Stages and treatment of squamous cell carcinoma of the esophagus

Squamous cell carcinoma, or squamous cell carcinoma, is a histological type of malignant tumor, such a diagnosis is made by the results of a biopsy after examining a sample of tumor tissue under a microscope. The neoplasm is formed from flat epidermal cells that look like scales. It can occur on the skin, in the oral cavity, in the larynx, trachea, bronchi, esophagus, genitals, and rectum.

At the European Oncology Clinic, the diagnosis and treatment of squamous cell carcinoma is carried out by expert doctors who have extensive experience working in leading oncology centers in Moscow. A team that includes oncologists, dermato-oncologists, surgeons, chemotherapists, radiotherapists and other specialists works with the patient. We use innovative treatment methods, the latest generation drugs, and conduct antitumor therapy in accordance with leading international recommendations. The European Oncology Clinic is the first Russian private oncology center where you can receive effective palliative treatment in late stages, even in cases where the patient was abandoned in other clinics.

• Causes of squamous cell carcinoma
• What are the types of squamous cell carcinoma?
• Types of disease diagnosis
• Treatment of squamous cell carcinoma
• Survival prognosis for squamous cell carcinoma
• Prevention

Causes of squamous cell carcinoma

The causes of squamous cell carcinoma are the same as for other types of malignant tumors. Certain mutations occur in cells that lead to malignant degeneration. “Incorrect” cells lose the external features and functions of normal ones, begin to multiply uncontrollably, and acquire the ability to spread throughout the body.

The main risk factors for squamous cell carcinoma:

• On the skin, such tumors often arise due to the action of ultraviolet rays. Exposed areas of the body are the most vulnerable.
• Squamous cell carcinoma of the genitals, head and neck is caused by certain types of human papillomavirus.
• The risk of developing squamous cell carcinoma is increased in smokers and people who drink a lot of alcohol.
• The likelihood of developing cancer increases with age as mutations accumulate in the cells of the body.
• Scars, burns, chronic inflammation.
• Exposure to certain carcinogenic substances, for example, if a person works in an industrial environment and comes into contact with chemicals.
• Decreased immunity.

None of these factors is guaranteed to lead to the disease - each of them only increases the likelihood to a certain extent.

Types and cases: nuances of forms

Studying a neoplasm with the help of modern instruments usually allows us to obtain a picture of encircling growth. Typically, cancer cells form a ring on the inner surface of the esophagus. Gradually, malignancy covers larger and larger areas, the lumen of the organ narrows, and a typical clinical picture is formed.

In some cases, cancer develops in the form of a polyp.

It has been established that in women the disease more often begins to progress in the lower part of the esophagus, gradually growing upward. Men are more likely to form atypical cells in the area where the esophagus enters the stomach.

What are the types of squamous cell carcinoma?

Malignant neoplasms of this histological type are found on different parts of the body. Depending on the location, their properties, approaches to diagnosis and treatment, and prognosis for the patient may differ slightly.

Skin cancer

Malignant skin tumors are represented by squamous cell carcinoma in approximately 20% of cases. Much more often, patients suffer from basal cell carcinoma, which originates from cells located in the lower layer of the epidermis.

Squamous cell carcinoma is more aggressive than basal cell carcinoma. It is more likely to grow into the deeper layers of the skin and spread throughout the body with the formation of distant metastases. However, this happens quite rarely. Most often, the tumor can be detected and removed at an early stage.

As a rule, squamous cell carcinoma occurs on the skin of the face, ears, neck, back of the hands, and less commonly in the genital area. Often, a neoplasm develops where scars and chronic injuries are located.

Squamous cell carcinoma of the red border of the lips

Malignant lip tumors account for no more than 1–3% of all cancers. In most cases (95%) they are represented by squamous cell carcinoma, which comes in two types:

• Squamous cell keratinizing carcinoma does not behave as aggressively, grows slowly, and rarely forms distant metastases.
• Nonkeratinizing squamous cell carcinoma grows rapidly, ulcerates earlier, and metastasizes more often.

