What Is The Treatment For Advanced Or Metastatic Squamous Cell Carcinoma
Locally advanced primary, recurrent or metastatic SCC requires multidisciplinary consultation. Often a combination of treatments is used.
- Experimental targeted therapy using epidermal growth factor receptor inhibitors
Many thousands of New Zealanders are treated for cutaneous SCC each year, and more than 100 die from their disease.
Staging Of Squamous Cell Carcinoma
Staging of squamous cell carcinomas is used to determine if, or how far, the cancer has spread. Treatment plans are determined by the stage or extent of the disease.
Factors that determine the stage of an SCC include:
- the size of the tumor
- the depth of growth into the skin
- whether the tumor has spread to lymph nodes or other parts of the body
Cancer staging helps determine treatment plans and provides information about survival.
Squamous cell carcinoma staging is based on the American Joint Committee on Cancer TNM system.
T Primary Tumor: Determined by tumor size and thickness, high-risk features, and level of invasion.
N Regional Lymph Nodes: Based on the location and number of lymph nodes with cancer cells, and the size of the metastatic tumor.
M Metastasis: Whether the tumor has spread to other parts of the body.
Once the detailed TNM stage is obtained, a simpler five-level stage is determined. The lower the stage, the better the prognosis.
How Is Metastatic Squamous Cell Carcinoma Of Skin Treated
The treatment measures for Metastatic Squamous Cell Carcinoma of Skin may include:
- A combination of chemotherapy, radiation therapy, and invasive procedures may be used to treat the tumor
- Targeted therapy medications are generally used for locally infiltrated or metastatic SCCs. This therapy destroys the tumor cells by acting against the proteins that are responsible for tumor growth
- Radiotherapy can be used as primary therapy in situations where the tumor cannot be removed completely, or when the tumor reappears after surgery
- Radiotherapy can also be used as additional therapy after surgery, if there is a possibility of tumor recurrence after surgery, or if there are inadequate margins following surgery. In some cases due to location of tumor, a complete surgical removal of the tumor is difficult
- Chemotherapy can be used for treating metastatic cases in the following conditions:
- When the tumors cannot be removed completely
- Tumors that recur after surgery
How Can Cutaneous Squamous Cell Carcinoma Be Prevented
There is a great deal of evidence to show that very careful sun protection at any time of life reduces the number of SCCs. This is particularly important in ageing, sun-damaged, fair skin in patients that are immune suppressed and in those who already have actinic keratoses or previous SCC.
- Stay indoors or under the shade in the middle of the day
- Wear covering clothing
- Avoid indoor tanning
Oral nicotinamide in a dose of 500 mg twice daily may reduce the number and severity of SCCs in people at high risk.
Patients with multiple squamous cell carcinomas may be prescribed an oral retinoid . These reduce the number of tumours but have some nuisance side effects.
Common Places To Find Squamous Cell Carcinoma
As we have discussed before, this type of skin cancer is commonly found. So where is it most common? Squamous cell carcinoma is reported to be found most on areas of the body that catch UV exposure from the sun. This includes the legs, the arms, the neck and the torso which includes the front and the back, so the chest and belly and also the back. This goes for both men and women.
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Types Of Cutaneous Squamous Cell Carcinoma
Distinct clinical types of invasive cutaneous SCC include:
- Cutaneous horn the horn is due to excessive production of keratin
- Keratoacanthoma a rapidly growing keratinising nodule that may resolve without treatment
- Carcinoma cuniculatum , a slow-growing, warty tumour on the sole of the foot
- – a cutaneous SCC that has developed in a scar or chronic ulcer
- Multiple eruptive SCC/KA-like lesions arising in syndromes, such as multiple self-healing squamous epitheliomas of Ferguson-Smith and Grzybowski syndrome
The pathologist may classify a tumour as well differentiated, moderately well differentiated, poorly differentiated or anaplastic cutaneous SCC. There are other variants.
Subtypes of cutaneous squamous cell carcinoma
What Are The Symptoms Of Squamous Cell Skin Cancer
Squamous cell cancers are usually raised growths, ranging from the size of a pea to the size of a chestnut. They may appear as scaly red patches, open sores or protruding growths with a dented center, or they may look like a wart. Most are found in areas of the body that are frequently exposed to the sun, such as the ears, lips, face, balding scalp, neck, hands, arms, and legs. Less commonly, they may appear on mucous membranes and genitals. Regardless of what form the bumps take, they do not heal or go away on their own.
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How Is Squamous Cell Carcinoma Of Vagina Treated
Once a diagnosis of vaginal cancer has been made, the extent to which the tumor has spread is assessed, known as staging. The staging for vaginal cancer is based upon the FIGO and the AJCC TNM staging systems.
