Oral Squamous Cell Carcinoma: Epidemiology, Clinical Presentation and Treatment

Liviu Feller, Johan Lemmer

Department of Periodontology and Oral Medicine, University of Limpopo, Medunsa campus, South Africa.

DOI: 10.4236/jct.2012.34037                

Abstract

Squamous cell carcinoma accounts for 90% of all oral cancers. It may affect any anatomical site in the mouth, but most commonly the tongue and the floor of the mouth. It usually arises from a pre-existing potentially malignant lesion, and occasionally de novo; but in either case from within a field of precancerized epithelium. The use of tobacco and betel quid, heavy drinking of alcoholic beverages and a diet low in fresh fruits and vegetables are well known risk factors for oral squamous cell carcinoma. Important risk factors related to the carcinoma itself that are associated with a poor prognosis include large size of the tumour at the time of diagnosis, the presence of metastases in regional lymphnodes, and a deep invasive front of the tumour. Squamous cell carcinoma is managed by surgery, radiation, and chemotherapy singularly or in combination; but regardless of the treatment modality, the five-year survival rate is poor at about 50%. This can be attributed to the fact that about two-thirds of persons with oral squamous cell carcinoma already have a large lesion at the time of diagnosis.

Keywords

Oral Squamous Cell Carcinoma; Epidemiology; Clinical Course; Field of Precancerization

