Squamous cell carcinoma. What is the danger of squamous cell carcinoma

Squamous cell carcinoma is a malignant tumor that develops from epithelial cells and mucous membranes. This disease develops at a fairly rapid pace, proceeds extremely aggressively. The starting points of development are the mucous membranes and skin, after which the local lymph nodes are affected and penetration into nearby tissues and organs, which leads to the destruction of their structure and failures in normal functioning. Without proper treatment, the body can be threatened by multiple organ failure, which leads to death. Squamous cell carcinoma accounts for about 25% of all types of skin cancers. In 75% of cases, the cancer process affects the scalp and face. The most susceptible to this disease are the elderly (from 65 years old), in men it occurs more often than in women.

Interesting Squamous Cell Cancer Facts:

• most often squamous cell carcinoma occurs in Caucasians;
• at risk are people whose skin burns quickly in the sun;
• the time from noon to 4 pm is the most dangerous, since the sun is most aggressive during this period;
• this oncological disease is quite rare in children, except in cases where there is a genetic predisposition.

Stages of squamous cell carcinoma

Classification of cancer by stages:

Stage 0: a small tumor localized in the epidermis or in the upper layers of the mucous membrane. There is no metastasis.

Stage I: the size of the tumor varies up to 2 cm, metastasis and germination in neighboring tissues is not observed.

Stage II: the size of the tumor exceeds 2 cm, penetration into nearby structures and no metastases.

Stage III: a malignant tumor grows into the skin, walls of organs, muscles, giving metastases to local The lymph nodes.

Stage IV: metastasis in organs, the size of the tumor is no longer so important.

Causes of squamous cell carcinoma

The specific causes of squamous cell carcinoma have not yet been identified. It is known that the process of its development is affected by the weakening of the protective processes in the body, as well as the action of harmful factors.

squamous epithelium in the human body

The surface of our body, organs and their cavities are lined with a layer of cells that make up the epithelial tissue. One of its varieties is the squamous epithelium, which covers the skin and mucous membranes.

Classification of squamous epithelium by structure:

• multilayer non-keratinizing (it consists of three cell layers: superficial, spiny, basal. The superficial and spiny layers are separate stages in the formation of the components of the basal layer. The cells that form the surface layer die over time and then exfoliate. This type of epithelium covers the mucous membranes of such organs like the mouth, vagina, esophagus, cervix, and also the cornea of ​​the eye.
• stratified keratinizing (another name is the epidermis. Four layers of its cells, namely the horny, granular, prickly and basal, line the skin. In addition, there is another layer on the soles and palms - shiny, which is located under the stratum corneum. In the basal layer they ripen cells that, moving along the stratum corneum, accumulate keratin, after which their structure is disrupted, and they die.The stratum corneum is formed from constantly exfoliating horny scales, that is, dead cells filled with air bubbles and keratin.Squamous cell carcinoma develops from the components of the spiny layer.

Factors that stimulate the development of squamous cell carcinoma:

There is a huge variety of carcinogenic factors that, having a negative effect on the skin and mucous membranes, can lead to the development of a malignant tumor. These factors include:

• congenital predisposition;
• ultra-violet rays;
• the use of immunosuppressants;
• ionizing radiation;
• smoking;
• unhealthy food;
• alcoholic drinks;
• exposure to carcinogens due to birth professional activity;
• ecology;
• infections;
• age.

Genetically programmed predisposition to squamous cell carcinoma

Thanks to modern advances in scientific disciplines such as molecular biology and genetics, it has become possible to determine the predisposition to the genesis of squamous cell carcinoma at the gene level. The genetic factor is manifested in:

1. Failures in the antitumor protective function of the cell. Each cell has a special gene that prevents the genesis of malignant neoplasms. This is an anti-oncogene or, as it is also called, the "guardian of the genome". If there are no violations in the genetic structure of the cell, which ensures its division, then this gene is passive. In case of damage to the deoxyribonucleic acid (DNA) molecule, which performs the functions of transmitting, storing and reproducing information, this gene “turns on” and prevents cell division, and, consequently, the formation of a tumor. In the event that the anti-oncogene itself undergoes a mutation process, the regulatory function is disrupted and, as a result, the threat of developing the process of tumor formation increases. Anti-oncogene mutation is the cause of 50% of cancer cases.
2. Changes in the functioning of antitumor immunity. Mutations in the human body are a regular phenomenon, which increases the likelihood of tumors. Antitumor immunity prevents the development of tumors and is provided by certain types of cells: B- and T-lymphocytes, macrophages and natural killers. They instantly detect and destroy the mutagenic factor. If the genes that are responsible for the genesis and functioning of cells undergo mutations, then the immune system can malfunction. Along with this, there favorable conditions for the development of the tumor process. Gene anomalies can be passed on to subsequent generations, which will cause a predisposition to cancer.
3. Violation of the exchange of carcinogens. When any type of carcinogen, whether chemical or physical, enters the body, special defense systems are activated, the action of which is aimed at protecting the body and removing harmful substances. If the genes that are responsible for the normal functioning of these systems undergo mutations, then the risk of the formation of a tumor process increases many times over.

Ultra-violet rays

Ultraviolet rays are the portion of solar radiation that cannot be seen with the naked eye. These rays affect the skin through long-term exposure to the sun or when trying to create an artificial tan, using ultraviolet baths, causing mutations of various kinds at the genetic level. This leads to the maturation of tumor cells, weakening the cell's antitumor defense system (since the anti-oncogene also undergoes mutation). Long-term exposure to ultraviolet rays leads to the progression of squamous cell skin cancer, as a result of which the immune system will lose the ability to neutralize most of the mutagen carrier cells.

Immunosuppressants

Medicines such as mercaptopurine, azathioprine and others that are used for various diseases and pathologies (with organ transplantation, tumors circulatory system, autoimmune diseases), negatively affect the state of the body's defense systems, and antitumor immunity is no exception. These drugs can cause squamous cell carcinoma.

ionizing radiation

This type of radiation includes gamma rays and x-rays, as well as radiation emitted by helium and hydrogen nuclei. When the organism comes into contact with this type of radiation, the genetic cellular apparatus is damaged, which leads to numerous mutations. Moreover, the probability of developing a cancerous disease increases hundreds of times, because in the first place the effect is on antitumor immunity. Through epidemiological studies, it was found that various forms malignant tumors, including squamous cell carcinoma, appear to a greater extent in those people who are most often exposed to these types of radiation. These are, for example, doctors who constantly use ionizing rays for medical purposes, as well as workers in the nuclear industry, especially after explosions. atomic bombs and during repair work at nuclear power plants.

Smoking

Scientists have proven that cigarettes and other smoking products based on tobacco (pipes, cigars) are drugs that greatly increase the likelihood of developing a tumor process, especially in the digestive and respiratory systems, as well as in oral cavity. It is worth noting that not only active smokers are exposed to the action of carcinogens, but also passive ones, that is, those who are surrounded by smokers and inhale tobacco smoke.

The danger of tobacco lies in the process of its combustion, which proceeds under the influence of high temperatures. Therefore, in addition to nicotine, the body also receives a lot of other reaction products, such as phenols, chromium, benzene, cadmium, formaldehyde and others. The harmful effect of these substances is proven and scientifically substantiated. Interestingly, when a cigarette is smoldering, the combustion temperature of tobacco in it is lower than during a puff, so the effect of carcinogenic factors on environment significantly less. Carcinogens enter the body by absorption through the mucous membranes of the mouth, after which they enter the respiratory tract and have a local effect. Tumors in tissues and organs are formed as a result of the fact that carcinogenic substances enter the bloodstream and are transported by it throughout the body.

In many countries, there are different types of tobacco, which are intended not only for smoking, but also for inhalation and chewing. Thus, combustion products do not enter the body, but other carcinogenic substances are also produced, which lead to the development of cancer of the oral cavity, lips, and pharynx.

Unhealthy food

It is also necessary to maintain the proper development and normal functioning of the body's defense systems. proper nutrition. The fact that an excess of animal fats in the food consumed increases the risk of tumor formation on the organs of the digestive system is a scientifically substantiated fact. The development of tumor formations is hindered by products plant origin(fruits, vegetables), which contain folic acid, vitamins of groups A, C, E and many other substances, such as selenium. That is why their lack in the daily menu increases the risk of cancer.

Alcoholic drinks

Ethyl alcohol itself, which is the main component of all strong drinks, is not the cause of diseases of this kind, but there is a connection between the use of alcohol-containing drinks and the progression of malignant tumors. Alcohol makes cells accessible to the penetration of benzapyrene and other chemical compounds, which explains the frequent cases of cancer of the oral cavity, pharynx, and larynx in alcohol addicts, because such people constantly contact these organs with ethyl alcohol vapor. If drinking alcohol is combined with smoking and other ways of using tobacco, then the likelihood of progression of squamous cell carcinoma in the above organs is much greater.

