MANAGEMENT OF ORAL SQUAMOUS CELL CARCINOMA: TREATMENTS AND PROGNOSIS

Abstract

Oral squamous cell carcinoma (OSCC) represents the most prevalent malignant neoplasm of the oral cavity, associated with high morbidity, significant functional impact, and high mortality rates. The oncogenesis of OSCC is multifactorial and involves continuous exposure to carcinogenic agents such as tobacco, alcohol, areca nut, and human papillomavirus infection, resulting in genetic and epigenetic alterations that activate oncogenic pathways such as EGFR, PI3K/AKT/mTOR, JAK/STAT, and Wnt/β-catenin. Furthermore, the tumor microenvironment plays a determining role in disease progression, since tumor-associated macrophages, fibroblasts, myeloid suppressor cells, and T lymphocytes modulate proliferation, invasion, angiogenesis, and immune evasion through cytokines, chemokines, and bioactive metabolites. Clinical management remains based on a multimodal approach, involving surgery, radiotherapy, and cisplatin-based chemotherapy, complemented by targeted therapies and immunotherapy in advanced or recurrent cases. However, tumor heterogeneity limits the effectiveness of these strategies, reinforcing the need for precise biomarkers, such as EGFR, APOBEC3A, and RRAS, for better patient stratification and therapeutic guidance. Additionally, patients diagnosed with squamous cell carcinoma (SCC) have an increased risk of developing secondary primary tumors due to the phenomenon of field cancerization, which negatively impacts prognosis and demands continuous surveillance. Therefore, understanding the molecular pathways involved in tumorigenesis, the cellular interactions of the tumor microenvironment, and the associated prognostic factors is fundamental to improving early diagnosis, guiding individualized therapeutic approaches, and improving patient survival. Recent advances in immunotherapy, proteogenomics, and understanding of tumor microenvironment (TME) offer new perspectives for the development of more effective and personalized therapeutic strategies in the treatment of SCC.