Oral cancer pathophysiology: Difference between revisions

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{{CMG}};{{AE}}{{SSW}}, {{Simrat}}
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==Overview==
==Overview==
It is understood that oral cancers occur as a the result of [[carcinogen]]-[[Metabolize|metabolizing]] [[enzymes]], [[alcohol]], [[tobacco]] and [[Genetics|genetic factors]]. [[Cytotoxicity|Cytotoxic]] [[enzymes]] such as [[alcohol dehydrogenase]] result in the production of [[free radicals]] and [[hydroxylation]] of [[DNA]] base units. [[Alcohol dehydrogenase]] oxidizes [[ethanol]] to [[acetaldehyde]] which is [[Cytotoxicity|cytotoxic]] in nature. Cigarette smoke has various [[carcinogens]] which can lead to oral cancers. Low reactive [[free radicals]] in [[cigarette smoke]] interact with [[redox]]-active [[metals]] in [[saliva]].The development of oral cancer is the result of multiple [[genetic mutations]].These [[mutations]] occur in [[Tumor suppressor genes|tumor suppressor genes (TSGs)]] and [[Oncogene|oncogenes]]. [[Squamous cell carcinoma]] is the most common [[malignancy]] of the oral cavity. It typically has three gross morphologic growth patterns, which are, exophytic, [[Ulcerated lesion|ulcerative]], and infiltrative. [[Microscopic|Microscopically]], oral cancers are broadly based and invasive through [[papillary]] fronds. Oral cancer consists of highly [[Differentiate|differentiated]] [[Squamous cell|squamous cells]] lacking frank [[Cytological|cytologic]] criteria of [[malignancy]] with rare [[Mitosis|mitoses]].The surface of the lesion is covered with compressed invaginating folds of [[keratin]] layers. A stroma-like [[Inflammatory response|inflammatory reaction]] and a blunt pushing margin may be seen.
It is understood that oral cancers occur as a the result of [[carcinogen]]-[[Metabolize|metabolizing]] [[enzymes]], [[alcohol]], [[tobacco]] and [[Genetics|genetic factors]]. [[Cytotoxicity|Cytotoxic]] [[enzymes]] such as [[alcohol dehydrogenase]] result in the production of [[free radicals]] and [[hydroxylation]] of [[DNA]] base units. [[Alcohol dehydrogenase]] oxidizes [[ethanol]] to [[acetaldehyde]] which is [[Cytotoxicity|cytotoxic]] in nature. Cigarette smoke has various [[carcinogens]], which can lead to oral cancers. Low-reactive [[free radicals]] in [[cigarette smoke]] interact with [[redox]]-active [[metals]] in [[saliva]].The development of oral cancer is the result of multiple [[genetic mutations]]. These [[mutations]] occur in [[Tumor suppressor genes|tumor suppressor genes (TSGs)]] and [[Oncogene|oncogenes]]. [[Squamous cell carcinoma]] is the most common [[malignancy]] of the oral cavity. It typically has three gross morphological growth patterns, which are exophytic, [[Ulcerated lesion|ulcerative]], and infiltrative. [[Microscopic|Microscopically]], oral cancers are broadly based and invasive through [[papillary]] fronds. Oral cancer consists of highly [[Differentiate|differentiated]] [[Squamous cell|squamous cells]] lacking frank [[Cytological|cytologic]] criteria of [[malignancy]] with rare [[Mitosis|mitoses]].The surface of the lesion is covered with compressed invaginating folds of [[keratin]] layers. A stroma-like [[Inflammatory response|inflammatory reaction]] and a blunt pushing margin may be seen.


==Pathophysiology==
==Pathophysiology==
It is understood that oral cancer occur as a the result of [[carcinogen]]-[[Metabolize|metabolizing]] [[enzymes]], [[alcohol]], [[tobacco]] and [[Genetics|genetic factors]].
It is understood that oral cancer occurs as a the result of [[carcinogen]]-[[Metabolize|metabolizing]] [[enzymes]], [[alcohol]], [[tobacco]] and [[Genetics|genetic factors]].