Occupational contact with carcinogens

The genesis of squamous cell carcinoma leads to the constant inhalation of certain chemical compounds and prolonged contact of the skin with them. In this case, the decisive role is played by the duration of exposure to a harmful factor, and not by the concentration of carcinogens.

Ecology

People who live in close proximity to oil refineries, metallurgical plants and other industrial enterprises have a risk of developing cancer respiratory tract much higher. The population of large cities is also at risk, since vehicles release harmful substances into the air. Automobile exhaust contains soot, which is a carcinogen.

infections

There is ample evidence that certain types of viruses contribute to the progression of squamous cell carcinoma. These viruses include:

• papillomavirus. This virus provokes the development of genital warts, papillomas and other benign neoplasms on the skin and mucous membranes. There are cases when the papilloma virus becomes the root cause of cervical cancer. First of all, this virus, getting into the DNA of cells, changes their structure and leads to the formation of viral copies in the cell. As a result, mutations at the gene level, which can lay the foundation for the onset of the cancer process.
• HIV (human immunodeficiency virus), which has a negative effect on the components immune system, which leads to the next stage of the disease - AIDS (acquired immunodeficiency syndrome). This reduces the ability of the body to resist infections that have entered the body, as well as potential tumors.

Age

People who are 65 years of age or older are more susceptible to squamous cell carcinoma. This is due to the fact that with age, the functions of most organs (including the immune system) are reduced and impaired. The antitumor defense of the cell is no longer so active, and the processes associated with the detection and destruction of mutagenic cells are deteriorating, which leads to an increase in the likelihood of cancer.

Diseases that precede cancer

Some benign skin diseases can also increase the risk of developing a cancerous process. Precancerous lesions are classified according to possible consequences two groups:

Obligate diseases

This species includes some skin diseases that precede the cancerous process. This includes:

• pigmented xeroderma. This disease is hereditary and occurs infrequently. The transmission occurs according to an autosomal recessive mechanism: a child can get sick only if he inherits the carrier gene from both parents. This disease manifests itself when a child reaches the age of 2-3 years in the form of warts, ulcerative formations, cracks, redness of the skin. The main reason for the development this disease- insufficient level of cell resistance to ultraviolet radiation: the DNA molecule is damaged when the skin comes into contact with the sun. The more often such contact occurs, the more mutations occur in cells. The end result is the development of cancer.
• Bowen's disease. This is an extremely rare skin disease that develops under the influence of various harmful factors, such as prolonged sunbathing, trauma, and occupational hazards. Visual signs of Bowen's disease are red spots, which are localized, for the most part, in the torso area. The area that is affected by the disease is distinguished by a red-brown plaque with a scaly surface. Over time, this plaque becomes ulcerative.
• Paget's disease. This disease is typical mainly for women. It is accompanied by redness of the armpits and the area of ​​​​the external genital organs. These reddenings have clear boundaries, within which it can have different properties: moisture, dryness, peeling. Over several years, the area of ​​this "red spot" can increase and be modified into squamous cell carcinoma.

Facultative diseases

These diseases do not always lead to the appearance of squamous cell carcinoma, but, nevertheless, increase the likelihood of its occurrence. Such diseases include:

• senile keratosis. This disease occurs in the elderly and affects mainly those areas of the skin that are not covered by clothing. main reason leading to the onset of senile keratosis is the prolonged exposure to ultraviolet radiation, due to which the hands and face are covered with red plaques, no larger than 1 cm. The plaques are covered with coarse yellowish scales that practically do not leave the skin. The probability of the genesis of squamous cell carcinoma in senile keratosis is 25%.
• skin horn. With an abnormal compaction of the stratum corneum, horny masses in the form of scales are deposited in some places. This phenomenon is called "hyperkeratosis" and is characterized by the appearance of a horn in the form of a cylinder or cone that protrudes above the skin surface. Its length can be up to several centimeters. In 7-15% of cases, this disease provokes squamous cell carcinoma, in which the formation grows into the distant layers of the skin.
• keratoacanthoma. This disease is most often observed in people over 60 years of age. It is expressed as a round formation, up to several centimeters in size, with a depression in the center. This depression is filled with a mass of horny scales. yellow color. It mainly affects the back of the hands and face.
• contact dermatitis. The cause of this disease is skin contact with various chemicals, including cosmetics. Local inflammation occurs, accompanied by redness and swelling of this area. Sometimes there is itching and burning. If this process is not detected in time, then it threatens with violations in cellular structure skin, which can lead to irreversible consequences in the form of cancer.

The mechanism of genesis of squamous cell carcinoma

Due to the influence of a combination of harmful factors, at the gene level, a mutation occurs in one of the cells of the spinous layer of the epithelium. This mutation cannot be eliminated by antitumor defense mechanisms. A cell that has undergone a mutation process has some features that make it different from an ordinary cell of the body.

Features of a cancer cell:

1. Independence. If the nervous and endocrine systems are responsible for the division of ordinary cells of the body, then cancer cells have no contact with the mechanisms of regulation. Normally, cell division is limited by their number: the more cells, the lower the intensity of their division. The reproduction of tumor cells is uncontrolled.
2. Unlimited lifetime. Ordinary cells divide a fixed number of times, after which their inevitable death occurs. The number of possible divisions is genetically determined and is not the same for different types tissues and organs. Since this mechanism is violated in the cells of malignant tumors, an unlimited number of divisions is possible in them, as a result of which a huge number of clones are formed, the life and reproduction of which is also unlimited.
3. Self-sufficiency. As the tumor grows in size, when it reaches 2-4 millimeters, its cells begin to produce specific substances that activate the formation of blood vessels. Thanks to this process, oxygen and nutrient compounds are transported to all layers of tumor cells. As a result, the tumor rapidly increases in size.
4. cell differentiation. During the development of epithelial cells, they lose some cellular structures, including the nucleus, after which they die. Then, in the stratified squamous non-keratinizing epithelium, the process of rejection of dead cells occurs, and keratin accumulates in the keratinizing epithelium and horny scales are formed. At cancer cell differentiation may be impaired.

Cancers are classified according to the degree of differentiation:

• Differentiated (keratinizing) squamous cell carcinoma. The mutation in this case comes from the structures of the spiny layer, but after the first divisions, large masses of keratin penetrate and settle into the structures of the clones. Tumor cells eventually lose their cellular structures and die. The surface of the affected area becomes a kind of "warehouse" of yellowish masses of keratin. Cornification in this type of cancer proceeds several times faster than in natural keratinization.
• Undifferentiated (non-keratinizing) squamous cell carcinoma. This is the most aggressive form of cancer, the danger of which lies in the rapid growth of the tumor. The mutation is localized in the cell of the spinous layer, then the process of its development stops, and all future batches of clones are similar in structure. Tumor cells do not collect keratin, and they do not die.

Metastasis of squamous cell carcinoma

Metastasis is the process of separating clones of a cancer cell from the focus of their initial localization and their movement to other tissues and organs. Metastases are secondary sources of tumor growth. The secondary division proceeds according to the same laws as the division in the primary source.

Ways of metastasis of squamous cell carcinoma:

1. Lymphogenic. Most common route (98% of cases). The cells are transported to the lymph nodes lymphatic vessels. In the place of their "arrival" they begin active division.
2. Hematogenous. Happens only in 2% of cases. When the walls of blood vessels are destroyed, cancer cells penetrate into them. With the blood flow, they are able to migrate to the organs (lungs, bones).
3. Implantation. The tumor spreads upon contact with nearby organs, and then malignant cells grow into the tissue of the organ, starting the formation of a secondary tumor.

Varieties of squamous cell carcinoma

It was noted above that squamous cell carcinoma is formed from the cells of the spinous layer of the epithelium. This section will highlight the most common types of squamous cell carcinoma. From the point of view of theory, the defeat of the cancerous process can begin in any organ that is lined with epithelium. With prolonged contact of epithelial cells with harmful factors, metaplasia (regeneration) can occur, accompanied by the formation of a squamous epithelium in organs to which it is not normally characteristic. For example, in a smoker, the ciliated epithelium of the respiratory tract can be replaced by stratified squamous epithelium, which becomes a medium for the progression of squamous cell carcinoma.

According to the nature of growth, there are:

1. Exophytic squamous cell carcinoma (tumor). At the initial stage, a sign of the disease is a node in the color of the skin. Its surface may be lined with yellow horny scales. This formation is growing rapidly, moreover, more in height than in diameter. The tumor is broad and passive at its base. It grows into the distant layers of the subcutaneous fatty tissue and skin, but the site of the lesion is clearly separated from healthy areas of the skin. The surface of the formation is uneven, embossed, sometimes covered with scales or warts. In later stages, the surfaces of the nodules may turn into ulcers.
2. Endophytic (infiltrative-ulcerative). Initially, a rather dense nodule of a small size appears, which after a while begins to ulcerate. Along its perimeter, child nodules can form, which also ulcerate and connect with each other, which leads to an increase in the affected area. Along with the growth of the formation, the depth and diameter of the ulcerative structure increases.
3. Mixed. It is characterized by an adjacent course of two processes: the growth of the node and ulceration of the mucous membrane and skin around.

