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Squamous cell carcinoma

 
Squamous Cell Carcinoma

 
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Squamous cell carcinoma
 
 
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In medicine
Medicine

Medicine is the art and science of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, squamous cell carcinoma (SCC) is a form of cancer
Cancer

Cancer is a class of diseases in which a group of cell display uncontrolled growth , invasion , and sometimes metastasis . These three malignant properties of cancers differentiate them from benign tumors, which are self-limited, do not invade or metastasize....
 of the carcinoma
Carcinoma

A carcinoma is any malignant cancer that arises from Epithelium. Carcinomas invade surrounding tissues and organs and may Metastasis, or spread, to lymph nodes and other sites....
 type that may occur in many different organs, including the skin
Skin

The skin is the outer covering of the body, also known as the epidermis. It is the largest organ of the integumentary system made up of multiple layers of epithelial biological tissue, and guards the underlying muscles, bones, ligaments and organ s....
, lip
Lip

Lips are a visible body part at the mouth of humans and many animals. Lips are soft, movable, and serve as the opening for food intake, as an erogenous organ used in kissing and other acts of intimacy, as a tactile sensory organ, and in the articulation of speech....
s, mouth
Mouth

The mouth, buccal cavity, or oral cavity is the first portion of the alimentary canal that receives food and begins digestion by mechanically breaking up the solid food particles into smaller pieces and mixing them with saliva....
, esophagus
Esophagus

The esophagus or oesophagus , sometimes known as the gullet, is an Organ in vertebrates which consists of a Muscle tube through which food passes from the pharynx to the stomach....
, urinary bladder
Urinary bladder

In anatomy, the urinary bladder is a solid, muscle, and distensible organ that sits on the pelvic floor in mammals. It is the organ that collects urine excreted by the kidneys prior to disposal by urination....
, prostate
Prostate

The prostate is a compound tubuloalveolar exocrine gland of the male mammalian reproductive system. Females do not have a prostate gland, although females do have tiny paraurethral Skene's glands connected to the distal third of the urethra in the prevaginal space that are homologous to the prostate....
, lung
Lung

The lung is the essential respiration organ in air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located in the chest on either side of the heart....
s, vagina
Vagina

The vagina is a fibromuscular cylinder tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles....
, and cervix
Cervix

The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall....
. It is a malignant tumor of squamous epithelium
Squamous epithelium

In anatomy, squamous epithelium is an epithelium characterised by its most superficial layer consisting of flat, scale-like cell called squamous cell....
 (epithelium
Epithelium

In biology and medicine, epithelium is a Biological tissue composed of cell s that line the cavities and surfaces of structures throughout the body....
 that shows squamous cell differentiation).

rcinoma can be characterized as either in situ
Carcinoma in situ

Carcinoma in situ is an early form of carcinoma defined by the absence of invasion of surrounding tissues. In other words, the neoplasm proliferate in their normal habitat, hence the name 'in situ' ....
 (confined to the original site) or invasive
Invasive (medical)

The term invasive in Medicine has two meanings:* A medical procedure which penetrates or breaks the skin or a body cavity, i.e., it requires a perforation, an incision, a catheterization, etc....
, depending on whether the cancer invades underlying tissues; only invasive cancers are able to spread to other organs and cause metastasis
Metastasis

Metastasis , or Metastatic disease, sometimes abbreviated mets, is the spread of a disease from one Organ or part to another non-adjacent organ or part....
.






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Encyclopedia


In medicine
Medicine

Medicine is the art and science of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, squamous cell carcinoma (SCC) is a form of cancer
Cancer

Cancer is a class of diseases in which a group of cell display uncontrolled growth , invasion , and sometimes metastasis . These three malignant properties of cancers differentiate them from benign tumors, which are self-limited, do not invade or metastasize....
 of the carcinoma
Carcinoma

A carcinoma is any malignant cancer that arises from Epithelium. Carcinomas invade surrounding tissues and organs and may Metastasis, or spread, to lymph nodes and other sites....
 type that may occur in many different organs, including the skin
Skin

The skin is the outer covering of the body, also known as the epidermis. It is the largest organ of the integumentary system made up of multiple layers of epithelial biological tissue, and guards the underlying muscles, bones, ligaments and organ s....
, lip
Lip

Lips are a visible body part at the mouth of humans and many animals. Lips are soft, movable, and serve as the opening for food intake, as an erogenous organ used in kissing and other acts of intimacy, as a tactile sensory organ, and in the articulation of speech....
s, mouth
Mouth