===Carcinogen-metabolizing enzymes===
===Carcinogen-metabolizing enzymes===
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**[[Free radicals]]
**[[Free radicals]]
**[[DNA]] hydroxylated [[Base (chemistry)|bases]]
**[[DNA]] hydroxylated [[Base (chemistry)|bases]]
*These [[cytotoxic]] [[enzymes]] especially play a key role in the development of oral squamous cell carcinoma.
*These [[cytotoxic]] [[enzymes]] dominantly play a key role in the development of oral squamous cell carcinoma.
===Alcohol===
===Alcohol===
*[[Alcohol dehydrogenase]] oxidizes [[ethanol]] to [[acetaldehyde]], which is [[cytotoxic]] in nature
*[[Alcohol dehydrogenase]] oxidizes [[ethanol]] to [[acetaldehyde]], which is [[cytotoxic]] in nature.
*[[CYP2E1|Cytochrome P450 IIEI]] ([[CYP2E1]]) also [[Metabolize|metabolizes]] [[ethanol]] to [[acetaldehyde]]
*[[CYP2E1|Cytochrome P450 IIEI]] ([[CYP2E1]]) also [[Metabolize|metabolizes]] [[ethanol]] to [[acetaldehyde]].
*[[Alcohol dehydrogenase]] type 3 genotype predisposes to oral squamous cell carcinoma
*[[Alcohol dehydrogenase]] type 3 genotype predisposes to oral squamous cell carcinoma.
*[[Carcinogen|Carcinogenic]] potential increases when combined with [[tobacco]] use
*[[Carcinogen|Carcinogenic]] potential increases when combined with [[tobacco]] use.
===Tobacco===
===Tobacco===
*[[Cigarette smoke]] has various [[carcinogens]] which can lead to oral cancers
*[[Cigarette smoke]] has various [[carcinogens]], which can lead to oral cancers.
*Low reactive [[free radicals]] in [[cigarette smoke]] interact with [[redox]]-active metals in [[saliva]]
*Low reactive [[free radicals]] in [[cigarette smoke]] interact with [[redox]]-active metals in [[saliva]].
*This causes [[saliva]] to loose its [[antioxidant]] potential and become a potent pro-oxidant milieu<ref name="pmid17344667">{{cite journal |vauthors=Nagler R, Dayan D |title=The dual role of saliva in oral carcinogenesis |journal=Oncology |volume=71 |issue=1-2 |pages=10–7 |year=2006 |pmid=17344667 |doi=10.1159/000100445 |url=}}</ref>
*[[saliva]] then looses its [[antioxidant]] potential and becomes a potent pro-oxidant milieu.<ref name="pmid17344667">{{cite journal |vauthors=Nagler R, Dayan D |title=The dual role of saliva in oral carcinogenesis |journal=Oncology |volume=71 |issue=1-2 |pages=10–7 |year=2006 |pmid=17344667 |doi=10.1159/000100445 |url=}}</ref>
==='''Pathology of classical or conventional squamous cell carcinoma'''===
==='''Pathology of classical or conventional squamous cell carcinoma'''===
* Most cancers of the [[oral cavity]] are classical or conventional squamous cell carcinoma  
* 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
* This type of SCC starts in the [[squamous epithelium]], which lines the [[oral cavity]] and occurs most often on the [[lower lip]], [[tongue]] and floor of the mouth.
* The [[microscopic]] features of classical SCC include:
* The [[microscopic]] features of classical SCC involve
** Keratin pearls
** Keratin pearls
*** These are circular layers of [[Squamous cell|squamous cells]] around a collection of [[keratin]] (a tough fibrous [[protein]]) in the centre
*** These are circular layers of [[Squamous cell|squamous cells]] that surround [[keratin]] (a tough fibrous [[protein]]).


*The cancer starts in the [[Squamous cell|squamous cells]] of the [[epithelium]] and invades the deeper layers of the [[oral cavity]]
*Cancer starts in the [[Squamous cell|squamous cells]] of the [[epithelium]], and then invades the deeper layers of the [[oral cavity]].
==='''Pathology of variants of squamous cell carcinoma'''===
==='''Pathology of squamous cell carcinoma variants'''===
* These [[squamous cell carcinomas]] have distinct [[microscopic]] features that make them look and behave differently from classical SCC.
* The following [[squamous cell carcinomas]] have distinct [[microscopic]] features that make them look and behave differently from classical SCC:


*'''Verrucous carcinoma'''
*'''Verrucous carcinoma'''
**These [[tumors]] make up less than 5% of all oral cavity tumors
**These [[tumors]] make up less than 5% of all oral cavity tumors.
**They have a wart-like appearance and develop most often on the [[gums]] ([[gingiva]]), lining of the cheeks ([[buccal mucosa]]) and [[larynx]]
**They have a wart-like appearance and develop most often on the [[gums]] ([[gingiva]]), lining of the cheeks ([[buccal mucosa]]) and [[larynx]].
**Verrucous carcinomas are low grade, slow growing and rarely spread
**Verrucous carcinomas are low grade, slow-growing and rarely spread.
**They are associated with the chronic use of snuff or chewing [[tobacco]]
**They are associated with the chronic use of snuff or chewing [[tobacco]].
*'''Basaloid SCC'''
*'''Basaloid SCC'''
**This is a rare but aggressive subtype of squamous cell carcinoma
**This is a rare but aggressive sub-type of squamous cell carcinoma.
**It is more common in men older than 60 years
**It is more common in men older than 60 years old.
*'''Papillary SCC'''
*'''Papillary SCC'''
**This is a rare subtype of squamous cell carcinoma that grows outward from the surface of the [[epithelium]] (exophytic)
**This is a rare sub-type of squamous cell carcinoma that grows outward from the surface of the [[epithelium]] (exophytic).
**[[Human papillomavirus|HPV]] infection may have a role in the development of this type of cancer
**[[Human papillomavirus|HPV]] infections may have a role in the development of this type of cancer.
*'''Spindle cell carcinoma (SpCC)'''
*'''Spindle cell carcinoma (SpCC)'''
**This is an aggressive, rare variant of squamous cell carcinoma
**This is an aggressive, rare variant of squamous cell carcinoma.
**These [[tumors]] contain a mixture of conventional squamous cell carcinoma and spindle cells that resemble a [[sarcoma]]
**These [[tumors]] contain a mixture of conventional squamous cell carcinoma and spindle cells that resemble a [[sarcoma]].
It is also known as sarcomatoid carcinoma, pseudosarcoma, carcinosarcoma, pleomorphic carcinoma, metaplastic carcinoma, collision tumor and Lane tumor.
**It is also known as sarcomatoid carcinoma, pseudosarcoma, carcinosarcoma, pleomorphic carcinoma, metaplastic carcinoma, collision tumor and Lane tumor.
 
*'''Acantholytic SCC'''
*'''Acantholytic SCC'''
**This is a rare variant of SCC in which the connections between the [[malignant]] [[Squamous cell|squamous cells]] break down
**This is a rare variant of SCC in which the connections between the [[malignant]] [[Squamous cell|squamous cells]] are broken down.
**This results in [[microscopic]] spaces in the tumor tissue, which appear like [[glands]] or [[vascular]] spaces
**This results in [[microscopic]] spaces in the tumor tissue, which appear like [[glands]] or [[vascular]] spaces.
*'''Adenosquamous carcinoma'''
*'''Adenosquamous carcinoma'''
**This is a very rare, aggressive type of squamous cell carcinoma
**This is a very rare, aggressive type of squamous cell carcinoma.
**It looks like classical squamous cell carcinoma, but also has [[mucus]] producing [[gland]] cells
**It looks like classical squamous cell carcinoma but also has [[mucus]]-producing [[gland]] cells.
*'''Lymphoepithelial carcinoma'''
*'''Lymphoepithelial carcinoma'''
**This is a rare subtype of squamous cell carcinoma
**This is a rare sub-type of squamous cell carcinoma.
**The [[microscopic]] appearance is similar to undifferentiated [[nasopharyngeal carcinoma]]
**The [[microscopic]] appearance is similar to undifferentiated [[nasopharyngeal carcinoma]].
**It is also called [[undifferentiated]] carcinoma
**It is also known as [[undifferentiated]] carcinoma.