The organs most commonly affected are:

• red lip border;
• oral cavity;
• leather;
• esophagus;
• larynx;
• Cervix;
• bronchi and trachea.

So, squamous cell carcinoma is one of those diseases that very often affects human body. It can be keratinizing (90%) and non-keratinizing. Areas of the body that are not covered by clothing (the back of the hands, neck, face) are most at risk of damage. It can occur in two forms: tumor and ulcerative necrotic. It has a number of local features. For example:

• burning;
• painful sensations;
• swelling of adjacent tissues;
• violation of sensitivity;
• redness of the skin.

In 75% of women with this disease, the papillomavirus is found, which plays a dominant role in the development of the tumor. The vaginal part of the cervix and the vaginal mucosa are lined with stratified squamous non-keratinized epithelium. Most often, squamous cell carcinoma affects the junction of the squamous epithelium in the cylindrical. The latter covers the uterine cavity and internal os. At the initial stages, the signs of low-quality formations are not specific, and can manifest themselves in various diseases of the reproductive system.

Possible signs of cervical cancer:

• non-menstrual bleeding from the vagina;
• bleeding after intercourse;
• discomfort during intercourse;
• regular pain in the lower abdomen, which is aching in nature;
• problems with stool and urination.

Squamous cell carcinoma of the red labial border

Although cancer of the lower lip is much more common, cancer of the lower lip is considered more dangerous due to its rapid and aggressive course. In 95% of cases, the result is keratinizing squamous cell carcinoma, while women are 3 times less at risk of this disease. The infiltrative-ulcerative form is much more common, and, unlike the tumor, develops much faster and metastasizes more often.

Squamous cell carcinoma of the oral cavity

With this disease, a malignant tumor develops from the epithelium of the mucous membrane of the inner surface of the lips, palate, gums and cheeks. A harmful factor in this case may be the consumption of hot foods and drinks, which leads to abnormal modifications of the epithelium, which is non-keratinizing in a healthy body. As a result of the lesion, areas of keratinization appear, which can develop into a tumor process. Keratinizing cancer is quite common (95%), develops and progresses rapidly, reaching neighboring tissues and metastasizing.

Indicative of oral cancer:

1. Pain. Appears in the later stages of genesis. It is characterized by the fact that the volume formation exerts pressure on nearby tissues. The organs to which the pain sensation can reach are the nose, ears, head area (depending on the location of the tumor).
2. Increased salivation. The tumor creates a feeling as if there is a foreign object in the oral cavity, which increases the secretion of saliva.
3. Bad smell from the mouth. It makes itself felt in the later stages and is characterized by local death (necrosis) of the tumor tissue and association with infection. This occurs as a result of a violation of the protective functions of the mucous membrane, which creates a breeding ground for the spread of infections.
4. Discomfort when chewing, impaired speech. These signs are also characteristic of the later stages of cancer, when the tumor affects the masticatory and facial muscles, and then destroys them.

Squamous cell carcinoma of the esophagus

95% of all malignant tumors of the esophagus are squamous cell carcinoma. Secondary factors that can aggravate the situation are excessive consumption of hot drinks and spicy foods. Other causes are gastroesophageal reflux disease (GERD) accompanied by emissions gastric juice into the esophagus. The most common form of esophageal cancer is tumor-like, while the tumor can grow to a large size, and even block the lumen of the esophagus.

Signs of esophageal cancer:

• violation of the swallowing reflex (dysphagia). This problem is the result of the growth of the tumor and its overlapping of the lumen of the esophagus, in connection with which the movement of food through it is disturbed. At the first stage, it is difficult to swallow solid food, and then there is discomfort when pushing liquid food, up to the obstruction of water.
• chest pain. This symptom appears as a consequence of the fact that the tumor compresses adjacent organs and tissues.
• regurgitation. When food particles get stuck at the location of the tumor, a couple of minutes after eating, the process of regurgitation begins.
• smell from the mouth. Appears if the tumor has reached the necrotic stage, as well as in case of infection.
• bleeding. With the destruction of the blood vessels of the esophagus (most often veins), bleeding occurs. Blood may appear in stool and vomit. These phenomena are life-threatening and require urgent medical attention.

Approximately 60% of the total number of malignant tumors affecting the larynx. It occurs in all forms, but the infiltrative-ulcerative process develops at a faster rate and is able to move to other organs.

Main features:

• breathing discomfort. With active growth, the tumor can sometimes block the laryngeal lumen, which complicates the process of air intake. It depends on where the cancer node is located and what parameters it has, which process will be difficult. It can be inhalation, exhalation or both.
• voice mutation. A characteristic sign that the cancerous process has spread to the vocal cords. In this regard, the voice may become hoarse, up to aphonia (complete loss of voice).
• pain during swallowing. If the tumor node grows to a large size, then the pain is due to its squeezing effect on the pharynx and upper esophagus.
• cough. Cough has a reflex nature, and appears as a result of irritation of the walls of the larynx. Most often medicines powerless against cough.
• expectoration. Expectoration of blood occurs as a result of the destruction of blood vessels and the destruction of the tumor.
• sensation of the presence of a foreign object in the airways.

Squamous cell carcinoma of the trachea and bronchi

Squamous cell carcinoma of the respiratory tract may be preceded by metaplasia of the tracheal and bronchial epithelium, when the ciliated epithelium is replaced by a flat one. The main factors influencing this process are smoking and environmental factors in the form of chemical air pollution. The tumor process has two ways of development: exophytic, that is, affecting the lumen of the respiratory tract, and endophytic, which affects the tracheal and bronchial walls and grows into the lung tissue.

Visually, tumors are classified by growth, differentiation, and also depending on the affected organ.

Squamous cell skin cancer: what does it look like?

1. Infiltrative-ulcerative form.

It manifests itself as an ulcerative formation on the skin, which has well-defined boundaries separating it from healthy areas. The surface is lined with a yellowish crust, which consists of horny scales. When it is removed, the base of the ulcer is found, exuding blood. Adjacent skin areas are inflamed, there is swelling and redness.

1. Tumor.

The formation is located above the skin surface, has a wide base and many tiny blood vessels. At the apex there is a small depression in the middle, which is dark brown in color and filled with yellow horny masses that adhere tightly to the tumor tissue.

1. Infiltrative-ulcerative.

It is characterized by the presence of a dense node, which is located above a wide base, passing to the face and mucous membranes of the lips, while the affected area has no pronounced boundaries. Its surface is covered with horny scales, and black necrosis progresses in the middle. The skin along the perimeter of the necrotic focus is deformed, it may have swelling and inflammation.

What does squamous cell carcinoma look like in the mouth?

1. Infiltrative.

Cancer affects the mucous membranes, giving the affected areas a bright red color. The surface in these areas is embossed, the edges are uneven, in some places there are yellow crusts, the removal of which causes bleeding.

2. Tumor.

A node with pronounced, uneven borders is formed on the affected area. The surface is uneven, slightly rough, covered with horny particles. The mucous membrane surrounding this area does not change.

What does squamous cell carcinoma look like in the esophagus?

1. Infiltrative-ulcerative

Endoscopic examination, which consists in the introduction of a special tube into the esophagus, which has a video camera at the end, allows you to identify an ulcerative formation on the mucous membrane of the esophagus, which is separated from healthy tissue. This formation has raised edges, an uneven surface that penetrates slightly into the lumen of the esophagus. At the slightest contact, it begins to bleed slightly.

2. Tumor

Endoscopic examination reveals various diseases associated with the development of tumors that differ in size and degree of penetration into the lumen of the esophagus. At the same time, they have a fairly wide base and continue the mucous membrane. The surface is covered with numerous blood vessels.

Forms of squamous cell carcinoma of the larynx

Mixed.

In appearance, it manifests itself as a volumetric formation of a distorted shape, which has an uneven surface with yellow crusts and small hemorrhages. There are numerous ulcerative formations around the mucous membrane of the tumor and on it.

What does squamous cell carcinoma of the trachea and bronchi look like?

Tumor.

Thanks to medical research (endoscopy), it is possible to determine a number of outgrowths in the form of cone-shaped tubercles that partially block the lumen of the respiratory tract. The upper layers are covered with plaque white color, ulcers. There are local bleeding.

Forms and types of squamous cell cervical cancer

1. Infiltrative-ulcerative

Gynecological examinations reveal redness of the cervix, as well as the presence of ulcers and bleeding. The edges of the formation are pronounced, slightly rising above the mucous membrane. In some places, yellow scaly formations are visible.

2. Tumor

A voluminous tumor with a wide base is formed on the cervix, which extends beyond the surface of the mucous membrane. The surface of the formation is uneven, covered with ulcers, roughness, and bleeds in places.

Diagnosis and detection of squamous cell carcinoma

Most often, this disease shows itself already in the later stages, when the process of metastasis starts. Positive forecasts in these cases should not be expected. The cancerous process requires correct, timely diagnosis. This will determine the correct course of treatment, which can save human life.

