Squamous cell carcinoma of a high degree of differentiation. Squamous cell carcinoma, treatment, causes, symptoms, signs

Some oncological diseases are also dangerous because they are well disguised as other pathologies. squamous cell skin cancer is no exception. , which can be confused with other skin diseases on initial stage its development, which sometimes makes it difficult to make an accurate diagnosis and timely treatment. The patient turns to the doctor already at the stage when the pathology began to show obvious symptoms. This type of oncology almost never metastasizes, and is most often observed in people who have had donor organ transplants.

Description of pathology

Squamous cell carcinoma – a malignant tumor that is formed from the skin tissue and mucous membranes. Pathology develops very quickly and proceeds aggressively. At first, malignant neoplasms occur on the skin or mucous membrane, over time they penetrate into the lymph nodes, internal organs and tissues, contributing to the disruption of their functions and structure. Delayed treatment leads to death due to the development of multiple organ failure. This neoplasm is formed from flat skin cells, which eventually grow into the subcutaneous tissue and the human skeleton. With the growth of the tumor, neoplasms appear in the form of nodes, from which processes extend into the skin tissue. They are often injured, therefore they are accompanied by foci of inflammation and the appearance of ulcers on the surface of the skin with constant bleeding.

There are two types of leather:

1. Keratinizing epithelium, which is a combination of skin.
2. Non-keratinizing epithelium, which is all the mucous membranes of the body.

Thus, malignant formations can appear both on the skin and on the mucous membrane, located on any part of the human body, since the epithelium is very widespread. But most often exposed areas of the skin, the genitals and the area around the anus are affected. Often, when a pathology occurs, a papule forms on the skin, which after a few months transforms into a node larger than one and a half centimeters.

Epidemiology

This pathology develops in people of different ages, but most often affects men who are over sixty-five years old. According to statistics, people with fair skin and red hair, as well as those who have undergone donor organ transplants followed by immunosuppressive therapy, suffer from squamous cell carcinoma. In children, pathology is rarely observed, usually the disease is associated with a hereditary predisposition. Squamous cell carcinoma occurs in 25% of all existing skin cancers. In 75% of cases, tumors are localized in the head and face. Especially often, malignant neoplasms appear in people who burn out in the sun in a short period of time. Untimely and ineffective treatment leads to death.

Reasons for the development of oncology

The exact causes of the onset of the disease have not yet been established. In medicine, it is customary to distinguish the following possible reasons squamous cell carcinoma:

1. Genetic predisposition, characterized by violations of the antitumor protective properties of cells, the work of antitumor immunity, the metabolism of carcinogenic substances. All this is associated with certain mutations in human genes that lead to the development of the disease.
2. Exposure to ultraviolet light, which causes genetic mutations and the formation of cancer cells. This usually occurs when exposed to the sun for a long period of time.

Note! It has been proven that the pathology is associated with human papillomavirus, ultraviolet radiation, disorders in the immune system, exposure to carcinogens.

1. Exposure to radiation, which has a destructive effect on human genes, contributing to the appearance of mutations. Most often, squamous cell carcinoma of the skin appears in people who are regularly exposed to ionizing radiation for medical purposes, as well as in workers in the nuclear industry.
2. Infectious diseases contribute to the development of cancer. These include HIV and papillomavirus.
3. Age over sixty-five years, when there is a decrease in all functions of organs and systems.
4. The use of immunosuppressants that have a negative effect on the human immune system.
5. Bad habits (smoking, drinking alcohol, drugs) affect the development of cancerous tumors in the mouth, stomach or respiratory organs. This is due to the impact on the body of carcinogens, which are contained in tobacco, narcotic drugs and alcohol. As a result of the abuse of bad habits, the permeability of healthy cells to various chemicals increases.
6. Polluted air exposes the skin to certain dangerous chemicals that cause squamous cell carcinoma.
7. An unhealthy diet, which includes a large amount of foods containing animal fats and a lack of vegetable fats.

Also, this disease can appear due to injuries and scars on the skin or mucous membrane, chronic dermatitis, ulcers, inflammatory diseases.

Note! Sometimes the pathology is formed as a result of the development of precancerous processes, which include xeroderma pigmentosum, Paget's disease and Bowen's disease, Queyre's erythroplasia, keratoacanthoma, and senile keratosis.

Forms of cancer

Squamous cell carcinoma has the following forms:

1. Exophytic form, caused by the formation of nodes with a dense texture and a wide base, which rise above the skin and are practically motionless.
2. Endophytic form, which is characterized by rapid expression of the node, the formation of an ulcer, around which secondary nodules appear, provoking an increase in their size. The ulcers are dark red in color and have sharp edges. This form cancer is divided into superficial cancer, which has ulcers with a brown crust, and deep cancer, which grows deep and looks like a yellow ulcer.

Types of pathological neoplasms

In medicine, it is customary to distinguish the following types of squamous cell carcinoma:

1. Squamous cell keratinizing cancer (differentiated). This pathology is caused by a mutation of the epithelial cell, its active reproduction with the appearance of clones that accumulate keratin in large quantities. Over time, abnormal cells lose their elements and die, depositing a keratin mass in the form of a yellowish crust on the surface of the neoplasm. Highly differentiated squamous cell carcinoma is characterized by slow division of pathological cells that are aimed at the destruction of blood vessels, tissues and bones. This type of squamous cell carcinoma has the most favorable prognosis of all the others. Poorly differentiated squamous cell carcinoma is similar in structure to sarcoma and is a more dangerous type of disease. Abnormal cells in this case are spindle-shaped and multiply very quickly, they are able to ensure the integrity of the tissue.
2. Non-keratinizing squamous cell carcinoma (undifferentiated). This pathology is the most malignant form of the disease, in which there is a rapid division of cancer cells, where keratin does not accumulate, and the process of their death is not observed. Such neoplasms can metastasize and are most often located on the mucous membranes of the body.

Note! Squamous cell undifferentiated cancer is the most malignant form of pathology that can be confused with sarcoma.

