Why squamous cell carcinoma is not an insurance claim. Squamous cell carcinoma, treatment, causes, symptoms, signs. Methods for diagnostic detection of pathology

Valery Zolotov

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Squamous cell carcinoma is a malignant tumor characterized by an aggressive course and rapid development. As a rule, it begins on the mucous membrane or skin.

Squamous cell carcinoma is divided into 3 types, well, moderately and poorly differentiated, the most common being moderately differentiated. The higher the differentiation, the more optimistic the prognosis, since the disease develops more slowly.

Squamous cell carcinoma of the skin accounts for about 25% of all skin cancers. Of these, in almost 75% the disease manifests itself in the area of ​​the face, head or. It mainly occurs in people over sixty-five years of age. Slightly more in males.

In six percent of cases, this disease can affect nearby lymph nodes, and sometimes even bones and. In this form, the pathology tends to quickly increase, and pain may also occur, therefore, if you do not know what is the cause of pain in a particular part of the body, we advise you to immediately consult a medical specialist.

The signs of this disease are as follows:

1. There are several forms of squamous cell carcinoma, the ulcerative one is characterized by sharply raised edges surrounding the perimeter of the ulcer. Visually, such an ulcer may resemble a crater, and bloody discharge may also be observed. This type of cancer progresses quite quickly, increasing not only in breadth, but also in depth;
2. Visually, the formation on the skin may resemble cabbage. The surface of the inflammation has a lumpy base, the base is wide. The color can vary, from brown to red. Ulcers or erosions may occur on the surface of the tumor;
3. the latter type is characterized by a plaque-like shape, bloody discharge and bumpy tubercles on the surface of the tumor. It spreads very quickly, initially only the surface of the skin is affected, and then the internal organs are affected.

This pathology can appear on many parts of the body, but most often it can be found:

• red border of lips;
• larynx;
• cervix;
• esophagus;
• oral cavity.

Squamous cell carcinoma of the larynx represents about 60% of diseases of this organ. There are two types of this disease; infiltration-ulcerative cancer has a more progressive form. may be the following.

1. change in voice (manifested in hoarseness or complete loss of voice – aphonia);
2. difficulty breathing (can be blocked due to growth);
3. pain when swallowing;
4. cough (occurs due to irritation of the walls of the larynx);
5. hemoptysis;
6. sensation of a foreign object in the larynx.

It is very important if you experience these signs or simply experience pain or discomfort in the larynx area, consult a doctor for a diagnosis.

• bleeding from the vagina outside of menstruation;
• pain in the cervix during intercourse, as well as bleeding after it;
• urinary disturbance;
• constant aching pain in the lower abdomen.

Features of prostate cancer

The male body is also susceptible to a similar disease, namely squamous cell prostate cancer.

The prostate, or otherwise the prostate gland, is the organ responsible for the male reproductive system. There are two types of prostate cancer: if the cancer originates from the glandular epithelium, it is called an adenoma; if it originates from the squamous epithelium, this type of cancer is called squamous cell. Symptoms of prostate pathology include the following:

1. increased urination at night;
2. feeling of incomplete emptying of the bladder;

In the early stages, it is very difficult to distinguish cancer from prostate adenoma, only over time in the bladder area, and weight loss can also be noticed.

There are several types of prostate diseases.

Metastases develop and spread through lymphogenous and hematogenous routes. To detect this type of oncology in the early stages, modern methods are used.

One of them is the introduction of PSA antigen and subsequent determination of its level in the blood. If prostate cancer is suspected, a biopsy is performed - a control examination to determine the disease.

Finally

If you find out that you have squamous cell carcinoma, do not panic; although this type of cancer is unusual, it is still cancer.

And in our time, medicine fights it quite effectively. Many methods have been developed to combat cancer tumors; radiation and chemotherapy are only the most well-known. In addition, if you are in the initial stage, then we want to make you happy, the probability of a complete cure is close to one hundred percent.

In later stages, the prognosis is also quite favorable, you should not immediately write out a death sentence for yourself, there is always a chance of recovery, even at the last stage there is always a chance that the situation will change.

The main thing is to understand how important it is to undergo the procedures that your doctor has prescribed for you and to always attend them. In this case, carcinoma can be defeated.

Even if you cannot be cured completely, medicine can stop the progression of the disease and no matter what subtype of cancer, moderate or poorly differentiated, carcinoma of the larynx or anything else.

It is important to know! Do not neglect the annual medical examination procedure, this will allow you to identify possible diseases in the early stages.

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Carcinomas have been known to mankind since time immemorial. The first mentions of such tumors can be found in the papyri of the ancient Egyptians, and Hippocrates determined their name - carcinoma, since in appearance they resembled a crab. Celsus later translated the term into Latin, which is how “cancer” came into being. Even in ancient times, carcinoma was considered an incurable disease, but even then it was proposed to remove tissue affected by the tumor in the early stages, and not treat advanced cases at all.

Time has passed, ideas have changed, but even today carcinoma remains an often incurable disease. The more scientists learn about it, the more new questions arise. Even modern diagnostic methods are not always able to detect cancer at an early stage, and treatment often does not bear the expected fruits.

Malignant tumors are considered the leaders in the number of deaths all over the world, they gave first place only to diseases of the cardiovascular system, and among all neoplasias, carcinoma is the most common type.

The term “cancer” in medicine refers to malignant tumors of the epithelium. This concept is identical to carcinoma.

Such neoplasms have a unique structure and are subject to certain general mechanisms of development and behavior. Their source can be the skin, mucous membranes, parenchyma of internal organs, consisting of highly functionally specialized cells (liver, pancreas, lungs, etc.). Often people who are not related to medicine call other tumors, for example, from bone, muscle or nervous tissue, cancer, however, this is incorrect. In this article we will try to figure out what carcinoma (cancer) is, where it grows and how to fight it.

Carcinomas are much more common than all other types of malignant neoplasms, and there is an explanation for this. The fact is that The epithelium, which covers the inner surface of many organs or makes up the upper layer of the skin, is constantly renewed, and this is associated with continuous cell division. The more intensely cells divide and multiply, the greater the likelihood that at some stage a failure may occur, and this will cause the appearance of a spontaneous genetic mutation. A mutated cell gives rise to a whole clone of new, changed ones, with an uncharacteristic structure or properties, which, moreover, are capable of dividing an unlimited number of times. Thus, in a short time, a formation will arise that is different in structure from the epithelium from which it originated, and the ability to intensively increase, grow into the surrounding space, spread through the blood or lymph throughout the body and predetermine its malignant nature.

Another possible reason for the prevalence of epithelial tumors can be considered the high probability of contact with. Thus, the skin experiences all kinds of environmental influences (sun, household chemicals, wind), the epithelium of the gastrointestinal tract is constantly in contact with carcinogens contained in food, polluted air and tobacco smoke enter the lungs, and the liver is forced to process a variety of toxic substances, drugs, etc., while the heart muscle or nervous tissue of the brain is limited from such dangers by barriers.

The epithelium of the female genital organs and the prostate gland is subject to the action of hormones, which cause complex transformations there, therefore, with any hormonal disruptions, especially likely in older patients, disruption of the maturation of epithelial cells may occur.

Carcinoma does not appear suddenly on unchanged epithelium; it is always preceded by a precancerous change. Since not everyone rushes to the doctor when any complaints appear, and certain types of precancer are completely asymptomatic, cases when a tumor is diagnosed immediately, bypassing its predecessors, are not uncommon.

stages of precancerous changes using the example of the cervix

Pre-tumor changes include dysplasia, leukoplakia, atrophic or hyperplastic processes, but the most important is dysplasia, the severe degree of which is, in fact, “cancer in situ”, that is, a non-invasive form of cancer.

Types of epithelial tumors

Carcinomas are extremely diverse, both in appearance and microscopic features, but they have been classified into groups based on common properties.

Externally, the tumor can resemble a node or grow in the form of an infiltrate, penetrating into the surrounding tissues; clear boundaries are not typical for cancer, and the process is often accompanied by severe inflammation and a tendency to ulceration, especially on the skin and mucous membranes.

