Malignant neoplasms arising from mucosal surface epithelium exhibiting squamous differentiation as characterized by the formation of keratin

A 65 year old male reported to Ear, Nose and Throat

(ENT) outpatient with painful ulcerative lesion of left lower two third of the face. It started as a tiny lesion at left nasomaxillary groove one year back. This gradually increase in size.On clinical examination,it was an ulcerated lesion of 5cm by 3 cm involving whole upper lip and right angle of mouth.The lesion extended to involve lower half of collumella and adjacent zygomaxillary lesion.The margins were irregular and the base was covered with purulent secretion.After cleaning, debridement the whole lesion was excised.On histopathological examination it was diagnosed as SQUAMOUS CELL CARCINOMA.

( Journal of Pakistan Medical Association)

HOW WOULD YOU MANAGE THIS PATIENT??????????

• EARLY DIAGNOSIS

• TUMOUR SIZE

• USUALLY ONLY ONE CHANCE TO CURE

• RECURRENCE

• COMPLEX

• DEPENDS ON AGE, MEDICAL CONDITION,EXACT SIZE,DEGREE OF SPREAD AND HISTOLOGICAL TYPE.

• CO-ORDINATED BY MULTIDISCIPLINARY TEAM

Identify the

Type

Spread

Stage of carcinoma

Evaluate co morbidity

• Clinical examination and imaging

CLINICAL EXAMINATION: Palpation

Clinical signs, such as nerve palsies, also indicate extent of spread.

IMAGING: CT ScanMRIPET(includes neck and chest to identify and exclude

lymphnode and blood borne metastasis.

• Biopsy of the carcinoma provide information on the degree of differentiation and the pattern of spread.

• Patients are heavy smokers or alcoholic

• CVS , respiratory ,neurological or liver disease poses an anesthetic risk or compromise recovery from surgery.

• Nutritional status should be assesed.

• Patient’s psychological fitness.

• MULTIMODALITY THERAPYSURGERY + RADIOTHERAPY

o SURGERY

o RADIOTHERAPY

o CHEMOTHERAPY

• Preferred for small carcinoma’s of tongue

• Those involving bones b/c of the risk of later radionecrosis and for verrucous carcinoma.

AIM??????

• Neck ressection to remove the cervical lymph nodes along with the juglar chain from the base of skull to clavicle + submental +submandibular lymph nodes for prevention of relapse.

• Acceptable and functional result.

• Discomfort and unwanted long term effects

• External beam radiotherapy

• Telotherapy

• Brachytherapy

• Act by radiosensitisation as well their direct effect on cancer cells.

• Carried out with radiotherapy for best effect.

• Alkylating agent cisplastin + 5 fluorouracil

• Neoadjuvant therapy = b /f surgery or radiotherapy

• Adjuvant chemotherapy after, both reducing side effects.

• Advanced tumours and treatment failure

• Radiotherapy

• Surgery when large tumours comprises the airway or become grossly necrotic.

• SENITAL NODE BIOPSY• PHOTODYNAMIC THERAPY• INHIBITORS OF EFGR LIKE

CETUXIMAB• OncoVex ( engineered Herpes

Simplex Virus)• INTENSITY MODULATED

RADIOTHERAPY