Squamous Cell Carcinoma (SCC)

Clinical Description

Squamous cell carcinomas (SCC) of the oral cavity are cancers that arise from the superficial tissues of the mouth. These tissues include the lip, tongue, floor of mouth, hard palate, buccal (cheek) mucosa, and alveolus (gums) in the illustration above. Salivary gland cancers are less common and are not discussed here.

Approximately 275,000 cases of oral cavity cancer are diagnosed worldwide each year, which represents nearly half of all squamous cell carcinoma of the head and neck. There are 137,000 deaths globally each year. Oral cavity SCC has a propensity to invade local tissue and spread to lymph nodes, but is rarely present with distant spread (metastasis).

Symptoms of Squamous Cell Carcinoma

Symptoms of oral cavity cancer include:

·         Discolored patches inside your mouth or on your lips

·         An ulcer or sore that will not heal

·         Bleeding

·         Loose teeth

·         Difficulty wearing dentures

·         Pain when swallowing

·         A lump in your neck

·         Numbness of lower lip and chin

·         An earache that won’t go away

These symptoms are most often from other health problems, but can be caused by oral cavity cancer. Anyone with these symptoms should contact their dentist or healthcare provider for evaluation.

Risk Factors of Squamous Cell Carcinoma

Tobacco smoking and alcohol use are the principal risk factors for developing oral cavity SCC. Oral tobacco use, human papillomavirus, periodontal disease, radiation, and immune deficiency are also risk factors. Extensive sunlight exposure is an important cause of lip cancer.  Oral tobacco and betel nut use are contributing factors for cancers within the mouth. Betel nut is a type of palm seed wrapped in a betel leaf and chewed. Its use is most common in Asia.

How Squamous Cell Carcinoma Is Diagnosed

If you have symptoms that suggest oral cancer, your doctor or dentist will check your mouth and throat for red or white patches, lumps, swelling, or other problems. A physical exam includes looking carefully at the roof of your mouth, back of your throat, and insides of your cheeks and lips. Your doctor or dentist also will gently pull out your tongue so it can be checked on the sides and underneath. The floor of your mouth and lymph nodes in your neck will also be checked.

If your doctor or dentist does not find the cause of your symptoms, you may be referred to a specialist. An ear, nose, and throat specialist can see the back of your nose, tongue, and throat by using a small, long-handled mirror or a lighted tube. Sometimes imaging with a CT scan or MRI is needed to find hidden tumors or determine the extent of visible lesions.

If a suspicious area is detected, a biopsy may be necessary. This is a minor surgical procedure involving removing just a piece or, if small enough, all of the lesion.  It may be done under local anesthesia or may require general anesthesia. Once the biopsy is obtained, it will be examined under a microscope to evaluate for the presence of cancer.

Treatment Options for Squamous Cell Carcinoma at Tufts Medical Center

Treatment for oral cavity squamous cell carcinoma usually depends on the extent, or stage, of the disease. Doctors stage the cancer based on its size and whether it has spread to lymph nodes or other tissues.  Staging ranges from I to IV, with IV being the most advanced.

Stage I and II oral cavity squamous cell carcinomas are small tumors that have not spread beyond the adjacent tissue.  In general, treatment options are either surgery or radiation therapy (RT).  Surgery is the preferred approach because it is associated with less toxicity, both in the immediate post-treatment time period and over the long term. The goal of surgery is to remove the entire cancer and a small amount of normal surrounding tissue. Usually, lymph nodes are removed from one or both sides of the neck. If it is not possible to remove the entire cancer, sometimes radiation therapy is combined with surgery for optimal treatment. 

Stage III and IV oral cavity SCC represents either big tumors (more than 4cm in size) or indicates that cancer has spread outside the local tissue, either to lymph nodes or other distant tissues. Again, whenever possible, surgery is the preferred method of treatment. In advanced oral cavity SCC, surgical resection may require large areas of the oral cavity and adjacent structures to be removed, sometimes requiring reconstruction.

Even if the entire tumor can be removed, stage III and IV oral SCC is at high risk for recurrence. Because of this, a course of postoperative radiation therapy is typically recommended. If the entire tumor cannot be removed, surgery is typically followed with radiation therapy as well as chemotherapy.

In certain cases, when the tumor is large or in an area that limits the surgeon’s ability to remove it, an initial course of chemotherapy may be warranted. This strategy has been shown to decrease the extent of surgery and improve the surgeon’s ability to remove the entire tumor, thus preventing the need for postoperative radiation therapy.

For patients with advanced oral cavity SCC who are not candidates for surgery, due to the extent of their disease or their overall medical condition, chemotherapy, radiation therapy, or a combination of both may be recommended. However, this type of treatment is associated with significant side effects, including significant inflammation, ulceration, and even death of the oral tissue and adjacent bone.  Patients are selected very carefully for this type of treatment if they are not candidates for surgical removal of their cancer.

If the cancer involves the lymph nodes of the neck, surgical removal of these lymph nodes along with postoperative radiation therapy is generally recommended.  This may involved one or both sides of the neck depending on the size and extent of the primary tumor.

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