Depending on the type of epithelium that gave rise to carcinoma, it is customary to distinguish:

1. Adenocarcinoma– glandular tumor, most often affecting the mucous membranes and glands (stomach, bronchi, etc.).
2. Squamous cell carcinoma(keratinizing or non-keratinizing), the source of which is the multilayered squamous epithelium of the skin, larynx, cervix, as well as areas of metaplasia on the mucous membranes, when foci of squamous epithelium appear where it should not be.
3. Mixed forms– so-called dimorphic cancers, in which both squamous and glandular components are found, each of which carries signs of malignancy.

They can have very different structures, resembling certain structures of healthy tissues, so their separate types are distinguished:

• Papillary carcinoma - when tumor complexes form branching papillary growths (eg in).
• Tubular adenocarcinoma - tumor cells develop into tubes and ducts.
• Acinar – resembles acini or rounded clusters of cancer cells.

Depending on the degree of maturity of tumor cells, glandular carcinoma can be highly, moderately and poorly differentiated. If the structure of the tumor is close to healthy epithelium, then they speak of a high degree of differentiation, while poorly differentiated tumors sometimes lose their resemblance to the original tissue from which they were formed. Carcinomas always contain such signs of malignancy as cell atypia, an enlarged, large and dark-colored nucleus, an abundance of defective (pathological) mitoses (dividing nuclei), polymorphism (one cell is not like another).

Squamous cell carcinoma is structured somewhat differently. In it you can find fields of multilayered squamous epithelium, but consisting of altered, atypical cells. In more favorable cases, such cancerous epithelium retains the ability to form a horny substance, which accumulates in the form of pearls, then they speak of a differentiated type of squamous cell carcinoma - keratinizing. If the epithelium is deprived of this ability, then the cancer will be called non-keratinizing and have a low degree of differentiation.

The described varieties are established using histological examination of fragments of tumor tissue after a biopsy or its removal during surgery, and the appearance can only indirectly indicate the degree of maturity and structure of the carcinoma.

The lower the differentiation, that is, the development of cancer cells, the more malignant the tumor, which is why it is so important to examine it microscopically and describe all its characteristics.

The greatest difficulties may arise during diagnosis poorly differentiated carcinomas, when the cells are so diverse or, on the contrary, have almost the same appearance that they do not fit into any of the above cancer options. However, it is still possible to distinguish individual forms: mucous, solid, small cell, fibrous (scirrhus), etc. If the structure of the tumor does not correspond to any of the known types, then it is called unclassified carcinoma.

well-differentiated carcinoma (left) and poorly differentiated (right) - in the first case, the difference between cancer cells is obvious visually

Features of the main types poorly differentiated carcinomas:

1. Slimy cancer, often found in the stomach or ovaries, is capable of producing a huge amount of mucus, in which carcinoma cells die.
2. Solid carcinoma consists of cells “laid” into a kind of beams, bounded by layers of connective tissue.
3. Small cell carcinoma represents clusters of cells resembling lymphocytes and is characterized by an extremely aggressive course.
4. For fibrous cancer(scirrhus) is characterized by a significant amount of connective tissue stroma, which makes it very dense.

Neoplasia can develop from the endocrine and exocrine glands, the cells of which retain similarities with the original tissue of the organ, for example, hepatocellular carcinoma, and grow as a large nodule or many small nodules in the parenchyma of the organ.

In rare cases, you can find the so-called carcinoma unclear origin. In fact, this is the original location of which it was never possible to establish even with the use of all existing research methods.

cancer metastasis is one of the causes of carcinomas of unknown origin

Carcinomas from an unknown source are often found in the liver and lymph nodes. In such a situation, a biopsy and immunohistochemical study of tumor fragments may be of decisive importance, making it possible to determine the presence of proteins characteristic of a particular type of cancer. Particularly difficult is the diagnosis of poorly differentiated or undifferentiated forms of such carcinomas, when their structure is not similar to the presumed source of metastasis.

When talking about malignant tumors, it is important to define the concept invasiveness. The transition of a precancerous process to carcinoma is accompanied by changes characteristic of cancer in the entire thickness of the epithelial layer, but at the same time, the tumor may not extend beyond its boundaries and may not grow into the basement membrane - “cancer in situ”, carcinoma “in situ”. This is how ductal carcinoma of the breast or cancer “in situ” of the cervix behaves for the time being.

Due to aggressive behavior, the ability of cells to divide indefinitely, to produce a variety of enzymes and biologically active substances, carcinoma, having overcome the stage of non-invasive cancer, grows through the basement membrane on which the epithelium was located, penetrates into the underlying tissue, and destroys the walls of blood and lymphatic vessels. Such a tumor will be called invasive.

Some details

One of the most common malignant epithelial tumors is, found predominantly among the male population of Japan, Russia, Belarus, and the Baltic countries. Its structure in most cases corresponds to adenocarcinoma - a glandular tumor, which can be papillary, tubular, trabecular, etc. Among the undifferentiated forms, mucous (ring cell carcinoma) can be detected, and such a variety as squamous cell carcinoma in the stomach is extremely rare.

development of carcinomas on the epithelium of the stomach/intestines

also cannot be called a rare pathology. It is diagnosed not only in the elderly, but also in young patients of reproductive age against the background of various precancerous processes (pseudo-erosion, leukoplakia), viral damage or cicatricial deformities. Since most of the cervix is ​​covered with stratified squamous epithelium, the development of squamous cell carcinoma is most likely here, and adenocarcinoma is more common in the cervical canal, which leads into the uterus and is lined with glandular epithelium.

are extremely diverse, but the most common variant is considered to be basal cell carcinoma (basal cell carcinoma). This neoplasm affects older people, and its favorite location is the face and neck. Basalioma has a peculiarity: although there are signs of malignancy in the cells and the ability to grow into underlying tissues, it never metastasizes, but grows very slowly and tends to recur or form multiple nodules. This form of cancer can be considered favorable in terms of prognosis, but only if you consult a doctor in a timely manner.

The clear cell type of carcinoma is the most common. Its name suggests that it consists of light cells of various shapes, inside of which fat inclusions are found. This cancer grows quickly, metastasizes early and is prone to necrosis and hemorrhage.

is presented in a variety of forms, among which there are lobular and ductal varieties, which are “cancer in situ”, that is, non-invasive options. Such tumors begin to grow within the lobule or milk duct and may not make themselves known for a long time and may not show any symptoms.

ductal (left) and lobular (right) breast carcinoma, the difference is in the area of ​​appearance of atypical cancer cells

The moment of development of infiltrating breast carcinoma characterizes the progression of the disease and its transition to the next, more severe stage. Pain and other symptoms are not typical for invasive cancer, and women often discover the tumor themselves (or during a routine mammogram).

A special group of malignant tumors consists of neuroendocrine carcinomas. The cells from which they are formed are scattered throughout the body, and their function is to form hormones and biologically active substances. With tumors of neuroendocrine cells, characteristic symptoms appear, depending on the type of hormone produced by the tumor. Thus, nausea, diarrhea, high blood pressure, hypoglycemia, exhaustion, development of stomach ulcers, etc. are possible. Neuroendocrine carcinomas are extremely diverse in their clinical characteristics.

The World Health Organization has proposed to distinguish:

• Well-differentiated benign neuroendocrine carcinomas;
• Well-differentiated carcinomas with a low degree of malignancy;
• Poorly differentiated tumors with a high degree of malignancy (large cell and small cell neuroendocrine carcinoma).

Carcinoid tumors (neuroendocrine) are more often found in the gastrointestinal tract (appendix, stomach, small intestine), lungs, and adrenal glands.

Urothelialcarcinoma- This is a transitional cell, making up more than 90% of malignant neoplasms of this localization. The source of such a tumor is the transitional epithelium of the mucous membrane, which has features similar to multilayered squamous and single-layered glandular epithelium at the same time. Urothelial cancer is accompanied by bleeding, dysuric disorders and is more often detected in older men.