The mouth, buccal cavity, or oral cavity is the first portion of the alimentary canal that receives food and begins digestion by mechanically breaking up the solid food particles into smaller pieces and mixing them with saliva....
, esophagus
Esophagus

The esophagus or oesophagus , sometimes known as the gullet, is an Organ in vertebrates which consists of a Muscle tube through which food passes from the pharynx to the stomach....
, urinary bladder
Urinary bladder

In anatomy, the urinary bladder is a solid, muscle, and distensible organ that sits on the pelvic floor in mammals. It is the organ that collects urine excreted by the kidneys prior to disposal by urination....
, prostate
Prostate

The prostate is a compound tubuloalveolar exocrine gland of the male mammalian reproductive system. Females do not have a prostate gland, although females do have tiny paraurethral Skene's glands connected to the distal third of the urethra in the prevaginal space that are homologous to the prostate....
, lung
Lung

The lung is the essential respiration organ in air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located in the chest on either side of the heart....
s, vagina
Vagina

The vagina is a fibromuscular cylinder tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles....
, and cervix
Cervix

The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall....
. It is a malignant tumor of squamous epithelium
Squamous epithelium

In anatomy, squamous epithelium is an epithelium characterised by its most superficial layer consisting of flat, scale-like cell called squamous cell....
 (epithelium
Epithelium

In biology and medicine, epithelium is a Biological tissue composed of cell s that line the cavities and surfaces of structures throughout the body....
 that shows squamous cell differentiation).

Terminology

A carcinoma can be characterized as either in situ
Carcinoma in situ

Carcinoma in situ is an early form of carcinoma defined by the absence of invasion of surrounding tissues. In other words, the neoplasm proliferate in their normal habitat, hence the name 'in situ' ....
 (confined to the original site) or invasive
Invasive (medical)

The term invasive in Medicine has two meanings:* A medical procedure which penetrates or breaks the skin or a body cavity, i.e., it requires a perforation, an incision, a catheterization, etc....
, depending on whether the cancer invades underlying tissues; only invasive cancers are able to spread to other organs and cause metastasis
Metastasis

Metastasis , or Metastatic disease, sometimes abbreviated mets, is the spread of a disease from one Organ or part to another non-adjacent organ or part....
. Squamous cell carcinoma in situ are also called Bowen's disease
Bowen's disease

Bowen's disease is a neoplastic skin disease, considered either as an early stage or intraepidermal form of squamous cell carcinoma. It was named after Dr John T....
.

HPV and Squamous Cell Cancers


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

Signs & Symptoms


  • The lesion caused by SCC is often asymptomatic
  • Ulcer or reddish skin plaque that is slow growing
  • Intermittent bleeding from the tumor, especially on the lip
  • The clinical appearance is highly variable
  • Usually the tumor presents as an ulcerated lesion with hard, raised edges
  • The tumor may be in the form of a hard plaque or a papule
    Papule

    A papule is a circumscribed, solid elevation of skin with no visible fluid, varying in size from a pinhead to 1 cm.With regard to the quote "...varying in size from a pinhead to 1cm," depending on which text is referenced, some authors state the cutoff between a papule and a Plaque as 0.5cm, not 1cm, while ot...
    , often with an opalescent quality, with telangiectasia
    Telangiectasia

    Telangiectasias are small dilated blood vessels near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter....
  • The tumor can lie below the level of the surrounding skin, and eventually ulcerates and invades the underlying tissue
  • The tumor commonly presents on sun-exposed areas (e.g. back of the hand, scalp, lip, and superior surface of pinna
    Pinna

    The pinna is the visible part of the ear that resides outside of the head ....
    )
  • On the lip, the tumor forms a small ulcer, which fails to heal and bleeds intermittently
  • Evidence of chronic skin photodamage, such as multiple actinic keratoses (solar keratoses)
  • The tumor grows relatively slowly
  • Unlike basal cell carcinoma (BCC), squamous cell carcinoma (SCC) has a substantial risk of metastasis
    Metastasis

    Metastasis , or Metastatic disease, sometimes abbreviated mets, is the spread of a disease from one Organ or part to another non-adjacent organ or part....
  • Risk of metastasis is higher in SCC arising in scars, on the lower lips or mucosa, and occurring in immunosuppressed patients. About *one-third of lingual and mucosal tumors metastasize before diagnosis (these are often related to tobacco and alcohol use)


Demographics

Incidence of squamous cell carcinoma varies with age, gender, race, geography, and genetics. The incidence of SCC increases with age and the peak incidence is usually around 66 years old. Males are affected with SCC at a ratio of 2:1 in comparison to females. Caucasians are more likely to be affected, especially those with fair Celtic skin, if chronically exposed to UV radiation. There are also a few rare congenital diseases predispose to cutaneous malignancy. Incidence of SCC has also been found to increase with decreasing latitude (e.g. southern US, Australia). Tumors are more common on the left side in the US and on the right side in England. This is probably due to asymmetric sun exposure during driving. In certain geographic locations, exposure to arsenic in well water or from industrial sources may significantly increase the risk of SCC.