Types of disease

In oncology, the following types of squamous cell carcinoma are distinguished:

1. Plaque cancer characterized by the formation of red plaques that have bleeding tubercles on the surface. This type of cancer is characterized by rapid growth, damage to the surface of the skin, spread of metastases to the inner layer of the skin.
2. Nodular cancer is caused by the formation of nodes of a red hue, which in their appearance resemble cauliflower. Their surface is bumpy, and the structure is dense.
3. Ulcerative cancer, which is characterized by the appearance of ulcers with raised edges on the skin. These sores are foul-smelling and bleed constantly. They tend to penetrate the body, affecting tissues that are nearby.

Stages of development of squamous cell skin cancer

There are four degrees of malignancy of the neoplasm, which depend on how deep it has penetrated:

1. The first degree, in which the cancerous tumor penetrates the level of the sweat glands, and inflammation appears around it. The neoplasm is small in size, the person does not experience pain during palpation.
2. The second stage is caused by the presence of a large number of cancer cells. The tumor grows to a size of more than two centimeters.
3. At the third stage of the pathology, keratinization of the tumor occurs, while the affected area increases.
4. The fourth degree is caused by the absence of keratinization of the neoplasm, the cessation of the inflammatory process, the formation of cells of irregular shape, size and structure. At this stage, not only the skin is affected, but also tissues, bones, and lymph nodes.

Symptoms and signs of the disease

Most often, the disease develops on the skin of the upper limbs, face and head. At the initial stage of the disease, the appearance of a mobile node of a pink hue, which is covered with scales, is observed. After a while, it becomes motionless, it begins to fuse with the skin, causing pain. Over time, the tumor grows into the deep skin layers, subcutaneous tissue and even bones. Then an ulcer appears on the surface of the neoplasm, which has uneven edges. After three months, a cancerous tumor can metastasize to the lymph nodes, but this happens infrequently. In some cases, squamous cell carcinoma can invade adjacent tissues.

Note! If the neoplasm has grown rapidly in size and exceeds two centimeters, this indicates the active development of cancer, which can metastasize to neighboring organs and tissues.

The symptomatology of the disease depends on where the malignant neoplasm is located, but all its types have common signs that indicate the characteristics of its growth. Squamous cell carcinoma may present with the following symptoms:

pain at the location of the cancerous tumor;

• tissue swelling;
• burning and itching;
• redness at the site of the tumor.

Diagnostics

First, a diagnosis is carried out in dermatology, in which the doctor conducts a preliminary examination of the neoplasms and examines the symptoms of the pathology. Then he prescribes endoscopy, thermography or scanning microscopy, MRI. This makes it possible to obtain a layered image of the skin, to study the nature of neoplasms, their composition and shape, as well as the degree of damage to the mucous membranes.

To make an accurate diagnosis, laboratory diagnostic methods can be prescribed. To do this, they conduct a blood and urine test, identify tumor markers, cytological examination of a scraping or smear. This allows to identify tumor cells of squamous cell carcinoma.

Also, the doctor must differentiate the disease from cell cancer, Bowen's disease, keratosis, dyskeratosis and other pathologies. The final diagnosis is made after the results of the biopsy. During the study, a part of the pathological material is taken from the skin or the surface of the mucous membrane. Then conduct a histological examination of the material.

Oncology treatment

Depending on the size of the cancerous tumor, its location, as well as the age of the patient, an individual treatment for squamous cell skin cancer is being developed. The important point here is to remove the affected tissue as early as possible.

Note! Timely treatment increases the patient's chances of survival.

Often, the cancerous tumor is removed surgically. During the operation, the surgeon removes the primary neoplasm, as well as the lymph nodes, if metastases are found in them. After removal of the neoplasm, radiological therapy is used. It can also be used in the placement of a tumor in any part of the face, as well as in the treatment of elderly people, if they are contraindicated for surgery. During the operation, not only the neoplasm is removed, but also all the structures into which it has sprouted. In some cases, it may be necessary to amputate a limb or remove an internal organ that has been affected.

In addition to surgery, the doctor may prescribe cryodestruction, in which the neoplasm is frozen with liquid nitrogen by spraying it with special equipment. This method is used for small tumors, it does not leave scars after the procedure. But this technique is never used for lesions of the scalp.

After surgery, oncology treatment usually involves the use to eliminate the remaining cancer cells. This method of treatment is quite effective, in 99% of cases the disease has a favorable prognosis.

In the presence of a large neoplasm, a course of radiation therapy is first carried out to reduce its size. The patient then undergoes chemotherapy. Most often, these two treatments are enough to cure the patient. Radiation therapy is used in the presence of cancerous tumors of any location. In most cases, this method treats the disease in the initial stages of development. In the case of the presence of squamous cell carcinoma of the last stages, radiation therapy is activated before the operation, after which the neoplasm is completely removed. The treatment of well-differentiated cancer requires a long period of time and sufficiently high doses of radiation. With the development of relapse, this method of treatment is not reused.

During all medical procedures, symptomatic treatment is carried out, the purpose of which is to reduce pain, stop bleeding, eliminate infections, and treat comorbidities.

Forecast

After successful surgery, the probability of recurrence in the next five years is about 30%. To prevent this from happening, it is recommended to normalize the functioning of the immune system, which is disturbed during the treatment of the cancer process. When cancer is treated at an early stage, the chances of a complete cure are high. But throughout life, a person will have to be under medical supervision. At an advanced stage of cancer, the prognosis is poor.

Prevention of pathology

In order to prevent, it is necessary to limit contact with dangerous chemicals, carcinogens, radiation and ultraviolet light. When any formations appear on the skin, it is necessary to undergo a medical examination to make an accurate diagnosis. Throughout life, each person should monitor the condition of his skin.

microinvasive growth. Foci of microinvasion against the background of carcinoma in situ significantly change the prognosis of the disease. In this case, we are talking about invasive squamous cell carcinoma, which can give early metastases (Fig. 10).

Differential Diagnosis initial forms invasion is very complex and time-consuming. Some authors consider it possible to predict invasive growth from cytological data. The following changes are noted in the preparations.

1. Cells are usually larger than normal, pleomorphism is pronounced, bizarre cell shapes are found. Cells are predominantly scattered, but complexes are also found.