The diagnostic process includes:

• medical examination (medical, instrumental and laboratory);
• neoplasm biopsy.

Medical examination

Recognizing the presence of a tumor in the early stages of its development is a skill that every doctor should have, regardless of specialty. If a focus of squamous cell carcinoma is suspected, a visit to an oncologist is necessary.

Squamous cell carcinoma: when is it necessary to visit a specialist?

Papillomas and other benign skin formations may not give any threatening signals for a long time. There are some superficial signs that suggest the presence of a neoplasm. The main thing is to notice them in time and contact a specialist to speed up the treatment process.

Signs of the absence of squamous cell carcinoma, detected during the diagnosis

If the formation is benign, there is:

• slow growth;
• undamaged surface;
• pronounced borders with healthy areas;
• homogeneous structure;
• surface location;
• Influence at general state does not appear.

In case of detection of squamous cell carcinoma, malignant neoplasm, tumor:

• growing rapidly (in a few weeks or months);
• has ulcers on the surface;
• has implicit boundaries;
• characterized by painful inflammation and redness of the mucosal or skin area;
• bleeds under mechanical action;
• passive;
• it hurts, itches, gives a burning sensation;
• changes the structure and location of adjacent lymph nodes (pain, adjacency with tissues);
• causes weakness, loss of strength;
• affects the increase subfebrile temperature(37-37.9 degrees for weeks and months).

Topics that may be covered by the doctor during the interview:

• type of activity of the patient;
• the period of appearance of the neoplasm;
• changes that occur over time;
• treatment and its results;
• cases of similar diseases in the family.

Doctor's actions during the examination:

• determination of the general condition of the body;
• assessment of the consistency and visual state of the tumor;
• examination of the color of the skin around the tumor;
• examination for the presence of similar formations in other parts of the body;
• inspection of nearby lymph nodes.

Instrumental studies of squamous cell carcinoma

It is widely used for diagnosing and drawing up a treatment plan. Used to detect squamous cell carcinoma:

• MRI (magnetic resonance imaging);
• confocal laser scanning microscopy;
• endoscopic examination;
• thermography.

Magnetic resonance imaging (MRI)

MRI is the latest and most reliable research technique that provides an image of each layer of tissues and organs. The method is based on an electromagnetic field created around a person, as a result of which atomic nuclei begin to exude energy, which is recorded on a tomograph. Then digital processing takes place and the results are obtained in the form of an image on the screen.

With MRI, you can:

• determine the presence of a tumor (if its size exceeds 5 mm);
• consider the shape of the tumor and study its composition;
• identify the presence of metastases in organs and tissues.

Confocal laser scanning microscopy

Thanks to this method, it is possible to obtain an image of the layers of the epidermis and skin. positive feature this method it is believed that suspicious areas can be diagnosed immediately, without additional collection of materials. This technique can be used right in the doctor's office, as it is absolutely safe and does not require preparation.

The examined area of ​​the skin is placed under a microscope, which allows you to view all the components of the epidermis, including the shape and contents of the cells. This type research helps to verify the presence of a tumor, determine the degree of its differentiation and the nature of its location in relation to other layers of the skin.

Endoscopy

The basis of the method is the introduction of a tube with a camera (endoscope) in a natural way or operably. The obtained indicators help to examine the inner surface of the organ, to determine the external signs of the neoplasm (shape, growth pattern, degree of damage to the mucous membranes).

For diagnostics it is used:

1. Bronchoscopy is the study of the bronchi and trachea through the respiratory tract.
2. Esophagoscopy - scanning the esophagus from the inside.
3. Laryngoscopy - the study of changes in the larynx and vocal cords.
4. Colposcopy - penetration of the endoscope into the vagina and cervix.

During endoscopy, it is possible to take materials for cytological and histological studies by endoscopic biopsy. This method also has its negative features, exacerbating the risk of infection and bleeding, so it is carried out only in special rooms in the presence of a specially trained specialist.

thermography

A fairly fast, simple method for determining a tumor that does not threaten the patient's health. The basis of the method is the fixation of thermal radiation of the studied area of ​​the skin. The patient without outerwear sits in front of the camera. To speed up the process, some water is sprayed onto the skin. In just a few minutes, the camera captures thermal radiation from both healthy areas and those affected by a tumor. The result is the compilation of a "thermal portrait" of the examined skin areas. At the same time, in the affected skin areas, the temperature will be increased, which is explained by the active growth of the neoplasm and blood vessels.

Research in the laboratory

Laboratory research refers to additional methods diagnosis of squamous cell carcinoma.

Routine tests

These include general analyzes blood and urine, which do not provide particularly important information in the diagnosis of squamous cell carcinoma. They are prescribed in order to determine the general condition of the body and identify concomitant diseases.

Laboratory diagnostics consists of the following procedures:

• detection of tumor markers;
• cytological analysis.

Determination of tumor markers of squamous cell carcinoma

This test, which has its own specifics, can detect squamous cell carcinoma.

Oncomarkers (tumor markers) are substances of different structure secreted by tumor cells. One of the main markers of squamous cell carcinoma is the SCC antigen, which controls the maturation of healthy squamous epithelium and activates the tumor growth in size (in the presence of squamous cell carcinoma). If the concentration of the SCC agent rises, exceeding 1.5 nanograms per milliliter, then this may signal the presence of squamous cell carcinoma. Sometimes this test can give false readings, so making a diagnosis based only on test data for tumor markers is impossible.

In what cases is an increase in the SCC antigen observed?

• with diseases preceding cancer;
• with psoriasis, eczema and other skin diseases;
• in the case of liver failure, since in the liver there is a violation of the destruction of this antigen, which leads to an increase in its concentration.

Cytological examination

This method exists for microscopic examination of the structure, size, shape and composition of tumor cells. For this, a cytological smear is taken, obtained in a variety of ways.

Materials for research:

• secrets from the vagina;
• sputum;
• scrapings of the pharynx and oral cavity;
• prints from the upper layers of the skin formation;
• swabs of biopsy material.

What can a cytological analysis reveal?

Keratinizing cancer.

The characteristic features of this species are large irregularly shaped cells arranged in a chaotic manner. The cell nucleus is enlarged, its structure is modified. The color of the nucleus is different from healthy cells. Chromatin, the genetic component of the cell, located inside the nucleus, is located unevenly. The cytoplasm, an intracellular fluid, has a dense consistency, sometimes becomes keratinized (under the action of keratin and keratohyalin). In the intercellular space, horny masses can be found.

Nonkeratinizing cancer.

The analysis allows you to identify individual cells or cell clusters, various in size and shape. The central nucleus of the cell has a large size, up to the fact that it occupies the entire cell. Chromatin is located chaotically, keratinization is not observed or it is poorly expressed. BUT

Biopsy

Biopsy is the standard method for diagnosing malignant tumors. The basis of the method is a biopsy, that is, a material that is taken from the surface of the affected area of ​​the skin or mucous membrane, after which it is subject to microscopic examination.

Types of squamous cell carcinoma biopsy:

1. Incisional.

Local anesthesia is performed, then a dissection of a part of the tumor is made, after which the following components are taken: the tissue of the affected area, the tissue of a healthy area and the tissue of the mucous membrane.

2. Puncture. A common method for the study of the neoplastic form of squamous cell carcinoma. The hollow pointed game plunges into the deep layers of the tumor by means of rotational movements. As a result, each layer of the tumor enters the cavity of the needle, which makes it possible to consider their structure and the nature of the relationship. The resulting sample is applied to laboratory glass for examination under a microscope.

3. Total. Serves for the study of the tumor in its entirety (after surgical removal).

Biopsy indications:

• visual changes due to the appearance of a tumor;
• inaccurate results of cytological analysis;
• search for reliable evidence of the diagnosis before starting the treatment course.

Histological analysis of the biopsy

The structure of the cellular composition of the biopsy is examined using a microscope. The sample taken during the biopsy is fixed with 70% alcohol, and then sent to the laboratory, where thin sections are made using a special knife. Tumor particles are transferred to laboratory glass, stained with special reagents, and then microscopic examination is carried out.

The histological picture shows:

• When a keratinizing type of squamous cell carcinoma (in a differentiated form) is detected, the following changes are observed: the tissue structure is disturbed, cell cords malignancy penetrate deep into the epidermis and skin. Cells and their nuclei are large. In some areas, there are signs of keratinization (due to the accumulation of keratohyalin and keratin). Horny pearls (keratin reserves) are visible between the tumor strands. Mitosis (cell division) is present in some places, but in an impaired form.
• In non-keratinizing (undifferentiated) squamous cell carcinoma, tumor strands damage the tissue structure. The size and shape of the cells vary (they can be elongated, round, elliptical), the nuclei are quite large. Places of keratinization are extremely rare, but the number of mitoses is much greater than in the keratinized form.

Treatment of squamous cell cancer

To prescribe a course of treatment for squamous cell carcinoma is within the competence of an oncologist only and only after passing complete examination. Treatment depends on the type and stage of the cancer. Self-medication is a threat to life.

