Squamous-cell carcinoma

Squamous-cell carcinoma or squamous cell cancer (SCC or SqCC) is a cancer of a kind of epithelial cell, the squamous cell. These cells are the main part of the epidermis of the skin, and this cancer is one of the major forms of skin cancer. However, squamous cells also occur in the lining of the digestive tract, lungs, and other areas of the body, and SCC occurs as a form of cancer in diverse tissues, including the lips, mouth, esophagus, urinary bladder, prostate, lung, vagina, and cervix, among others. Despite sharing the name squamous cell carcinoma, the SCCs of different body sites can show tremendous differences in their presenting symptoms, natural history, prognosis, and response to treatment.

SCC is a histologically distinct form of cancer. It arises from the uncontrolled multiplication of cells of epithelium, or cells showing particular cytological or tissue architectural characteristics of squamous cell differentiation, such as the presence of keratin, tonofilament bundles, or desmosomes, structures involved in cell-to-cell adhesion.

SCC is still sometimes referred to as "epidermoid carcinoma" and "squamous cell epithelioma", though the use of these terms has decreased.

SCC typically initially occurs in the sixth decade of life (the 50s), but is most common in the eighth decade (the 70s). It is twice as prevalent in men as in women. People with darker skin are less at risk to develop SCC. Populations with fair skin, light hair, and blue/green/grey eyes are at highest risk of developing the disease. Frequent exposure to direct, strong sunlight without adequate topical protection also increases risk.

Signs and symptoms



Symptoms are highly variable depending on the involved organs.

SCC of the skin begins as a small nodule and as it enlarges the center becomes necrotic and sloughs and the nodule turns into an ulcer.

  • The lesion caused by SCC is often asymptomatic
  • Ulcer or reddish skin plaque that is slow growing
  • Intermittent bleeding from the tumor, especially on the lip
  • The clinical appearance is highly variable
  • Usually the tumor presents as an ulcerated lesion with hard, raised edges
  • The tumor may be in the form of a hard plaque or a papule, often with an opalescent quality, with tiny blood vessels
  • The tumor can lie below the level of the surrounding skin, and eventually ulcerates and invades the underlying tissue
  • The tumor commonly presents on sun-exposed areas (e.g. back of the hand, scalp, lip, and superior surface of pinna)
  • On the lip, the tumor forms a small ulcer, which fails to heal and bleeds intermittently
  • Evidence of chronic skin photodamage, such as multiple actinic keratoses (solar keratoses)
  • The tumor grows relatively slowly
  • Unlike basal cell carcinoma (BCC), squamous cell carcinoma (SCC) has a substantial risk of metastasis
  • Risk of metastasis is higher in SCC arising in scars, on the lower lips or mucosa, and occurring in immunosuppressed patients.

About one-third of lingual and mucosal tumors metastasize before diagnosis (these are often related to tobacco and alcohol use).

Causes



Human papilloma virus

Human papilloma virus (HPV) has been associated with SCC of the oropharynx, lung, fingers, and anogenital region.

By region

Skin

Squamous cell carcinoma is the second-most common cancer of the skin (after basal cell carcinoma but more common than melanoma). It usually occurs in areas exposed to the sun. Sunlight exposure and immunosuppression are risk factors for SCC of the skin, with chronic sun exposure being the strongest environmental risk factor. There is a risk of metastasis starting more than 10 years after diagnosable appearance of squamous cell carcinoma, but the risk is low, though much higher than with basal cell carcinoma. Squamous cell cancers of the lip and ears have high rates of local recurrence and distant metastasis (20รข€"50%). Squamous cell cancers of the skin in individuals on immunotherapy or suffering from lymphoproliferative disorders (i.e. leukemia) tend to be much more aggressive, regardless of their location.

SCCs represent about 20% of the non-melanoma skin cancers, but due to their more obvious nature and growth rates, they represent 90% of all head and neck cancers that are initially presented. The vast majority of SCCs are those of the skin, and like all skin cancers, are the result of ultraviolet exposure. SCCs usually occur on portions of the body commonly exposed to the Sun; the face, ears, neck, hands, or arm. The main symptom is a growing bump that may have a rough, scaly surface and flat reddish patches. Unlike basal cell carcinomas, SCCs carry a significant risk of metastasis, often spreading to the lymph nodes, and are thus more dangerous. During its earliest stages, it is sometimes known as Bowen's disease.

Saree cancer may occur along the waist in females wearing saree, and caused by constant irritation which can result in scaling or pigmentation. It is a rare type of cancer and generally found in the Indian subcontinent where saree is a lifetime costume worn by the female.

