|N3
|Metastasis in a lymph node more than 6 cm in greatest dimension
|[[Metastasis]] in a [[lymph node]] more than 6 cm in greatest dimension
|-
|-
| colspan="2" |'''Distant Metastasis (M)'''
| colspan="2" |'''Distant Metastasis (M)'''
|-
|-
|MX
|MX
|Distant metastasis cannot be assessed.
|Distant [[metastasis]] cannot be assessed
|-
|-
|M0
|M0
|No distant metastasis
|No distant [[metastasis]]
|-
|-
|M1
|M1
|Distant metastasis
|Distant [[metastasis]]
|-
|-
| colspan="2" |M = Distant metastasis; N = regional lymph nodes; T= primary tumor; Tis = carcinoma in situ.  
| 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.
<nowiki>#</nowiki> = Staging system of the American Joint Committee on Cancer.
|}
|}
{| class="wikitable"
{| class="wikitable"
! colspan="2" |Staging of Oral Squamous Cell Carcinoma
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Staging of Oral Squamous Cell Carcinoma
|-
|-
|'''Stage'''
|'''Stage'''
Line 187: Line 189:
|Any T, any N, M1
|Any T, any N, M1
|-
|-
| colspan="2" |M = Distant metastasis; N = regional lymph nodes; T = primary tumor; Tis = carcinoma in situ.
| colspan="2" |M = Distant [[metastasis]]; N = regional [[lymph nodes]]; T = [[primary tumor]]; Tis = [[carcinoma in situ]].
|}
|}


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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