How Is Squamous Cell Carcinoma Of Oral Cavity Diagnosed
A diagnosis of Squamous Cell Carcinoma of Oral Cavity is made by:
- Complete physical examination with detailed medical history evaluation
- Examination by a dermatologist using a dermoscopy, a special device to examine the skin
- Woodâs lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment.
- A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
- Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
- Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis
In case of metastatic SCC, the following diagnostic procedures can be used to procure the tissue sample:
Squamous Cell Carcinoma Survival Rate
In general, the squamous cell carcinoma survival rate is very highwhen detected early, the five-year survival rate is 99 percent. Even if squamous cell carcinoma has spread to nearby lymph nodes, the cancer may be effectively treated through a combination of surgery and radiation treatment. Nevertheless, a patient who has been treated for squamous cell carcinoma in the past always faces the possibility of a recurrence, so lifelong monitoring to increase the chance of early detection is highly encouraged.
What Causes This Type Cancer
The reason why a particular dog may develop this, or any cancer, is not straightforward. Very few cancers have a single known cause. Most seem to be caused by a complex mix of risk factors, some environmental and some genetic or hereditary.
As with SCC in humans, exposure to ultraviolet rays/sunlight has been attributed to the development of these tumors. Exposure to papilloma-like viruses appears to contribute to multicentric SCC in the mouth and other areas of the skin where squamous cells are present.
Certain breeds are known to have an increased incidence of SCC, including Scottish Terriers, Pekingese, Boxer Dogs, Poodles, and Norwegian Elkhounds. SCC of the skin is also more common in dogs that are sparsely haired and have light-colored hair and skin . In contrast, large-breed dark-coated dogs are more prone to SCC of the toes .
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Squamous Cell Carcinoma Of The Lungs
Squamous cell carcinoma of the lungs is one form of non-small cell lung cancer. Non-small cell lung cancers account for about 85 percent of lung cancers, and of these, roughly 30 percent are squamous cell carcinomas.
Squamous cell carcinoma begins in the tissues that line the air passages in the lungs. It is also known as epidermoid carcinoma. Most squamous cell carcinomas of the lungs are located centrally, usually in the larger bronchi that join the trachea to the lung.
How Is Squamous Cell Skin Cancer Of The Head And Neck Diagnosed
Diagnosis is made by clinical exam and a biopsy. Squamous cell cancers are staged by size and extent of growth. Squamous cell cancers can metastasize to nearby lymph nodes or other organs, and can invade both small and large nerves and local structures.
Biopsy can help determine if the squamous cell cancer is a low-risk tumor or a high-risk tumor that requires more aggressive treatment. Low-risk tumors are less than 10 millimeters in size, less than or equal to 5 millimeters deep and do not involve structures beyond the surrounding fat. High-risk tumors in the head and neck are those that involve the central face, nose and eye area, as well as those tumors that are greater than or equal to 10 millimeters on the cheeks, scalp and neck, tumors that are more than 5 millimeters thick or involve adjacent structures, tumors that invade nerves, tumors that are recurrent or arising from previously radiated tissue, and tumors arising in patients who are immunosuppressed.
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Stage 0 Squamous Cell Carcinoma
This is a very early stage that may or may not develop into SCC depending on whether it is caught in time and treated. This is considered a pre-malignant or pre-cancerous stage and is also known as carcinoma in situ or Bowens disease. It is at this point only present in the upper layer of the skin known as the epidermis and is yet to penetrate to lower layers and spread to deeper areas. Cells have begun to turn cancerous but have not yet spread and affected surrounding areas.6
How Is Squamous Cell Skin Cancer Treated
Although squamous cell cancers usually grow slowly, it is important to see a dermatologist quickly. The sooner you see your doctor and the cancer is diagnosed and treated, the less complicated the surgery to remove it will be, and the faster you will make a complete recovery, Dr. Leffell explains. The treatment for squamous cell cancer varies according to the size and location of the lesion. The surgical options are the same as those for basal cell cancer:
- Surgical excision: Removing a squamous cell lesion is a simple procedure that typically takes place in the dermatologists office. After numbing the cancer and the area around it with a local anesthetic, the doctor uses a scalpel to remove the tumor and some of the surrounding skin to make sure all cancer is eliminated. Estimating how much to take requires skill and expertise, Dr. Leffell notes. The risk of taking too little tissue is that some cancer remains taking too much leaves a larger scar than is necessary. Shaped like a football, the wound is stitched together, using plastic surgery techniques. If dissolvable stitches are used, they will disappear on their own as the area heals. Though the procedure leaves some redness and a small scar, it tends to become less noticeable over time. The cure rate for this type of excision is typically about 90 to 93 percent, says Dr. Leffell. But, of course, this is dependent on the skill and experience of the doctor.