== Genetics ==
== Genetics ==
* The development of oral cancer is the result of multiple [[genetic mutations]]
* The development of oral cancer is the result of multiple [[genetic mutations]].
* These [[mutations]] include:
* These [[mutations]] include:
** [[Tumor suppressor genes]] (TSGs)
** [[Tumor suppressor genes]] (TSGs)
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====Tumor suppressor genes (TSGs)====
====Tumor suppressor genes (TSGs)====
*Oral cavity cancer may be the result of [[Allele|allelic]] imbalance, which is caused by [[chromosomal]] changes particularly in [[chromosome]] 3,9,11 and 17.
*Oral cavity cancer may be the result of an [[Allele|allelic]] imbalance, which is caused by [[chromosomal]] changes- particularly in [[chromosome]] 3, 9, 11 and 17.
*These changes lead to [[mutation]] in [[tumor suppressor genes]] ([[Tumor suppressor genes|TSGs]]).
*These changes lead to [[mutation]] in [[tumor suppressor genes]] ([[Tumor suppressor genes|TSGs]]).
*Normally [[Tumor suppressor genes|TSGs]] modulate normal growth.
*In non-cancerous situations, [[Tumor suppressor genes|TSGs]] modulate normal growth.
*Mutation of these [[Tumor suppressor genes|TSGs]] leads to dysfunctional growth control.
*Mutation of these [[Tumor suppressor genes|TSGs]] lead to dysfunctional growth control.
*Mutation most commonly occurs in either of the following:
*Mutation most commonly occurs in one of the following:
**Short arm of [[Chromosome 3 (human)|chromosome 3]]
**Short arm of [[Chromosome 3 (human)|chromosome 3]]
**TSG termed ''[[P16 (gene)|P16]]'' on [[chromosome 9]]
**TSG termed ''[[P16 (gene)|P16]]'' on [[chromosome 9]]
**TSG termed ''[[TP53]]'' on [[chromosome 17]]
**TSG termed ''[[TP53]]'' on [[chromosome 17]]
*[[Cytochrome P450]] [[genotype]] is related to [[mutations]] in some [[Tumor suppressor genes|TSGs]] and lead to oral squamous cell carcinoma.
*The [[Cytochrome P450]] [[genotype]] is related to [[mutations]] in some [[Tumor suppressor genes|TSGs]] and leads to oral squamous cell carcinoma.
*In western countries (eg, United Kingdom, United States, Australia) ''[[TP53]]'' [[Mutation|mutations]] are the most common molecular change that leads to oral [[squamous cell carcinoma]].
*In western countries (eg. United Kingdom, United States, or Australia), ''[[TP53]]'' [[Mutation|mutations]] are the most common molecular change that leads to oral [[squamous cell carcinoma]].
====Oncogenes====
====Oncogenes====
*Cancer may also occur if there is mutation in other [[genes]] that control [[cell growth]], mainly [[oncogenes]].
*Cancer may also occur if there is mutation in other [[genes]] that control [[cell growth]], typically [[oncogenes]].
*[[Oncogenes]] most commonly involved are:
*[[Oncogenes]] most commonly involved are:
**[[Chromosome 11]] (''PRAD1)''
**[[Chromosome 11]] (''PRAD1)''
**[[Chromosome 17]] (Harvey ras [H-''ras''])
**[[Chromosome 17]] (Harvey ras [H-''ras''])
*In eastern countries (eg, India, Southeast Asia), ''[[Ras gene|ras]]'' [[oncogenes]] is a more common cause of oral squamous cell carcinoma.
*In eastern countries (eg. India or Southeast Asia), ''[[Ras gene|ras]]'' [[oncogenes]] is a more common cause of oral squamous cell carcinoma.
==Gross Pathology==
==Gross Pathology==
* [[Squamous cell carcinoma]] is the most common [[Bone or cartilage mass|malignancy]] of the oral cavity.  
* [[Squamous cell carcinoma]] is the most common [[Bone or cartilage mass|malignancy]] of the oral cavity.  
* It typically has three gross morphologic growth patterns, which are, exophytic, [[Ulcerated lesion|ulcerative]], and infiltrative.  
* It typically has three gross morphological growth patterns, which are exophytic, [[Ulcerated lesion|ulcerative]], and infiltrative.  
* The infiltrative and [[Ulceral|ulcerative]] are the types most commonly observed in the oral cavity.
* The infiltrative and [[Ulceral|ulcerative]] are the growth patterns most commonly observed in the oral cavity.
* The [[macroscopic]] appearance of oral cancer depends on the following:
* The [[macroscopic]] appearance of oral cancer depends on the following:
**Duration of the [[lesion]]
**Duration of the [[lesion]]
**The amount of [[keratinization]]
**The amount of [[keratinization]]
**The changes in the adjoining [[Mucosal|mucosa]]
**The changes in the adjoining [[Mucosal|mucosa]]
**A fully developed oral cavity lesion appears as an exophytic bulky lesion that is gray to grayish-red and has a rough, shaggy, or [[Papilloma|papillomatous]] surface.
**A fully developed oral cavity lesion appears as an exophytic bulky lesion that is gray to grayish-red and has a rough, shaggy, or [[Papilloma|papillomatous]] surface
[[File:PLoS oral cancer.png|300px|center|thumb|Gross pathology of oral SCC, source: By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632]]
[[File:PLoS oral cancer.png|300px|center|thumb|Gross pathology of oral SCC, source: By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632]]