2. The nuclear material is rough, in the form of large lumps.

3. Nucleoli are large, acidophilic.

4. The nuclear-cytoplasmic ratio varies significantly, may be higher or lower than normal.

5. As a rule, cytophagy and multinucleation are noted.

6. Cytoplasm can be acidophilic and basophilic

It should be recognized that most researchers do not consider it possible to reliably differentiate between carcinoma in situ and invasive cancer on the basis of cytological examination alone. In addition, a significant number of individuals examined by G. Saccomano et al. (1974), subsequently developed small cell carcinoma. To date, there are no published studies that provide reliable data on the incidence, progression and regression of cytologically moderate or severe cellular dysplasia or cancer in situ, similar to studies in the field of precancer or cervical cancer.

. In the cytological classification of tumors (except for tumors of the female genital tract), the following basic features are proposed for the verification of bronchogenic cancer in situ, in which there are: 1) individual malignant cells that correspond to the structure of squamous cell carcinoma, possibly less polymorphic than cells in the classical invasive form of cancer; 2) large cells of polygonal or irregular shape with abundant, usually orange- or eosinophilic cytoplasm and enlarged, slightly hyperchromic nuclei; 3) small atypical squamous epithelial cells, usually round, oval in shape with signs of keratinization; in the latter case, the nuclei are round or somewhat irregular in shape with varying degrees of hyperchromia and clumping of chromatin.

These signs are quite typical for squamous cell carcinoma. However, the cytological criteria that should be used to differentiate between epithelial dysplasia with severe atypia and cancer in situ remain unclear. Apparently, in each case with overly emphasized signs of dysplasia, repeated sputum examinations or bronchoscopy with the study of as many samples as possible are necessary to detect the area of ​​bronchial mucosa affected by cancer in situ. In our opinion, the state of cell nuclei is of the most significant importance in this situation.

With the transition of dysplasia to cancer, a number of signs are noted that indicate dystrophic and necrobiotic changes in the structures of nuclear chromatin and the nuclear envelope. Often there is fragmentation of the nuclei with lacing of individual lobules. Nuclear chromatin with areas of destruction and the appearance of zones of enlightenment in the nuclei. The state of the nuclear membrane is characteristic. Its uneven thickening is noted, in some places it seems to merge with areas of marginal condensation of chromatin, becomes blurry and indistinguishable. In other cells, where signs of karyopyknosis are noted, the boundaries of the nuclear membrane become distinctly uneven, with acute-angled bends, intussusceptions, and deep slit-like depressions. Signs of cytophagy are also characteristic, while the formation of structures of the "bird's eye" type (the beginning of the formation of cancerous pearls) is not uncommon.

The background of the drug is also noteworthy. The absence of pronounced inflammatory and destructive changes indicates that the observed atypia is not concomitant, for example, to tuberculous endobronchitis, in which, as a rule, pronounced changes in the bronchial epithelium are observed. Such a sign as a significant increase in the number of small atypical squamous epithelial cells is also extremely important. The presence of these elements, similar to parabasal ones, indicates an excessive intensification of the proliferative process characteristic of the development of cancer.

. Cancer in situ is usually found as confluent patches of pathologically altered integumentary epithelium, clearly demarcated from intact respiratory epithelium. Four variants of in situ cancer can be distinguished: in situ cancer without signs of microinvasion, in situ cancer in combination with signs of microinvasion, in situ cancer in combination with microinvasive carcinoma affecting various parts of the respiratory tract, areas of preinvasive cancer in combination with an invasive growth node (Fig. .eleven).

The affected area of ​​the mucous membrane, often up to 4 mm long, has a rough surface, a whitish color, and is quite clearly delimited from the surrounding unchanged bronchial mucosa. In some cases, such areas can be represented by micropapillomatous growths. Histologically, the tumor has the structure of a moderately differentiated squamous cell carcinoma with keratinization of the surface layers, or it is a highly differentiated squamous cell carcinoma with pronounced keratinization.

It should be noted, however, that the type of cancer differentiation in situ is not decisive for the shape of the tumor that develops in the future. Carcinoma in situ with pronounced keratinization in the superficial sections can also develop into undifferentiated cancer. The pathological changes described above can capture not only the mucous membrane of the trachea, but also the mouths, ducts and deeper sections of the mucous glands. In some cases, the tumor is not detected on the surface of the mucous membrane, but is localized exclusively in the glands. In cases where the distal ducts of the submucosal glands with pre-invasive cancer enter the cut, this lesion must be distinguished from invasive cancer with invasion of the submucosal lymphatic vessels.

The onset of infiltrating growth (microinvasive cancer) can be observed both in areas of the tracheal mucosa and glands. At the same time, there is a violation of the integrity of the basement membrane and the penetration of tumor elements into the submucosal sections of the tracheal wall, accompanied by inflammatory infiltration of the stroma surrounding the tumor with lymphocytes and plasma cells. A more pronounced invasive growth may be accompanied by a desmoplastic stromal reaction. Microinvasion should include cases in which tumor cells infiltrating the bronchus wall do not penetrate beyond the inner surface of the cartilage.

L.Woolner and Farrow (1982) offer the following gradation of invasion depth for X-ray negative cancer: 1) cancer in situ; 2) up to 1 mm - intraepithelial cancer; 3) 2-3 mm - invasion to the cartilage; 4) 3-5 mm - complete infiltration of the wall; 5) more than 5 mm (5-10) - peritracheal invasion. These degrees of gradation are of great importance for clinical practice. If 2-3 degrees can be classified as microinvasive forms of cancer, then with the 4th and, especially, with the 5th degree, the likelihood of vascular invasion with regional metastasis increases sharply. It should be noted that with an invasion depth of up to 10 mm, the cancer, as a rule, is latent and is detected only endoscopically.

Invasive growth. Despite the similarity of the histological structure of the mucous membrane of the trachea and bronchi, there are 180 cases per patient with tracheal cancer. lung cancer and 75 for cancer of the larynx.

Unlike other types, squamous cell carcinoma, according to the literature, occurs predominantly in men (more than 75% of cases). Smokers 50-70 years old prevail. On our material, the age of patients was 20-75 years. In the youngest patient, cancer developed against the background of long-term papillomatosis of the larynx and trachea. The ratio of men and women is 4:1. The age of 68.8% of patients is older than 50 years. 97% of men smoked cigarettes. Most are heavy smokers.

The etiology of this tumor is closely related to air pollution and cigarette smoking. However, there are no reliable statistics on this score. The development of cancer from metaplastic epithelium is promoted by papillomatosis, inflammatory processes in the tracheostomy area and tracheomegaly. Hyperplastic and inflammatory reactions increase the sensitivity of epithelial cells to carcinogens. However, many hypotheses of the origin of the tumor are based on speculative conclusions based on single observations.