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What Does Squamous Cell Carcinoma Look Like
Squamous cell carcinomas most often affect areas with lot of sun exposure such as the face, scalp, neck, ears, backs of hands, forearms, and shins. Squamous cell carcinomas can occur in many other areas of the skin. Squamous cell carcinoma often looks like a rough scaly spot, scab or sore that just will not heal. They tend to bleed easier than normal skin.
Scabs and scratches typically heal within 4 weeks. Skin cancer does not heal because the cells are abnormal. If you have a non-healing scab or sore, and it has been more than 4 weeks you should call your dermatologist to have this spot examined.
It is very important to note that while these characteristics are some of the most common signs of squamous cell carcinoma, there is no substitute for your skin concern being examined in person by a Board-Certified Dermatologist. This is the gold standard for having any of your skin concerns addressed. Your Board-Certified Dermatologist will perform a comprehensive examination and is the expert when it comes to diagnosis and treating skin cancers.
What causes squamous cell carcinoma?
How is squamous cell carcinoma diagnosed?
Diagnosis Of Oral Squamous Cell Carcinoma
Data from Amin MB, Edge S, Greene F, Byrd DR, et al: American Joint Committee on Cancer Cancer Staging Manual, 8th edition. New York, Springer, 2017 AJCC Cancer Staging Form Supplement, 2018. For a comparison of the 7th and 8th edition, see Cramer JD, Reddy A, Ferris RL, et al: Comparison of the seventh and eighth edition American Joint Committee on Cancer oral cavity staging systems. Laryngoscope, 128:2351-2360, 2018. doi: 10.1002/lary.27205
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When Your Cancer Comes Back
Finishing your treatment can come as a huge relief, especially if your doctor tells you youre in remission. Yet your cancer can come back. This is called a recurrence.
See your doctor for regular follow-up visits to catch any recurrence early, when its most treatable. The doctor who treated your cancer will let you know how often to get check-ups. You may see your doctor every 3 months for the first year, and then less often.
How Can Squamous Cell Carcinoma Of Oral Cavity Be Prevented
A few methods to prevent Squamous Cell Carcinoma of Oral Cavity include:
- Maintain proper oral hygiene
- Avoid chewing tobacco and smoking
- Avoid prolonged and chronic exposure to the sun
Regular medical screening at periodic intervals with blood tests, scans, and physical examinations, are mandatory, due to its high metastasizing potential and possibility of recurrence. Often several years of active vigilance is necessary.
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Symptoms And Signs Of Oral Squamous Cell Carcinoma
Oral lesions are asymptomatic initially, highlighting the need for oral screening. Most dental professionals carefully examine the oral cavity and oropharynx during routine care and may do a brush biopsy of abnormal areas. The lesions may appear as areas of erythroplakia or leukoplakia and may be exophytic or ulcerated. Cancers are often indurated and firm with a rolled border. As the lesions increase in size, pain, dysarthria, and dysphagia may result.
This photo shows a close-up of the inside of the mouth in a patient with squamous cell carcinoma of the oral mucosa.
Erythroplakia is a general term for red, flat, or eroded velvety lesions that develop in the mouth. In this image, an exophytic squamous cell carcinoma on the tongue is surrounded by a margin of erythroplakia.
Leukoplakia is a general term for white hyperkeratotic plaques that develop in the mouth. About 80% are benign. However, in this image, squamous cell carcinoma is present in one of the leukoplakic lesions on the ventral surface of the tongue .
Treatment Of Oral Squamous Cell Carcinoma
Surgery, with postoperative radiation or chemoradiation as needed
For most oral cavity cancers, surgery is the initial treatment of choice. Radiation or chemoradiation is added postoperatively if disease is more advanced or has high-risk features.
Selective neck dissection is indicated if the risk of nodal disease exceeds 15 to 20%. Although there is no firm consensus, neck dissections are typically done for any lesion with a depth of invasion > about 3.5 mm.
Routine surgical reconstruction is the key to reducing postoperative oral disabilities procedures range from local tissue flaps to free tissue transfers. Speech and swallowing therapy may be required after significant resections.
Radiation therapy is an alternative treatment. Chemotherapy is not used routinely as primary therapy but is recommended as adjuvant therapy along with radiation in patients with advanced nodal disease.
Treatment of squamous cell carcinoma of the lip is surgical excision with reconstruction to maximize postoperative function. When large areas of the lip exhibit premalignant change, the lip can be surgically shaved, or a laser can remove all affected mucosa. Mohs surgery can be used. Thereafter, appropriate sunscreen application is recommended.