Metastasis Carcinomas occur predominantly by the lymphogenous route, which is associated with the good development of the lymphatic network in the mucous membranes and parenchymal organs. First of all, metastases are detected in nearby lymph nodes (regional) in relation to the site of cancer growth. As the tumor progresses and grows into blood vessels, hematogenous seedings appear in the lungs, kidneys, bones, brain, etc. The presence of hematogenous metastases in a malignant epithelial tumor (cancer) always indicates an advanced stage of the disease.

How to identify and how to treat?

Quite varied and depend on the location of the tumor. So, in order to suspect some types of cancer, a simple examination (of the skin) is sufficient, but for other tumors, instrumental and laboratory research methods come to the aid of oncologists.

After inspection And conversations with the patient, the doctor always prescribes General and biochemical analysis of blood and urine. In case of localization of carcinoma in the cavity organs, resort to endoscopy– fibrogastroduodenoscopy, cystoscopy, hysteroscopy. A large amount of information can be provided X-ray methods– X-ray of the lungs, excretory urography.

For the study of lymph nodes and tumor spread into surrounding tissues, they become indispensable. CT, MRI, ultrasonic diagnostics.

In order to exclude metastases, radiography of the lungs, bones, and ultrasound of the abdominal organs are usually performed.

The most informative and accurate diagnostic method is considered morphological studies(cytological and histological), allowing to establish the type of neoplasm and the degree of its differentiation.

Modern medicine offers cytogenetic analysis to detect genes indicating a high risk of developing a particular type of carcinoma, as well as definition in the blood (prostate-specific antigen, SCCA for suspected squamous cell carcinoma, etc.).

Early diagnosis of cancer is based on the determination of specific tumor proteins (markers) in the patient's blood. Thus, in the absence of visible foci of tumor growth and an increase in certain indicators, the presence of the disease can be assumed. In addition, for squamous cell carcinomas of the larynx, cervix, and nasopharynx, the detection of a specific antigen (SCC) may indicate the likelihood of tumor recurrence or progression.

Treatmentcarcinoma consists in using all possible methods of combating the tumor, and the choice remains with the oncologist, radiologist, and surgeon.

The main one is still considered, and the volume of intervention depends on the size of the neoplasm and the nature of its ingrowth into the surrounding tissue. In severe cases, surgeons resort to complete removal of the affected organ (stomach, uterus, lung), and in the early stages it is possible to perform tumor resection (breast, liver, larynx).

And are not applicable in all cases, since different types of carcinomas have different sensitivity to this type of influence. In advanced cases, these methods are intended not so much to remove the tumor as to reduce the suffering of the patient, who is forced to endure severe pain and dysfunction of the affected organs.

The prognosis for carcinoma is always serious, but in cases of early cancer detection and timely treatment, it is possible to completely get rid of the problem. In other stages of the disease, patient survival decreases, and the likelihood of cancer recurrence and metastasis appears. In order for treatment and prognosis to be successful, it is necessary to consult a specialist in a timely manner, and in the presence of precancerous lesions, an increased risk of tumor development, or an unfavorable family situation, the patient must regularly undergo appropriate examinations and treatment to prevent the development of carcinoma.

The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not provided at this time.

First, let's look at what squamous cell carcinoma is. This is a malignant formation that develops from flat epithelial cells in which pathological processes have begun to occur. Considering that such epithelium is present in many organs of the human body, the disease can affect each of them.

Important! The disease progresses very quickly, therefore, it is considered one of the most aggressive types of oncology. That is why in this case, early diagnosis plays an important role, allowing treatment to begin as soon as possible, improving the prognosis for recovery.

What is SCC antigen

The squamous cell carcinoma antigen SCC is of glycoprotein origin. The latter belongs to the family of serine protease inhibitors. The mass of the substance is about 50 kilodaltons.

In a healthy body, a small number of SCCA antigen cells in the absence of squamous cell carcinoma are produced by the skin epithelium. These processes occur in the cervix and anus. But, it does not extend to the extracellular space. In the presence of cancer, an increased level of antigen is diagnosed, which contributes to tumor growth and metastasis.

Important! It has been determined that there is a dependence of the amount of antigen in the blood on the size of the malignant tumor and the stage of the disease. At different stages it can vary between 10-80%.

Speaking in numbers, the norm for SCC antigen in the absence of squamous cell carcinoma is 2.5 ng/ml. If the indicators are higher, then doctors will talk about the presence of cancer.

Important! It is also necessary to take into account the fact that there may be other situations when, when refuting the diagnosis of squamous cell carcinoma, the antigenSCCabove the norm µg/l. These are pregnancy more than 16 weeks, asthma, kidney or liver failure.

Cervical cancer

It was mentioned above that CC can be the cause of an increase in the squamous cell carcinoma antigen SCCA. Considering that it is in the cervix that there is squamous epithelium, this disease is diagnosed in this form most often.

In order to get a good chance of recovery, it is necessary to identify squamous cell cancer of the cervix as early as possible, because it progresses very quickly. You should consult a doctor if you have the following symptoms:

• bloody vaginal discharge;
• menstrual irregularities;
• pain in the lower abdomen and lower back;
• pain during sexual intercourse;
• problems with urination and bowel movements.

To make a diagnosis you will have to undergo a full examination. It involves a blood test for tumor markers, an examination by a gynecologist, a biopsy followed by histopathology, as well as OMT ultrasound and CT. This will make it clear that the SCCA squamous cell carcinoma antigen is elevated due to the presence of cancer.

Lungs' cancer

This disease also has a number of characteristic symptoms that make it possible to identify it at the initial stage. This:

• cough;
• chest pain;
• labored breathing;
• increased weakness;
• dyspnea;
• blood in the sputum.

The last symptom usually occurs in cases where squamous cell carcinoma of the lung is already at stage 3 or 4.

The disease is diagnosed using radiography, CT scan of the whole body, as well as biopsy followed by histopathology. Donating blood for laboratory tests is not excluded.

Laryngeal cancer

Squamous cell carcinoma of the larynx manifests itself with a fairly large number of symptoms. The main ones are:

• difficulty swallowing;
• feeling of a foreign body in the throat;
• voice change;
• cough;
• enlargement of regional lymph nodes.

During diagnostics, doctors refer the patient for blood donation, ultrasound and CT. The further examination program is determined based on the results obtained.

Esophageal carcinoma

Squamous cell carcinoma of the esophagus is less common. But, nevertheless, you should know how the disease manifests itself. It is characterized by the following symptoms:

• heaviness in the stomach after eating;
• heartburn, belching;
• indigestion;
• chest pain;
• nausea, vomiting.

For diagnostic purposes, ultrasound, CT, and esophagoscopy are performed. Donating blood for analysis is required. During the examination, doctors have the opportunity to confirm oncology, receive information about the size of the tumor and the characteristics of its location. Metastasis, if present, can also be detected.

Skin cancer

Squamous cell skin cancer is another type of carcinoma that is much more common than others. In the initial stages, a small red or pink bump simply appears on the surface of the skin. The skin in this area is keratinized and begins to peel off. Further, deeper layers of tissue are affected, and the compaction begins to increase in size.

In later stages, the formation becomes painful. An ulcer may appear in its place. Metastases spread to regional lymph nodes.

How to donate blood for tumor markers

In order for the test results to be as accurate and informative as possible, appropriate preparation must be made for donating blood for the presence of squamous cell carcinoma. It assumes the following rules:

1. Do not eat 8-10 hours before the test.
2. Do not drink alcohol 3 days before the test.
3. Do not smoke on the day of blood collection.
4. Follow the diet for three days before the test. Do not eat fatty, smoked, fried foods.
5. Avoid physical activity before the test.
6. Do not have sexual activity for 7 days before blood collection.
7. It is recommended to donate blood before 11 am.

If the above requirements are met, the results of the analysis for tumor markers will be as objective as possible; accordingly, the accuracy of the diagnosis is guaranteed, which will contribute to the development of the most effective treatment program.