Macroscopic examination drug after resection of the trachea for cancer has the following goals: comparison of the macroscopic picture with the results of radiological and endoscopic data; determination of the stage of the process to correct the previous clinical and radiological codification (according to TNM).

An exclusively exophytic type of growth occurs only in the early stages of tumor development, and later (with a depth of invasion of the tracheal wall of more than 10 mm), as a rule, a mixed exo- and endophytic growth pattern is noted. The frequency of macroscopic forms in our material is presented in Table 12. Most often, the tumor invaded all layers of the tracheal wall, infiltrating growth predominated.

Table 12. Distribution of patients depending on the form of tumor growth

The exophytically growing part of the tumor looks like a whitish plaque or polyp that stenoses the lumen of the trachea. In rare cases of tracheal cancer with pronounced exophytic growth, the tumors reach large sizes, while there is a pronounced stretching and thinning of the bronchus wall, which acquires a whitish uniform appearance, in places with remnants of cartilaginous plates.

With the proximal spread of the tumor, in some cases, the wall of the trachea may macroscopically look unchanged, and its inner surface in the affected areas is dull, rough. The identification of such zones is important for determining the true prevalence of the tumor process when correcting clinical and radiological data in accordance with the TNM system.

The extent of the lesion with a mixed type of growth is much greater than with endotracheal (5-7 cm). A relatively limited lesion (2-4 cm) occurs in single observations. At the same time, bulging of the wall and changes in the mucosa do not reflect the true prevalence of the tumor. With an endoscopic border of the tumor with a length of 2 cm, the peritracheal spread of malignant elements can reach 5-6 cm. If the posterior wall is affected, the tumor compresses the esophagus early, germinates its wall with the formation of an esophageal-tracheal fistula. If the lesion is located on the anterior-lateral walls of the cervical region, the thyroid gland may grow.

Some features have bifurcation cancer trachea. With exophytic growth, the anatomy of the bifurcation is not disturbed. Usually it is possible to determine the zone of initial growth. Tumor infiltration extends to both clivus, mouths or initial sections of the main bronchi along their medial and posterior walls, as well as to the membranous wall of the suprabifurcation segment up to 3 cm long.

With mixed growth, the anatomical structures of the bifurcation do not differentiate. The mucous membrane in all departments is occupied by large-tuberous growths. Infiltration circularly spreads to the main bronchi with a narrowing of their lumen. There is a rough longitudinal folding of the mucous membrane, bulging into the lumen of the posterior wall of the trachea in the suprabifurcation segment. Sometimes the deformity occurs due to bulging of one or both tracheobronchial angles. This may be due to compression by the primary tumor or damage to the lymph nodes, which form a single conglomerate that covers the entire bifurcation in a muff-like manner.

Small squamous cell carcinoma trachea (within T1 - see section 2.3) has some macroscopic features. Row characteristic features malignant growth may be absent. In 3 patients, small cancer did not exceed 1 cm in diameter, was located on membranous wall respectively in the brachiocephalic, aortic and suprabifurcational segments. The depth of invasion was limited to the mucous and submucosal layers. Dense immobile exophytic tumor with a coarsely tuberous surface or a flat infiltrate, slightly elevated above the surface, localized or extended along the length of the trachea with a relatively smooth surface, Pink colour, with clear boundaries, without signs of infiltration. There is no erosion or necrosis on the surface of the tumor.

With further tumor growth, the appearance of the node, depending on the histological type of cancer, has some characteristic features.

The primary focus of squamous cell carcinoma is whitish or grayish in color, usually quite dense due to an accompanying desmoplastic reaction. On the section, the destroyed cartilages infiltrated by the tumor tissue are clearly defined. In some cases, in the presence of a tumor node, there is a pronounced peritracheal spread of the process, while the walls of the trachea are thickened, whitish, the lumen is sharply narrowed. In rare cases, the node is not macroscopically detected and only peritracheal and perivascular branched growth is noted.

Unlike squamous cell carcinoma, the node of small cell carcinoma is usually large, whitish, fleshy in appearance with extensive necrosis and hemorrhage, and sometimes with pronounced degenerative changes, accompanied by mucus. The tumor usually surrounds adjacent structures and spreads along the trachea and into the submucosa. Large tumors often compress the lumen of the trachea. The exophytic component is usually weakly expressed.

As an example of differential macroscopic diagnosis, we will describe the growth of a focus of small cell carcinoma with peritracheal growth. The bifurcation of the trachea is deployed, motionless. Carina, anterior and posterior triangles are not differentiated. The bifurcation structures are very dense, there is no mobility. The mucous membrane with local edema, bright hyperemia, rough, with areas of fragmentation. The anterior wall of the main bronchus bulges, narrowing the lumen by 1/3 of the diameter. The same changes were noted on the posterior wall of the initial sections of the right main bronchus.

The localization of the primary focus of squamous cell carcinoma is presented in Table. 13. The most frequently noted compression or germination of the esophagus (27.1% of cases), damage to neighboring organs (17.6%), vagus nerve (15.3%), subglottis of the larynx (14.1%). In single patients, tumor invasion into the thyroid gland, vena cava, sternocleidomastoid muscle, and chest wall was noted.

Table 13. Localization of the primary tumor in squamous cell carcinoma

Affected part of the trachea	Number of observations
with transition to the larynx
with the transition to the upper chest
bifurcation
total defeat
Area of ​​permanent tracheostomy

Keiser et al. (1987) by reconstructing the three-dimensional form of the tumor node, it was established that the lesions are irregularly bizarre in shape with numerous annular outgrowths (mainly in squamous cell carcinoma), ellipsoid (often in small cell cancer), mixed: ellipsoid or spheroidal with several child screenings adjacent to the main node (usually in small cell and large cell undifferentiated cancer). In practice, determining the true volume of the tumor without the use of reconstruction methods is extremely difficult. Therefore, in the morphological correction of X-ray endoscopic data, particular importance is attached to the histotopographic relationship of the tumor node with the surrounding tissues, since the involvement of some neighboring anatomical structures in the process, even with a small size of the node, aggravates the course of the process and is a prognostically unfavorable factor, which serves as the basis for changing the treatment tactics. . For this purpose, the proximal boundaries of the lesion and the prevalence of inflammatory changes in the tracheal wall are carefully studied.

regional metastasis. The sites of metastasis of tracheal cancer are the lymph nodes of the neck and mediastinum. There were no clear patterns of lymphogenous metastasis depending on the level of tracheal lesion in our material. In general, lymphogenous metastasis was noted in 54 (63.5%) of 78 cases. In cervical cancer, metastases were often detected in the mediastinum, and in the primary focus in the thoracic region, in the regional zones of the neck (Table 14).