What is the treatment for squamous cell carcinoma?

• surgical intervention;
• radiation therapy;
• taking medications;
• symptomatic treatment;
• other methods.

Surgical treatment of squamous cell carcinoma

Indication for surgical treatment squamous cell carcinoma is, firstly, cancer of III-IV degrees, is prescribed in conjunction with chemotherapy, and, secondly, tumors of stages I and II, if radiation therapy has not had the desired effect. The operation, depending on the location and parameters of the tumor, is performed under general or local anesthesia. In this case, the tumor is removed along with healthy tissues along the edges (at a distance of 2 cm), as well as nearby muscles, bones and organs into which it penetrates (up to amputation). Local lymph nodes, when the metastasis process starts, are also removed. The extracted material is immediately sent to the laboratory for histological examination.

Radiation therapy for squamous cell carcinoma

It is used to treat squamous cell carcinoma at stages I and II, regardless of the location of the cancerous tumor. The meaning of this method lies in powerful ionizing radiation, which affects the base of the tumor, which prevents further division of its cells. Thanks to modern achievements, the influence of the negative factor on healthy structures is much less. To slow down growth and reduce the parameters of malignancy, radiation therapy is also used in cases of cancer of III and IV degrees, but as a preparation of the body for surgery to remove the tumor.

The duration of treatment is affected by the histological form of the tumor. Treatment of well-differentiated cancer takes more time and requires higher degrees of radiation than undifferentiated. If after a course of radiotherapy there is a re-development of the tumor (in the same place), that is, a relapse occurs, then secondary treatment this way will have no effect.

Medicines for squamous cell cancer

The positive effect of this method is a variable phenomenon, therefore, drug treatment is considered an alternative method. Most often, it is used to prepare for surgery to reduce the size of the formation, as well as in conjunction with radiation therapy (in the event that the tumor is inoperable, causing metastases).

Chemotherapy for squamous cell carcinoma

• Bleomycin is an antibiotic that destroys the DNA molecule at the initial stages of cell reproduction. Helps reduce cell growth. It is administered intravenously, slowly (over 5 minutes). Concentration: per 20 ml of the drug 0.9% sodium chloride solution.

Dosage: 30 mg twice a week - people under 60;
after 60 years - 15 mg (twice a week).

Treatment period: 5 weeks. During the course, a maximum of 300 mg of the drug is taken. Break between courses - 1.5 months.

• Cisplatin is a drug that, by causing a failure in the synthesis of a DNA molecule, stimulates the death of a tumor cell. Slowly, by drip, injected into a vein, mixed with a solution of sodium chloride (0.9%). There are 2.5 mg of the drug per 1 kilogram of weight. Reception is made 1 time in 4 weeks, while the composition of blood cells should be regularly checked.
• 5-fluorouracil is a drug with cytostatic properties. It has a cumulative effect (in tumor cells), causes a violation of DNA synthesis, stopping cell division. It is administered intravenously (drip or jet character). Dosage: per 1 kg of weight - 12 mg of the drug. The course is 5 days, break - 4 weeks.

There is also an ointment for external use, applied in small amounts to the top layer of the tumor (without rubbing). Used once a week. The duration of the course of treatment is individual, depending on the nature of the course of the disease.

Other Treatments for Squamous Cell Cancer

These methods are used much less often, because they have a lot of contraindications. If the method is still chosen correctly, then a complete cure can be predicted.

Alternative methods:

• Electrocoagulation. Effective in removing tumors that have a diameter of up to 1 m, while located on the lips, face, neck. At the same time, tissues unaffected by the disease are removed at a distance of 5-6 mm from the affected area. This method practically does not create visual defects on the skin.
• cryogenic method. The indication is a small formation (up to 1 cm), which does not affect other tissues. The tumor and nearby tissues are frozen with liquid nitrogen (-196 degrees). The cosmetic effect of the procedure is certainly an advantage, but further histological analysis of the seized material is not possible.
• Photodynamic therapy. The top layer of the tumor is treated with hematoporphyrin or another chemical that accumulates in tumor cells. Then a laser is applied to the affected area, which activates the formation of highly toxic oxygen radicals). As a result, tumor cells are destroyed, and there is no negative effect on the tissue structure.

Symptomatic treatment of squamous cell carcinoma

Indications for symptomatic treatment are the appearance of complications in the formation itself or the manifestation side effects medical and radiotherapy.

Content

If a tumor appears on the skin, the development of oncology should not be ruled out, as an option - it may be squamous cell carcinoma. Such malignant neoplasm in the absence of surgical intervention, it can cause the death of a patient at any age. Patients often confuse squamous cell keratinizing skin cancer at the initial stage with other dermatological diseases, and they turn to the doctor only in case of acute pain syndrome of the visualized focus of pathology.

What is squamous cell carcinoma

In fact, it is a malignant tumor with aggressive development in the body, where epithelial cells are involved in the pathological process, and eventually lymph nodes. A characteristic ailment often develops in adulthood, more prevalent in men of pre-retirement age. Every year, such a diagnosis only gets younger, and a number of pathogenic factors precede the pathological process, including human living conditions (society).

Symptoms

The pathological process develops rapidly, can lead to death. This is explained by the latent course of the disease, its disguise as other, less dangerous diagnoses. In order to determine squamous cell cancer in time, it is necessary to collect anamnesis data, study the complaints of a clinical patient. Mandatory differential diagnosis to clarify the clinical picture. Below are the symptoms characteristic of squamous cell carcinoma of different localization. So:

The reasons

Highly differentiated keratinizing squamous cell carcinoma or another form of oncology can be determined by performing a biopsy to detect cancerous epithelial cells. However, it is important to find out the cause of the characteristic ailment in order to significantly reduce the statistics of mortality from progressive oncology in the future. The disease-causing factors are listed below:

• genetic predisposition (hereditary factor);
• chronic diseases skin;
• Availability bad habits;
• long-term decrease in general immunity;
• high-dose ultraviolet radiation;
• poisoning with metals, vapors of toxic substances;
• the presence in the daily diet of carcinogens, chemicals;
• social conditions;
• chronic nicotine and alcohol intoxication of the body;
• environmental factor;
• age-related changes organism, gender;
• long-term use of toxic drugs.

Classification of squamous cell carcinoma

Depending on the form and focus of the pathology, the following types of squamous cell cancer are distinguished with characteristic features:

1. Plaque form. It can be characterized by the appearance of tubercles on the skin of a rich red color, which often bleed on palpation.
2. Nodal form. The neoplasm is localized at the surface of the dermis, outwardly resembles a capsule, dense on palpation.
3. Ulcerative form. These are the so-called "craters" with raised edges, which have a loose structure, are prone to bleeding.

In the course of the pathological process, squamous cell carcinoma is:

1. Keratinizing. Occurs more often. After the mutation, the epithelial cells die off, and characteristic yellow or brown crusts appear on the skin.
2. Non-keratinizing. Characterized rapid growth, a mutation of the cells of the spiny layer, the affected epithelium does not die.

stages

Squamous cell cancer has five stages of development, which are found in the same ratio in extensive medical practice. The sooner a laboratory study of the alleged pathology is carried out, the greater the chances of a favorable clinical outcome. So, doctors distinguish the following stages of this oncological disease with characteristic features:

1. Zero stage. The tumor is small, localized on the mucosa or in the upper layer of the epidermis. Does not metastasize.
2. First stage. The development of the tumor reaches up to 2 cm in diameter, while metastasis is not observed.
3. Second stage. The tumor exceeds the size of 2 cm, grows into neighboring structures, but so far without metastases.
4. Third stage. A malignant tumor can massively affect the walls of organs, muscles and blood vessels, metastasizes to local lymph nodes.
5. Fourth stage. The last one is critical. In such a clinical picture, all internal organs are affected, systems are disturbed, a large number of metastases, and a high risk of death.

Diagnostics

The earlier to determine squamous cell nonkeratinizing cancer of the cervix or other organ, the more likely it is to carry out a successful complex treatment. The disease consists in the rapid division of cancer cells and the infection of vast areas of the dermis, its deep layers. Diagnosis consists in a laboratory study of multi-layered areas, a clinical examination of the body to identify concomitant diseases, metastases. The main directions are as follows:

• endoscopy methods;
• CT scan;
• radiological methods;
• Magnetic resonance imaging;
• laboratory studies of biological fluids;
• positron emission tomography;
• confocal laser scanning microscopy.

Squamous cell cancer antigen

This is a marker, a glycoprotein with a molecular weight of 48 kDa, identified from liver metastases in the diagnosis of cervical squamous cell carcinoma. It is a serum protease inhibitor that is normally expressed in squamous epithelium, predominantly in the epidermis. Its main sources are the stratified squamous epithelium of the bronchi, anal canal, esophagus, cervix, and skin. The half-life of squamous cell carcinoma antigen is at least 24 hours.