Sites


Skin

Squamous cell carcinoma is the second most common cancer of the skin
Skin cancer

Skin cancer is a malignant growth on the skin which can have many causes. The most common skin cancers are basal cell cancer, squamous cell cancer, and melanoma....
 (after basal cell carcinoma
Basal cell carcinoma

Basal cell carcinoma is the most common of all types of skin cancer. Statistically speaking, approximately 3 out of 10 caucasians develop a basal cell cancer within their lifetime....
 but more common than melanoma
Melanoma

Melanoma is a malignant tumor of melanocytes which are found predominantly in skin but also in the bowel and the eye . It is one of the rarer types of skin cancer but causes the majority of skin cancer related deaths....
). It usually occurs in areas exposed to the sun. Sunlight exposure and immunosuppression
Immunosuppression

Immunosuppression involves an act that reduces the activation or efficacy of the immune system. Some portions of the immune system itself have immuno-suppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other conditions....
 are risk factors for SCC of the skin with chronic sun exposure being the strongest environmental risk factor. The risk of metastasis is low, but is much higher than basal cell carcinoma. Squamous cell cancers of the lip and ears have high metastatic and recurrence rate (20 to 50%). Squamous cell cancers of the skin in individuals on immunotherapy or having lymphoproliferative disorders (leukemias) are much more aggressive, regardless of their location.

Squamous cell carcinoma can generally be treated by excision
Excision

Excision means "to remove by cutting".* In surgery, an excision is the complete removal of an organ or a tumor from a body, as opposed to a biopsy....
 or mohs surgery
Mohs surgery

Mohs surgery, also known as chemosurgery, was created by a general surgeon, Dr. Fredrick E. Mohs, is microscopically controlled surgery that is highly effective for common types of skin cancer, with a cure rate cited by most studies between 97% and 99.8% for primary basal cell carcinoma, the most common type of skin cancer....
. Nonsurgical options for the treatment of cutaneous SCC include topical chemotherapy, topical immune response modifiers, photodynamic therapy (PDT), radiotherapy, and systemic chemotherapy. The use of topical therapy and PDT is generally limited to premalignant (ie, AKs) and in situ lesions. Radiation therapy is a primary treatment option for patients in whom surgery is not feasible and is an adjuvant therapy for those with metastatic or high-risk cutaneous SCC. At this time, systemic chemotherapy is used exclusively for patients with metastatic disease.

Australian scientist Ian Frazer who developed the cervical cancer vaccine, says that animal tests have been effective in preventing squamous cell carcinoma in animals, and there may be a human vaccine against this kind of skin cancer within the decade.

Head and neck cancer

Oral Cancer (1) Squamous Cell Carcinoma Histopathology
Most cases of head and neck cancer
Head and neck cancer

The term head and neck cancer refers to a group of biologically similar cancers originating from the upper aerodigestive tract, including the lip, oral cavity , nasal cavity, paranasal sinuses, pharynx, and larynx....
 (cancer of the mouth, nasal cavity, throat and associated structures) are due to squamous cell carcinoma. Symptoms may include a poorly healing mouth ulcer
Mouth ulcer

An oral ulcer is the name for the appearance of an open sore inside the mouth caused by a break in the mucous membrane or the epithelium on the lips or surrounding the mouth....
, a hoarse voice or other persistent problems in the area. Treatment is usually with surgery
Surgery

Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason....
 (which may be extensive) and radiotherapy. Risk factors include smoking
Tobacco smoking

Tobacco smoking is the inhalation of smoke from burned dried or cured leaves of the tobacco plant, most often in the form of a cigarette. People may smoke casually for pleasure, habitually to satisfy an addiction to the nicotine present in tobacco and to the act of smoking, or in response to social pressure....
 and alcohol consumption
Alcoholic beverage

An alcoholic beverage is a drink containing ethanol . Alcoholic beverages are divided into three general classes: beers, wines, and distilled beverage....
 Cancers of the head and neck are usually caused by tobacco and alcohol, but according to the CDC, recent studies show that about 25% of mouth and 35% of throat cancers are caused by HPV. The 5 year disease free survival rate for HPV positive cancer is significantly higher when appropriately treated with surgery, radiation and chemotherapy as compared to non-HPV positive cancer, substantiated by multiple studies including research conducted by Dr. Maureen Gillison et. al. of Johns Hopkins Sidney Kimmel Cancer Center.