This type of disease occurs in people of different age categories, but most often it affects older people (after 65 years), more developed in men. Light-skinned and red-haired people suffer from this disease, which is very typical; these are residents of the southern regions of the country. Ultimately, without appropriate treatment, multiple organ failure rapidly develops, leading to death.

Microflora of squamous cell carcinoma

To date, the exact causes of the disease have not been established. But the suspected causes of squamous cell carcinoma can be quite different. People who spend a long time in the sun or under artificial ultraviolet rays (go to a solarium) are at risk for this disease.

Squamous cell carcinoma can be caused after thermal or chemical burns, and in some cases after exposure to radiation. Most people with this type of disease are those who work in hazardous industries and have frequent contact with chemicals. Thus, the skin is exposed to contamination with resins and arsenic. Sometimes the cause of oncology development is the so-called precancerous processes.

For example:

1. Xeroderma pigmentosum.
2. Bowen's disease.
3. Paget's disease.

In addition, very often people suffering from chronic dermatitis and ulcers are not aware of the possibility of this insidious disease occurring. Sometimes cancer occurs as a result of skin injuries or inflammatory diseases, for example, carbuncles, boils. What squamous cell carcinoma looks like is shown in the photo below.

Squamous cell skin cancer

Most often, tumors occur on the area that is most often exposed to ultraviolet rays. Typically this is the area () and .

There are the following types of squamous cell skin cancer:

• Plaque form:

This type is characterized by the formation of plaques that have an intense red color. This formation is dense to the touch; small tubercles are noticeable on its surface, which bleed. The plaque form has a very active spread with damage to the superficial layers of the skin, as well as metastasis to the inner layer of the epidermis.

• Knot shape:

The nodular form of the malignant disease is characterized by the formation of nodules that look like cauliflower. They develop very quickly. At the base, such a nodule is very wide, and the surface is lumpy. The appearance of this manifestation has a red-brown tint, and palpation reveals a dense structure. Various formations begin to form on the skin with rapid damage to the surface of the epidermis.

• Ulcerative form:

It is characterized by the appearance of ulcers on the surface of the epidermis; in appearance they look like craters. The edges of the tumor are ridged and slightly raised over the entire area of ​​the tumor. Ulcers have a specific smell, and you should be wary. This is the main symptom of this form of cancer. At the same time, they also bleed. Their spread speed is very high. Ulcers affect not only the surface of the skin, but also penetrate inside.

Worth paying attention to the fact that squamous cell carcinoma is characterized by a very high rate of spread.

In most cases, the tumor affects scars. In this place, small cracks first form, which are very painful, and then certain nodes begin to form, which have their own mobility and painlessness. Over time, the nodes lose their mobility and pain appears; this is when they grow together with the skin.

If the tumor increases in size and exceeds 2 cm in diameter, then in this case we are talking about the active development of the oncological process. It is accompanied by the formation of metastases.

Squamous cell carcinoma

Degrees of differentiation and their differences:

In order to make a diagnosis, the oncologist refers the patient to histology, to analyze biopsies, scrapings from the affected areas of the skin or ulcers. Based on the results of the histological examination, the type of squamous cell skin cancer is revealed.

1. Undifferentiated squamous cell carcinoma (non-keratinizing). The most malignant form is characterized by rapid growth. The mutation occurs in the cell of the spinous layer, after which its development stops, and all subsequent clones have a similar structure. Keratin does not accumulate in cancer cells and the process of their death does not occur.
2. Differentiated squamous cell carcinoma (keratinizing). In this case, the mutation also occurs at the level of the cell of the spinous layer, but after several divisions the resulting clones, on the contrary, begin to accumulate large amounts of keratin. Cancer cells gradually lose cellular elements and die, which is externally manifested by the deposition of crusts (keratin masses) on the surface of the tumor, which have a yellowish color. Unlike normal keratinization, with keratinizing cancer this process is accelerated several times.

Classification of stages of disease development

In oncology, cancer has four stages:

1. the first stage is characterized by the identification of a small lesion of the skin measuring 2 cm. At stage 1, the cancer has not yet affected a large area and has not metastasized. The base of the tumor is mobile, but the patient does not feel pain;
2. in the second stage, the disease rapidly progresses, the size of the tumor exceeds two centimeters and the area of ​​spread becomes more extensive. However, at this stage, the cancer does not manifest itself so actively, but there may be single metastases in nearby tissues. It is worth considering that squamous cell carcinoma spreads through the lymph nodes, and therefore metastases at this stage appear in them;
3. As cancer develops, it invades not only nearby lymph nodes, but also tissues that are nearby. This stage of cancer is characteristic of stage 3;
4. at the last stage, the fourth, squamous cell carcinoma has a serious spread and affects not only tissues and bones, but also cartilage. Even if the tumor is still small, this stage is characterized by distant metastases, which sometimes occur in multiple numbers. In this case, the joints begin to lose their mobility.

Squamous cell carcinoma: treatment

For most cancers, treatment methods are similar. However, depending on the type of malignant tumor and the affected area, they may have their own specifics. An important process is the timely removal of the affected tissue. Moreover, the earlier the therapy process begins, the greater the patient’s chances of survival.

The doctor decides how to treat squamous cell carcinoma. The main criteria that are taken into account when treating a tumor process are the age category and health of the patient.

Small malignant formations are treated with curettage, electrocoagulation, cryodestruction. If the tumor is localized in the scalp, then the latter method is not used.

Cryodestruction

Chemosurgical therapy (by the Moch method) has a significant advantage in squamous cell carcinoma, a prognosis of 99% in the direction of effectiveness. The advantage of this technique is that healthy areas of the skin can be preserved. This type of therapy is effective in treating tumors with poorly defined boundaries.

At the initial stage, radiotherapy is also very effective.

Chemotherapy for squamous cell carcinoma allows you to treat tumors that are not serious in size. For this purpose, special means for external use are used. Thus, they prevent cancer cells from growing.

The photodynamic therapy method used is used if the eye and nose areas are affected, as other methods can lead to visual impairment and damage to the nasal cartilage.

Folk remedies

When treating squamous cell carcinoma, you can alleviate the condition using traditional medicine recipes. However, you should not refuse traditional treatment from an oncologist.

Areas affected by squamous cell carcinoma should be treated with birch bud tincture. Verbena lotions to which table vinegar is added have also shown themselves to work well.

Also, to treat ulcers and plaques, an ointment is used, which is prepared from dried pomegranate seeds and honey.

Very useful for external use against this type of cancer, an ointment that is prepared on the basis of vegetable oil with powder from the inside of walnuts. The amount in the oil is added so that it becomes like an ointment.

How to avoid getting squamous cell carcinoma and what is the prognosis?

When treating any oncology, early detection of the problem is extremely important. If cancer is treated at an early stage, the likelihood of recovery is very high. But in any case, the former patient will have to be under the supervision of a doctor throughout his life.

As a rule, after discharge from the hospital, examinations are performed monthly, but gradually the intervals become larger.

What is the prevention of the disease?

1. 1. you need to be careful in the sun in summer, when it is most active;
   2. You should not overuse tanning in a solarium;
   3. if dermatitis occurs, they need to be treated promptly, as they are precancerous diseases;
   4. If you plan to go to the beach, you should use sunscreen. They should be applied approximately 20 minutes before the start of the procedure. This should be repeated every three hours;
   5. You need to carefully monitor the condition of your skin. If moles have acquired a strange shape, or some strange lumps have appeared, then you should urgently seek advice from an oncologist.

Informative video

Squamous cell carcinoma– malignant neoplasm ( tumor), developing from epithelial tissue ( epithelium) skin and mucous membranes. This disease is characterized by relatively rapid development and an aggressive course. Starting in the skin or mucous membrane, the cancer process quickly affects local lymph nodes and grows into neighboring organs and tissues, disrupting their structure and function. Ultimately, without appropriate treatment, multiple organ failure develops with a fatal outcome.