Squamous cell carcinoma are generally treated by surgical excision or Mohs surgery. Non-surgical options for the treatment of cutaneous SCC include topical chemotherapy, topical immune response modifiers, photodynamic therapy (PDT), radiotherapy, and systemic chemotherapy. The use of topical therapy, such as Imiquimod cream and PDT is generally limited to premalignant (i.e., AKs) and in situ lesions. Radiation therapy is a primary treatment option for patients in whom surgery is not feasible and is an adjuvant therapy for those with metastatic or high-risk cutaneous SCC. At this time, systemic chemotherapy is used exclusively for patients with metastatic disease.

Head and neck cancer

Ninety percent of cases of head and neck cancer (cancer of the mouth, nasal cavity, nasopharynx, throat and associated structures) are due to squamous cell carcinoma.

Thyroid

Primary Squamous cell thyroid carcinoma shows an aggressive biological phenotype resulting in poor prognosis for patients.

Oesophagus

Oesophageal cancer may be due to either squamous cell carcinoma (ESCC) or adenocarcinoma (EAC). SCCs tend to occur closer to the mouth, while adenocarcinomas occur closer to the stomach. Dysphagia (difficulty swallowing, solids worse than liquids) and odynophagia are common initial symptoms. If the disease is localized, esophagectomy may offer the possibility of a cure. If the disease has spread, chemotherapy and radiotherapy are commonly used.

Lung

When associated with the lung, it is typically a centrally located large cell cancer (non-small cell lung cancer or NSCLC) that often has a paraneoplastic syndrome causing ectopic production of parathyroid hormone-related protein (PTHrP), resulting in hypercalcemia. It is primarily due to smoking.

Penile Genitalia

When squamous cell carcinoma in situ (Bowen's disease) is found on the penis, it is called erythroplasia of Queyrat. This type of cancer responds very well to imiquimod.

Prostate

When associated with the prostate, squamous cell carcinoma is very aggressive in nature. It is difficult to detect as there is no increase in prostate specific antigen levels seen; meaning that the cancer is often diagnosed at an advanced stage.

Vagina and cervix

Vaginal squamous cell carcinoma spreads slowly and usually stays near the vagina, but may spread to the lungs and liver. This is the most common type of vaginal cancer.

Bladder

Most bladder cancer is transitional cell, but bladder cancer associated with Schistosomiasis is often squamous cell carcinoma.

Diagnosis



Diagnosis is via a biopsy. For the skin, look under skin biopsy.

The pathological appearance of a squamous cell cancer varies with the depth of the biopsy. For that reason, a biopsy including the subcutaneous tissue and basalar epithelium, to the surface is necessary for correct diagnosis. The performance of a shave biopsy (see skin biopsy) might not acquire enough information for a diagnosis. An inadequate biopsy might be read as actinic keratosis with follicular involvement. A deeper biopsy down to the dermis or subcutaneous tissue might reveal the true cancer. An excision biopsy is ideal, but not practical in most cases. An incisional or punch biopsy is preferred. A shave biopsy is least ideal, especially if only the superficial portion is acquired.

Classification

Cancer can be considered a very large and exceptionally heterogeneous family of malignant diseases, with squamous cell carcinomas comprising one of the largest subsets. All squamous cell carcinoma lesions are thought to begin via the repeated, uncontrolled division of cancer stem cells of epithelial lineage or characteristics. Squamous-cell carcinomas arise from squamous cells, which are flat cells that line many areas of the body. Accumulation of these cancer cells causes a microscopic focus of abnormal cells that are, at least initially, locally confined within the specific tissue in which the progenitor cell resided. This condition is called squamous cell carcinoma in situ, and it is diagnosed when the tumor has not yet penetrated the basement membrane or other delimiting structure to invade adjacent tissues. Once the lesion has grown and progressed to the point where it has breached, penetrated, and infiltrated adjacent structures, it is referred to as "invasive" squamous cell carcinoma. Once a carcinoma becomes invasive, it is able to spread to other organs and cause the formation of a metastasis, or "secondary tumor".

