Squamous-cell carcinoma explained

Squamous-cell carcinoma (SCC), also known as epidermoid carcinoma, comprises a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the lining of the respiratory and digestive tracts.[1]

The squamous-cell carcinomas of different body sites can show differences in their presented symptoms, natural history, prognosis, and response to treatment.

By body location

Human papillomavirus infection has been associated with SCCs of the oropharynx, lung,[2] fingers,[3] and anogenital region.

Head and neck cancer

See main article: Head and neck cancer.

About 90%[4] of cases of head and neck cancer (cancer of the mouth, nasal cavity, nasopharynx, throat and associated structures) are due to SCC.

Skin

Cutaneous squamous-cell carcinoma is the second most common skin cancer, accounting for over 1 million cases in the United States each year.

Thyroid

Primary squamous-cell carcinoma of the thyroid shows an aggressive biological phenotype resulting in poor prognosis for patients.[5]

Esophagus

Esophageal cancer may be due to either esophageal squamous-cell carcinoma (ESCC) or adenocarcinoma (EAC). SCCs tend to occur closer to the mouth, while adenocarcinomas occur closer to the stomach. Dysphagia (difficulty swallowing, solids worse than liquids) and painful swallowing are common initial symptoms. If the disease is localized, surgical removal of the affected esophagus may offer the possibility of a cure. If the disease has spread, chemotherapy and radiotherapy are commonly used.[6]

Lung

See main article: Squamous-cell carcinoma of the lung.

When associated with the lung, it is typically a centrally located large-cell cancer (non-small-cell lung cancer). It often has a paraneoplastic syndrome causing ectopic production of parathyroid hormone-related protein, resulting in hypercalcemia, but paraneoplastic syndrome is more commonly associated with small-cell lung cancer. It is primarily due to smoking.[7]

Penis

Human papillomavirus (HPV), primarily HPV 16 and 18, are strongly implicated in the development of SCC of the penis.Three carcinomas in situ are associated with SCCs of the penis:

  1. Bowen's disease presents as leukoplakia on the shaft. Around a third of cases progress to SCC.
  2. Erythroplasia of Queyrat, a variation of Bowen's disease, presents as erythroplakia on the glans.
  3. Bowenoid papulosis, which histologically resembles Bowen disease, presents as reddish papules.[8]

Prostate

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

Vagina and cervix

Squamous cell carcinoma of the vagina 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.[9]

Ovary

Ovarian squamous cell carcinoma (oSCC) or squamous ovarian carcinoma (SOC) is a rare tumor that accounts for 1% of ovarian cancers.[10]

Bladder

Most bladder cancer is transitional cell, but bladder cancer associated with schistosomiasis is often SCC.

Eye

Conjunctival squamous cell carcinoma and corneal intraepithelial neoplasia comprise ocular surface squamous neoplasia (OSSN).

Diagnosis

Medical history, physical examination and medical imaging may suggest a squamous-cell carcinoma, but a biopsy for histopathology generally establishes the diagnosis. TP63 staining is the main histological marker for squamous-cell carcinoma. In addition, TP63 is an essential transcription factor to establish identity of the squamous cells.[11]

Classification

Cancer can be considered a very large and exceptionally heterogeneous family of malignant diseases, with squamous-cell carcinomas comprising one of the largest subsets.[12] [13] [14] All SCC lesions are thought to begin via the repeated, uncontrolled division of cancer stem cells of epithelial lineage or characteristics. SCCs arise from squamous cells, which are flat cells that line many areas of the body. Some of which are keratinocytes. Accumulation of these cancer cells causes a microscopic focus of abnormal cells that are, at least initially, locally confined within the specific tissue in which the progenitor cell resided. This condition is called squamous-cell carcinoma in situ, and it is diagnosed when the tumor has not yet penetrated the basement membrane or other delimiting structure to invade adjacent tissues. Once the lesion has grown and progressed to the point where it has breached, penetrated, and infiltrated adjacent structures, it is referred to as "invasive" squamous-cell carcinoma. Once a carcinoma becomes invasive, it is able to spread to other organs and cause the formation of a metastasis, or "secondary tumor".