Squamous cell carcinoma accounts for approximately 25% of all types skin cancer and mucous membranes. In almost 75% of cases, this tumor is localized in the skin of the face and head. The disease is more common in old age ( after 65 years), somewhat more often in men.

Interesting Facts

• Squamous cell skin cancer is more common in Caucasian people.
• People who burn quickly in the sun are predisposed to developing squamous cell skin cancer.
• The most dangerous time for sunbathing is from 12.00 to 16.00, since ultraviolet radiation from the sun is maximum during this period.
• Squamous cell carcinoma in children develops in extremely rare cases, in the presence of a genetic predisposition.

Causes of squamous cell carcinoma

Flat epithelium in the human body

Depending on the structure there are:

• Multilayered squamous non-keratinizing epithelium. Consists of three layers of cells ( basal, spinous and superficial). The spinous and superficial layers represent separate stages of maturation of the cells of the basal layer. The cells of the surface layer gradually die and peel off. This epithelium lines the cornea of ​​the eye, the mucous membrane of the mouth and esophagus, the mucous membrane of the vagina and the vaginal part of the cervix.
• Stratified squamous keratinizing epithelium ( epidermis). Lines the skin and is represented by four layers of cells ( basal, spinous, granular, horny). In the area of ​​​​the palms and soles there is a fifth layer - shiny, located under the stratum corneum. Epidermal cells are formed in the basal layer, and as they move towards the superficial ( horny) a layer of keratin protein accumulates in them, they lose their cellular structure and die. The stratum corneum is represented by completely dead cells ( horny scales), filled with keratin and air bubbles. Horny scales are constantly peeling off.

Risk factors for the development of squamous cell carcinoma

Factors contributing to the development of cancer are:

• genetic predisposition;
• ultraviolet radiation;
• taking immunosuppressants;
• ionizing radiation;
• smoking tobacco;
• poor nutrition;
• alcoholic drinks;
• occupational hazards;
• contaminated air;
• age.

Genetic predisposition is expressed through:

• Violations of antitumor cell defense. Each cell of the body has a specific gene that is responsible for blocking the development of malignant tumors ( so-called antioncogene, “guardian of the genome”). If the genetic apparatus of the cell ( ensuring cell division) is not disrupted, this gene is in an inactive state. If DNA is damaged ( deoxyribonucleic acid, responsible for the storage, transmission and reproduction of genetic information) this gene is activated and stops the process of cell division, thus preventing the formation of a tumor. When a mutation occurs in the antioncogene itself ( occurs in more than half of squamous cell carcinoma cases) its regulatory function is disrupted, which can contribute to the development of the tumor process.
• Impaired functioning of antitumor immunity. Every minute, thousands of gene mutations occur in the human body, meaning potentially thousands of new tumors are formed. However, thanks to the immune system ( so-called antitumor immunity), tumors do not develop. Several types of cells are involved in providing antitumor immunity ( T lymphocytes, B lymphocytes, macrophages, natural killer cells), which very quickly recognize and destroy mutant cells. With mutations in the genes responsible for the formation and functioning of these cells, the effectiveness of antitumor immunity may decrease, which creates favorable conditions for the occurrence of malignant neoplasms. Gene mutations can be passed on from generation to generation, causing a predisposition to tumor processes in offspring.
• Impaired metabolism of carcinogens. If any carcinogens enter the body ( physical or chemical) certain protective systems are activated, aimed at their neutralization and rapid removal. When the genes responsible for the operation of these systems are mutated, the risk of developing a tumor process increases.

With prolonged and intense exposure to ultraviolet rays, antitumor immunity may not be able to neutralize all cells with a mutant genome, which will lead to the development of squamous cell skin cancer.

Taking immunosuppressants
Some medications ( azathioprine, mercaptopurine and so on), used for various diseases and pathological conditions ( tumors of the blood system, autoimmune diseases, organ transplantation) have an inhibitory effect on the body's defense systems, including antitumor immunity. The use of such drugs can lead to the development of squamous cell carcinoma.

Ionizing radiation
Ionizing radiation includes x-rays, gamma rays, hydrogen and helium nuclei. By affecting the body, ionizing radiation has a damaging effect on the genetic apparatus of cells, leading to the occurrence of numerous mutations. In addition, damage to the body's immune system leads to a weakening of antitumor immunity, which increases the likelihood of developing cancer hundreds of times.

Numerous epidemiological studies have shown that squamous cell carcinoma and other forms of malignant neoplasms occur hundreds of times more often in individuals exposed to these types of radiation ( with frequent use of ionizing radiation for medical purposes, among nuclear industry workers, during accidents at nuclear power plants and explosions of atomic bombs).

Smoking tobacco
It has been scientifically proven that smoking cigarettes and other products containing tobacco ( cigars, pipes) increases the risk of developing squamous cell cancer of the oral cavity, digestive system and respiratory tract. At the same time, both active smokers ( direct smokers), and passive ( people around who inhale tobacco smoke).

Combustion of tobacco when inhaling occurs at very high temperatures, as a result of which, in addition to nicotine, many other combustion products enter the body ( benzene, formaldehyde, phenols, cadmium, chromium and others), the carcinogenic effect of which has been scientifically proven. When a cigarette is smoldering ( not while puffing) the combustion temperature of tobacco is lower, and significantly fewer carcinogens are released into the environment.

Carcinogenic substances, absorbed through the mucous membranes of the oral cavity and respiratory tract, have a local carcinogenic effect. In addition, when absorbed into the blood and distributed throughout the body, they can cause the development of tumors in various organs and tissues.

In many countries, tobacco is used not only for smoking ( there is snuff, chewing tobacco). With these methods of use, substances formed during the combustion process do not enter the body, but other carcinogens are released that increase the risk of developing cancer of the lips, oral cavity and pharynx.

Poor nutrition
Proper, balanced nutrition ensures the normal development and functioning of the body's immune system, in particular antitumor immunity, which reduces the likelihood of developing cancer.

It has been scientifically proven that excessive dietary intake of animal fats significantly increases the risk of developing digestive cancer. At the same time, plant-based foods ( vegetables and fruits) contain vitamins ( A, C, E, folic acid) and other substances ( selenium), preventing the development of tumors. Their lack in the diet can significantly increase the risk of developing malignant neoplasms.

Alcoholic drinks
Directly ethyl alcohol ( active ingredient in all alcoholic beverages) does not cause the development of malignant neoplasms. At the same time, the connection between alcohol abuse and the risk of cancer has been scientifically proven. This is explained by the fact that alcohol increases the permeability of cells to various chemicals ( benzopyrene and other carcinogens). This fact is confirmed by the most common localization of squamous cell carcinoma in alcoholics in the oral cavity, larynx and pharynx, that is, in organs in direct contact with ethyl alcohol and its vapors.

The likelihood of developing squamous cell carcinoma in these areas is several times higher if you combine alcohol consumption with smoking or other tobacco use.

Occupational hazards
Inhalation of certain chemicals, as well as intense and prolonged exposure to the skin, can lead to the development of squamous cell carcinoma. The duration of exposure to carcinogens plays a more important role than their concentration.

Occupational carcinogens in people of various professions

Infections
It has been scientifically proven that certain viruses can contribute to the development of squamous cell carcinoma.

The occurrence of squamous cell carcinoma can be caused by:

• Human papillomavirus. This virus can cause the development of various benign tumors in the skin and mucous membranes ( condylomas, papillomas), and in very rare cases can cause cervical cancer. By introducing itself into the DNA of the body's cells, the virus changes their structure, which leads to the formation of new copies of the virus in the cell. This process can lead to various mutations at the genome level, up to the occurrence of a malignant process.
• Human immunodeficiency virus ( HIV). This virus infects cells of the immune system, which ultimately leads to the development of human acquired immunodeficiency syndrome ( AIDS), which reduces both the anti-infective and anti-tumor defenses of the body.

Precancerous diseases

Depending on the likelihood of developing cancer, there are:

• obligate precancerous diseases;
• optional precancerous diseases.