Table 14. Lymph node involvement in tracheal squamous cell carcinoma (percentage of all cases)???

Affected segment	Zones of lymphogenous metastasis
		mediastinum
with upper chest
bifurcation
total defeat

Organotropism of metastasis of squamous cell carcinoma of the trachea is not expressed; distant metastases can be detected in the most unexpected places. Metastasis to the lungs, brain, bones, liver is quite typical. Lung involvement is found in every third patient with tumor generalization (Grillo H.C. 1986?).

Squamous cell (epidermoid) cancer is a malignant lung tumor that has at least one of three manifestations of specific differentiation: individual signs of keratinization, the formation of horny pearls, the presence of clearly visible intercellular bridges. The severity of these signs is the basis for determining the degree of tumor differentiation.

Cytological characterization. Cytological manifestations of squamous cell carcinoma largely depend on the severity of structural and cellular signs of squamous epithelial differentiation in the tumor.

Cytological examination of sputum can sometimes detect a tumor at an early stage.

In case of urgent cytological diagnosis, the conclusion has to be given on wet preparations, and this somewhat changes the microscopic picture. The cytoplasm has a less intense color and looks slightly basophilic, often merging with the background of the smear. The hyperchromicity of the nuclei is less pronounced. As the drug dries, the cytoplasm becomes sharply defined, takes on an intensely basophilic tone, and when keratinized, it has a vitreous character.

When diagnosing keratinization, the presence of polymorphic scattered cells with a sharply defined vitreous cytoplasm, stained in intense basophilic tones, is taken into account. Hyperchromic, polymorphic, pycnotic nuclei occupy a smaller part of the cell. The background of the smear is dirty, formed by fragments of the nuclei and cytoplasm of malignant elements (Fig. 12)

In the absence of keratinization, smears are dominated by large rounded polygonal cells with a large, centrally located nucleus and a narrow rim of the cytoplasm. Cells tend to form complexes. Chromatin in the nuclei has a stringy character. Nuclei are not visible.

To highly differentiated squamous cell carcinoma refers to neoplasms, the cytological material of which contains polymorphic tumor cells with pronounced signs of keratin production. In sputum, elements from the superficial sections of the tumor predominate. These are large scattered tumor cells, often located along the mucous cords among abundant cellular and (or) amorphous detritus. Their nuclei are large, hyperchromic, with pronounced signs of alteration of nuclear chromatin structures, karyopyknosis, foci of enlightenment, karyolysis.

The consequence of these processes, which occur in parallel with the accumulation of keratin masses in the cell, is the appearance of nuclear-free cells (horny scales) in the preparation. The cytoplasm of tumor cells is characterized by pronounced basophilia, and in some elements it becomes very dense, vitreous, sometimes merges with the nucleus in tone and color saturation.

In endoscopic material, cellular elements are more preserved, while mature elements of squamous cell carcinoma have the greatest diagnostic value. Often they are arranged in parallel layers (stratification), while the tumor cells are flattened, elongated. Their shape is highly variable. There are cells oval, polygonal, ribbon-shaped, club-shaped. In the nuclei and cytoplasm, pronounced dystrophic changes leading to the appearance of basophilic fine-grained detritus, often occupying large areas.

An accompanying cellular reaction is one of the characteristic features of highly differentiated forms of squamous cell carcinoma. The most common reaction is neutrophils and mixed neutrophil-macrophage, less common are lymphocytic, plasmacytic, histiocytic, eosinophilic cellular reactions.

For squamous cell carcinoma moderate differentiation a pronounced tendency to the formation of extensive layers is characteristic (Fig. 13a). This trend is also reflected in the study of sputum, in which elements of squamous cell carcinoma of moderate differentiation are located in the form of complexes (Fig. 13 b). Tumor cells are less polymorphic than in highly differentiated cancer. They are practically the same type, round or polygonal in shape with a large centrally located nucleus, often containing hypertrophied nucleoli. The cytoplasm is basophilic. It is characterized by the presence in it of small grouping vacuoles, more often located in the paranuclear zones.

In endoscopic material, intercellular bridges can sometimes be seen between adjacent elements in layers of tumor cells. In some cases, the polymorphism of cells and their nuclei is much less pronounced than in highly differentiated forms of squamous cell carcinoma. Cells and their nuclei have a rounded shape, signs of keratinization are insignificant and are detected only in individual elements. Such forms of moderately differentiated squamous cell carcinoma, especially when located peripherally, are extremely difficult to distinguish from moderately differentiated adenocarcinoma. This similarity is emphasized by the presence of hypertrophied nucleoli.

In differential diagnosis, it is necessary to take into account the irregular shape of the nucleoli of malignant cells, the clear delineation of cell boundaries, the doubling of the cell boundary in individual elements, which is unusual for glandular cancer. The germination of squamous cell carcinoma in the pleura is often accompanied by peculiar cytological changes. The neoplasm in these cases can mimic mesothelioma and is characterized by the presence of large, often multinucleated tumor cells, the appearance of numerous large vacuoles in the cytoplasm (hydropic vacuolization), and the proliferation of mesothelial elements. With the development of pleurisy, elements of squamous cell carcinoma in the fluid also often acquire signs that are unusual for them. The appearance of multinucleated cells, hypertrophy of the nucleoli, an increase in the volume of the cytoplasm and its vacuolization make it impossible to identify the histological type of cancer.

Squamous cell carcinoma of low differentiation is a tumor prone to destructive changes. The sputum of this form of squamous cell carcinoma is accompanied by an abundant amount of cellular debris, among which small clusters of cells can be detected, which are difficult to identify as tumors and are practically indistinguishable from undifferentiated cancer. In bronchoscopic material, poorly differentiated squamous cell carcinoma is represented by rounded or somewhat elongated rather monomorphic tumor cells, which are larger than cells of undifferentiated cancer.