Tissue of origin

The International Classification of Diseases for Oncology (ICD-O) system lists a number of morphological subtypes and variants of malignant squamous-cell neoplasms, including:[15]

Other variants of SCCs are recognized under other systems, such as keratoacanthoma.

Other histopathologic subtypes

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

Prevention

Studies have found evidences for an association between diet and skin cancers, including SCC. The consumption of high-fat dairy foods increases SCC tumor risk in people with previous skin cancer. Green leafy vegetables may help prevent development of subsequent SCC and multiple studies found that raw vegetables and fruits are significantly protective against SCC risk.[20] [21] On the other hand, consumption of whole milk, yogurt, and cheese may increase SCC risk in susceptible people.[22] In addition, meat and fat dietary pattern can increase the risk of SCC in people without a history of SCC, but the association is again more prominent in people with a history of skin cancer.[23] Tobacco smoking and a dietary pattern characterized by high beer and liquor intake also increase the risk of SCC significantly.[24]

Notes and References

  1. Web site: NCI Dictionary of Cancer Terms. National Cancer Institute. 9 November 2016. 2011-02-02.
  2. Yu Y, Yang A, Hu S, Yan H . Correlation of HPV-16/18 infection of human papillomavirus with lung squamous cell carcinomas in Western China . Oncology Reports . 21 . 6 . 1627–32 . June 2009 . 19424646 . 10.3892/or_00000397 . free .
  3. Web site: Recurrent Squamous Cell Carcinoma In Situ of the Finger. 2010-09-22.
  4. Web site: Types of head and neck cancer - Understanding - Macmillan Cancer Support. 15 March 2017.
  5. Syed MI, Stewart M, Syed S, Dahill S, Adams C, McLellan DR, Clark LJ . Squamous cell carcinoma of the thyroid gland: primary or secondary disease? . The Journal of Laryngology and Otology . 125 . 1 . 3–9 . January 2011 . 20950510 . 10.1017/S0022215110002070 . 28225556 .
  6. Web site: Esophageal Cancer. The Lecturio Medical Concept Library . 26 October 2020. 6 August 2021.
  7. Book: Charlotte . Pooler . Ruth A . Hannon . Carol . Porth . Glenn . Matfin . vanc . Porth pathophysiology: concepts of altered health states . 2010 . Wolters Kluwer Health/Lippincott Williams & Wilkins . Philadelphia, PA . 978-1-60547-781-7 . 660 . 1st Canadian.
  8. Book: Robbins . Stanley . Kumar . Vinay . Abbas . Abul . Fausto . Nelson . vanc . Robbins Basic Pathology . 2007 . Saunders/Elsevier . Philadelphia . 978-1-4160-2973-1 . 688 . 8th.
  9. Web site: Squamous-cell Carcinoma of the Vagina. www.dynamed.com. 2018-02-20.
  10. Srivastava . Himsweta . Shree . Sneha . Guleria . Kiran . Singh . Usha R . May 2017 . Pure Primary Squamous Cell Carcinoma of Ovary – A Rare Case Report . Journal of Clinical and Diagnostic Research . 11 . 5 . QD01–QD02 . 10.7860/JCDR/2017/16899.9771 . 2249-782X . 5483757 . 28658855 . Case report.
  11. Prieto-Garcia C, Hartmann O, Reissland M, Braun F, Fischer T, Walz S, Schülein-Völk C, Eilers U, Ade CP, Calzado MA, Orian A, Maric HM, Münch C, Rosenfeldt M, Eilers M, Diefenbacher ME . 6 . Maintaining protein stability of ∆Np63 via USP28 is required by squamous cancer cells . EMBO Molecular Medicine . 12 . 4 . e11101 . April 2020 . 32128997 . 10.15252/emmm.201911101 . 7136964 . free .