Research shows that this type of cancer is 3 to 13 times more common in men than in women. This is probably due to the fact that males are more often exposed to sunlight at work, and smoking and drinking alcohol are more common among them.

Oral cancer

Oral cancer is a malignant tumor that occurs on the mucous membrane of the lips, cheeks, gums, the anterior two-thirds of the tongue, the palate, and the floor of the mouth (located under the tongue). In 90% of cases they are represented by squamous cell carcinoma, of which 5% are keratinizing squamous cell carcinoma, which is less aggressive, less likely to grow into surrounding tissues, spread to lymph nodes and metastasize.

Esophageal carcinoma

The mucous membrane of the esophagus is lined with stratified squamous epithelium, and squamous cell carcinoma can develop from it. Most often, such tumors are located in the cervical esophagus and the upper two-thirds of the thoracic region. In the lower third of the organ, adenocarcinomas, malignant tumors of glandular cells, are more common.

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Laryngeal cancer

In laryngeal cancer, the tumor almost always develops from squamous epithelium and is a squamous cell carcinoma. Typically, the appearance of a tumor is preceded by precancerous changes - dysplasia. The cells that are located in the lesion do not look like normal ones, but they also differ from cancer cells. In some cases, dysplasia does not lead to the development of cancer and even goes away on its own, especially if its cause is eliminated, for example, a person quits smoking. But in some people, precancerous changes lead to “cancer in situ” and then an invasive tumor.

Trachea and bronchus cancer

Squamous cell carcinoma is the most common type of malignant tumor in the trachea. It usually occurs in the lower part of the trachea, grows quite quickly, invades its wall, leading to ulceration and bleeding. This is a rare type of cancer and its main cause is smoking.

The most common lung cancer is non-small cell cancer - it occurs in 80% of cases and in 30% of cases it is squamous cell carcinoma. Often these tumors are located in the bronchi.

Cervical cancer

The cervix consists of two parts. The exocervix is ​​located outside, in the vagina, this is what the gynecologist sees during the examination. The endocervix is ​​the canal of the cervix, it connects the uterus to the vagina. Normally, the exocervix is ​​lined with squamous epithelium, and the endocervix is ​​lined with glandular epithelium. The place where they meet is called the transformation zone.

Squamous cell carcinoma represents 90% of malignant tumors of the cervix. Most often, the neoplasm occurs in the area of ​​the transformation zone. Cancers that develop from the glandular cells of the endocervix are called adenocarcinomas.

In rare cases, glandular squamous cell carcinoma occurs in the cervix.

Vulvar cancer

The vulva is the name given to the external female genitalia: the vestibule of the vagina, the labia majora and minora, and the clitoris. The majority of cancer types that develop in this area are squamous cell carcinoma (70–90%). They are divided into two groups:

• A large group are tumors whose origin is unknown. Most often they are diagnosed in older women.
• A smaller group are malignant tumors caused by the human papillomavirus.

Rectal cancer

In most cases, malignant tumors of the rectum are represented by adenocarcinomas - glandular cancer. Squamous cell carcinoma in this organ is very rare and accounts for 10 to 25 cases for every 100 thousand cases of colorectal cancer.

Squamous cell carcinoma accounts for 90% of all malignant neoplasms of the anal canal, the narrow passage that connects the rectum to the anus.

Tonsil cancer

A person has four types of tonsils: palatine (when they become inflamed, tonsillitis develops), tubal (located in the pharynx near the openings of the auditory tubes), lingual (behind the tongue) and pharyngeal (in children this causes adenoids). Most often, malignant tumors develop in the tonsils. In most cases it is squamous cell carcinoma. It is difficult to diagnose, so it is often detected in late stages.