The cell nuclei are large, located centrally, the nuclear chromatin is coarse-grained, the rim of the cytoplasm is narrow. Nuclear chromatin is extremely sensitive to mechanical impact and its stretching is often noted in individual “naked” cells. In these cases, it acquires a teardrop shape or occurs in the form of strands and threads. Sometimes the cellular elements of the tumor are characterized by severe anaplasia, are scattered, the nuclei are depleted in chromatin. Such neoplasms are difficult to differentiate from anaplastic cancer.

Cytological differential diagnosis of poorly differentiated squamous and undifferentiated types of cancer usually causes significant difficulties. Squamous cell carcinoma cells are larger and more monomorphic. The nuclei occupy almost the entire cell, surrounded by a narrow rim of the cytoplasm. Often single complexes of malignant cells are found with the presence of elongated elements along the periphery. Small cells of atypical carcinoid usually do not form complexes, lie scattered, the background of the smear is clean.

Histological characteristics. Differentiated forms of squamous cell carcinoma of the trachea are usually represented by cells and layers of tumor cells separated to varying degrees by the stroma. In the focus of highly differentiated squamous cell carcinoma, the parenchymal component is represented mainly by large light polygonal cells resembling elements of the prickly layer of the epidermis. The cells have rounded nuclei with well-defined nucleoli, abundant cytoplasm with varying degrees of acidophilia. Atypical mitoses are rare.

Cells are interconnected by well-defined intercellular bridges, the presence of which is better detected when using a green light filter. In the zone of contact of intercellular bridges there is a thickening of the cytoplasm, the intercellular spaces are expanded. In cancer cells, a layered arrangement of cells (stratification) is noted, while the basal sections are represented by smaller dark cells with a distinct polar orientation (anisomorphism). At the same time, there are signs of a violation of the alternation of layers with the appearance of individual keratinizing elements among the cells of the basal and parabasal layers (dyskeratosis).

Cellular elements with pronounced signs of keratinization are characterized by a small pycnomorphic nucleus and abundant acidophilic cytoplasm. Characteristic is the formation of concentric layers of prickly cells, flattening towards the center, with increasing signs of keratinization - horn pearls. There are also pearls with incomplete keratinization and accumulations of keratin in the form of homogeneous masses, and in some areas - groups of keratinized cells that do not form complexes and are located in isolation.

Moderately differentiated squamous cell carcinoma is characterized by the presence of more extensive layers and strands of large polymorphic cells of the prickly type with a large rounded nucleus (Fig. 14 a). Mitoses occur. The signs of stratification in the layers are preserved, and the peripheral sections are represented by smaller basal cells with their anisomorphic arrangement. In some layers, cellular elements of the basal type predominate over spinous ones in the zone of infiltrating growth. The processes of keratinization are less pronounced, but signs of dyskeratosis persist. The formation of pearls is observed, but complete keratinization does not occur in them. In such tumors, as a rule, there are also more differentiated areas with distinct signs of keratinization. The tumor is assessed as a moderately differentiated squamous cell carcinoma in the case when the differentiated areas occupy less than 50% of the total volume.

Poorly differentiated squamous cell carcinoma is represented by malignant cells of small size, characterized by pronounced polymorphism (Fig. 14). Cells have a polygonal, oval or elongated shape, their nuclei are rounded or elongated. A large number of pathological mitoses are noted. Malignant cells grow in the form of layers, along the periphery of which the polar orientation of tumor elements can be observed. Intercellular bridges, as a rule, are not detected, however, there may be individual cells with signs of keratinization, which are better detected using Kreiberg stain. In some layers there are signs of stratification. Destructive changes are often found in neoplasms of this group: hemorrhages, extensive fields of necrosis.

Among the variants of the structure of squamous cell carcinoma, spindle cell squamous cell carcinoma and squamous cell carcinoma of the clear cell type should be noted.

Spindle cell (squamous) cancer occurs as a component of squamous cell carcinoma, but usually spindle cell tumors grow in the form of a polyp (IG Olkhovskaya, 1982). In this case, areas of typical squamous cell carcinoma may not be detected, and the tumor, due to pronounced cellular polymorphism and a large number of pathological mitoses, may mimic sarcoma. In such cases, the macroscopic appearance of the tumor should be taken into account and additional research methods (electron microscopy) should be used to confirm the epithelial nature of the neoplasm.

Squamous cell carcinoma of the clear cell type in light-optical examination resembles hypernephroma metastasis. Cells grow in sheets, have relatively small, centrally located nuclei, and abundant, optically empty cytoplasm. Great importance for the differential diagnosis of these tumors, electron microscopy reveals signs of squamous differentiation (tonofilaments).

The severity of infiltrating growth of squamous cell carcinoma depends on the duration of the existence of the tumor and the degree of its differentiation. This type of cancer can grow into lymph nodes, large vessels, and merge with metastatic nodes, forming a single conglomerate. The spread of the tumor occurs both by simple germination in neighboring tissues, and through the vessels of the peribronchial lymphatic network. Peripheral sections of squamous cell carcinoma are characterized by screenings located near or at some distance from the tumor, giving the node a bizarre shape and appearing on radiographs in the form of spicules of various widths and lengths.

Highly differentiated subtypes of squamous cell carcinoma are characterized by a well-developed stroma, often with signs of pronounced collagenization and the formation of cell-free areas (desmoplastic reaction). Sometimes among the vast fields there are, as it were, small cancerous alveoli immured in it, the cellular elements of which have pronounced dystrophic changes.

One of the characteristic signs of squamous cell carcinoma of the trachea is an accompanying inflammatory reaction, which manifests itself in the form of predominantly leukocyte and (or) lymphoid cell infiltration of the stroma. In the zone of dystrophic or destructive changes, giant multinucleated cells such as foreign bodies are often found. Near the primary tumor focus, secondary changes are usually found in the form of endotracheitis, areas of squamous metaplasia, sometimes with the formation of cancer foci in these areas.

Ultrastructure. The tumor has a structure similar to squamous cell carcinoma of other localizations, that is, it contains all the signs of a squamous epithelium: filaments, tonofibrils, desmosomes, fragments of the basement membrane (Fig. 15).

