Lecture 7 - Diagnosis of SCC Flashcards
(19 cards)
Potentially Malignant Lesions
Leukoplakia
Erythroplakia
Submucous Fibrosis
Lichen Planus
Leukoplakia
“White patch”
Clinical term, diagnosis of exclusion
Lesions on floor of mouth, ventral tongue, and soft palate (non-keratinized squamous cell epithelium)
Leukoplakia Major Types and Subcategories
Types:
- Localized
- Proliferative
Both Types have these Subcategories:
- Homogeneous
- Verrucous/nodular
- Erythro-leukoplakia
Leukoplakia Treatment
ALWAYS biopsy
Options:
- watch w/ periodic biopsies
- Complete excision
- Laser ablation (destroys tissue)
Long-term follow-up
Address risk factors
Risk of Leukoplakia developing into SCC
30-40% are dysplasia, carcinoma in situ, or SCC
15% of “benign hyperkeratosis without dysplasia” develop into SCC
Proliferative Leukoplakia
Women
Verrucous Carcinoma
Warty mass on alveolar ridge, buccal mucosa, or palate
Marked epithelial hyperplasia
Associated with smokeless tobacco use
Usually doesn’t metastasize
Treat by excision
Erythroplakia
Uncommon
Velvety red plaque or macule, sometimes with leukoplakia
Usually painless
> 90% are dysplastic, carcinoma-in-situ, or invasive
Oral Submucous Fibrosis
Associated with Betel/Areca nut chewers in SE Asia
Thick bands (piano wires) on buccal mucosa
Pain, burning, limits opening of mouth
Squamous Cell Carcinoma Risk Factors
Smoking Alcohol Areca/Betel nut Immune suppression Autoimmune disease Hx of cancer Chemo Family hx of cancer Plummer-Vinson syndrome HPV-16 (mostly oropharyngeal)
Squamous Cell Carcinoma Prevalence
30,000 cases in US
> 50yo - 1/3000
SCC Appearance
Leukoplakia Erythroplakia Non-healing ulcer Mass Induration (painless)
SCC Histo
Invasion of underlying tissue by islands of malignant cells, depending on how much keratin is formed
SCC Treatment
Wide excision
Lymph node dissection
Radiation, Chemo (mainly stage III or IV laryngeal and nasopharyngeal)
SCC 5yr Survival Prognosis
Overall: 58.8%
Stage I and II: 81%
Stage III and IV (with M0): 52%
Stage III and IV (with M1): 25%
Tumor Staging
TNM
T = Tumor Size N = Lymph node involvement M = Metastases
1 = T1N0M0 2 = T2N0M0 3 = T3N0/1M0 4 = Any T4, Any TN2M0, Any M1
Tumor Size
T1 = <2cm T2 = 2-4cm T3 = 4cm T4 = Invades surrounding structures
Lymph Node Involvement Staging
NX = cannot assess N0 = no metastases N1 = one ipsilateral node, 3cm N2(a,b,c) = any nodes, 3-6cm) N3 = >6cm
Biopsy Techniques
Exfoliative cytology (pap smear) Transepithelial brush biopsy Scalpel biopsy (excisional or incisional) Punch biopsy Fine needle aspiration (glands)
