PARIPEX - INDIAN JOURNAL OF RESEARCH | Volume - 12 | Issue - 04 |April - 2023 | PRINT ISSN No. 2250 - 1991 | DOI : 10.
36106/paripex
ORIGINAL RESEARCH PAPER Oral Medicine
KEY WORDS: squamous cell
A NOVEL SQUAMOUS CELL CARCINOMA: carcinoma, the floor of the mouth,
FLOOR OF THE MOUTH. carcinoma on the floor of the
A REVIEW OF THE LITERATURE. mouth
Dr.Hariharan Intern, Department of Oral Medicine and Radiology, Adhiparasakthi Dental
Sivakumar College And Hospital, Melmaruvathur.
Head Of the Department, Department of Oral Medicine and Radiology,
Dr.Deivanayagi Adhiparasakthi Dental College And Hospital, Melmaruvathur.
Dr Mukundh Lecturer, Department of Oral Medicine and Radiology, Adhiparasakthi Dental
Chaithanya* College And Hospital, Melmaruvathur.*Corresponding Author
The article provides an overview of squamous cell carcinoma of the oral cavity (SCC), a malignant lesion that emerges
from squamous epithelial cells which line the body's mucosal surfaces. SCC is the most common type of oral cancer, and
it is becoming more common. Alcohol and tobacco use, human papillomavirus (HPV) infestation, poor oral hygiene, and
ABSTRACT
a nutrition lacking in fruits and vegetables are all major risk factors for SCC. SCC is caused by a number of factors,
including smoking, alcohol intake, dietary patterns, immunosuppression, and viral infections such as HPV 16/18.
Tobacco use, as well as alcohol consumption, are the two biggest known factors that increase the likelihood of oral
cancer. Chewing tobacco inconjunction with betel nut has also been linked to oral malignancies in several Asian
countries, but in Western countries, excessive alcohol consumption and smoking tobacco are the main risk factors. SCC
prognosis improves with early detection and treatment, and alternative treatments may include surgical procedures,
radiotherapy, and chemotherapy. Oral cancer survival rates vary depending on the clinical stage of the illness and the
particular intraoral site involved.
Introduction:- The fact that head-neck cancer occurs more frequently than
Oral Squamous cell carcinoma (SCC) is a cancerous lesion other types of cancer in India may be attributed to the
that develops from the squamous epithelial cells that line the country's low socioeconomic status, which is linked to poor
mucosal surfaces of the body. It is the 6th most frequent oral food, poor hygiene, and a high prevalence of viral
malignancy, with a yearly prevalence of approximately more infections(6).
than 5 lakh cases. SCC is the most common type of oral cancer
and can appear on the tongue, lips, gums, and floor of the In India along with several Asian nations, chewing tobacco
mouth. The floor of the mouth is the area that sits under the with betel nut has been linked to oral neoplasia, but in
tongue and between the lower jawbone and the surface of the western nations, heavy drinking and cigarette smoking are
mouth(1,2). SCC on the floor of the mouth often presents as a the main risk factors. Chewing tobacco while using Betel Quid
non-healing ulcer or a white or red patch and can cause pain, enhances exposure to nitrosamines that are cancer-causing
difficulty swallowing or speaking, and numbness in the and come from the areca nut alkaloids. Furthermore, chewing
tongue or lower lip(3,4). It mostly occurs over the 4th decade generates significant levels of reactive oxygen species (ROS),
of life and predominantly it affects the male population with a which have been linked to multistage carcinogenesis(7).
male-female ratio of 7:1.Metastasis of the cervical lymph
node is the most significant prognostic factor in oral The most major etiological cause of oral submucous fibrosis is
squamous cell carcinoma (SCC)(5). Neck dissection is mostly reported to be betel chewing. The application of Betel quid
required in all patients. Risk factors for SCC on the floor of the containing either areca nut or tobacco is associated with a
mouth include tobacco and alcohol use, human substantially increased relative risk of oral cancer, ranging
papillomavirus (HPV) infection, poor oral hygiene, and a diet from 8 to 15 times that of using the quid without tobacco. Betel
devoid of fruits and vegetables(6).Various studies reveal Quid chewing generates ROS that are harmful to the oral
approximately 30-40 % of deaths in oral squamous cell mucosa and can play a direct role in tumour initiation by
carcinoma occur due to some tissue abuse habits. The generating mutations or rendering the mucosa sensitive to
survival rate for oral cancer depends on the clinical stage of Betel Quid components and environmental toxins. Chewing
the disease and the specific intraoral site involved(7). betel quid (BQ) generates reactive oxygen species (ROS),
which negatively affect the oral mucosa(6).