In highly differentiated squamous cell carcinoma, layers of large differentiated cells predominate, containing coarse bundles of tonofilaments and well-developed desmosomes. Polygonal cells with large oval or rounded nuclei. The cytoplasm is abundant, contains ribosomes and polysomes, mitochondria, and profiles of the rough and smooth endoplasmic reticulum.

In moderately differentiated cancer, large polygonal cells with a smooth cytolemma also predominate, tightly adjacent to each other, contacting through well-developed desmosomes. The cytoplasm of the cells is well developed, the number of filaments and tonofibrils in different cells varies, but in general they are less than in the focus of highly differentiated cancer. Along with squamous differentiation, cells with signs of glandular differentiation can be found in moderately differentiated squamous cell carcinoma: gaps with microvilli facing into them are formed between adjacent cells, and serous secretory granules are found in individual cells.

Poorly differentiated squamous cell carcinoma is characterized by a predominance of small cells. The nuclei are oval, with invaginations, the chromatin is large-lumpy. In the cytoplasm, ribosomes and polysomes predominate, other organelles are poorly developed. Tonofilaments are represented by small scattered bundles. Only individual desmosomal contacts are preserved.

On our material, highly differentiated squamous cell carcinoma of the trachea was confirmed in 24 (30.8%) of 78 patients, moderately differentiated - in 35 (44.9%), poorly differentiated - in 15 (19.2%). In the remaining 4 observations, only a cytological study was performed, in which it was not possible to establish a subtype of squamous cell carcinoma.

The prognosis for squamous cell carcinoma largely depends on the extent of the primary lesion and the presence of metastases. Unlike adenoid cystic cancer, the tumor tends to progress early. According to H.C. Grillo et al. (1986?) Of 49 radically operated patients, 22.7% lived for 3 years, 9.1% lived for 5 years. When using only radiation therapy, the average life expectancy was 10 months. Of 22 patients without tumor progression, regional metastases were confirmed in 2 (%). On the other hand, out of 13 deaths from progression, 6 (46!%) surgical observations revealed metastases in the lymph nodes. An unfavorable prognosis was observed in most patients with germination of all layers of the tracheal wall.

The method of treatment significantly affects the survival of patients. In our experience, the most radical method of treatment is circular resection of the affected tracheal segment. The prognosis largely depends on the radicalness of the operation (elements of the tumor along the border of the intersection of the walls). Postoperative radiation therapy at a dose of 40-50 Gy can significantly reduce the risk of local and regional recurrence. Radiation therapy without surgery in most cases leads to partial and sometimes complete regression of the tumor, but patients die from relapses and progression of squamous cell carcinoma. Endoprosthetics in combination with symptomatic treatment can significantly prolong the life of patients and improve the quality of life. The results of treatment, depending on the method, are shown in Fig. 16.

Figure 16. Survival of patients with squamous cell carcinoma of the trachea

Squamous cell carcinoma is a malignant neoplasm. The disease has been known since antiquity, and information has also been preserved that in those days, at the initial stage of development, the tumor was removed. In a neglected state, treatment was considered meaningless.

Characteristics of the disease

Squamous cell carcinoma is the most common disease among other types of cancer. This feature can be explained because the epithelial layer, which covers all the internal organs, and the skin is constantly updated. The more intense the process of cell division, the greater the likelihood of a malfunction or mutation, which leads to the formation of cancer.

Cells resulting from such mutations begin to rapidly divide. In a short time, with the participation of such a mechanism, a malignant tumor is formed, from which metastases are carried through the bloodstream and lymphatic system to other vital organs.

Carcinomas occur different kind so they were divided into groups. Sometimes the tumor is a formation with numerous nodes, and in some cases, the carcinoma grows inward, forming ulcers. Neoplasms are divided into the following types:

• damage to the mucous membranes of the stomach, prostate, intestines, bronchi is called adenocarcinoma;
• squamous cell carcinoma develops from flat layers of the epithelium, due to which carcinoma of the cervix, larynx is formed;
• there are also mixed forms of oncological formations, when both mucous membranes and flat layers of epithelial tissues are affected.

The scca squamous cell carcinoma antigen is a tumor marker that can detect the presence of a tumor, including neoplasms of the head and neck. Squamous cell carcinoma has an increased sensitivity to such an antigen even at the initial stage of development. After surgery to remove the tumor, a sharp decrease in this sensitivity can be observed.

If, after surgery or chemotherapy, it is still observed high rate, the disease continues to progress. Perhaps even metastases to nearby organs are formed.

Before starting treatment, it is necessary to identify the exact cause, determine what carcinoma is and how it affects the body in a particular case. Since malignant cells spread rapidly, therapy should be started as early as possible.

The reasons

Squamous cell carcinoma occurs due to the following factors:

• hereditary predisposition;
• exposure to ultraviolet rays;
• tobacco smoking abuse;
• drinking alcoholic beverages a lot;
• lack of proper nutrition;
• daily work with pesticides;
• environmental problems;
• infectious damage to the body;
• age after 50 years.

Cervical carcinoma occurs for the following reasons:

• the onset of sexual activity in early adolescence;
• frequent change of sexual partners throughout life;
• the presence of infectious diseases, sexually transmitted, including the herpes virus and human papillomavirus;
• the use of an intrauterine device as a means of contraception;
• traumatic injury to the vagina during natural childbirth, as well as abortion;
• hormonal failure of the body as a result of uncontrolled medication;
• disorders associated with age-related changes in the mucous membranes;
• decrease in protective functions.

The use of scc antigen of squamous cell carcinoma allows you to determine the further course of treatment. Why the antigen rises, the reasons for such deviations:

• previous therapy was ineffective;
• the development in the body of other tumor lesions of a benign type, including abnormalities associated with squamous metaplasia.

It should also be remembered that scca is increased only in the presence of a pathological process in the body. In a healthy person, the indicator does not exceed the norm.

Adenocarcinoma and squamous cell carcinoma are promoted by the advanced age of the patient - after 65 years. This feature is associated with the loss of protective functions of the body. Especially if there is exposure to sunlight, the surface of the skin undergoes significant changes. In addition, there are failures in the mechanism of recognition of mutated cells.