Treatment

Each clinical case is individual, so the patient needs a comprehensive diagnosis to understand what is happening in the body. Based on the results of a qualitative examination, the doctor prescribes a treatment that combines surgical and conservative methods. In the first case, we are talking about the extermination of the pathogenic structure and the excision of the approximate tissues involved in the pathology. In the second - about the period of rehabilitation already by physiotherapeutic and conservative methods. Photos of what squamous cell cancer can lead to are shocking, so it needs to be treated on time.

Radiation therapy

X-ray exposure is appropriate for small tumor sizes, as an independent method intensive care squamous cell cancer. In advanced clinical pictures, radiation therapy is necessary for the purpose of preoperative preparation and postoperative recovery of the patient. In addition, such a progressive method can remove metastases and improve the clinical outcome. Radiation therapy is shown to take courses, since a malignant neoplasm of the dermis or deep layers of the skin can progress again.

Surgery

When implementing such radical method treatment of squamous cell cancer is the removal of the primary focus and lymph nodes affected by metastases. Doctors use a special material, and the method itself is highly effective in combination with radiation therapy to excise metastases, the stratum corneum of cells. If the tumor is large, irradiation of the affected tissues is required before surgery to narrow the focus of the pathology.

When implementing surgical methods for the removal of squamous cell carcinoma, the following directions are appropriate strictly for medical reasons: conization with curettage, removal of lymph nodes, extirpation, adjuvant chemotherapy and extended modified hysterectomy. The final choice is up to the specialist, but after the operation, the patient is prescribed conservative methods of intensive care to maintain the general state of health at a satisfactory level.

Medical treatment

Conservative treatment of squamous cell carcinoma is more appropriate after excision of the affected tissues, provides for local and oral administration. The main goal is to prevent complications of chemotherapy and radiotherapy, to suppress side effects postoperative period. Medicines are prescribed individually, since toxic components are present in the composition of potent drugs. In case of violation of daily dosages, the risk of intoxication of the affected organism increases.

Symptomatic treatment

This type of intensive therapy is not able to suppress the root cause of the disease, and its main task is to reduce the intensity of the pronounced symptoms of oncology, as an option, to remove the pain syndrome. Especially for these purposes, oncologists recommend taking painkillers up to narcotic analgesics, which are sold in pharmacies strictly by prescription. Additionally prescribed hemostatic drugs, parenteral or enteral nutrition. All comorbidities that have developed against the background of oncological disease are treated conservatively.

Forecast

The clinical outcome of the disease depends on the stage of the pathological process and timely response measures. If squamous cell carcinoma has a diameter of up to 2 cm, while there is no mechanical damage to the dermis, and adequate treatment is prescribed in a timely manner, the prognosis is favorable. Five-year survival is observed in 90% of all clinical pictures.

Diagnosis of infiltration of a characteristic neoplasm into the deep layers of the skin reduces the percentage in terms of patient survival for the next five years. This indicator is less than 50% for all clinical pictures, and in the presence of mechanical damage, extensive foci of metastasis formation - approximately 6-7%. The clinical outcome is unfavorable. At the fourth stage of the tumor, the patient may not live even a month, but they are prescribed only narcotic analgesics for anesthesia.

Prevention

To avoid the development of squamous cell cancer, doctors report measures effective prevention, especially for patients at risk in the line of inheritance of oncology. It is recommended to systematically complex diagnostics body to detect dangerous neoplasms, respond in time to changes in the structure of the dermis. Additional preventive actions for all segments of the population are detailed below:

• complete rejection of all bad habits, careful control of nutrition and habitual lifestyle;
• avoid prolonged exposure to the sun, dose the supply of ultraviolet rays to the upper layer - the epidermis;
• timely treat dermatitis of all kinds and eczema, since such diseases are accompanied by a precancerous condition of the skin.

Video

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment, based on individual features specific patient.

"Light Cancer" is about 10 times more common than the aggressive black variant. The main reason for its appearance is considered to be ultraviolet radiation, it appears, as a rule, on those places of the skin that are usually exposed to sunlight, for example, on the head, on the face or on outside hands Nevertheless, physicians are aware of cases of detection of squamous cell formations in the most unexpected places, such as the oral mucosa or on the tongue.

Causes

Symptoms

Treatment

Removal of the formation can also be done with a laser, while quite deep scars can remain on the skin, but at the same time, this method allows you to get rid of squamous cell cancer with a probability of almost 100%. If a relapse does occur, it is usually detected within 3-6 months from the date of surgery.

Prevention

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Squamous cell carcinoma - general characteristics, definition and mechanism of development

First, you should know that cancer is a rapidly growing tumor of degenerated cells that have been able to quickly and constantly divide, that is, multiply. It is this constant, uncontrolled and unstoppable division that ensures the rapid and continuous growth of a malignant tumor. That is, degenerated cells grow and multiply constantly, as a result of which they first form a compact tumor, which at a certain moment ceases to have enough space in the area of ​​​​its localization, and then it simply begins to "grow" through the tissues, affecting everything in its path - blood vessels, neighboring organs, lymph nodes, etc. Normal organs and tissues cannot resist the growth of a malignant tumor, since their cells multiply and divide in a strictly dosed manner - new cellular elements are formed to replace the old and dead ones.

The cells of a malignant tumor are constantly dividing, as a result of which new elements are continuously formed along its periphery, squeezing normal cells of an organ or tissue, which simply die as a result of such an aggressive effect. The place vacated after dead cells is quickly occupied by a tumor, since it grows incomparably faster than any normal tissue in the human body. As a result, normal cells in tissues and organs are gradually replaced by degenerate ones, and the malignant tumor itself grows in size.

At a certain moment, individual cancer cells begin to detach from the tumor, which first of all enter the lymph nodes, forming the first metastases in them. After some time, with the flow of lymph, tumor cells spread throughout the body and enter other organs, where they also give rise to metastases. In the last stages, cancer cells that give rise to metastatic growth in various organs can also spread through the bloodstream.

The key moment in the development of any malignant tumors is the moment of formation of the first cancer cell, which will give rise to the uncontrolled growth of the neoplasm. This cancer cell is also called degenerated because it loses the properties of normal cellular structures and acquires a number of new ones that allow it to give rise to and maintain the growth and existence of a malignant tumor. Such a degenerate cancer cell always has an ancestor - some normal cellular structure, which, under the influence of various factors, has acquired the ability to divide uncontrollably. With regard to squamous cell carcinoma, any epithelial cell acts as such an ancestor-predecessor of the tumor.

That is, a degenerated cell appears in the epithelium, which gives rise to a cancerous tumor. And since this cell looks flat under the microscope, a cancerous tumor consisting of cellular structures of the same shape is called squamous cell carcinoma. Thus, the term "squamous cell carcinoma" means that this tumor has developed from degenerated epithelial cells.

Since the epithelium in the human body is very widespread, squamous cell tumors can also form in almost any organ. So, there are two main types of epithelium - it is keratinized and non-keratinized. Non-keratinizing epithelium is all the mucous membranes of the human body (nose, oral cavity, throat, esophagus, stomach, intestines, vagina, vaginal part of the cervix, bronchi, etc.). The keratinizing epithelium is a collection of skin integuments. Accordingly, squamous cell carcinoma can form on any mucous membrane or on the skin. In addition, in more rare cases, squamous cell carcinoma can form in other organs from cells that have undergone metaplasia, that is, they have turned first into epithelial-like, and then into cancerous ones. Thus, it is clear that the term "squamous cell carcinoma" is most relevant to the histological characteristics of a malignant tumor. Of course, determining the histological type of cancer is very important, as it helps to choose best option therapy taking into account the properties of the detected tumor.

Squamous cell carcinoma most often develops in the following organs and tissues:

• Leather;
• Lungs;
• Larynx;
• Esophagus;
• Cervix;
• Vagina;

However, squamous cell carcinoma can also develop in other organs and tissues, such as the vulva, lips, lungs, colon and etc.

Photo of squamous cell carcinoma

This photo shows the structure of keratinizing squamous cell carcinoma (foci of a cancerous tumor are large rounded formations, consisting, as it were, of concentric circles, separated from each other and from the surrounding tissues by a white border).

This photo shows foci of squamous cell carcinoma of the skin surface.

This photo shows two tumor growths that were classified as squamous cell carcinoma after histological examination of the biopsy.

This photo shows foci of squamous cell skin cancer.

This photo shows a malignant tumor, which, when histological examination biopsy was identified as squamous cell carcinoma.

Reasons for the development of squamous cell carcinoma

Precancerous diseases

Facultative precancerous diseases do not always degenerate into cancer, even with a very long course. However, since the likelihood of their degeneration into cancer in facultative diseases still exists, such pathologies also need to be treated. Facultative and obligate precancerous diseases of squamous cell carcinoma are shown in the table.

Predisposing factors

Unfortunately, the likelihood of developing squamous cell carcinoma is not linearly related to the length of time a person has been exposed to predisposing factors. That is, in one person, cancer can form after a short exposure to predisposing factors (for example, 1 to 2 weeks), and the other will remain healthy even if he has suffered a very long exposure to exactly the same factors.

