Verrucous Carcinoma Treatment in Delhi, India

Verrucous carcinoma is a rare type of squamous cell cancer that mostly affects the mouth, and less frequently, the feet or genitals. When it affects the mouth, it is known as oral verrucous carcinoma.

As it is a slow-growing cancer, symptoms take time to appear, which may cause a delay in diagnosis. Following the diagnosis, verrucous carcinoma is treated like any other oral cancer. 

An uncontrolled growth of squamous cells lining the mouth causes verrucous carcinoma. The actual cause of this growth is not yet known, but several risk factors have been linked to it, including:

• Tobacco: Smoking and Tobacco use have been strongly linked with development of verrucous carcinoma in the mouth.
• Chronic irritation: Any injury or chronic irritation such as exposure to allergens can increase the risk of developing this type of cancer.
• Radiation therapy history: A history of receiving radiation to the mouth, feet, or genitals increases the risk of verrucous carcinoma in the irradiated area.
• HPV Infection: Infection with certain strains of HPV virus have been linked to the development of verrucous carcinoma in the mouth or genital regions.

Symptoms generally appear at later stages and vary according to the location of the verrucous carcinoma.

• Oral Verrucous Carcinoma: Rough, wart-like surface, thickened white areas, and ulcers that don't heal easily. If the lesion is in the larynx or oral cavity, patients may have pain, swallowing difficulties, or voice alterations.
• Cutaneous Verrucous Carcinoma: Lesions that resemble warts and have the potential to bleed or release an unpleasant odour.
• Genital verrucous carcinoma: Lesions in the genital region that could be mistaken for warts or other benign disorders.

Diagnosis of verrucous carcinoma involves a combination of tests that include:

Physical exam

Diagnosis begins with a physical exam, where the doctor checks for symptoms such as wart-like growths on the skin. This is also accompanied by questions regarding a patient’s medical history.

Biopsy

In a biopsy test, a small tissue is taken from the lesion and examined under a microscope. The test helps in distinguishing it from other forms of tumours, and helps in establishing the stage of the cancer.

Imaging tests

Imaging tests such as MRI and CT scans help in assessing the spread of the cancer. These tests provide clear detailed images of the cancer and the affected tissue.

The biopsy of the cancerous tissue helps in identifying the stage of verrucous carcinoma. It is categorised based on the extent of the spread of the cancer using the traditional way of staging.

• Early stage: The cancer is confined to the first lining of the skin and has not spread to deeper tissues. It appears like thick, wart-like lesions.
• Locally Advanced Stage: At this stage, the cancer is still localised to the affected area but has spread deeper into the muscles or connective tissue.
• Advanced Stage: In the advanced stages of the cancer, it spreads to nearby lymph nodes and other tissues. 

The treatment of verrucous carcinoma is the same as for many other oral cancers. The first line of treatment is almost always surgery.

Surgery

The aim of the surgery is to excise the entire tumour with extreme care, and leave much of the surrounding tissue intact. To reduce the risk of recurrence and ensure there are no lingering cancer cells, a wide local excision or Mohs surgery may be performed.

Radiation therapy

Radiation therapy is employed if surgical intervention is not possible, or the condition has already grown into deeper tissue. This is done with the understanding that verrucous carcinoma is known to be more aggressive after radiation, which is why it is often recommended after careful consideration.

Topical or Systemic therapy

For small lesions or in cases where surgery is not an option, topical medications or systemic therapy (like chemotherapy) may be recommended. Conversely, verrucous carcinoma tends to respond poorly to chemotherapy.

Cryotherapy

In this process, liquid nitrogen is used to freeze the cancerous tissue. Cryotherapy is a treatment done for small superficial lesions, particularly if surgery is not an option. That said, it is not frequently used for verrucous carcinoma due to being less effective on more deeper or aggressive lesions.

Laser Therapy

Laser treatment utilises focused light beams to eliminate or destroy cancerous cells. It may be applied in situations where verrucous carcinoma involves specific body parts such as the oral cavity or genital region, where precision is crucial. In cases where surgery is not possible, laser therapy can reduce harm to adjacent tissues. As with cryotherapy, laser therapy has limited use and is not appropriate for larger or deeper tumours.

To reduce the likelihood of developing verrucous carcinoma, it is imperative to implement preventive measures:

• Avoid tobacco use: Verrucous carcinoma, particularly in the oral cavity, has been correlated with tobacco consumption. Consequently, refraining from or ceasing the use of smoking and chewing tobacco is essential for preventing any variant of oral cancer.
• Maintain good oral hygiene: Good oral care practices (such as brushing your teeth twice daily) alongside regular flossing can significantly diminish the risk of this condition.
• Protect skin from sunlight: Protecting the skin from sunlight is important; in cases of skin verrucous carcinoma, applying sunscreen, wearing protective clothing, and minimising prolonged sun exposure can be beneficial. However, one must remain vigilant, as these measures alone may not guarantee complete prevention.
• Control infections: Some strains of the human papillomavirus (HPV) are associated with verrucous cancer in genital areas. The risk can be reduced by vaccination against hpv and practising safe sex.

Although verrucous carcinoma is a slow-growing type of cancer, it may still cause complications if left untreated. Depending on the site, it may invade deeper into the tissues or muscles, producing pain, loss of function, and/or disfigurement. The cancer is also highly recurrent following therapy, requiring close follow-ups.

1. Can verrucous carcinoma transmit from one person to another?

Verrucous carcinoma is not contagious. It cannot be transmitted from one person to another whether through direct contact, saliva, or bodily fluids.

2. Can verrucous carcinoma recur after treatment?

Yes, verrucous carcinoma has a significant chance of coming back after treatment. This makes regular follow-up appointments with your doctor crucial.

3. Is verrucous carcinoma hereditary?

While genetic predisposition might play a role, there's no direct evidence of hereditary transmission. Family history of cancer can increase risk factors.

4. How is verrucous carcinoma different from other types of skin or oral cancers?

Verrucous carcinoma is distinct from other types of skin and oral cancers in several respects:

• It is a well-differentiated, slow-growing form of squamous cell carcinoma.
• It rarely spreads (metastasizes) to distant areas of the body.
• It can be locally aggressive, invading nearby tissues.

In contrast, other skin and oral cancers may grow more rapidly and have a higher chance of spreading to other organs.

Reviewed By Dr. Sameer Khatri, Senior Director - Cancer Care / Oncology, Medical Oncology, Head & Neck Oncology, Gastrointestinal & Hepatobiliary Oncology on 23 Dec 2024.