The TNM classification for vaginal cancer is given below:
Tumor extent :
- Tis: Cancer cells are only in the most superficial layer of cells of the vagina without growth into the underlying tissues. This stage is also called carcinoma in situ or vaginal intraepithelial neoplasia 3 . It is not included in the FIGO system
- T1: The cancer is only in the vagina
- T2: The cancer has grown through the vaginal wall, but not as far as the pelvic wall
- T3: The cancer is growing into the pelvic wall
- T4: The cancer is growing into the bladder or rectum or is growing out of the pelvis
Lymph node spread of cancer :
- N0: The cancer has not spread to lymph nodes
- N1: The cancer has spread to lymph nodes in the pelvis or groin
Distant spread of cancer :
- M0: The cancer has not spread to distant sites
- M1: The cancer has spread to distant sites
Stage grouping: Once the T, N, and M categories have been assigned, this information is combined to assign an overall stage in a process called stage grouping. The stages identify tumors that have a similar outlook and are treated in a similar way.
Stage 0 :
Stage I :
- The cancer has grown through the top layer of cells but it has not grown out of the vagina and into nearby structures
- It has not spread to nearby lymph nodes or to distant sites
Stage II :
How Widespread Is Scc
While SCC is less common than basal cell carcinoma , the number of reported SCC cases in the U.S. has steadily increased.
- An estimated 1.8 million cases of SCC are diagnosed each year, which translates to about 205 cases diagnosed every hour.
- SCC incidence has increased up to 200 percent in the past three decades.
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Basal Cell Carcinoma Stages
There are certain features that are considered to make the cancer at higher risk for spreading or recurrence, and these may also be used to stage basal cell carcinomas. These include:
- Greater than 2 mm in thickness
- Invasion into the lower dermis or subcutis layers of the skin
- Invasion into the tiny nerves in the skin
- Location on the ear or on a hair-bearing lip
After the TNM components and risk factors have been established, the cancer is given a stage. For basal cell carcinoma staging, the factors are grouped and labeled 0 to 4. The characteristics and stages of basal cell carcinoma are:
Stage 0: Also called carcinoma in situ, cancer discovered in this stage is only present in the epidermis and has not spread deeper to the dermis.
Stage 1 basal cell carcinoma: The cancer is less than 2 centimeters, about 4/5 of an inch across, has not spread to nearby lymph nodes or organs, and has one or fewer high-risk features.
Stage 2 basal cell carcinoma: The cancer is larger than 2 centimeters across, and has not spread to nearby organs or lymph nodes, or a tumor of any size with 2 or more high-risk features.
Stage 3 basal cell carcinoma: The cancer has spread into facial bones or 1 nearby lymph node, but not to other organs.
Stage 4 basal cell carcinoma: The cancer can be any size and has spread to 1 or more lymph nodes which are larger than 3 cm and may have spread to bones or other organs in the body.
Treatment Of Advanced Squamous Cell Carcinoma
Advanced SCCs can become life-threatening. In rare cases, when the SCC has spread to local lymph nodes and to more distant organs of the body, treatment often involves surgery, radiation therapy, and/or chemotherapy.
For patients with advanced disease who are not eligible for more standard treatments, inhibitor immunotherapy is an option. The FDA has approved an intravenous infusion drug, Cemiplimab. Cemiplimab is for patients with locally advanced SCC of the skin, metastatic cutaneous squamous cell carcinoma, or for patients where surgery or radiation is not an option. Pembrolizumab is also an effective and well-tolerated immunotherapy option for patients with advanced disease.
Anti-cancer chemotherapy agents such as cisplatin , doxorubicin, and 5-fluorouracil may be used.
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What Is Squamous Cell Carcinoma Of The Skin
Squamous cells are found throughout the human body. These cells line organs, such as the lungs, throat, and thyroid. We also have squamous cells in our skin.
The job of squamous cells is to protect what lies beneath. In our skin, these cells sit near the surface, protecting the tissue beneath.
Anywhere we have squamous cells, we can develop a type of cancer called squamous cell carcinoma .
In the skin, this cancer is usually not life-threatening. It tends to grow slowly, but it can grow deep. When the cancer grows deep, it can injure nerves, blood vessels, and anything else in its path. As the cancer cells pile up, a large tumor can form.
Most people who develop this skin cancer have fair skin that they seldom protected with sunscreen or sun-protective clothing. Before developing this skin cancer, they tend to notice signs of sun damage on their skin, such as age spots, patches of discolored skin, and deep wrinkles.
Anyone can develop squamous cell carcinoma
While anyone can develop this skin cancer, you have a greater risk if you live with a transplanted organ, use tanning beds, or have fair skin that you seldom protected from the sun.
Another sign of sun-damaged skin is having one or more pre-cancerous growths on your skin called actinic keratoses . Some AKs progress, turning into squamous cell carcinoma of the skin.
To find out what this skin cancer can look like and see pictures of it, go to: Squamous cell carcinoma of the skin: Signs and symptoms.