However, the likelihood of squamous cell carcinoma correlates with the number of predisposing factors. This means that the greater the number of predisposing factors affected a person, the higher his likelihood of developing cancer. But, unfortunately, this relationship is also not linear, and therefore the total risk of cancer in a person exposed to several predisposing factors at the same time cannot be calculated by simple arithmetic addition. Let's look at this with an example.

Thus, predisposing factor 1 increases the risk of squamous cell carcinoma by 8 times, and factor 2 by 5 times, factor 3 by 2 times. The total risk arising from the impact of all these three factors will be higher than that of each of them separately, but will not be equal to the simple arithmetic sum of their risks. That is, the total risk is not equal to 8 + 2 + 5 = 15 times. In each case, this total risk will be different, since it depends on many factors and parameters that determine the general condition of the body. So, for one person, the total risk of developing cancer can be increased by 9 times relative to the norm, and for another - by 12, etc.

Predisposing factors for squamous cell carcinoma include the following:
1. genetic predisposition.
2. Any chronic inflammatory diseases skin and mucous membranes, such as:

• Burns of any origin (solar, thermal, chemical, etc.);
• Chronic radiation dermatitis;
• Chronic pyoderma;
• chronic ulcer;
• Discoid lupus erythematosus;
• Chronic bronchitis, laryngitis, tracheitis, vulvitis, etc.

• Traumatic scars that appeared after exposure to mechanical, thermal and chemical factors;
• Scars left after skin diseases, such as boils, carbuncles, lupus erythematosus and elephantiasis;
• Kangri or kairo cancer (cancer at the site of a burn scar);
• Cancer after burns with sandalwood or pieces of sandalwood.

Classification (varieties) of squamous cell carcinoma

• Squamous cell keratinizing (differentiated) cancer;
• Squamous cell non-keratinizing (undifferentiated) cancer;
• Poorly differentiated cancer, similar to sarcoma in appearance of the cells that form it;
• Glandular squamous cell carcinoma.

So, every normal cell of the human body has the ability to proliferate and differentiate. Proliferation refers to the ability of a cell to divide, that is, to multiply. However, normally, each cell division is strictly controlled by the nervous and endocrine systems, which receive information about the number of dead cellular structures and "make a decision" about the need to replace them.

When it is necessary to replace dead cells in any organ or tissue, the nervous and endocrine systems start the process of division of living cellular structures that multiply and, thereby, the damaged area of ​​the organ or tissue is restored. After the number of living cells in the tissue is restored, nervous system transmits a signal about the end of division and proliferation stops until the next similar situation. Normally, each cell is able to divide a limited number of times, after which it simply dies. Due to cell death after a certain number of divisions, mutations do not accumulate and cancerous tumors do not develop.

However, during cancerous degeneration, the cell acquires the ability for unlimited proliferation, which is not controlled by the nervous and endocrine system. As a result, the cancer cell divides an infinite number of times without dying after a certain number of divisions. It is this ability that allows the tumor to grow rapidly and constantly. proliferation can be various degrees from very low to high. The higher the degree of proliferation, the more aggressive the growth of the tumor, since the shorter the time interval between two successive cell divisions.

The degree of cell proliferation depends on its differentiation. By differentiation is meant the ability of a cell to develop into a highly specialized one, designed to perform a small number of strictly defined functions. To illustrate this with an example, after leaving school, a person does not have any narrow and unique skills that can be used to perform a small range of specialized jobs, such as conducting surgical operations on the eyes. To acquire such skills, you need to learn and practice, constantly maintaining and improving your skills.

In humans, the acquisition of certain skills is called learning, and the process of acquiring specialized functions for each newly formed cell as a result of division is called differentiation. In other words, a newly formed cell does not have the necessary properties to perform the functions of a hepatocyte (liver cell), cardiomyocyte (myocardial cell), nephrocyte (kidney cell), etc. In order to obtain such properties and become a full-fledged highly specialized cell with strictly defined functions (regular contractions in a cardiomyocyte, blood filtration and urine concentration in a nephrocyte, bile production in a hepatocyte, etc.), it must undergo a kind of "training", which is the process differentiation.

This means that the higher the degree of cell differentiation, the more highly specialized and capable of performing a narrow list of strictly defined functions. And the lower the degree of cell differentiation, the more “universal” it is, that is, it is not capable of performing any complex functions, but it can multiply, utilize oxygen and nutrients and ensure tissue integrity. In addition, the higher the differentiation, the lower the ability to proliferate. In other words, the more highly specialized cells do not divide as rapidly as the less specialized ones.

With regard to squamous cell carcinoma, the concept of differentiation is very relevant, since it reflects the degree of maturity of tumor cells and, accordingly, the rate of its progression and aggressiveness.

Differentiated squamous cell carcinoma (keratinizing squamous cell carcinoma, keratinizing squamous cell carcinoma, highly differentiated squamous cell carcinoma, and moderately differentiated squamous cell carcinoma)

The main distinguishing feature of this type of tumor is the differentiated cancer cells of which it actually consists. This means that the tumor forms limited structures, called "pearls", because their shell has a characteristic grayish-white color with a slight sheen. Differentiated squamous cell carcinoma grows and progresses more slowly than all other types of squamous cell carcinoma, so it can be conditionally considered the most "favorable".

Depending on the degree of differentiation of the cells that form the tumor, this type of cancer is divided into moderately and highly differentiated forms. Accordingly, the higher the degree of differentiation of tumor cells, the more favorable the prognosis, since the slower the tumor progresses.

A specific sign of differentiated squamous cell carcinoma is the presence of horny scales on the outer surface of the tumor, which form a yellowish border. This type of cancer in almost all cases develops on the skin, almost never being localized in other organs or tissues.

Squamous cell nonkeratinizing cancer (undifferentiated squamous cell carcinoma)

Non-keratinizing undifferentiated squamous cell carcinoma can form in any organ or tissue, but is most often localized on the mucous membranes. On the skin, non-keratinizing squamous cell carcinoma is formed only in 10% of cases, and in the remaining 90%, a keratinizing type of malignant tumor is found.

In non-keratinizing squamous cell carcinoma, the formation of characteristic “pearl” structures does not occur, since cancer cells do not produce horny scales that would be deposited on the surface of the tumor, forming a grayish-white capsule.

Poorly differentiated squamous cell carcinoma

Glandular squamous cell carcinoma

Symptoms

So, depending on the method of growth, squamous cell carcinoma is divided into the following forms:

• Exophytic form (papillary) characterized by the formation of a nodule, clearly delimited from the surrounding tissues, which gradually increases in size. As a result, a tumor is formed appearance reminiscent of cauliflower inflorescences and colored red-brown. The surface of the tumor has a pronounced uneven bumpy structure with a well-defined depression in the central part. Such a tumor can be attached to the surface of the mucosa or skin with a thin stalk or a wide base. Gradually, the entire surface of the exophytic form of cancer can ulcerate, which marks its transition to the endophytic variety.
• Endophytic form (infiltrative-ulcerative) characterized by rapid ulceration of a small primary nodule, in place of which one large ulcer forms. Such an ulcer has an irregular shape, dense and raised edges above the center, a rough bottom, covered with a whitish coating with a fetid odor. The ulcer practically does not increase in size, since the tumor grows deep into the tissues, affecting muscles, bones, neighboring organs, etc.
• mixed form.

Thus, the general clinical symptoms squamous cell carcinoma of various localizations are only the above-described external signs of the tumor. All other symptoms of squamous cell carcinoma depend on its location, so we will consider them in relation to different organs in which this malignant tumor can form.

Squamous cell skin cancer

In the early stages, skin cancer appears as an irregular red or brownish patch that can grow and ulcerate over time. Then the tumor becomes similar to a traumatic injury to the skin - a red surface, on which numerous ulcers, bruises, and also brown caked pieces of blood are visible. If the tumor grows exophytically, then it takes the form of an outgrowth on the skin of various sizes, on the surface of which there may also be numerous ulcers.

The tumor is characterized by the following features:

• soreness;
• Burning sensation;
• Redness of the skin surrounding the tumor;
• Bleeding from the surface of the tumor.

Squamous cell carcinoma of the neck, nose and head

Squamous cell carcinoma of the lip

Squamous cell lung cancer

• Dry cough, not stopped by antitussive drugs and existing for a long time;
• Coughing up blood or mucus;
• Frequent lung diseases;
• Pain in the chest when inhaling;
• Weight loss without objective reasons;
• Hoarse voice;
• Constantly elevated body temperature.

Squamous cell carcinoma of the uterus

• Pain in the abdomen (pain can be localized in the lower abdomen and move to other departments);
• Beli;
• Increased fatigue;
• General weakness.

Squamous cell carcinoma of the cervix

• Vaginal bleeding, most commonly occurring after sexual intercourse;
• Aching pain in the lower abdomen, felt constantly;
• Violation of urination and defecation.