Esophagus

Esophageal cancer
Esophageal cancer

Esophageal cancer is cancer of the esophagus. There are various subtypes, primarily squamous cell cancer and adenocarcinoma. Squamous cell cancer arises from the cells that line the upper part of the esophagus....
 may be due to either squamous cell carcinoma (ESCC) or adenocarcinoma
Adenocarcinoma

Adenocarcinoma is a cancer that originates in glandular tissue. This tissue is also part of a larger tissue category known as epithelial tissue....
 (EAC). SCCs tend to occur closer to the mouth, while adenocarcinomas occur closer to the stomach. Dysphagia
Dysphagia

Dysphagia is the medical term for the symptom of difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, the term is sometimes used as a condition in its own right....
 (difficulty swallowing, solids worse than liquids) and odynophagia
Odynophagia

Odynophagia is painful swallowing, in the mouth or esophagus. It can occur with or without dysphagia, or difficult swallowing.Odynophagia often results in weight loss....
 are common initial symptoms. If the disease is localized, esophagectomy
Esophagectomy

Esophagectomy or Oesophagectomy is the surgical removal of all or part of the esophagus ....
 may offer the possibility of a cure. If the disease has spread, chemotherapy
Chemotherapy

Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer....
 and radiotherapy are commonly used.

Lung


When associated with the lung, it often causes ectopic production of parathyroid hormone-related protein
Parathyroid hormone-related protein

Parathyroid hormone-related protein is a protein member of the parathyroid hormone family. It is occasionally secreted by cancer cells . However, it also has normal functions....
 (PTHrP), resulting in hypercalcemia.

Penis

When squamous cell carcinoma in situ (Bowen's disease
Bowen's disease

Bowen's disease is a neoplastic skin disease, considered either as an early stage or intraepidermal form of squamous cell carcinoma. It was named after Dr John T....
) is found on the penis, it is called erythroplasia of Queyrat. This type of cancer responds very well to imiquimod
Imiquimod

Imiquimod is a prescription medication that acts as an immune response modifier. It is marketed by MEDA AB, Graceway Pharmaceuticals and iNova Pharmaceuticals under the trade name Aldara and by Mochida as Beselna....
.

Prostate

When associated with the prostate
Prostate

The prostate is a compound tubuloalveolar exocrine gland of the male mammalian reproductive system. Females do not have a prostate gland, although females do have tiny paraurethral Skene's glands connected to the distal third of the urethra in the prevaginal space that are homologous to the prostate....
, squamous cell carcinoma is very aggressive in nature. It is difficult to detect as there is no increase in prostate specific antigen
Prostate specific antigen

Prostate specific antigen is a protein produced by the cells of the prostate gland. PSA is present in small quantities in the Blood plasma of normal men, and is often elevated in the presence of prostate cancer and in other prostate disorders....
 levels seen; meaning that the cancer is often diagnosed at an advanced stage.

Vagina and cervix

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

Vaginal cancer is any type of cancer that forms in the tissues of the vagina. Vaginal cancer is not common. It occurs primarily in women over age 50, but can occur at any age, even in infancy....
.

Diagnosis of Squamous Cell Carcinoma


Diagnosis is via a biopsy
Biopsy

A biopsy is a medical test involving the removal of Cell_s or Biological tissues for examination. It is the removal of tissue from a living subject to determine the presence or extent of a disease....
. For the skin, look under skin biopsy
Skin biopsy

Skin biopsy is a biopsy technique in which a skin lesion is removed and sent to the pathologist to render a microscopic diagnosis. It is usually done under local anesthetic in a physician's office, and results are often available in 4 to 10 days....
.

The pathological appearance of a squamous cell cancer varies with the depth of the biopsy. For that reason, a biopsy including the subcutanous tissue and basalar epithelium, to the surface is necessary for correct diagnosis. The performance of a shave biopsy (see skin biopsy
Skin biopsy

Skin biopsy is a biopsy technique in which a skin lesion is removed and sent to the pathologist to render a microscopic diagnosis. It is usually done under local anesthetic in a physician's office, and results are often available in 4 to 10 days....
) might not acquire enough information for a diagnosis. An excision biopsy is ideal, but not practical in most cases. An incisional or punch biopsy is preferred. A shave biopsy is least ideal, especially if only the superficial portion is acquired.

Treatment

Most squamous cell carcinomas are removed with surgery or topical medication.