Obligate precancers are:

• Xeroderma pigmentosum. A rare hereditary disease transmitted in an autosomal recessive manner ( a child will only get sick if he inherits the defective gene from both parents). Appears in children aged 2–3 years and is externally manifested by redness of the skin, the formation of cracks, ulcerations, and warty growths on open areas of the body. The mechanism of development of this disease is explained by a violation of cell resistance to ultraviolet rays. As a result, DNA damage occurs when sunlight hits the skin. With each new exposure to a damaging factor, the number of mutations in cells increases, which ultimately leads to the development of cancer.
• Bowen's disease. A rare skin disease that occurs as a result of prolonged exposure to adverse factors ( chronic trauma, prolonged exposure to the sun, occupational hazards). Externally it manifests itself as one or more small red spots, located mainly on the skin of the body. Over time, a red-brown plaque forms in the affected area, from the surface of which scales are easily separated. With the development of squamous cell carcinoma, the surface of the plaque becomes ulcerated.
• Paget's disease. A precancerous disease that mainly affects women. Characterized by the appearance on the skin ( in the area of ​​the external genitalia and in the axillary region) redness, which has clear boundaries. The surface may be wet or dry, flaky. The affected area can increase over several years, degenerating into squamous cell carcinoma.

Optional precancers are:

• Actinic keratosis. It occurs in older people, mainly in areas of the skin not covered by clothing. The main cause is considered to be prolonged exposure to ultraviolet rays. As a result, reddish plaques appear on the skin of the hands and face, ranging in size from a few millimeters to a centimeter. Their surface is covered with hard, yellowish scales that are difficult to separate from the skin. The probability of developing squamous cell carcinoma with this disease reaches 25%.
• Cutaneous horn. Represents hyperkeratosis ( pathological thickening of the stratum corneum of the epidermis), manifested by local deposition of horny masses ( scales). As a result, a cylindrical or cone-shaped horn protrudes above the skin is formed, the length of which can reach several centimeters. The development of cancer is observed in 7–15% of cases and is characterized by growth of the formation deep into the skin.
• Keratoacanthoma. A disease that occurs predominantly in people over 60 years of age. It is a round formation up to several centimeters in diameter, in the center of which there is a depression filled with horny masses ( yellow scales). Located on the skin of the face or the back of the hands.
• Contact dermatitis. It develops as a result of exposure to various chemicals and cosmetic creams on the skin. It is characterized by a local inflammatory reaction, redness and swelling of the affected area, itching and a burning sensation may appear. With the long-term existence of this process, various disturbances occur in the cellular structure of the skin, which can ultimately lead to the development of cancer.

The mechanism of development of squamous cell carcinoma

A cancer cell is characterized by:

• Autonomy. Reproduction ( division) normal cells of the body are regulated by the nervous and endocrine systems, as well as the number of cells themselves ( the more there are, the less they divide). Tumor cells are deprived of any contact with regulatory mechanisms, resulting in their uncontrolled division.
• Immortality. Regular body cells can only divide a certain number of times before they die. The number of possible divisions is determined genetically and varies in different organs and tissues. In tumor cells, this process is disrupted, as a result of which an unlimited number of divisions are possible with the formation of many clones, which are also immortal and can divide an unlimited number of times.
• Self-sufficiency. During tumor growth ( when reaching dimensions 2 – 4 mm), tumor cells begin to produce special substances that stimulate the formation of new blood vessels. This process ensures the delivery of oxygen and nutrients to deeper tumor cells, as a result of which the tumor can grow to a significant size.
• Violation of differentiation. During the development of epithelial cells, they lose the nucleus and other cellular elements, die and are rejected ( in stratified squamous non-keratinizing epithelium) or accumulate keratin and form horny scales ( in stratified squamous keratinizing epithelium). In cancer cells, the differentiation process may be disrupted.

Depending on the degree of differentiation there are:

• Undifferentiated squamous cell carcinoma ( non-keratinizing). It is the most malignant form, characterized by rapid growth. In this case, the mutation occurs in a cell of the spinous layer, after which its development stops, and all subsequent clones have a similar structure. Keratin does not accumulate in cancer cells and the process of their death does not occur.
• Differentiated squamous cell carcinoma ( keratinizing). In this case, the mutation also occurs at the level of the stratum spinosum cell, however, after several divisions, the resulting clones begin to accumulate large amounts of keratin. Cancer cells gradually lose cellular elements and die, which is externally manifested by the deposition of crusts on the surface of the tumor ( keratin masses) yellowish in color. Unlike normal keratinization, with keratinizing cancer this process is accelerated several times.

Metastasis

Squamous cell carcinoma can metastasize:

• Lymphogenous route. This type of metastasis occurs in 98% of cases of squamous cell carcinoma. Through lymphatic vessels, cancer cells can travel to local lymph nodes, where they linger and begin to divide.
• By hematogenous route. Occurs only in 2% of cases. Tumor cells enter blood vessels when their walls are destroyed, and with the blood flow they can migrate to almost any organ ( most often to the lungs, bones).
• By implantation. In this case, the spread of the tumor occurs through direct contact with neighboring organs, as a result of which tumor cells grow into the tissue of the organ, and the development of a secondary tumor begins in it.

Types of squamous cell carcinoma

Thus, when smoking, the ciliated epithelium of the respiratory tract can be replaced by stratified squamous epithelium, and in the future, squamous cell carcinoma can develop from these cells.

Depending on the growth pattern, squamous cell carcinoma can be:

• Exophytic ( tumor). At the beginning of the disease, a dense skin-colored nodule forms. Its surface may initially be covered with yellow horny masses. It quickly increases in size ( greater in height than in diameter). The base of the tumor is wide, inactive ( the tumor simultaneously grows into the deep layers of the skin and subcutaneous fat). The formation is clearly demarcated from unaffected skin. Its surface is uneven, bumpy, and may be covered with scales or warty growths. At later stages of development, the surface of tumor nodes can ulcerate and transform into an infiltrative-ulcerative form.
• Endophytic ( infiltrative-ulcerative). At the beginning of the disease, a small dense nodule in the skin may be detected, which soon ulcerates. Around it can be formed daughter ( secondary) nodules that ulcerate and merge with each other, causing an increase in the affected area. Tumor growth is characterized by an increase in the diameter and depth of the ulcerative defect.
• Mixed. It is characterized by the simultaneous growth of a tumor node and ulceration of the skin and mucous membrane around it.

• skin;
• red border of lips;
• oral cavity;
• esophagus;
• larynx;
• trachea and bronchi;
• cervix.

Squamous cell skin cancer

Local manifestations of squamous cell skin cancer are:

• soreness;
• swelling of adjacent tissues;
• burning;
• sensory disturbance;
• redness of the skin around the affected area.

Squamous cell carcinoma of the red border of the lips

Much more common is the infiltrative-ulcerative form, characterized by rapid development and aggressive course. The tumor form develops more slowly and metastasizes less frequently.

Oral squamous cell carcinoma

Risk factor for oral cancer ( in addition to the main ones listed above) is the frequent consumption of hot drinks and dishes. This leads to pathological changes in the epithelium ( normally a multi-layered non-keratinizing), resulting in the appearance of zones of keratinization, which can degenerate into a cancerous process.

Squamous cell keratinizing carcinoma occurs in 95% of cases. Both forms of growth occur equally frequently and are characterized by rapid development, invasion of adjacent tissues and metastasis.

Symptoms of oral cancer are:

• Pain. Appears in the later stages of development and is caused by the pressure of the space-occupying formation on neighboring tissues. The pain may spread to the head, nose, ears ( depending on the location of the tumor).
• Increased salivation. The tumor creates the sensation of a foreign body in the oral cavity, which reflexively increases the activity of the salivary glands.
• Bad breath. Appears in the later stages of the disease and is caused by necrosis ( local dieback) tumor tissue and infection ( in the area affected by cancer, the barrier functions of the mucous membrane are impaired, which creates favorable conditions for the growth and development of infectious microorganisms).
• Disorders of chewing and speech processes. These manifestations are characteristic of the later stages of the disease, when the cancer process grows into the masticatory and other facial muscles, destroying them.