Squamous cell carcinoma of the vulva

• Irritation and itching in the vulva, worse at night. Itching and irritation have the character of attacks;
• Ulceration of the external genitalia;
• Weeping in the area of ​​​​the entrance to the genital gap;
• Pain and tightness of tissues in the vulva;
• Purulent or bloody discharge from the genital slit;
• Swelling of the vulva, pubis and legs (typical only for late stages and advanced cases).

Squamous cell carcinoma of the larynx

• Difficulty breathing (moreover, it can be difficult for a person to both inhale and exhale);
• Hoarseness of voice or complete loss of the ability to speak due to the destruction of the vocal cords;
• Persistent, dry cough, not stopped by antitussives;
• Hemoptysis;
• Feeling an obstacle or foreign body in the throat.

Squamous cell carcinoma of the esophagus

• Difficulty swallowing (first it becomes difficult for a person to swallow solid food, then soft, and eventually water);
• Chest pain;
• Spitting up pieces of food;
• Bad breath;
• Bleeding manifested by vomiting or bloody stools.

Squamous cell carcinoma of the tongue, throat and cheeks

• Pain that also spreads to surrounding tissues and organs;
• Increased salivation;
• Bad breath;
• Difficulty chewing and speaking.

Squamous cell carcinoma of the tonsil

Squamous cell carcinoma of the rectum

• Stool disorders in the form of alternating diarrhea and constipation;
• Feeling incomplete emptying intestines after defecation;
• False urge to defecate;
• Tape feces (feces in the form of a thin ribbon);
• An admixture of blood, mucus or pus in the feces;
• Pain during bowel movements;
• Incontinence of feces and gases (typical of the later stages);
• Pain in the abdomen and in the anus;
• General weakness, pallor,;
• Black feces (melena);
• Difficulty swallowing, salivation and pain behind the sternum with localization of cancer in the area of ​​​​the transition of the esophagus to the stomach;
• Persistent vomiting and sensations of heaviness in the stomach with localization of cancer in the area of ​​​​the transition of the stomach into the duodenum;
• Anemia, weight loss, general weakness and low performance in the last stages of the disease.

Squamous cell carcinoma of the lymph nodes

Stages of the disease

The numbers and letters of the TNM classification mean the following:

• Tx - no data on the tumor;
• T0 - no primary tumor;
• Tis, cancer in situ;
• T1 - tumor less than 2 cm;
• T2 - tumor from 2 to 5 cm;
• T3 - tumor more than 5 cm;
• T4 - the tumor has grown into neighboring tissues;
• N0 - lymph nodes are not affected by metastases;
• N1 - lymph nodes are affected by metastases;
• M0 - no metastases to other organs;
• M1 - metastases to other organs are present.

Squamous cell cancer prognosis

The prognosis for squamous cell cervical cancer is a five-year survival rate at stage I of 90%, at stage II - 60%, at stage III - 35%, at stage IV - 10%.

Prognosis for squamous lung cancer- five-year survival rate at stage I is 30-40%, at stage II - 15-30%, at stage III - 10%, at stage IV - 4-8%.

Prognosis for lip cancer - a five-year survival rate is 84 - 90% in stages I-II and 50% - in stages III and IV.

The prognosis for cancer of the oral cavity (cheeks, tongue, throat) - five-year survival rate at stage I is 85 - 90%, at stage II - 80%, at stage III - 66%, at stage IV - 20 - 32%.

The prognosis for cancer of the tongue and tonsils - a five-year survival rate at stage I is 60%, at stage II - 40%, at stage III - 30%, at stage IV - 15%.

The prognosis for skin cancer (head, nose, neck and other localizations) - five-year survival rate is 60% in stages I, II and III and 40% in stage IV.

The prognosis for cancer of the intestine and stomach - a five-year survival rate at stage I is almost 100%, at stage II - 80%, at stage III - 40 - 60%, at stage IV - about 7%.
bronchoscopy, etc.);

Laboratory methods in the diagnosis of squamous cell carcinoma are widely used only in gynecological practice to detect malignant neoplasms of the cervix. This is a cytology smear method that women take every year. With squamous cell carcinomas of other localization laboratory methods diagnostics are not important.

Squamous cell carcinoma antigen

The oncomarker of squamous cell carcinoma is the SCC antigen, the concentration of which in the blood is more than 1.5 ng/ml, which indicates a high probability of the presence of this type of tumor in any organ. If such a concentration of SCC antigen is detected, a thorough examination using tomography and endoscopic methods should be performed.

With squamous cell skin cancer, surgical removal of the affected tissues is not always resorted to; often, the use of radiation or chemotherapy is quite enough to cure.

The specific method of treatment is always selected individually for each person.

Keratinizing cancer is most common in people with a genetic predisposition. This type of cancer belongs to the squamous type, when a change in the structure occurs in the cells of the spinous layer, followed by the accumulation of keratin. Cancer cells gradually die off, forming a yellow crust on the surface of the tumor formation, represented by keratin masses.

Reasons for the appearance

To date, it is impossible to say exactly about the cause of the appearance of this type of oncology, as discussions about this continue. One is singled out by all physicians, which has an important effect low level immune protection, as well as, as mentioned above, genetic predisposition.

In addition, there are such provoking factors:

1. Heredity (keratinizing squamous cell carcinoma may develop due to gene mutations in the form of a violation of antitumor cellular protection, dysfunction of antitumor immunity, a violation of the utilization of carcinogens).
2. Immunosuppressive therapy, which is carried out for systemic, autoimmune diseases, which also inhibits antitumor immunity.
3. Smoking (by damaging the mucous membrane with combustion products).
4. Occupational hazards (nuclear, metallurgical, mining, woodworking, paint and varnish industries).
5. Incorrect nutritious diet not only reduces immune defenses, but cancer has also been linked to the consumption of large amounts of food of animal origin. On the contrary, plant foods high in selenium, vitamin A, E, ascorbic, folic acids significantly reduce.
6. Alcoholism.
7. Polluted air exhaust gases, soot.
8. Ultraviolet radiation is one of the most aggressive factors that acts directly on the skin, especially from 11:00 to 16:00, when the radiation intensity is maximum. As a result, cells change their structure.
9. Infectious pathogens (human papillomavirus, HIV).
10. Age after 65 years, when the antitumor, immune defense of the body decreases.

Also, diseases that have a risk of malignancy are separately distinguished. These include pigmentary, Paget's disease, senile keratosis, skin horn, contact dermatitis.

Development mechanism

Cancer cells are characterized by autonomy, which is manifested by uncontrolled division, the regulation of which is absent. The tumor grows due to constant cell reproduction, and the old cells do not die. The tumor takes nutrients and oxygen from new blood vessels that are part of the oncological focus.

Keratinizing oncology refers to a differentiated pathology, which is manifested by the appearance of a yellowish crust on the surface of the tumor due to the accumulation of keratin.

Metastasis occurs by spreading cancer cells throughout the body. Thus, secondary foci of screening are formed, in which a malignant tumor develops.

Metastasis is carried out in 98% of the lymphatic vessels, being deposited in the lymph nodes where the tumor occurs. In a hematogenous way, a neoplasm is transmitted in almost 2% of cases when altered cells penetrate the bloodstream. Also, an increase in the tumor is observed by implantation, which is characterized by the spread of malignant tissues to neighboring organs upon their contact.

Peculiarities

Theoretically, a keratinizing type of cancer is possible in all organs, tissues, even in the absence of a keratinizing cell type. This is due to primary metaplasia, when at first normal cells are transformed into a keratinizing type, and then a malignant process develops.

In practice, there are several forms of squamous cell carcinoma localized:

• on the skin;
• on the border of the lips;
• in the oral cavity;
• cervical canal of the uterus;
• esophagus
• larynx;
• bronchial tree;
• trachea.

The first three forms grow from keratinizing cells. An oncological neoplasm can grow exophytically, that is, with the formation of a dense nodule, or endophytically, when ulcerative defects appear.

Skin cancer

Most frequently registered. In 90% of cases it belongs to the keratinizing type. It develops mainly in open areas of the skin (face, hand, neck).

Locally marked itching, pain, burning, swelling, changes in sensitivity, redness.

Cancer of the border of the lips

The lower lip is often affected, it is characterized by a fast, aggressive course. Locally manifested by swelling, induration, redness, soreness, ulcerative defects.

oral cancer

The focus is localized on the cheeks, gums, palate. Pain, increased salivation, bad breath, violation of the process of chewing, speech are symptomatic.

Diagnosis and treatment of keratinizing cancer

During the diagnosis, microscopy, thermography, endoscopy, MRI are carried out in order to establish the stage of the oncological process, to identify metastases. Tumor markers are detected in the laboratory.

With the help of cytological histological analysis material taken by biopsy, it is possible to establish cellular composition and type of tumor.

Keratinizing cancer requires a comprehensive treatment approach, which includes surgery, radiation, chemotherapy, symptomatic treatment aimed at reducing pain, as well as preventing infection and improving the patient's quality of life.