Mohs surgery
Mohs surgery

Mohs surgery, also known as chemosurgery, was created by a general surgeon, Dr. Fredrick E. Mohs, is microscopically controlled surgery that is highly effective for common types of skin cancer, with a cure rate cited by most studies between 97% and 99.8% for primary basal cell carcinoma, the most common type of skin cancer....
 is frequently utilized; considered the treatment of choice for squamous cell carcinoma of the skin, physicians have also utilized the method for the treatment of squamous cell carcinoma of the mouth, throat, and neck.

Imiquimod
Imiquimod

Imiquimod is a prescription medication that acts as an immune response modifier. It is marketed by MEDA AB, Graceway Pharmaceuticals and iNova Pharmaceuticals under the trade name Aldara and by Mochida as Beselna....
 (Aldara) has been used with success for squamous cell carcinoma in situ of the skin and the penis, but the morbidity and discomfort of the treatment is severe. An advantage is the cosmetic result: after treatment, the skin resembles normal skin without the usual scarring and morbidity associated with standard excision. Imiquimod is not FDA-approved for any squamous cell carcinoma.

In 2007, Australian biopharmaceutical company Clinuvel Pharmaceuticals Limited began clinical trials with an experimental treatment, a melanocyte-stimulating hormone
Melanocyte-stimulating hormone

The melanocyte-stimulating hormones are a class of peptide hormones that in nature are produced by cells in the intermediate lobe of the pituitary gland....
 called afamelanotide
Afamelanotide

Afamelanotide is a Peptide synthesis Analog of the naturally occurring peptide hormone Melanocyte-stimulating hormone that has been shown to induce skin sun tanning through Melanocyte#Melanogenesis and reduce Sunburn in preliminary studies and clinical trials....
  (formerly CUV1647) to provide photoprotection
Photoprotection

The term Photoprotection designates the mechanisms that nature has developed to minimize the damages that the human body suffers when exposed to UV-irradiation....
 for organ transplant patients against squamous cell carcinoma of the skin and actinic keratosis
Actinic keratosis

Actinic keratosis is a premalignant condition of thick, scaly, or crusty patches of skin. It is more common in fair-skinned people. It is associated with those who are frequently exposed to the sun, as it is usually accompanied by Sun damage....
.

Related conditions

  • Erythroplasia of Queyrat
    Erythroplasia of Queyrat

    Erythroplasia of Queyrat is squamous cell carcinoma in situ of the glans penis.Reference...
  • Keratoacanthoma
    Keratoacanthoma

    Keratoacanthoma is a relatively common low-grade malignancy that originates in the pilosebaceous glands and closely and pathologically resembles squamous cell carcinoma ....
     is a low-grade malignancy of the skin. It originates in the pilo-sebaceous glands
    Sebaceous gland

    Sebaceous glands are small glands in the skin which secrete an oily matter in the hair follicles to lubricate the skin and hair of animals. In humans, they are found in greatest abundance on the face and scalp, though they are distributed throughout all skin sites except the palms and soles....
    , and is similar in clinical presentation and microscopic analysis to squamous cell carcinoma, except that it contains a central keratin
    Keratin

    Keratins are a family of fibrous protein; tough and insoluble, they form the hard but mineral structures found in reptiles, birds, amphibians and mammals....
     plug. Statistically, it is less likely to become invasive than squamous cell carcinoma.
  • Bowen's disease
    Bowen's disease

    Bowen's disease is a neoplastic skin disease, considered either as an early stage or intraepidermal form of squamous cell carcinoma. It was named after Dr John T....
     is a sunlight-induced skin disease, and is considered to be an early form of squamous cell carcinoma.
  • Marjolin's ulcer
    Marjolin's ulcer

    Marjolin's ulcer refers to an aggressive Ulcer squamous cell carcinoma presenting in an area of previously Physical trauma , chronically inflamed , or scarred skin ....
     is a type of squamous cell carcinoma that arises from a non-healing ulcer
    Ulcer

    An ulcer is a discontinuity of the skin exhibiting complete loss of the epidermis and often portions of the dermis and even subcutaneous fat....
     or burn wound.
  • Melanoma
    Melanoma

    Melanoma is a malignant tumor of melanocytes which are found predominantly in skin but also in the bowel and the eye . It is one of the rarer types of skin cancer but causes the majority of skin cancer related deaths....
  • Basal Cell Carcinoma
    Basal cell carcinoma

    Basal cell carcinoma is the most common of all types of skin cancer. Statistically speaking, approximately 3 out of 10 caucasians develop a basal cell cancer within their lifetime....


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