  12. Berman JJ . Tumor taxonomy for the developmental lineage classification of neoplasms . BMC Cancer . 4 . 1 . 88 . November 2004 . 15571625 . 535937 . 10.1186/1471-2407-4-88 . free .
  13. Berman JJ . Tumor classification: molecular analysis meets Aristotle . BMC Cancer . 4 . 1 . 10 . March 2004 . 15113444 . 415552 . 10.1186/1471-2407-4-10 . free .
  14. Book: Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart . Travis . William D . Brambilla . Elisabeth . Muller-Hermelink . H Konrad . Harris . Curtis C . vanc . IARC Press . Lyon . 2004 . World Health Organization Classification of Tumours . 978-92-832-2418-1 . 27 March 2010 . 23 August 2009 . https://web.archive.org/web/20090823210304/http://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb10/bb10-cover.pdf . dead .
  15. Book: Van Holten, Valerie . World Health Organization . C.S. . Muir . C.L. . Percy . V. . Van Holten . International Classification of Diseases for Oncology: ICD-0 . 2nd . Geneva, Switzerland . World Health Organization . 1990 . 9789241544146 .
  16. Book: Rapini . Ronald P. . Bolognia . Jean L. . Jorizzo . Joseph L. . vanc . Dermatology: 2-Volume Set . Mosby . St. Louis . 2007 . 978-1-4160-2999-1 .
  17. Sinha S, Su S, Workentine M, Agabalyan N, Cheng M, Gabriel V, Biernaskie J . Transcriptional Analysis Reveals Evidence of Chronically Impeded ECM Turnover and Epithelium-to-Mesenchyme Transition in Scar Tissue Giving Rise to Marjolin's Ulcer . Journal of Burn Care & Research . 38 . 1 . e14–e22 . January 2017 . 27679957 . 10.1097/BCR.0000000000000432 . 3702018 .
  18. Book: Thomas B . Fitzpatrick . Irwin M . Freedberg . vanc . 2003 . Fitzpatrick's dermatology in general medicine . 6th . New York, NY . McGraw-Hill . 978-0-07-138076-8 . 743.
  19. Book: Radhi, Jasim . https://books.google.com/books?id=dxyaDwAAQBAJ&pg=PA68 . Basaloid Squamous Cell Carcinoma . 68 . Squamous Cell Carcinoma . Xiaoming . Li . 2012 . InTech . Rijeka, Croatia . 978-953-51-0024-9.
  20. De Stefani E, Deneo-Pellegrini H, Ronco AL, Boffetta P, Brennan P, Muñoz N, Castellsagué X, Correa P, Mendilaharsu M . Food groups and risk of squamous cell carcinoma of the oesophagus: a case-control study in Uruguay . British Journal of Cancer . 89 . 7 . 1209–14 . October 2003 . 14520448 . 2394307 . 10.1038/sj.bjc.6601239 .
  21. Chen YK, Lee CH, Wu IC, Liu JS, Wu DC, Lee JM, Goan YG, Chou SH, Huang CT, Lee CY, Hung HC, Yang JF, Wu MT . Food intake and the occurrence of squamous cell carcinoma in different sections of the esophagus in Taiwanese men . Nutrition . 25 . 7–8 . 753–61 . July 2009 . 19394796 . 10.1016/j.nut.2009.02.002 .
  22. Hughes MC, van der Pols JC, Marks GC, Green AC . Food intake and risk of squamous cell carcinoma of the skin in a community: the Nambour skin cancer cohort study . International Journal of Cancer . 119 . 8 . 1953–60 . October 2006 . 16721782 . 10.1002/ijc.22061 . free .
  23. Ibiebele TI, van der Pols JC, Hughes MC, Marks GC, Williams GM, Green AC . Dietary pattern in association with squamous cell carcinoma of the skin: a prospective study . The American Journal of Clinical Nutrition . 85 . 5 . 1401–8 . May 2007 . 17490979 . 10.1093/ajcn/85.5.1401 . free .
  24. Bahmanyar S, Ye W . Dietary patterns and risk of squamous-cell carcinoma and adenocarcinoma of the esophagus and adenocarcinoma of the gastric cardia: a population-based case-control study in Sweden . Nutrition and Cancer . 54 . 2 . 171–8 . 2006 . 16898861 . 10.1207/s15327914nc5402_3 . 1959103 .

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