Oral squamous cell carcinoma (OSC) is a malignant tumor that develops from the flat epithelial cells lining the oral mucosa. This disease is characterized by aggressive behavior, the ability to invade surrounding tissues and spread to regional lymph nodes. Oral squamous cell carcinoma most often affects such anatomical structures as the tongue, gums, buccal mucosa and the floor of the mouth. The age group of patients is quite wide, but the greatest number of cases is observed in people over 40 years old, with a predominance among men.
History of the disease and interesting historical facts
The history of studying squamous cell carcinoma of the oral cavity dates back to ancient times, when doctors first described various cancers. In the 18th-19th centuries, interest in oncology increased, and the first attempts to classify tumors were made. One of the outstanding activities in this area was the improvement of methods for surgical removal of neoplasms. In the 20th century, active research into the etiology and pathogenesis of squamous cell carcinoma began, which contributed to the improvement of diagnostics and treatment of this disease. Interestingly, at the beginning of the 20th century, the first data on the relationship between tobacco use and the development of oral cancer were described. This opened up new horizons for researchers who began to study various risk factors that contribute to the development of carcinoma.
Epidemiology
Oral squamous cell carcinoma accounts for approximately 90% of all malignant tumors arising in this area and is one of the leading cancers in the world. According to WHO, up to 500,000 new cases of SCC are registered annually, and the incidence varies depending on the geographic regions. For example, in South Asian countries, a higher prevalence of the disease is noted, associated with the widespread use of tobacco in various forms. Studies show that in Europe, the incidence of SCC is approximately 1-3 cases per 100,000 population, while in some regions of India and Pakistan this figure can reach 10-20 cases per 100,000 population, which emphasizes the importance of identifying and controlling risk factors.
Genetic predisposition to this disease
In recent years, it has been established that genetic factors play a significant role in the development of oral squamous cell carcinoma. Studies have shown that mutations in certain genes, such as TP53 and CDKN2A, can contribute to the malignant transformation of epithelial cells. The TP53 gene is responsible for the synthesis of a protein that controls the cell cycle and DNA damage, while the CDKN2A gene regulates the passage of cells through the cell cycle. Mutations identified in these genes can lead to impaired apoptosis and increased cell proliferation, which contributes to tumor development. In addition, it has been found that polymorphisms in tobacco metabolism genes, such as CYP1A1 and GSTM1, can also increase the risk of the disease in people with high levels of tobacco consumption.
Risk factors for the development of this disease
There are many risk factors that contribute to the development of squamous cell carcinoma of the oral cavity. The main ones include:
- Tobacco use (smoking and chewing tobacco).
- Alcohol intoxication – high levels of alcohol consumption increase the likelihood of illness.
- Viral infections, especially human papillomavirus (HPV) infection, which is associated with some forms of oral cancer.
- Chronic inflammatory diseases of the oral mucosa, such as leukoplakia and erythroplasia.
- Poor nutrition and lack of vitamins, especially vitamins A, C and E, may contribute to the development of the disease.
- Age and gender – men and people over 40 years of age are more likely to suffer from this form of cancer.
Diagnosis of this disease
Diagnosis of oral squamous cell carcinoma involves a multi-step approach. The main symptoms of the disease may vary, but the following are distinguished:
- Rare (or, conversely, constant) ulcers or damage to the mucous membrane that do not heal.
- Pain in the affected area.
- Change in color or texture of the mucous membrane.
- Enlarged lymph nodes.
Laboratory tests may include cytology, tissue biopsy, and histopathology of samples. Radiological examinations (CT, MRI) allow assessment of tumor spread and involvement of surrounding tissues. Human papillomavirus testing is also performed. Differential diagnosis should be made with other diseases, such as infectious processes and precancerous changes.
Treatment
Treatment for oral squamous cell carcinoma depends on the stage of the disease and may include:
- Surgical treatment, which is the main method in the early stages, may include resection of the damaged area followed by reconstruction.
- Radiation therapy, which can be used in either the adjuvant or neoadjuvant setting to shrink a tumor before surgery or to kill any remaining cancer cells after surgery.
- Chemotherapy, which may be given when the cancer has spread or in combination with radiation therapy.
- Immunotherapy and targeted drugs are being actively investigated to improve treatment outcomes for oral cancer.
List of medications used to treat this disease
Drugs used to treat oral squamous cell carcinoma include:
- Cisplatin - used in chemotherapy.
- Doxorubicin is used in systemic chemotherapy.
- Paclitaxel - being studied for effectiveness in combination with other drugs.
- Nivolumab is an immunotherapeutic drug designed to restore the activity of T-lymphocytes against tumor cells.
- Ramusirumab is a targeted drug that affects tumor angiogenesis.
Disease monitoring
Monitoring of oral squamous cell carcinoma includes regular medical examinations, follow-up examinations, and relapse testing. The prognosis of the disease depends on the stage at the time of diagnosis, but with early detection and adequate treatment, five-year survival can reach 70-80%. At later stages, when metastasis occurs, this figure is significantly reduced. It is also important to consider possible complications, such as relapse of the disease, which requires a comprehensive approach to treatment and patient monitoring.
Age-related features of the disease
Oral squamous cell carcinoma can occur in different age groups. In young people, the disease may be associated with HPV infection and habits such as smoking. In older people, higher incidence is associated with the accumulation of risk factors such as a tendency to abuse alcohol and smoking, as well as chronic inflammatory diseases. In children and adolescents, squamous cell carcinoma is extremely rare and may be caused by an oncogenic infection or a hereditary predisposition.
Questions and Answers
- What are the common symptoms of oral squamous cell carcinoma? The main symptoms include long-lasting ulcers in the mouth, enlarged lymph nodes, pain, and changes in the condition of the mucous membrane.
- How is this disease diagnosed? Diagnosis includes biopsy, histological examination, cytology, and imaging techniques such as CT and MRI.
- What are the risk factors associated with the development of oral carcinoma? Major risk factors include tobacco use, alcohol abuse, HPV infection, the presence of chronic diseases and nutritional disorders.
- What are the treatments for oral squamous cell carcinoma? Treatment may include surgery, chemotherapy, radiation therapy, and immunotherapy depending on the stage of the disease.
- What is the prognosis for oral squamous cell carcinoma? The prognosis depends on the stage of the disease: with early diagnosis, five-year survival can reach 70-80%, but at a late stage it decreases significantly.