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What Makes A Squamous Cell Carcinoma Of The Skin More Aggressive
Being told you have skin cancer is alarming to say the least, but if youve been diagnosed with squamous cell carcinoma , exactly how worried should you be? Of the three most common types of skin cancer, SCC is considered less serious than melanoma, but more serious than basal cell carcinoma, which very rarely spreads, explains Dr. Adam Mamelak, a board certified Dermatologist and Mohs surgeon in Austin, Texas. SCC sometimes grows into the deeper layers of the skin and spreads to other parts of the body. While the potential for this happening is quite low, certain characteristics of the cancer suggest a higher risk.
Differentiation of a tumor refers to how closely the cancer cells resemble the cells of origin, which are, in this case, the squamous skin cells. When SCC is poorly differentiated, the cancer cells dont resemble the normal cells very much at all, Dr. Mamelak shares.
Tumors larger than 2 cm when identified have poorer outcomes than smaller lesions.
Skin cancers that invade deeper than 6mm below the surface of the skin have a higher potential to spread.
Management Of Cutaneous Squamous Cell Carcinoma
Treatment options include the following:
Surgical excision with clear margins, as verified by frozen sections
Mohs micrographic surgery for invasive cSCC in the facial region
Radiation therapy as an adjuvant to surgery, to provide improved locoregional control, or as primary therapy in patients who are unable to undergo surgical excision
Chemotherapy, such as treatment with oral 5-fluorouracil and epidermal growth factor receptor inhibitors, as adjuvant therapy for select highest-risk cases
Systemic chemotherapy for metastatic cSCC
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Squamous Cell Skin Cancer Of The Head And Neck Treatment
Surgery is the preferred management method for the majority of squamous cell skin cancers. Low-risk, early stage, small squamous cell cancers can be removed by Mohs surgery, which is a technique that spares normal tissue through repeated intraoperative margin testing, removing only the cancer and leaving adjacent normal tissue. Excision, curettage and desiccation, and cryosurgery can also be used to remove the cancer while sparing normal tissue. Radiation alone is an alternative for low-risk tumors when surgery is not desirable because of cosmetic concerns or medical reasons.
Large tumors and tumors with nerve or lymph node involvement are not suitable for Mohs surgery and require removal of at least 5-millimeter margins of normal tissue around the cancer and neck dissection for involved lymph nodes. Larger tumors require reconstruction, which can be done at the time of surgery if margin status is clear. Reconstruction should be staged when margins status is not clear.
Patients with high-risk tumors should meet with a radiation therapist to discuss postoperative radiation. Chemotherapy may be added to radiation for extensive lymph node involvement or positive margins that cannot be cleared with additional surgery. In patients with high-risk tumors who are not surgical candidates, systemic treatment with both radiation and chemotherapy is used. Such cases require multidisciplinary care by a team of surgeons, radiation oncologists and medical oncologists.
What Are The Symptoms Of Squamous Cell Carcinoma
The first sign of an SCC is usually a thickened, red, scaly spot thatdoesnt heal. You are most likely to find an SCC on the back of your hands,forearms, legs, scalp, ears or lips. If its on your lips, it can look like asmall ulcer or patch of scaly skin that doesnt go away.
An SCC may also look like:
- a crusted sore
- a sore or rough patch inside your mouth
- a red, raised sore around your anus or genitals
An SCC will probably grow quickly over several weeks or months.
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How Skin Cancer Progresses
All cancer starts in one part of your body. With SCC, it starts in your skin. From there, cancer cells can spread.
How far your cancer has spread is known as its stage. Doctors assign skin cancers a stage number between 0 and 4.
Stage 4 means your cancer has spread beyond your skin. Your doctor might call the cancer advanced or metastatic at this stage. It means your cancer has traveled to one or more of your lymph nodes, and it may have reached your bones or other organs.
The stage of your cancer and where it is located will help your doctor find the right treatment for you. At stage 4 your cancer may not be curable, but it is still treatable.
Squamous Cell Skin Cancer Is More Serious Than Basal Cell Carcinoma
Squamous Cell Carcinoma is a less prevalent form of skin cancer compared to Basal Cell Carcinoma, which has about a million cases each year. However, it is a more dangerous skin cancer due to its potential to metastasize. It has a cure rate of 90% of treatments in its early stages. Treatment becomes more difficult once it has metastasized, which occurs in 1%-5% of cases.
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Treating Squamous Cell Carcinoma Of The Skin
Treatment options for squamous cell skin cancer depend on the risk of the cancer coming back, which is based on factors like the size and location of the tumor and how the cancer cells look under a microscope, as well as if a person has a weakened immune system.
Most squamous cell skin cancers are found and treated at an early stage, when they can be removed or destroyed with local treatment methods. Small squamous cell cancers can usually be cured with these treatments. Larger squamous cell cancers are harder to treat, and fast-growing cancers have a higher risk of coming back.
In rare cases, squamous cell cancers can spread to lymph nodes or distant parts of the body. If this happens, treatments such as radiation therapy, immunotherapy, and/or chemotherapy may be needed.