Tissue of origin

The International Classification of Diseases for Oncology (ICD-O) system lists a number of morphological subtypes and variants of malignant squamous cell neoplasms, including:

  • Papillary thyroid carcinoma (Code 8050/3)
  • Verrucous squamous cell carcinoma (Code 8051/3)
  • Papillary squamous cell carcinoma (Code 8052/3)
  • Squamous cell carcinoma (Code 8070/3)
  • Large cell keratinizing squamous cell carcinoma (Code 8071/3)
  • Large cell nonkeratinizing squamous cell carcinoma (Code 8072/3)
  • Small cell keratinizing squamous cell carcinoma (Code 8073/3)
  • Spindle cell squamous cell carcinoma (Code 8074/3)
  • Adenoid/pseudoglandular squamous cell carcinoma (Code 8075/3)
  • Intraepidermal squamous cell carcinoma (Code 8081/3)
  • Lymphoepithelial carcinoma (Code 8082/3)

Other variants of squamous cell carcinoma are recognized under other systems, such as:

  • Keratoacanthoma

Morphology

  • Bowen's disease is a sunlight-induced skin disease, and is considered to be an early form of squamous cell carcinoma.
  • Erythroplasia of Queyrat
  • Keratoacanthoma is a low-grade malignancy of the skin. It originates in the pilo-sebaceous glands, and is similar in clinical presentation and microscopic analysis to squamous cell carcinoma, except that it contains a central keratin plug. Statistically, it is less likely to become invasive than squamous cell carcinoma.
  • Marjolin's ulcer is a type of squamous cell carcinoma that arises from a non-healing ulcer or burn wound.

Microscopic appearance

One method of classifying squamous cell carcinomas is by their appearance under microscope. Subtypes may include:

  • Adenoid squamous-cell carcinoma' (also known as "Pseudoglandular squamous-cell carcinoma"), characterized by a tubular microscopic pattern and keratinocyte acantholysis.
  • Basaloid squamous-cell carcinoma is characterized by a predilection for the tongue base.
  • Clear-cell squamous-cell carcinoma (also known as "Clear-cell carcinoma of the skin") is characterized by keratinocytes that appear clear as a result of hydropic swelling.
  • Signet ring cell squamous cell carcinoma (occasionally rendered as "signet-ring-cell squamous-cell carcinoma") is a histological variant characterized by concentric rings composed of keratin and large vacuoles corresponding to markedly dilated endoplasmic reticulum. These vacuoles grow to such an extent that they radically displace the cell nucleus toward the cell membrane, giving the cell a distinctive superficial resemblance to a "signet ring" when viewed under a microscope.
  • Spindle-cell squamous-cell carcinoma (also known as "Spindle-cell carcinoma") is a subtype characterized by spindle-shaped atypical cells.

Prevention



Appropriate clothing, sunscreen with at least SPF 30, and avoidance of intense sun exposure may prevent skin cancer.

Management



Most squamous cell carcinomas are removed with surgery. A few selected cases are treated with topical medication. Surgical excision with a free margin of healthy tissue is a frequent treatment modality. Radiotherapy, given as external beam radiotherapy or as brachytherapy (internal radiotherapy), can also be used to treat squamous cell carcinomas.

Mohs surgery is frequently utilized; considered the treatment of choice for squamous cell carcinoma of the skin, physicians have also utilized the method for the treatment of squamous cell carcinoma of the mouth, throat, and neck. An equivalent method of the CCPDMA standards can be utilized by a pathologist in the absence of a Mohs-trained physician. Radiation therapy is often used afterward in high risk cancer or patient types.

Electrodesiccation and curettage or EDC can be done on selected squamous cell carcinoma of the skin. In areas where SCC's are known to be non-aggressive, and where the patient is not immunosuppressed, EDC can be performed with good to adequate cure rate.

Nodal spread:

1) Surgical block dissection- if palpable nodes or in cases of Marjolin's ulcers but the benefit of prophylactic block lymph node dissection with Marjolin's ulcers is not proven.

2) Radiotherapy.

(Manoj Ramachandran, Marc A Gladman; Clinical cases and OSCES in Surgery- 2nd ed; churchil livingstone)

Imiquimod (Aldara) has been used with success for squamous cell carcinoma in situ of the skin and the penis, but the morbidity and discomfort of the treatment is severe. An advantage is the cosmetic result: after treatment, the skin resembles normal skin without the usual scarring and morbidity associated with standard excision. Imiquimod is not FDA-approved for any squamous cell carcinoma.

In 2007, Australian biopharmaceutical company Clinuvel Pharmaceuticals Limited began clinical trials with an experimental treatment, a melanocyte-stimulating hormone called afamelanotide (formerly CUV1647) to provide photoprotection for organ transplant patients against squamous cell carcinoma of the skin and actinic keratosis.

The Nigro protocol has been recommended as one approach to treatment of lesions less than 5ร‚ cm.