Squamous cell carcinoma of the esophagus

Due to the growth pattern, the tumor-like form of squamous cell carcinoma is more common. The tumor can reach significant sizes, up to completely blocking the lumen of the esophagus.

Signs of esophageal cancer are:

• Swallowing disorder ( dysphagia). It occurs as a result of tumor growth in the lumen of the esophagus, which disrupts the movement of food. At first it becomes difficult to swallow solid food, and after a few months it becomes difficult to swallow liquid food and even water.
• Chest pain. They appear in the later stages of development, due to compression of nearby tissues and organs by the tumor.
• Vomiting food. Pieces of food may get stuck in the area of ​​the swelling and regurgitate a few minutes after eating.
• Bad breath. Develops in case of tumor necrosis and infection.
• Bleeding. Occur when the cancer process destroys the blood vessels of the esophagus ( more often veins), are often repeated. Manifested by bloody vomiting and blood in the stool. This condition is life-threatening and requires urgent medical attention.

Squamous cell carcinoma of the larynx

Signs of laryngeal cancer may include:

• Difficulty breathing. As a result of tumor growth, the lumen of the larynx may partially overlap, making it difficult for air to pass through. Depending on the location of the tumor node and its size, it may be difficult to inhale, exhale, or both.
• Voice change. It occurs when the cancer process spreads to the vocal cords and can manifest itself as hoarseness of the voice, up to its complete loss ( aphonia).
• Pain when swallowing. They can appear when the tumor node is large, compressing the pharynx and upper esophagus.
• Cough. It occurs reflexively, as a result of mechanical irritation of the walls of the larynx. As a rule, it is not eliminated by antitussive drugs.
• Hemoptysis. It can occur when blood vessels are destroyed and as a result of tumor disintegration.
• Sensation of a foreign body in the throat.

Squamous cell carcinoma of the trachea and bronchial tubes

The cancer process can develop exophytically ( protruding into the airway), and endophytic ( spreading in the walls of the trachea, bronchi and growing into the lung tissue).

The mucous membrane of the vagina and the vaginal part of the cervix are covered with stratified squamous non-keratinizing epithelium. Squamous cell carcinoma often develops in the area of ​​transition of stratified squamous epithelium to columnar epithelium ( lining the internal os and uterine cavity).

Symptoms of a malignant neoplasm in the initial stages are nonspecific and can occur with other diseases of the genitourinary system.

Signs of cervical cancer may include:

• bleeding from the vagina outside of menstruation;
• bleeding after sexual intercourse;
• constant aching pain in the lower abdomen;
• disturbance of urination and defecation.

What does squamous cell carcinoma look like?

External characteristics of squamous cell carcinoma

Type of cancer	Growth form	Description	Photo
Squamous cell skin cancer	Infiltrative-ulcerative	It is a dense ulcerative skin defect, the edges of which are clearly demarcated from undamaged areas. The surface is covered with a yellowish crust ( consisting of horny masses), when removed, an uneven, bleeding bottom of the ulcer is revealed. Nearby areas of skin are inflamed ( red, swollen).
	Tumor	A tumor-like formation rising above the skin on a broad base. Many small blood vessels are visible on the surface. In the area of ​​the apex, a small central depression of dark brown color is determined, filled with yellowish horny masses, tightly adjacent to the tumor tissue.
Squamous cell carcinoma of the red border of the lips	Infiltrative-ulcerative	It is an irregularly shaped ulcerative defect of the red border of the lips. The edges of the ulcer are clear, slightly undermined. The bottom is tuberous, covered with black areas of necrosis and yellow horny masses.
	Tumor	A dense node rising on a wide base, which without clear boundaries passes onto the mucous membrane of the lips and facial skin. The surface is covered with horny crusts. A black necrosis center is identified in the center of the formation. The skin around it is deformed, inflamed, and swollen.
Oral squamous cell carcinoma	Infiltrative	The affected mucous membrane is bright red, with a bumpy surface and uneven edges. In places, yellow crusts are detected, the removal of which causes bleeding.
	Tumor	Nodular formation with clear, uneven edges. The surface is lumpy, rough, abundantly covered with horny masses. The surrounding mucous membrane is not changed.
Squamous cell carcinoma of the esophagus	Infiltrative-ulcerative	During endoscopic examination ( insertion of a flexible tube into the esophagus, at the end of which there is a video camera) an ulcerative defect of the mucous membrane of the esophagus is revealed, clearly demarcated from intact tissue. The edges are raised, the surface is lumpy, slightly protruding into the lumen of the esophagus, and bleeds easily on contact.
	Tumor	An endoscopic examination reveals multiple tumor formations of various sizes protruding into the lumen of the esophagus. The base is wide and is a continuation of the mucous membrane. The surface is covered with many blood vessels.
Squamous cell carcinoma of the larynx	Mixed	A volumetric formation of irregular shape, with an uneven surface, on which yellow crusts and pinpoint hemorrhages are noted, is visually determined. The mucosa on the surface of the tumor and around it is ulcerated.
Squamous cell carcinoma of the trachea and bronchial tubes	Tumor	During endoscopy, several tuberous cone-shaped outgrowths are identified, protruding into the lumen of the respiratory tract. The surface is covered with a white coating, ulcerated, and bleeding in places.
Squamous cell carcinoma of the cervix	Infiltrative-ulcerative	A gynecological examination reveals a red, ulcerated, bleeding cervix. The edges of the ulcer are clearly demarcated and slightly raised above the mucous membrane. In some places yellow crusts are visible.
	Tumor	It is characterized by the presence of a wide-based mass formation on the cervix, protruding above the surface of the mucous membrane. Its surface is lumpy, rough, sometimes ulcerated and bleeding.

Diagnosis of squamous cell carcinoma

The diagnostic process includes:

• examination by a doctor;
• instrumental studies;
• laboratory research;
• tumor biopsy.

Examination by a doctor

When should you see a doctor?
Some benign skin lesions ( papillomas and others) may not manifest themselves in any way for many years. However, there are certain external signs, the presence of which indicates a possible malignant degeneration of the tumor. It is important to recognize them in time and immediately consult a doctor, since if squamous cell carcinoma develops, treatment should begin as soon as possible.

Diagnostic criteria for the tumor process

• What is the patient's profession?
• How long ago did the tumor appear?
• Does the neoplasm change over time ( in size or appearance)?
• Are there local symptoms ( pain, itching or other symptoms)?
• What treatment was carried out and what were its results?
• Did family members and close relatives have similar neoplasms?

• general condition of the body;
• consistency and appearance of the formation;
• the color of the skin and mucous membranes directly around the tumor;
• nearby lymph nodes;
• the presence of similar formations in other parts of the body.

Instrumental research

The following are used to diagnose squamous cell carcinoma:

• confocal laser scanning microscopy;
• thermography;
• endoscopic examination;

This method is absolutely harmless, does not require special preparation and can be used directly at a doctor’s appointment. The essence of the method is to place the area of ​​skin under study under a special microscope, with which you can study all layers of the epidermis, examine the structure of cells, their shape and composition. The method allows you to visually determine the presence of a tumor, the degree of differentiation and its growth into the deep layers of the skin.

Thermography
A fairly simple, fast and safe method for identifying a malignant process. The essence of the method is to register thermal radiation from the studied area of ​​the body. The patient takes off his outer clothing and sits in front of a special camera. To speed up the examination, a small amount of water is applied to the surface of the skin with a sprayer.

Within a few minutes, the camera registers thermal radiation from normal and pathologically changed areas of the skin, after which it produces a so-called “thermal portrait” of the studied areas.

Squamous cell carcinoma is characterized by the identification of zones of elevated temperature. This is due to the intensive growth of the tumor, as well as the presence of a large number of newly formed vessels.