Etiopathogenesis:-
The present estimates of age-standardised mortality and Oral malignancy is a complex process that is influenced by
incidence for oral squamous cell carcinoma (OSCC) show an numerous factors. During this process, the epithelial cells are
overall increase in incidence and mortality. Recent studies impacted by genetic changes, which eventually rise to a
have shown that a significant portion of cancer cases in some number of neoplastic sites throughout the oral cavity; these
regions of India are due to mouth cancer. The two most sites may eventually evolve into OSCC. If an oral mucosal
significant known risk factors for the occurrence of oral lesion does not improve after a month, it should be considered
cancer are tobacco use and alcohol consumption. Dietary a life-threatening condition that necessitates a biopsy and
factors, immunodeficiency, and viral infections like HPV further histological investigation(7).
16/18 are cofactors in OSCC. Potential risk factors include
intra-oral carcinogens linked to cigarette use, which may Smoking, consumption of alcohol, inflammation & oncogenic
contribute to the development of oral tumours synergistically. viruses can cause long-term harm to individual genes as well
According to estimates based on cigarette and alcohol risk as chromosomes.
factors, More than 75 per cent of all oral malignancies can be
avoided. The cause or causes of the cancers in the remaining The collection of such genetic changes might result in the
twenty-five per cent of individuals, who weren't subjected to outbreak of premalignant lesions and, later aggressive
these drugs, are still unknown(6). cancer. These genetic changes include activating mutations
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PARIPEX - INDIAN JOURNAL OF RESEARCH | Volume - 12 | Issue - 04 |April - 2023 | PRINT ISSN No. 2250 - 1991 | DOI : 10.36106/paripex
or proliferation of oncogenes that enhance the survival of S h i m a m o t o H , M i c h i Y, S a k a m o t o K , I ke d a T. C o m p a r i s o n o f
clinicopathological characteristics between the anterior and posterior type
cells and growth, as well as inactivation of tumour suppressor of squamous cell carcinoma of the floor of the mouth: the anterior type is a risk
genes involved in cell proliferation inhibition(8,9). factor for multiple primary cancer. Frontiers in Oncology. 2021 Jun
29;11:682428.
3. Alves AM, Diel LF, Lamers ML. Macrophages and prognosis of oral squamous
Tumour cells gain autonomous self-sufficient proliferation cell carcinoma: a systematic review. Journal of Oral Pathology & Medicine.
and avoid growth-inhibitory signals as a result of these 2018 May;47(5):460-7.
changes in oncogenes and tumour suppressor genes, 4. Du W, Fang Q, Liu S, Chen D, Luo R, Zhang X. Feasibility of submandibular
gland preservation in cT1-2N0 squamous cell carcinoma in the floor of the
resulting in uncontrolled tumour growth. Tumour cells are mouth. Frontiers in oncology. 2020 Apr 21;10:579.
thus able to avoid planned cell death and reproduce 5. Yang Z, Du W, Zhang X, Chen D, Fang Q, He Y,Yang Y, Li D, Fan J. Nonsmoking and
indefinitely thanks to telomere lengthening(10). nondrinking oral squamous cell carcinoma patients: a different entity.
Frontiers in Oncology. 2021 Jun 28;11:558320.
6. Choi S, Myers JN. Molecular pathogenesis of oral squamous cell carcinoma:
Management of squamous cell carcinoma:- implications for therapy. Journal of dental research. 2008 Jan;87(1):14-32.
According to a recent poll, there is a lack of communication 7. Chinn SB, Myers JN. Oral cavity carcinoma: current management,
controversies, and future directions. Journal of clinical oncology. 2015 Oct
among head and neck surgeons and pathologists. The 10;33(29):3269.
surgeon collected sections that are frozen from the 8. Baba A, Hashimoto K, Kuno H, Masuda K, Matsushima S, Yamauchi H, Ikeda K,
preliminary sample in about thirty-two per cent of instances Yamazaki M, Taiki S, Ogane S, Kurokawa R. Assessment of squamous cell
carcinoma of the floor of the mouth with magnetic resonance imaging.
and from the tumour bed in twenty-seven per cent Japanese Journal of Radiology. 2021 Dec;39:1141-8.