Diagnostics

How squamous cell carcinoma will be diagnosed depends on the location of the tumor and on the signs of manifestation. This disease is defined in the following ways:

• CT scan;
• general blood analysis;
• blood chemistry;
• biopsy;
• determination of the norm of oncomarkers;
• endoscopic examination.

To identify at what stage of development a non-keratinizing squamous cell carcinoma or adenocarcinoma is located, an analysis for cytology is necessary. According to the result of such a diagnosis, doctors establish further prognosis.

Not always a study on tumor markers gives a true result. Even with renal insufficiency, hypersensitivity may be detected. Therefore, it is important for specialists to distinguish normal indicators from malignant pathology.

Symptoms

Squamous cell carcinoma is divided into several stages:

1. The tumor does not cause any signs, the diameter does not exceed 2 cm, it is localized on the surface of the skin.
2. There is an increase in size, penetration of the tumor into the deep layers, primary metastases appear.
3. The neoplasm has an impressive size, affects the nearest organs, but does not affect the cartilaginous tissues.
4. The last stage is characterized by numerous metastases, including in cartilaginous and bone tissues.

Carcinoma of the lungs and throat in some cases is accompanied by keratinization, the following symptoms occur:

• mucous discharge with blood from the larynx;
• persistent cough;
• high body temperature;
• drastic weight loss.

When the lungs and pharynx are affected, other chronic diseases immediately become aggravated. The inflammatory process in the body cannot be stopped with conventional cough medicines.

Treatment

Since the carcinoma grows rapidly and signs of growth appear, it is removed surgically. In addition, the following methods are used:

• chemotherapy, radiation therapy;
• laser exposure;
• immunotherapy.

If lung carcinoma is detected, the prognosis will depend on the size and location of the tumor. Of great importance will be the analysis indicator for the oncomarker.

Sometimes it becomes necessary to remove the bronchial glands, while it is necessary to control the lines of resection of the bronchus, the lesion. Small tumors are eliminated by chemotherapy.

If primary signs of appearance are observed and the diagnosis showed the presence of an initial stage carcinoma, then the problem can be dealt with without any health consequences. However, such a tumor is most common in the advanced form; further prognosis will depend on the degree of resistance of the organism, as well as on the location of the carcinoma.

Even now, the possibilities of modern medicine do not always help to cope with oncology. Cancer of this type is the most common, from such tumors every year a huge number of people die around the world.

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

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

What is an SCC antigen

The SCC antigen is derived from a glycoprotein. The latter belongs to the family of serine protease inhibitors. The mass of the substance is about 50 kilodaltons.

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

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

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

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

Cervical cancer

It was mentioned above that cervical cancer can become the reason for the increase in the antigen of squamous cell carcinoma SCCA. Considering that it is in the cervix that there is a squamous epithelium, this disease is diagnosed in this form most often.

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

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

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

Lungs' cancer

This disease also has a number of characteristic symptoms that make it possible to identify it at an early stage. It:

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

The latter symptom usually occurs when the squamous cell carcinoma of the lung is already in stage 3 or 4.

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

Cancer of the larynx

Squamous cell carcinoma of the larynx appears quite large quantity symptoms. The main ones are:

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

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

Esophageal carcinoma

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

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

For the purpose of diagnosis, ultrasound, CT, esophagoscopy are performed. Blood donation is required for analysis. During the examination, doctors get the opportunity to confirm oncology, get information about the size of the tumor and the features of its localization. Metastasis can also be detected if it occurs.

Skin cancer

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

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

How to donate blood for tumor markers

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

1. Do not eat 8-10 hours before the analysis.
2. Do not drink alcohol 3 days before the examination.
3. Do not smoke on the day of blood sampling.
4. Follow the diet for three days before the analysis. Do not eat fatty, smoked, fried.
5. Eliminate physical activity before the study.
6. Do not have sex for 7 days prior to blood sampling.
7. It is recommended to donate blood before 11 am.

Subject to the above requirements, the results of the analysis for oncomarkers will be as objective as possible, respectively, the accuracy of the diagnosis is guaranteed, which will contribute to the development of the most effective treatment program.

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 a malignant neoplasm, in the absence of surgical intervention, 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:

Symptom Name		Cancer of the mouth and lips	Esophageal carcinoma	Cancer of the larynx	Cancer of the trachea and bronchi	Cervical cancer	Lung cancer	Stomach cancer	Cancer of the lymph nodes
Appearance and localization of the focus of pathology	plaques. The upper layer of the epidermis, more often sensitive skin	Oral mucosa, lips	ring-shaped growth that partially encircles the esophagus	Epiglottis, ventricles of the larynx, often vocal cords	node of the glandular or columnar epithelium of the lungs, less often - alveolar lung epithelium	tumor of the cervical cavity, obstruction of the fallopian tubes	nodes in the branches of the lungs and bronchi	ulcers of the gastrointestinal mucosa	tumors of the inguinal, cervical and axillary areas
Detection	visualization of the focus of pathology	palpation of the ulcer, pain on palpation					ultrasound, x-ray		palpation, ultrasound
Internal sensations	pain on palpation	pain with impaired salivation, redness and swelling of the gums, difficulty speaking	lack of appetite, heartburn, signs of dyspepsia, regurgitation of solid food, chest pain, disturbed stools with blood	pain when eating, lack of appetite, feeling thirsty,	dry cough, blood impurities during expectoration, impaired respiratory function	disturbed menstrual cycle, severe pain, premenstrual syndrome, bleeding	respiratory failure, coughing up blood, hoarse voice	lack of appetite, digestive problems, chronic constipation, diarrhea	severe attacks of pain depending on the focus of the pathology

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 skin diseases;
• 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 in the body, 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. It is characterized by rapid growth, mutation of the cells of the spinous 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. malignant tumor can massively affect the walls of organs, muscles and blood vessels, gives metastases 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 rehabilitation period already with physiotherapy 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 tumors, as an independent method of intensive therapy for 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 a radical method of treating squamous cell cancer, the primary focus and lymph nodes affected by metastases are removed. 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 according to medical indications: 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 radiation therapy, to suppress side effects of the 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, and only narcotic analgesics are prescribed to him for pain relief.

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 perform a comprehensive diagnosis of the body to identify dangerous neoplasms, to respond in time to changes in the structure of the dermis. Additional preventive measures 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.

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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 give recommendations for treatment, based on the individual characteristics of a particular patient.

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