Endoscopic examination
The essence of the method is the introduction of an endoscope ( a special tube with a camera at the end connected to the monitor) through natural routes or as a result of surgery. This study allows you to study the internal surface of the organ under study, visually determine the presence of a tumor, the form of its growth, the nature and extent of damage to the mucous membranes.

• Bronchoscopy– insertion of an endoscope into the respiratory tract and examination of the trachea and bronchi.
• Esophagoscopy– examination of the inner surface of the esophagus.
• Laryngoscopy– examination of the vocal cords and laryngeal mucosa.
• Colposcopy– examination of the vagina and vaginal part of the cervix.

The method is associated with certain risks ( bleeding, infection), and therefore it can only be carried out in specially equipped premises of a medical institution, in the presence of an experienced specialist.

Magnetic resonance imaging ( MRI)
A modern high-precision research method that allows you to obtain layer-by-layer images of various organs and tissues. The essence of the method is to create a strong electromagnetic field around the human body, as a result of which atomic nuclei begin to emit a certain energy, which is recorded by a tomograph and, after digital processing, is presented as an image on the monitor.

MRI allows you to:

• detect the presence of a tumor measuring 5 mm or more;
• obtain information about the composition and shape of the tumor;
• determine the presence of metastases in various organs and tissues.

Laboratory research

Routine tests ( general blood test, general urine test) are not of particular diagnostic value in identifying squamous cell carcinoma and are prescribed to determine the general condition of the body and identify possible concomitant diseases.

In the laboratory diagnosis of squamous cell carcinoma the following is used:

• determination of tumor markers for squamous cell carcinoma;
• cytological examination.

Tumor markers ( tumor markers) – substances of various structures produced by tumor cells. A specific marker for squamous cell carcinoma is the SCC antigen. It regulates differentiation processes ( maturation) normal squamous epithelium, and also stimulates tumor growth in the case of squamous cell carcinoma.

An increase in the concentration of SCC antigen in the blood of more than 1.5 nanograms per milliliter may indicate squamous cell carcinoma of various localizations. However, in some cases, the test may be false positive, and therefore establishing a final diagnosis only on the basis of determining this tumor marker is unacceptable.

An increase in the level of SCC antigen can be observed:

• for precancerous skin diseases;
• for other skin diseases ( eczema, psoriasis);
• with liver failure ( this antigen is destroyed in the liver, if its functions are impaired, its concentration may increase).

Cytological examination
The essence of the method is to study the size, shape, structure and internal composition of tumor cells under a microscope. A cytological preparation is subject to examination ( smear), obtained in various ways.

The material for cytological examination may be:

• imprints from the surface of a skin tumor;
• scrapings of the mouth, pharynx;
• biopsy smears ( biopsy material).

• Squamous cell keratinizing carcinoma. Characterized by the presence of large, irregularly shaped cells lying scattered. The cell nucleus is enlarged, structurally changed, its color is more pronounced than in normal cells. Chromatin ( intranuclear genetic material of a living cell) is located unevenly. Cytoplasm ( internal cell environment) dense, there may be signs of early keratinization ( presence of keratohyalin and keratin). Clusters of horny scales can be detected between the cells.
• Squamous cell non-keratinizing carcinoma. Isolated cells or their clusters are determined. Their sizes and shapes are not the same. The cell nucleus is enlarged ( can occupy the entire cell), located in the center. Chromatin in the nucleus is evenly distributed. Signs of keratinization are absent or only slightly expressed.

Biopsy

To diagnose squamous cell carcinoma the following is used:

• Incisional biopsy. After local anesthesia, partial excision of a fragment of the tumor is performed. In this case, it is necessary to take both tumor tissue and intact skin or mucous membrane.
• Needle biopsy. Mainly used for the tumor form of squamous cell carcinoma. It is performed as follows: a special hollow needle with sharp edges is inserted deep into the tumor using rotational movements. As a result, all layers of the neoplasm fall into it, which makes it possible to further study their structure and relationship. The resulting material is transferred to a glass slide for further microscopic examination.
• Total biopsy. The entire surgically removed tumor is examined.

• external signs of malignant neoplasm;
• questionable cytological data;
• the need to confirm the diagnosis of squamous cell carcinoma before starting treatment ( Necessarily).

The material obtained from the biopsy is fixed with 70% alcohol, after which it is sent to the laboratory for histological examination. In the laboratory, ultra-thin sections of the drug are taken with a special knife, which are transferred to a glass slide, stained with special dyes and examined under a microscope.


Depending on the histological picture, the following are distinguished:

• Keratinizing squamous cell carcinoma ( differentiated form). The structure of the tissue is disrupted, strands of tumor cells are detected, penetrating into the deep layers of the epidermis and skin. The cells are large, light-colored, with large nuclei. Some of them contain accumulations of keratin and keratohyalin ( signs of keratinization). Accumulations of keratin are detected between the strands ( horny pearls). In some places processes of disturbed cell division are detected ( mitosis).
• Non-keratinizing squamous cell carcinoma ( undifferentiated form). Characterized by the presence of strands of tumor cells that disrupt the structure of the tissue. Tumor cells of various sizes, unequal shapes ( round, oval, elongated), contain large nuclei. Very rarely, small foci of keratinization may occur. The number of mitoses is many times greater than in the differentiated form.

Treatment of squamous cell carcinoma

Depending on the stage of cancer, there are:

• Stage 0 – a small tumor located in the epidermis or in the superficial parts of the mucous membrane. There are no metastases.
• Stage I – tumor up to 2 cm in greatest dimension, does not grow into underlying structures. There are no metastases.
• Stage II – the tumor is more than 2 cm, but does not grow into the underlying tissue. There are no metastases.
• Stage III – the tumor grows into the underlying tissue ( into the skin, muscles, organ walls). Metastases to local lymph nodes.
• IV stage – there are distant metastases to other organs. The size of the tumor does not matter.

• surgery;
• drug treatment;
• other treatments;
• symptomatic treatment.

Radiation therapy

For stage III–IV tumors, radiation therapy is used in the preoperative period to slow the growth and reduce the size of the tumor, after which it is surgically removed.

The duration of radiation therapy depends on the histological type of the tumor. Well-differentiated squamous cell carcinoma requires longer treatment and higher doses of radiation than undifferentiated squamous cell carcinoma.

If a relapse occurs after radiotherapy ( development of squamous cell carcinoma in the same location), then repeated use of this method is ineffective.

Surgery

The operation is performed under local or general anesthesia ( depending on the size and location of the tumor). The tumor is removed, taking 2 centimeters of healthy, unchanged tissue from each edge. Both the tumor itself and the underlying structures into which it grows are removed ( muscles, bones, up to amputation of a limb or removal of the affected organ). If there are metastases in local lymph nodes, they are also completely removed.

The removed material must be sent for histological examination.

Drug treatment

Chemotherapy for squamous cell carcinoma

Other treatments for squamous cell carcinoma

Alternative treatments are:

• Electrocoagulation. Used to remove small ( up to 1 cm in diameter), superficial tumors in the face, neck, lips. Healthy tissue within 5–6 mm of the tumor is also removed. The advantage of this method is that it is less traumatic, which is good from a cosmetic point of view.
• Cryogenic treatment. It is used mainly for squamous cell skin cancer up to 1 cm in diameter, which does not grow into deep tissues. The essence of the method is to freeze the tumor and adjacent tissues with liquid nitrogen ( whose temperature is -196 ºС). The advantage of cryotherapy is a good cosmetic effect. The main disadvantage is the impossibility of histological examination of the removed material.
• Photodynamic therapy. The essence of the method is as follows. At the first stage, the surface of the tumor is treated with a special chemical ( for example, hematoporphyrin), which has the ability to selectively accumulate in cancer cells. The second stage is laser exposure to the tumor area, as a result of which hematoporphyrin is activated and stimulates the formation of highly toxic compounds ( oxygen free radicals), which leads to the destruction of tumor cells. Healthy tissues are not damaged.

Symptomatic treatment

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