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. P. Shah and Z. Gil, “Current Concepts in Management of Oral Cancer-Surgery,” Oral Oncology, Vol. 45, No. 4, 2009, pp. 394-401. doi:10.1016/j.oraloncology.2008.05.017
[2]	E. Attar, S. Dey, A. Hablas, I. A. Seifeldin, M. Ramadan, L. S. Rozek and A. S. Soliman, “Head and Neck Cancer in a Developing Country: A Population-Based Perspective Across 8 Years,” Oral Oncology, Vol. 46, No. 8, 2010, pp. 591-596. doi:10.1016/j.oraloncology.2010.05.002
[3]	J. Bagan, G. Sarrion and Y. Jimenez, “Oral Cancer: Clinical Features,” Oral Oncology, Vol. 46, No. 6, 2010, pp. 414-417. doi:10.1016/j.oraloncology.2010.03.009
[4]	S. Petti, “Lifestyle Risk Factors for Oral Cancer,” Oral Oncology, Vol. 45, No. 4, 2009, pp. 340-350. doi:10.1016/j.oraloncology.2008.05.018
[5]	B. W. Neville and T. A. Day, “Oral Cancer and Precancerous Lesions,” CA: A Cancer Journal for Clinicians, Vol. 52, No. 4, 2002, pp. 195-215. doi:10.3322/canjclin.52.4.195
[6]	A. D. Rapidis, P. Gullane, J. D. Langdon, J. L. Lefebvre, C. Scully and J. P. Shah, “Major Advances in the Knowledge and Understanding of the Epidemiology, Aetiopathogenesis, Diagnosis, Management and Prognosis of Oral Cancer,” Oral Oncology, Vol. 45, No. 4, 2009, pp. 299-300. doi:10.1016/j.oraloncology.2009.04.001
[7]	S. Warnakulasuriya, “Global Epidemiology of Oral and Oropharyngeal Cancer,” Oral Oncology, Vol. 45, No. 4, 2009, pp. 309-316. doi:10.1016/j.oraloncology.2008.06.002
[8]	C. Scully and J. Bagan, “Oral Squamous Cell Carcinoma Overview,” Oral Oncology, Vol. 45, No. 4, 2009, pp. 301-308. doi:10.1016/j.oraloncology.2009.01.004
[9]	I. O. Bello, Y. Soini and T. Salo, “Prognostic Evaluation of Oral Tongue Cancer: Means, Markers and Perspectives (I),” Oral Oncology, Vol. 46, No. 9, 2010, pp. 630-635. doi:10.1016/j.oraloncology.2010.06.006
[10]	C. Scully and R. Bedi, “Ethnicity and Oral Cancer,” TheLancet Oncology, Vol. 1, No. 1, 2000, pp. 37-42. doi:10.1016/S1470-2045(00)00008-5
[11]	C. H. Shiboski, B. L. Schmidt and R. C. Jordan, “Racial Disparity in Stage at Diagnosis and Survival among Adults with Oral Cancer in the US,” Community Dentistry and Oral Epidemiology, Vol. 35, No. 3, 2007, pp. 233-240. doi:10.1111/j.0301-5661.2007.00334.x
[12]	D. Brandizzi, M. Gandolfo, M. L. Velazco, R. L. Cabrini and H. E. Lanfranchi, “Clinical Features and Evolution of oral Cancer: A Study of 274 Cases in Buenos Aires, Argentina,” Medicina Oral, Patologia Oral, Cirugia Bucal, Vol. 13, No. 9, 2008, pp. 544-548.
[13]	R. Mazeron, Y. Tao, A. Lusinchi and J. Bourhis, “Current Concepts of Management in Radiotherapy for Head and Neck Squamous-Cell Cancer,” Oral Oncology, Vol. 45, No. 4, 2009, pp. 402-408. doi:10.1016/j.oraloncology.2009.01.010
[14]	J. Massano, F. S. Regateiro, G. Januario and A. Ferreira, “Oral Squamous Cell Carcinoma: Review of Prognostic and Predictive Factors,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics, Vol. 102, No. 1, 2006, pp. 67-76. doi:10.1016/j.tripleo.2005.07.038
[15]	J. A. Brennan, L. Mao, R. H. Hruban, J. O. Boyle, Y. J. Eby, W. M. Koch, S. N. Goodman and D. Sidransky, “Molecular Assessment of Histopathological Staging in Squamous-Cell Carcinoma of the Head and Neck,” New England Journal of Medicine, Vol. 332, No. 7, 1995, pp. 429-435. doi:10.1056/NEJM199502163320704
[16]	S. R. Larsen, J. Johansen, J. A. Sorensen and A. Krogdahl, “The Prognostic Significance of Histological Features in Oral Squamous Cell Carcinoma,” Journal of Oral Pathology and Medicine, Vol. 38, No. 8, 2009, pp. 657-662. doi:10.1111/j.1600-0714.2009.00797.x
[17]	M. P. Tabor, R. H. Brakenhoff, H. J. Ruijter-Schippers, J. E. Van Der Wal, G. B. Snow, C. R. Leemans and B. J. Braakhuis, “Multiple Head and Neck Tumors Frequently Originate from a Single Preneoplastic Lesion,” American Journal of Pathology, Vol. 161, No. 3, 2002, pp. 1051-1060. doi:10.1016/S0002-9440(10)64266-6
[18]	V. M. van Houten, C. R. Leemans, J. A. Kummer, J. Dijkstra, D. J. Kuik, M. W. van den Brekel, G. B. Snow and R. H. Brakenhoff, “Molecular Diagnosis of Surgical Margins and Local Recurrence in Head and Neck Cancer Patients: A Prospective Study,” Clinical Cancer Research, Vol. 10, No. 11, 2004, pp. 3614-3620. doi:10.1158/1078-0432.CCR-03-0631
[19]	R. E. Friedrich, “Primary and Second Primary Cancer in 649 Patients with Malignancies of the Maxillofacial Region,” Anticancer Research, Vol. 27, No. 4A, 2007, pp. 1805-1818.