Stages and grades of esophageal cancer

Modern medicine defines 4 stages of esophageal cancer:

1. At the first stage, the patient may not notice any changes in his body. When eating solid food, he has to drink liquid so that the food can reach the stomach.
2. In the second stage of esophageal cancer, the patient may begin to have problems with nutrition. Many patients at this stage of cancer switch to liquid foods, purees and cereals.
3. At the third stage of esophageal cancer, patients experience a narrowing of the food passage, which makes even the process of swallowing liquid difficult and painful.
4. At the fourth stage of cancer, the patient experiences complete obstruction of the esophagus.

Esophageal cancer stage 1

The first stage of esophageal cancer is very often not accompanied by pronounced symptoms. The malignant neoplasm is very small in size and practically does not bother the patient. At this time, damage occurs to the mucous membranes of the walls of the esophagus, as well as the submucosa. A cancerous tumor at the first stage does not grow into the muscular layer of the esophagus and therefore responds very well to surgical treatment. Patients do not experience a narrowing of the lumen of the esophagus; they can eat well, as they do not experience discomfort either during meals or after meals.

Esophageal cancer stage 2

At the 2nd stage of development of esophageal cancer, the following organs are affected:

• mucous membranes of the walls of the esophagus;
• muscular membranes;
• submucosa.

At this time, the malignant neoplasm does not extend beyond the affected esophagus. In many patients, the lumen of the esophagus narrows, and therefore they have to switch to liquid food. When examining a patient, specialists can detect single metastases that affect regional lymph nodes.

Esophageal cancer stage 3

At the 3rd stage of development, the malignant neoplasm grows into all layers of the walls of the esophagus. In patients, the tumor affects the serosa, as well as the peri-esophageal tissue. As cancer develops, the lumen of the esophagus narrows and patients have problems with nutrition, as swallowing solid foods becomes problematic for them. In parallel, tumor metastasis occurs (metastases are found in regional lymph nodes). Organs adjacent to the esophagus are not damaged at this stage of cancer development.

Esophageal cancer stage 4

At stage 4 of esophageal cancer, patients experience metastasis of the tumor, which affects both regional and distant lymph nodes. The cancerous tumor spreads to the periesophageal tissue. A malignant neoplasm also affects the walls of the esophagus, the serosa and nearby organs. Most patients at this stage of cancer develop an esophageal-tracheal or esophageal-bronchial fistula.

Types of disease diagnosis

The oncologist prescribes certain types of diagnostics to the patient, depending on which organ the malignant tumor is located in:

In all cases where a pathological formation is detected, a biopsy is performed - a study during which a fragment of suspicious tissue is obtained and sent to the laboratory for histological and cytological examination. Biopsy is the most accurate method for diagnosing cancer. It helps not only to reliably establish a diagnosis, but also to determine the histological type of the tumor. In order to check the extent of cancer spread in the body and clarify the stage, the doctor may prescribe additional tests:

• computed tomography, MRI;
• X-ray of the chest, bones;
• PET scan;
• Ultrasound and endoscopic examination of organs into which cancer could have grown.

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Treatment of squamous cell carcinoma

Treatment depends on the location, stage of cancer, the general condition of the patient, the presence of concomitant diseases and other factors.

Radiation therapy

Ionizing radiation damages tumor and other rapidly multiplying cells. This type of treatment for squamous cell carcinoma can be prescribed before or after surgery, or in advanced stages for palliative purposes.

Surgery

Radical operations are possible if there are no metastases and the cancer has not grown strongly into surrounding tissues. In some cases, only surgical treatment is indicated for such patients, in others it is supplemented with antitumor drugs and radiation therapy - this helps reduce the risk of relapse.

For advanced squamous cell carcinoma, palliative surgery can be performed to eliminate symptoms and restore the patency and function of the affected organ.

Drug treatment of squamous cell carcinoma

Chemotherapy for squamous cell carcinoma can be adjuvant (after surgery), neoadjuvant (before surgery), or used as a stand-alone treatment in advanced stages.

If the tumor has certain molecular genetic characteristics, targeted therapy is prescribed. Targeted drugs target molecules that help cancer grow and maintain its vital functions.