==Microscopic Pathology==
==Microscopic Pathology==
*[[Microscopic|Microscopically]], oral cancers are broadly based and invasive through [[papillary]] fronds.
*[[Microscopic|Microscopically]], oral cancers are broadly based and invasive through [[papillary]] fronds.
*Oral cancer constitutes of highly [[Differentiate|differentiated]] squamous cells lacking frank cytologic criteria of [[malignancy]] with rare [[mitoses]].  
*Oral cancer constitutes of highly-[[Differentiate|differentiated]] squamous cells lacking frank cytologic criteria of [[malignancy]] with rare [[mitoses]].  
*The surface of the lesion is covered with compressed invaginating folds of [[keratin]] layers
*The surface of the lesion is covered with compressed invaginating folds of [[keratin]] layers.
*A stroma-like inflammatory reaction and a blunt pushing margin may be seen
*A stroma-like inflammatory reaction and a blunt pushing margin may be seen.


* SCC is subdivided by the WHO into:<ref name="pmid23015393">{{cite journal| author=Peterson BR, Nelson BL| title=Nonkeratinizing undifferentiated nasopharyngeal carcinoma. | journal=Head Neck Pathol | year= 2013 | volume= 7 | issue= 1 | pages= 73-5 | pmid=23015393 | doi=10.1007/s12105-012-0401-4 | pmc=3597164 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23015393  }}</ref>
* SCC is subdivided by the WHO into:<ref name="pmid23015393">{{cite journal| author=Peterson BR, Nelson BL| title=Nonkeratinizing undifferentiated nasopharyngeal carcinoma. | journal=Head Neck Pathol | year= 2013 | volume= 7 | issue= 1 | pages= 73-5 | pmid=23015393 | doi=10.1007/s12105-012-0401-4 | pmc=3597164 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23015393  }}</ref>
**[[Keratinized|Keratinizing]] type: Worst [[prognosis]]
**[[Keratinized|Keratinizing]] type: Worst [[prognosis]]
**Undifferentiated type: Intermediate prognosis, [[Epstein Barr virus|EBV]] association<ref name="pmid7778675">{{cite journal| author=Pathmanathan R, Prasad U, Chandrika G, Sadler R, Flynn K, Raab-Traub N| title=Undifferentiated, nonkeratinizing, and squamous cell carcinoma of the nasopharynx. Variants of Epstein-Barr virus-infected neoplasia. | journal=Am J Pathol | year= 1995 | volume= 146 | issue= 6 | pages= 1355-67 | pmid=7778675 | doi= | pmc=1870892 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7778675  }}</ref>
**Undifferentiated type: Intermediate prognosis and [[Epstein Barr virus|EBV]] association<ref name="pmid7778675">{{cite journal| author=Pathmanathan R, Prasad U, Chandrika G, Sadler R, Flynn K, Raab-Traub N| title=Undifferentiated, nonkeratinizing, and squamous cell carcinoma of the nasopharynx. Variants of Epstein-Barr virus-infected neoplasia. | journal=Am J Pathol | year= 1995 | volume= 146 | issue= 6 | pages= 1355-67 | pmid=7778675 | doi= | pmc=1870892 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7778675  }}</ref>
**Nonkeratinizing type: Good [[prognosis]], [[Epstein Barr virus|EBV]] association
**Non-keratinizing type: Good [[prognosis]] and [[Epstein Barr virus|EBV]] association
[[File:Oral cancer (1) squamous cell carcinoma histopathology.jpg|300px|center|thumb|Microscopic picture of oral SCC, source: By No machine-readable author provided. KGH assumed (based on copyright claims). - No machine-readable source provided. Own work assumed (based on copyright claims)., CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=486166]]
[[File:Oral cancer (1) squamous cell carcinoma histopathology.jpg|300px|center|thumb|Microscopic picture of oral SCC, source: By No machine-readable author provided. KGH assumed (based on copyright claims). - No machine-readable source provided. Own work assumed (based on copyright claims)., CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=486166]]


Revision as of 15:14, 19 February 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]

Overview

It is understood that oral cancers occur as a the result of carcinogen-metabolizing enzymes, alcohol, tobacco and genetic factors. Cytotoxic enzymes such as alcohol dehydrogenase result in the production of free radicals and hydroxylation of DNA base units. Alcohol dehydrogenase oxidizes ethanol to acetaldehyde which is cytotoxic in nature. Cigarette smoke has various carcinogens, which can lead to oral cancers. Low-reactive free radicals in cigarette smoke interact with redox-active metals in saliva.The development of oral cancer is the result of multiple genetic mutations. These mutations occur in tumor suppressor genes (TSGs) and oncogenes. Squamous cell carcinoma is the most common malignancy of the oral cavity. It typically has three gross morphological growth patterns, which are exophytic, ulcerative, and infiltrative. Microscopically, oral cancers are broadly based and invasive through papillary fronds. Oral cancer consists of highly differentiated squamous cells lacking frank cytologic criteria of malignancy with rare mitoses.The surface of the lesion is covered with compressed invaginating folds of keratin layers. A stroma-like inflammatory reaction and a blunt pushing margin may be seen.