Prognosis



The long-term outcome of Squamous-cell carcinomas is dependent upon several factors: the sub-type of the carcinoma, available treatments, location(s) and severity, and various patient health-related variables (accompanying diseases, age, etc.). Generally, the long-term outcome is positive, as less than 4% of Squamous-cell carcinoma cases are at risk of metastasis. Some particular forms of squamous-cell carcinomas have a higher mortality rate. One study found squamous-cell carcinoma of the penis had a much greater rate of mortality than some other forms of squamous-cell carcinoma, that is, about 23%, although this relatively high mortality rate may be associated with possibly latent diagnosis of the disease due to patients avoiding genital exams until the symptoms are debilitating, or refusal to submit to a possibly scarring operation upon the genitalia.

Squamous-cell carcinomas of the head and neck have been found to have a greater risk of metastatis to the lymphatic system, hence possibly reducing treatment efficacy.

Carcinomas of the esophagus were found in one study to have a 58% mean rate of metastasis to local lymph nodes. In the same study, the number of lymph nodes compromised was correlated with a decrease of the survival rate. The study found that in cases of lymphatic metastasis, the mean 5-year survival rate was 49.5%, with a decrease for every lymph node compromised.

Epidemiology



Incidence of squamous cell carcinoma varies with age, gender, race, geography, and genetics. The incidence of SCC increases with age and the peak incidence is usually around 66 years old. Males are affected with SCC at a ratio of 2:1 in comparison to females. Caucasians are more likely to be affected, especially those with fair Celtic skin, if chronically exposed to UV radiation. There are also a few rare congenital diseases predisposed to cutaneous malignancy. In certain geographic locations, exposure to arsenic in well water or from industrial sources may significantly increase the risk of SCC.



10 comments:

  1. Am from United State. I don't just know the reason why some people are finding it difficult to believe that, there is a cure for HPV,and herpes well I have been suffering from HPV since 9 month now but today I am happy that am cure from it with the herbal medicine of Dr. Ekpiku the great healer,I was browsing the internet searching for help when I came across a testimony shared by someone on how Dr. Ekpiku cure his HPV I was so much in need of getting his treatment so I contacted Dr.Ekpiku for the HPV cure. I am so much happy today that we have someone like this great herbal Dr out there, contact Dr Ekpiku on email address: ekpikuspellhomeofgrace@gmail.com or text me 270) 693-5854. DOCTOR Ekpiku CAN AS WELL CURE ALL MANNER OF DEADLY DISEASE.

    ReplyDelete
  2. I can’t believe this. A great testimony that i must share to all HERPES SIMPLEX VIRUS patient in the world i never believed that their could be any complete cure for Herpes or any cure for herpes,i saw people’s testimony on blog sites of how dr Ero prepare herbal medicine that cure and brought them back to life again. i had to try it too and you can,t believe that in just few weeks i started using it all my pains stop gradually and i had to leave without the pills the doctor gave to me. Right now i can tell you that few months now i have not had any pain,delay in treatment leads to death. Here is his email:(dreroherbaltreatment@gmail.com) whatsapp him with +2348073673757 or text/call me 650) 653-8578....

    ReplyDelete
  3. The doctors said Herpes virus do not have medical cure because the virus is capable of hiding within the human cells, it remains protected from your immune system. Herpes isn’t a special virus – your immune system has the tools to fight it back. But because it is able to lay dormant in protected cells, your immune system is unable to remove it from your body,But with strong reactive herbal medication is capable of getting rid of the virus gradually and totally from your body without damaging any of your cells,natural herbs kills the virus totally not just reducing the out break. Get natural herbs cure from Dr. Oshuku (droshuku@gmail.com) or WhatsApp number +2348130419838

    ReplyDelete
  4. I'm 61 years old, I contracted hpv in 2011' I has be taking lot treatment for it and some months ago the wart stated coming out seriously, I used lot recommendation because there was lot warts around my anus and was so embarrassed. but today I'm totally happy I got the virus eliminated by using natural treatment from Dr Onokun herbal center after his treatment I got cured. all the warts went away' seriously believed Dr Onokun he have the cure for human papillomavirus because he has eliminated hpv been in my body since 2011, Dr Onokun make it possible for me. Here is Dr Onokun email to reach him: Dronokunherbalcure@gmail.com  he is welled capable of curing terrible diseases.  

