Squamous cell carcinoma

Aetiology and Aetiological factors usually unidentifiable although pathology widely regarded as related to tobacco and alcohol use.

However, in Britain, oral cancer incidence in men has steadily declined while cigarette and alcohol consumption has increased. There is a closer relationship with pipe smoking. The high incidence of oral cancer in India is possibly related to different types and forms of tobacco usage. HPV 16 and related strains have been implicated, possibly by triggering mutation of the p53 gene. Squamous cell carcinoma usually develops after age 50 and the incidence increases with age.

Lip cancer is associated with excess exposure to sunshine, especially in fair skinned males. It is associated with leukoplakia in only a minority.

Microscopy Essential features are epithelial abnormalities (dysplasia) and invasion. Later, metastases develop, particularly in regional lymph nodes. Most are well differentiated with obvious squamous pattern and formation of whorls of keratin deeply (cell nests) (Fig. 179).

The basement membrane tends to disappear and the tumour appears as invading, irregular epithelial processes or sheets of cells with ill-defined outlines typically surrounded by chronic inflammatory cells (Fig. 180). Invasion is characterized by destruction of tissues in the path of the tumour (Fig. 181).

Neoplastic epithelial cells are pleomorphic, show variably enlarged, often hyperchromatic, nuclei or vcsicular nuclei with prominent or multiple nucleoli (Fig. 182). Mitoses (Fig. 183, p. 100) may be numerous and atypical. With increasing dedifferentiation, the neoplastic cclls may become progressively more uniformly hypcrchromatic and regular in size (Fig. 184, p. 100) so that they may become difficult to recognize as carcinomas by light microscopy in extreme (anaplastic) examples.

Squamous Cell Carcinoma Survival Rate

Fig 181 Squamous carcinoma destroying Rg 182 Squamous carcinoma: atypia.

muscle.

Fig 181 Squamous carcinoma destroying Rg 182 Squamous carcinoma: atypia.

muscle.

Treatment and The main forms of treatment are wide excision often prognosis with radiotherapy, or radiotherapy alone. Good survival rates depend on early diagnosis and treatment. Survival also deteriorates with age. Average 5-year survival rates for carcinoma of the tongue are 37% for males and 46% for females. Most other sites within the mouth have a rather better prognosis.

Carcinoma of the lip has a much better prognosis and a 5-year survival rate of 94% for males but (inexplicably) only 84% for females.

Verrucous carcinoma

An uncommon variant which appears as a prominent white warty- plaque. It may result from the prolonged use of smokeless tobacco (snuff dipping) but frequently no cause is apparent. HPV 2a-e may be implicated.

Microscopy There is gross hyperkeratosis and papillary epithelial overgrowth producing a folded appearance with intervening cleft-like spaces. The uniform level of downgrowth of the tumour gives a well-defined deep margin in the pre-invasive stage (Fig. 185), but can transform to invasive carcinoma. Epithelial atypia is minimal (in the early stages), but there is typically a chronic inflammatory infiltrate in the corium.

Treatment and Spread and metastasis is slower than squamous cell prognosis carcinoma and the response to adequate excision is better.

Verrucous hyperplasia

An essentially similar lesion to verrucous carcinoma but differing histologically in that the mass docs not push down into the lamina propria and the basement membrane zone is level with that of the surrounding normal epithelium.

Verrucous Carcinoma
Rg. 185 Verrucous carcinoma.
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Responses

  • kevin
    What is pleomorphic nuclei in squamous cell carcinoma?
    1 year ago

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