Oral Squamous Cell Carcinoma, OSCCA

Notes
  • This constitutes > 90% of malignancy of the oral cavity.
  • Risk factors include: smoking tobacco, alcoholism, exposure to UV light (lips affected most), human papilloma viruses 16 (HPV 16), chronic hyperplastic candidiasis, iron deficiency, erythroplakia, leukoplakia and nutritional deficiencies (mainly vitamins A, C and E)
  • Statistics: Gender prevalence: male (especially older males) > women
Symptoms
  • Oral lesions may be asymptomatic
  • Non-healing painless ulcer
  • Pain and paraesthesia (with neural involvement)
  • Trismus (reduced opening of the jaws caused by spasm of the muscles of mastication)
  • Dysphagia
  • Dysphonia
  • Halitosis
  • Enlarged lymph nodes
Diagnosis
  • Physical examination
  • Biopsy and staging
  • X-ray
  • CT scan
  • MRI
Differential
  • Actinic Keratosis
  • Adenocarcinoma
  • Adenoid cystic carcinoma
  • Erythroplasia
  • Infected ranula
  • Infection from teeth
  • Lichen Planus
  • Liposarcoma
  • Lymphoma
  • Mucoepidermoid carcinoma
  • Mucosal Candidiasis
  • Oral Leukoplakia
  • Radionecrosis
  • Rhabdomyosarcoma
Prevention
  • Avoiding smoking tobacco
  • Avoiding alcoholism
Management
  • Stages 0, 1 and 2 are mainly treated by surgery and close monitoring
  • Stage 3 is treated by surgery, chemotherapy and radiation therapy
  • Stage 4 is treated by surgery, chemotherapy, radiation therapy and palliative treatment.Chemotherapy includes the following:
  • 5FU with/without cisplatin regime is preferred in low resource settings.
  • Cisplatin and taxanes are preferred where resources are not limited.

 Other medicines include;

  • Docetaxel
  • Epirubicin
  • Bleomycin
  • Carboplatin
  • Oxaliplatin
  • Mitomycin-C
  • Paclitaxel
  • Methotrexate
  • Capecitabine
  • Ifosfamide
  • Gemcitabine
  • Erlotinib
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