Pathophysiology

It is understood that oral cancer occurs as a the result of carcinogen-metabolizing enzymes, alcohol, tobacco and genetic factors.

Carcinogen-metabolizing enzymes

Alcohol

Tobacco

Pathology of classical or conventional squamous cell carcinoma

Pathology of squamous cell carcinoma variants

  • Verrucous carcinoma
    • These tumors make up less than 5% of all oral cavity tumors.
    • They have a wart-like appearance and develop most often on the gums (gingiva), lining of the cheeks (buccal mucosa) and larynx.
    • Verrucous carcinomas are low grade, slow-growing and rarely spread.
    • They are associated with the chronic use of snuff or chewing tobacco.
  • Basaloid SCC
    • This is a rare but aggressive sub-type of squamous cell carcinoma.
    • It is more common in men older than 60 years old.
  • Papillary SCC
    • This is a rare sub-type of squamous cell carcinoma that grows outward from the surface of the epithelium (exophytic).
    • HPV infections may have a role in the development of this type of cancer.
  • Spindle cell carcinoma (SpCC)
    • This is an aggressive, rare variant of squamous cell carcinoma.
    • These tumors contain a mixture of conventional squamous cell carcinoma and spindle cells that resemble a sarcoma.
    • It is also known as sarcomatoid carcinoma, pseudosarcoma, carcinosarcoma, pleomorphic carcinoma, metaplastic carcinoma, collision tumor and Lane tumor.
  • Acantholytic SCC
  • Adenosquamous carcinoma
    • This is a very rare, aggressive type of squamous cell carcinoma.
    • It looks like classical squamous cell carcinoma but also has mucus-producing gland cells.
  • Lymphoepithelial carcinoma

Genetics

Tumor suppressor genes (TSGs)

Oncogenes

Gross Pathology

  • Squamous cell carcinoma is the most common malignancy of the oral cavity.
  • It typically has three gross morphological growth patterns, which are exophytic, ulcerative, and infiltrative.
  • The infiltrative and ulcerative are the growth patterns most commonly observed in the oral cavity.
  • The macroscopic appearance of oral cancer depends on the following:
    • Duration of the lesion
    • The amount of keratinization
    • The changes in the adjoining mucosa
    • A fully developed oral cavity lesion appears as an exophytic bulky lesion that is gray to grayish-red and has a rough, shaggy, or papillomatous surface
Gross pathology of oral SCC, source: By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632

Microscopic Pathology

  • Microscopically, oral cancers are broadly based and invasive through papillary fronds.
  • Oral cancer constitutes of highly-differentiated squamous cells lacking frank cytologic criteria of malignancy with rare mitoses.
  • The surface of the lesion is covered with compressed invaginating folds of keratin layers.
  • A stroma-like inflammatory reaction and a blunt pushing margin may be seen.
Microscopic picture of oral SCC, source: By No machine-readable author provided. KGH assumed (based on copyright claims). - No machine-readable source provided. Own work assumed (based on copyright claims)., CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=486166

References

  1. ↑ Nagler R, Dayan D (2006). "The dual role of saliva in oral carcinogenesis". Oncology. 71 (1–2): 10–7. doi:10.1159/000100445. PMID 17344667.
  2. ↑ Peterson BR, Nelson BL (2013). "Nonkeratinizing undifferentiated nasopharyngeal carcinoma". Head Neck Pathol. 7 (1): 73–5. doi:10.1007/s12105-012-0401-4. PMC 3597164. PMID 23015393.
  3. ↑ Pathmanathan R, Prasad U, Chandrika G, Sadler R, Flynn K, Raab-Traub N (1995). "Undifferentiated, nonkeratinizing, and squamous cell carcinoma of the nasopharynx. Variants of Epstein-Barr virus-infected neoplasia". Am J Pathol. 146 (6): 1355–67. PMC 1870892. PMID 7778675.


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