[20]	M. Weijers, G. B. Snow, P. D. Bezemer and I. van der Waal, “Malignancy Grading Is No Better than Conventional Histopathological Grading in Small Squamous Cell Carcinoma of Tongue and Floor of Mouth: Retrospective Study in 128 Patients,” Journal of Oral Pathology and Medicine, Vol. 38, No. 4, 2009, pp. 343-347. doi:10.1111/j.1600-0714.2009.00751.x
[21]	H. Kurita, Y. Nakanishi, R. Nishizawa, T. Xiao, T. Kamata, T. Koike and H. Kobayashi, “Impact of Different Surgical Margin Conditions on Local Recurrence of Oral Squamous Cell Carcinoma,” Oral Oncology, Vol. 46, No. 11, 2010, pp. 814-817. doi:10.1016/j.oraloncology.2010.08.014
[22]	L. Feller and J. Lemmer, “Field Cancerization and Oral Leukoplakia,” In: G. D. Dakubo, Ed., Field Cancerization: Basic Science and Clinical Applications, Nova Science Publishers, Ontario, 2011, pp. 95-111.
[23]	E. Rennemo, U. Zatterstrom and M. Boysen, “Impact of Second Primary Tumors on Survival in Head and Neck Cancer: An Analysis of 2,063 Cases,” Laryngoscope, Vol. 118, No. 8, 2008, pp. 1350-1356. doi:10.1097/MLG.0b013e318172ef9a
[24]	B. J. Braakhuis, M. P. Tabor, C. R. Leemans, I. van der Waal, G. B. Snow and R. H. Brakenhoff, “Second Primary Tumors and Field Cancerization in Oral and Oropharyngeal Cancer: Molecular Techniques Provide New Insights and Definitions,” Head and Neck, Vol. 24, No. 2, 2002, pp. 198-206. doi:10.1002/hed.10042
[25]	N. de Vries, I. Van der Waal and G. B. Snow, “Multiple Primary Tumours in Oral Cancer,” International Journal of Oral and Maxillofacial Surgery, Vol. 15, No. 1, 1986, pp. 85-87. doi:10.1016/S0300-9785(86)80015-1
[26]	I. van der Waal and R. de Bree, “Second Primary Tumours in Oral Cancer,” Oral Oncology, Vol. 46, No. 6, 2010, pp. 426-428. doi:10.1016/j.oraloncology.2010.02.018
[27]	I. J. Dhooge, M. De Vos and P. B. Van Cauwenberge, “Multiple Primary Malignant Tumors in Patients with Head and Neck Cancer: Results of a Prospective Study and Future Perspectives,” Laryngoscope, Vol. 108, No. 2, 1998, pp. 250-256. doi:10.1097/00005537-199802000-00017
[28]	I. van der Waal, “Potentially Malignant Disorders of the Oral and Oropharyngeal Mucosa; terminology, Classification and Present Concepts of Management,” Oral Oncology, Vol. 45, No. 4-5, 2009, pp. 317-323. doi:10.1016/j.oraloncology.2008.05.016
[29]	M. Weijers, I. Ten Hove, R. H. Allard, D. P. Bezemer and I. van der Waal, “Patients with Oral Cancer Developing from Pre-Existing Oral Leukoplakia: Do They Do Better than Those with De Novo Oral Cancer?,”Journal of Oral Pathology and Medicine, Vol. 37, No. 3, 2008, pp. 134- 136. doi:10.1111/j.1600-0714.2007.00601.x
[30]	M. Gorsky, M. M. Littner, Y. Sukman and A. Begleiter, “The Prevalence of Oral Cancer in Relation to the Ethnic Origin of Israeli Jews,” Oral Surgery, Oral Medicine, Oral Pathology, Vol. 78, No. 3, 1994, pp. 408-411. doi:10.1016/0030-4220(94)90077-9
[31]	A. J. Swerdlow, M. G. Marmot, A. E. Grulich and J. Head, “Cancer Mortality in Indian and British Ethnic Immigrants from the Indian Subcontinent to England and Wales,” British Journal of Cancer, Vol. 72, No. 5, 1995, pp. 1312-1319. doi:10.1038/bjc.1995.507
[32]	P. E. Petersen, “Oral Cancer Prevention and Control—The Approach of the World Health Organization,” Oral Oncology, Vol. 45, No. 4, 2009, pp. 454-460. doi:10.1016/j.oraloncology.2008.05.023
[33]	J. H. Lorch, M. R. Posner, L. J. Wirth and R. I. Haddad, “Seeking Alternative Biological Therapies: The Future of Targeted Molecular Treatment,” Oral Oncology, Vol. 45, No. 4, 2009, pp. 447-453. doi:10.1016/j.oraloncology.2008.08.009
[34]	B. J. Braakhuis, E. Bloemena, C. R. Leemans and R. H. Brakenhoff, “Molecular Analysis of Surgical Margins in Head and Neck Cancer: More than a Marginal Issue,” Oral Oncology, Vol. 46, No. 7, 2010, pp. 485-491. doi:10.1016/j.oraloncology.2010.01.019
[35]	F. Levi, V. C. Te, L. Randimbison, M. Maspoli and C. La Vecchia, “Second Primary Oral and Pharyngeal Cancers in Subjects Diagnosed with Oral and Pharyngeal Cancer,” International Journal of Cancer, Vol. 119, No. 11, 2006, pp. 2702-2704. doi:10.1002/ijc.22183
[36]	O. Gallo and S. Bianchi, “P53 Expression: A Potential Biomarker for Risk of Multiple Primary Malignancies in the Upper Aerodigestive Tract,” European Journal of Cancer Part B, Oral Oncology, Vol. 31, No. 1, 1995, pp. 53-57. doi:10.1016/0964-1955(94)00031-X
[37]	D. Goldenberg, S. Harden, B. G. Masayesva, P. Ha, N. Benoit, W. H. Westra, W. M. Koch, D. Sidransky and J. A. Califano, “Intraoperative Molecular Margin Analysis in Head and Neck Cancer,” Archives of Otolaryngology—Head and Neck Surgery, Vol. 130, No. 1, 2004, pp. 39-44. doi:10.1001/archotol.130.1.39