Signs And Symptoms Of Squamous Cell Lung Carcinoma
Lung cancer symptoms begin when a tumor presses against other organs in the body or causes damage. Consequently, symptoms of lung cancer often do not occur until the disease has progressed into an advanced stage. Common signs and symptoms of lung cancer include:
- Chest pain that worsens with coughing, laughing, or deep breathing
- Swollen lymph nodes
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How Serious Is A Squamous Cell Carcinoma
Id had a few skin cancers removed before, all basal cell carcinomas , the most common type. But when I was diagnosed with a squamous cell carcinoma on my scalp, it seemed different, and a little more scary. I asked C. William Hanke, MD, a Mohs surgeon at the Laser and Skin Surgery Center of Indiana and a senior vice president of The Skin Cancer Foundation, what we need to know about this second most common form of skin cancer.
Q: When people talk about nonmelanoma skin cancers, they tend to lump basal cell and squamous cell carcinomas together as the ones that are far less dangerous than melanoma. Should we take SCCs more seriously?
Dr. Hanke: Yes and no. BCCs hardly ever metastasize. Ive seen two cases in my entire career. But when SCCs that havent been treated early get big, then the chance of metastasis becomes real. Its uncommon, but its much more common than in BCC. We see it in our practice. But we dont want to scare people into thinking that just because they have squamous cell, Oh wow, Ive got a chance of metastasis. Remember, the rate is very low. Its just those big ones.
Q: OK, so its rare. But what happens when an SCC does spread?
Q: Whats the usual treatment for SCCs?
Q: How can we detect SCCs as early as possible?
Where Squamous Cell Carcinoma Occurs
SCC can be found anywhere on the body, but is most commonly seen in sun-exposed areas. Common SCC sites include the face, ears, lips, scalp, shoulders, neck, hands, and forearms. Its also possible to be diagnosed with SCC in areas without sun exposure, such as inside the mouth, under fingernails or toenails, on the genitals, or in the anus.
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Esophageal Squamous Cell Carcinoma
Esophageal cancer ranks as the eighth most common cancer, with the sixth highest mortality in the world . As the predominant histological subtype of esophageal cancer, esophageal squamous cell carcinoma contributed 80% of all esophageal cancers worldwide. ESCC is characterized by extreme diversity in geographical distribution and high mortality. The Asian esophageal cancer belt region shows much higher incidence than other areas of the world. For example, Linxian and surrounding counties in China . Despite advances in diagnostic methods and combined treatment modalities, the majority of tumors are diagnosed at advanced stages and the overall 5-year survival rate is only 40% . Although relatively less common in the United States than in other countries, there were still 15,560 new cases and 13.940 deaths reported in 2007, which was the sixth leading cause of death from cancers among American men that year . In the US, ESCC occurs more commonly in African American than Caucasian patients and more commonly in men than women, although the prevalence in women has been increasing steadily . The majority of ESCC patients present with advanced metastatic disease, with the overall 5-year survival of these patients being < 10%
Skin Cancer Types: Squamous Cell Carcinoma Overview
All content solely developed by the American Academy of Dermatology
Squamous cell carcinoma of the skin
What is squamous cell carcinoma of the skin?A common type of skin cancer, squamous cell skin cancer can develop from a pre-cancerous skin growth called an actinic keratosis .
Is it contagious? No
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Uncommon Places To Find Squamous Cell Carcinoma
Because squamous cells are so present on the body, squamous cell carcinoma is also found in places you would not suspect directly.
For example, the lips. On the lips, an SCC can present as a persistent small ulcer or thickened firm scaly skin. It usually appears on the lips itself, or on the lining of the mouth. Another uncommon place is the genital area, dermatologists report.
What Is The Outlook For Cutaneous Squamous Cell Carcinoma
Most SCCs are cured by treatment. A cure is most likely if treatment is undertaken when the lesion is small. The risk of recurrence or disease-associated death is greater for tumours that are > 20 mm in diameter and/or > 2 mm in thickness at the time of surgical excision.
About 50% of people at high risk of SCC develop a second one within 5 years of the first. They are also at increased risk of other skin cancers, especially melanoma. Regular self-skin examinations and long-term annual skin checks by an experienced health professional are recommended.
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What Makes Yale Medicines Approach To Squamous Cell Carcinoma Unique
Simple, small cancers can often be treated very well by a local dermatologist, according to Dr. Leffell. We rarely see the small cancers. We get referred to the cases that need special attention.
Dr. Leffell emphasizes that at Yale Medicine, the patient always comes first. We like to have a discussion with the patient about what happens after the skin cancer is removed, he says. We talk about what’s involved with plastic surgery and what’s involved with letting the area heal naturally. We prefer to take a minimalist approach and let the patient decide what they want us to do and how they want to let their skin heal.
If the decision is made to repair the wound using plastic surgery, we do that immediately in the office setting, Dr. Leffell says. Alternatively, allowing the wound to heal naturally is often a great option, and does not rule out doing plastic surgery down the road if needed, though that is very rarely the case.
Metastatic Squamous Cell Carcinoma
Squamous cell carcinoma – a very common form of nonmelanoma skin cancer that originates in the squamous cells – becomes metastatic when it spreads beyond the primary cancer site and affects other areas of the body. Metastatic squamous cell carcinoma is uncommon but can develop if the primary cancer is not surgically removed or treated in a timely manner.
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