    ReplyDelete
  5. Happiness is all i see now I never thought that I will live on
    earth before the year runs out. I have been suffering from a
    deadly disease (Herpes) for the past 3 years now; I had spent
    a lot of money going from one places to another, from
    churches to churches, hospitals have been my home every day
    residence. Constant checks up have been my hobby not until
    this faithful day, I was searching through the internet, I saw a
    testimony on how pp him +2348154637647 Dr Lucky, helped
    someone in curing his Herpes disease, quickly I copied his
    email which is (drluckyherbalcure@gmail.com) just to give
    him a test I spoke to him, he asked me to do some certain
    things which I did, he told me that he is going to provide the
    herbal cure to me, which he did, then he asked me to go for
    medical checkup after some days after using the herbal cure, I
    was free from the deadly disease, he only asked me to post
    the testimony through the whole world, faithfully am doing it
    now, please brothers and sisters, he is great, I owe him in
    return. if you are having a similar problem just email him on
    (drluckyherbalcure@gmail.com) or Call him or WhatsApp him
    +2348154637647

    ReplyDelete
  6. Can't still believe that i got cured from Genital Herpes through herbal treatment from Dr LUCKY who I met through the internet, I actually couldn't believe it at first because it sounded impossible to me knowing how far I have gone just to get rid of it. Dr LUCKY send me his medicine which I took as instructed and here I am living a happy life once again, a big thanks to Dr LUCKY , I am sure there are many herbal doctors out there but Dr LUCKY did it for me, contact him on Email him; { drluckyherbalcure@gmail.com }

    ReplyDelete
  7. this is real take it serious, who will believe that a herb can cure ten
    years HIV in my body, i never believe that this will work i have spend a
    lot when getting drugs from the hospital to keep me healthy, what i was
    waiting for is death because i was broke, one day i hard about this great
    man who is well know of HIV and cancer cure, i decided to email him,
    unknowingly to me that this will be the end of the HIV aids in my body, he
    prepare the herb for me, and give me instruction on how to take it, at the
    end of the two week, he told me to go to the hospital for a check up, and i
    went, surprisingly after the test the doctor confirm me negative, i thought
    it was a joke, i went to other hospital was also negative, then i took my
    friend who was also HIV positive to the Dr voodoo after the treatment she
    was also confirm negative . He also have the herb to cure cancer please i
    want every one with this virus to be free, that is why am dropping his
    email address, voodoospelltemple66@gmail.com i want you to email him he
    is a great man. the government is also interested in this Dr voodoo
    thank you for saving my life, and I promise I will always testify
    for your good work you can also add him on whatsApp
    +2348140120719

    ReplyDelete
  8. herpes is a serious and recurring disease which can't be cured through drugs or injections by the American doctors but the best way to deal with herpes is by taking natural herbs medicine for it and is only few American doctors that know about this herbal medicine from Dr Akhanene .. I have read about Dr Akhanene the great herbalist doctor from African who can cure disease with his powerful herbal medicine. for the people suffering from the following diseases, Herpes, Cancer, Also,Herpatitis, Diabetes, Hps,Infections ETC should contact him for his herbal medicine because i am a living testimony and i was cured of herpes. Although, i sent him what he requested and he sent me his medicine which i took for 1 weeks and today when i went for test i was tested herpes negative. you can reach him through his Emai drakhanenespellhome@gmail.com.com or whatsapp or call him +2348168714427  

    ReplyDelete

  9. A friend of mine recommended me to contact this herbal Doctor for herpes cure and he asked me to purchase his herbal medicine which i did, when i received this herbal medicine, he gave me instructions on how to use it, after taking the medicine as instructed for 2 weeks, i went for check up and the result shows negative and i was cured of herpes, I am now free from Herpes. You can contact him on his email …………His result is ๐Ÿ’ฏ๐Ÿ’ฏ๐Ÿ’ฏ๐Ÿ’ฏ๐Ÿ’ฏ guaranteed. I highly recommend..........


    You can win your Ex lover back in 48 hours just like me.

    Very effective ...

    For fast and reliable solution.

    Get boyfriend back after break up.

    Get girlfriend back after break up.

    Get Gay partner back.

    Get Lesbian partner back.

    Make Your Husband/Wife love you Forever.

    Stop Having Bad Dreams.

    Make Women/Men To Run After You.

    Stop Divorce from happening.

    Divorce Your Husband/Wife.

    Make Partner marry you.

    Make Wishes To Be Granted.

    Win Court Case/Law suit.

    Get pregnant.

    Luck To Win A Lottery.

    Stop Marriage/Relationship from Breaking Apart.

    I used his herbal remedy to cure Hsv-2..

    100% result guaranteed..

    Email R.buckler11 (( @gmail .com))…………

    ReplyDelete