Pathologists, on the other hand, examined the primary 9. Gontarz M,Wyszy ska–Pawelec G, Zapa a J, Czopek J, Lazar A, Tomaszewska
sample 40% of the moment. R. Immunohistochemical predictors in squamous cell carcinoma of the
tongue and floor of the mouth. Head & neck. 2016 Apr;38(S1):E747-53.
10. Piazza C, Grammatica A, Montalto N, Paderno A, Del Bon F, Nicolai P.
The visor flap avoids the need for a facial incision and has Compartmental surgery for oral tongue and floor of the mouth cancer:
been associated with lower rates of oral incompetence and oncologic outcomes. Head & Neck. 2019 Jan;41(1):110-5.
11. Yamagata K, Terada K, Uchida F, Kanno N, Hasegawa S,Yanagawa T, Bukawa H.
fistula. The advent of transoral robotics surgery provides an A case of primary combined squamous cell carcinoma with neuroendocrine
alternative method for resecting more posterior tumours (atypical carcinoid) tumor in the floor of the mouth. Case Reports in Dentistry.
without requiring a mandibulotomy, but this is still 2016 Dec 27;2016.
12. Liu XC, Ma SR, Shi S, Zhao YF, Jia J. Prognostic significance of lymph node ratio
experimental(12). in patients with squamous cell carcinoma of the floor of the mouth.
International Journal of Oral and Maxillofacial Surgery. 2022 Mar 1;51(3):307-
Mandibular resection is guided by a pre-operative 13.
13. Saggi S, Badran KW, Han AY, Kuan EC, St. John MA. Clinicopathologic
assessment of periosteum and cortex invasion. The results of characteristics and survival outcomes in floor of mouth squamous cell
pre-operative physical examination are only two-thirds of the carcinoma: a population-based study. Otolaryngology–Head and Neck
time predictive of bone invasion, whereas the inclusion of Surgery. 2018 Jul;159(1):51-8.
14. Stoeckli SJ, Huebner T, Huber GF, Broglie MA. Technique for reliable sentinel
scans has extremely good precision despite limitations in the node biopsy in squamous cell carcinomas of the floor of mouth. Head & neck.
ev a l u a t i o n o f m i c ro s c o p i c i nv a s i o n ( 8 ) . M a rg i n a l 2016 Sep;38(9):1367-72.
mandibulectomy produces comparable results to segmental 15. Zirk M, Safi AF, Buller J, Nickenig HJ, Dreiseidler T, Zinser M, Drebber U, Zöller
JE, Kreppel M. Lymph node ratio as prognosticator in floor of mouth
mandibulectomy in the treatment of small tumours with squamous cell carcinoma patients. Journal of Cranio-Maxillofacial Surgery.
periosteal involvement. Intraoperative bone invasion, tooth 2018 Feb 1;46(2):195-200.
loss with low mandibular bone height, and previously
i r ra d i a t e d b o n e a re i n d i c a t i o n s o f s e g m e n t a l
mandibulectomy(13).
The harmfulness of postirradiation osteoradionecrosis is
undesirably high (71% in cases of both a mandibulotomy and
a marginal mandibulectomy) and shouldn't be done.
Maxillary alveolar ridge and hard palate cancers are
frequently resected through the mouth. A facial incision can
improve access for larger tumours that extend into the
infratemporal fossa, masticator space, and paranasal
sinuses(14).
Neck dissection is a safe procedure for surgical management
of the neck, but it can result in complications such as shoulder
dysfunction, nerve palsy injuries, vasculature insult. Selective
neck dissection is an established treatment option for oral
squamous cell carcinoma that involves removing only the
nodal basins that are likely to metastasize while leaving
uninvolved non-lymphatic lymphatic structures alone. More
selective approaches do not affect geographic control or
survival rates(15).
Conclusion:-
Squamous cell carcinoma (SCC) is a type of cancer that can
develop in many different parts of the body, including the oral
cavity. SCC of the mouth floor is a major public health
concern, with a high prevalence in men and health risks such
as alcohol and tobacco use, Human papillomavirus, and
nutrition lacking in fruits and vegetables. Early detection and
treatment, which may include surgery, radiatiotherapy and
chemotherapy are critical in improving the prognostic value
of SCC.
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