Doctors at the European Oncology Clinic use original antitumor drugs of the latest generation for squamous cell cancer, prescribing them in accordance with modern international protocols.

Symptomatic treatment for squamous cell carcinoma

Treatment for squamous cell carcinoma and any other malignant neoplasms should be aimed not only at fighting the tumor itself, but also at relieving symptoms and improving the patient’s condition. At the European Oncology Clinic, the patient can receive all types of symptomatic therapy for cancer:

• Relief of pain syndrome in accordance with the WHO three-step scheme.
• Restoration of patency of the esophagus, intestines, and respiratory tract.
• Elimination of bleeding, if necessary, blood transfusion.
• Relief of nausea.
• Removing tumor compression of internal organs, nerves, and blood vessels.
• Treatment of emergency conditions in an intensive care unit equipped with modern equipment.
• Monitoring and correction of nutritional status.
• Maintenance therapy helps you comfortably endure chemotherapy and prevent and manage side effects.

Classification

Esophageal cancer is classified according to the international TNM nomenclature for malignant neoplasms:

• by stage (T0 - precancer, carcinoma, non-invasive epithelial tumor, T1 - cancer affects the mucous membrane, T2 - tumor grows into the submucosal layer, T3 - layers up to the muscular layer are affected, T4 - tumor penetration through all layers of the esophageal wall into the surrounding tissues);
• by the distribution of metastases in regional lymph nodes (N0 – no metastases, N1 – there are metastases);
• by the spread of metastases in distant organs (M1 – yes, M0 – no metastases).

Cancer can also be classified into stages from first to fourth, depending on the extent of the tumor in the wall and its metastasis.

Survival prognosis for squamous cell carcinoma

The prognosis depends on where the cancer began to grow, at what stage the diagnosis was made and treatment started. For example, often the survival rate for cancer of the skin and red border of the lips tends to 100%, because such tumors, as a rule, can be detected early enough, and they are not very aggressive. If distant metastases appear, the chances of remission become extremely low. But such patients can still be helped: to slow down the progression of squamous cell carcinoma, prolong life, improve their general condition, and relieve painful symptoms.

We at the European Oncology Clinic believe that there are no hopeless patients. You can always help. You should never give up. We know how to help.

Diagnoses and dangers

It is known that in the predominant case, patients with squamous cell carcinoma of the esophagus are infected with the papilloma virus. Scientists suggest that HPV may be one of the triggering factors for malignancy.

Esophagitis is suspected as a precursor to cancer. The pathological condition leads to regular entry of hydrochloric acid into the esophagus. This negatively affects the mucous membrane, irritates it and can provoke cell transformation. Esophagitis is often observed against the background of excess weight and gastric diseases. It can lead to a complication medically known as Barrett's esophagus. This term describes the progression of the disease with the degeneration of multilayer epithelial structures into cylindrical ones.

Prevention

Basic measures to prevent squamous cell carcinoma:

• Quitting smoking and drinking alcohol.
• Protecting your skin from ultraviolet rays is the most important measure for preventing skin cancer. You should not visit solariums or go to the beach from 10.00 to 16.00, when solar activity is highest. Clothes with long sleeves and trousers, a wide-brimmed hat, and sunglasses help protect yourself.
• Preventing infection with HPV, which leads to the development of cancer: you need to avoid promiscuity and use condoms. There is currently a vaccine against human papillomavirus infection. It is recommended that all adolescents be vaccinated before becoming sexually active.

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What is the prognosis for grade 3?

In stage 3 esophageal cancer, the tumor has grown through all layers of the esophagus and affected surrounding organs.

At this stage, metastases are detected in the nearest lymph nodes. If, for health reasons, the patient can undergo surgery, then it will be an extensive intervention. The surgeon will remove a significant portion of the esophagus and lymph nodes. In this case, about 10% of patients live more than 5 years.

If the tumor has affected vital organs, then supportive (palliative) treatment is prescribed. In this case, life expectancy is 8-12 months.