Squamous Cell Carcinoma Treatment in Delhi, India

Squamous cell carcinoma (SCC) is a type of skin cancer that originates in the squamous cells, which are thin, flat cells found on the surface of the skin. It is characterised by the development of red, scaly patches or open sores on the skin. SCC can occur anywhere on the body but is most commonly found on sun-exposed areas such as the face, ears, neck, lips, and back of the hands. If left untreated, squamous cell carcinoma can become more aggressive and potentially spread to other parts of the body. Early detection is crucial for effective management and treatment.

There are several different types of squamous cell carcinoma, each with its own appearance and growth pattern. The most common types include:

Cutaneous Squamous Cell Carcinoma (CSCC)

This is the most common type and occurs in the skin. It is often related to prolonged sun exposure and may appear on sun-exposed areas such as the face, ears, neck, and hands.

Lung Squamous Cell Carcinoma:

This type of SCC originates in the squamous cells lining the airways of the lungs. It is one of the main subtypes of non-small cell lung cancer.

Cervical Squamous Cell Carcinoma

Cervical SCC develops in the squamous cells of the cervix and is a common type of cervical cancer.

Head and Neck Squamous Cell Carcinoma (HNSCC)

HNSCC can occur in the mucous membranes of the head and neck region, including the mouth, throat, nasal passages, and larynx.

Anal Squamous Cell Carcinoma

This type of SCC occurs in the anal canal and is associated with human papillomavirus (HPV) infection.

Esophageal Squamous Cell Carcinoma

Originating in the squamous cells lining the oesophagus, this type of SCC is one of the two main subtypes of esophageal cancer.

Vulvar Squamous Cell Carcinoma

Vulvar SCC develops on the skin of the vulva, which is the outer part of the female genitalia.

It's important to note that while these are some common types, squamous cell carcinoma can potentially occur in various other organs and tissues as well. The specific characteristics and treatment options for SCC can vary depending on its location and stage of development.

Understanding the factors that contribute to the development of squamous cell carcinoma (SCC) is crucial for both prevention and early intervention. Here's a list of both the direct causes and risk factors associated with SCC.

• UV Radiation Exposure: Prolonged exposure to UV radiation, a primary cause, directly leads to DNA damage in skin cells, contributing to the development of SCC.
• Sun Exposure: Cumulative lifetime sun exposure is a direct cause, particularly in individuals with fair skin, and is a crucial factor in the increased risk of cutaneous SCC.
• Age: While not a direct cause, age is a contributing factor, reflecting the cumulative effects of UV exposure over time and an increased likelihood of SCC development.
• Fair Skin: Fair skin, a characteristic that enhances susceptibility to UV damage, is both a cause and a predisposing factor for SCC.
• Immunosuppression: Weakened immune systems, whether due to medical conditions or medications, are risk factors that exacerbate the development of SCC.
• Chemical Exposure: Long-term exposure to certain chemicals is a risk factor, contributing to the likelihood of SCC, especially in non-cutaneous locations.
• Chronic Inflammatory Conditions: Chronic inflammation is a risk factor, creating an environment conducive to cancer development.
• Human Papillomavirus (HPV): Certain high-risk strains of HPV increase the risk of SCC, particularly in anogenital regions.
• Age and Gender: While age is a contributing factor, gender plays a role as a risk factor, with men being more frequently affected.
• Previous Skin Damage: Skin damage, such as scars, is a risk factor that can increase susceptibility to SCC in affected areas.

Occupational Exposures: Certain occupations involving exposure to carcinogens or UV radiation are risk factors that elevate the likelihood of SCC.

Symptoms of squamous cell carcinoma (SCC) can vary depending on its location. Here is a generalised list of symptoms associated with SCC:

Skin Changes

• A persistent, scaly, or crusty patch on the skin.
• A firm, red nodule.
• An open sore that doesn't heal, or heals and then reopens.

Changes in Existing Moles or Lesions

• Changes in size, shape, or colour of an existing mole.
• Itching, tenderness, or pain in a mole or lesion.

Mouth and Oral Cavity (Oral SCC)

• Persistent sore throat or mouth sore.
• Red or white patches on the tongue or mouth lining.
• Difficulty or pain when swallowing.

Genital Area (Genital SCC)

• Changes in the skin colour or texture.
• Persistent itching or discomfort.
• Ulcers or sores that do not heal.

Respiratory Symptoms (Lung SCC)

• Chronic cough or coughing up blood.
• Shortness of breath.
• Chest pain or discomfort.

Anogenital Area (Anal SCC)

• Changes in bowel habits.
• Bleeding from the rectum or blood in the stool.
• Pain or discomfort in the anal area.

Head and Neck (Head and Neck SCC)

• Swelling or a lump in the neck.
• Persistent ear pain.
• Hoarseness or changes in the voice.

It's important to note that these symptoms can be caused by various conditions, and not all cases of SCC will present with these signs. It's advisable to seek prompt medical attention in case of any persistent or concerning symptoms, for proper evaluation and diagnosis. Early detection and treatment can significantly improve outcomes for individuals with squamous cell carcinoma.

The diagnosis of squamous cell carcinoma (SCC) involves a combination of clinical examination, imaging studies, and laboratory tests. Here's an overview of the typical steps in diagnosing SCC:

1. Clinical examination

A healthcare provider will examine the skin, mucous membranes, or other relevant areas for any visible signs of SCC. This may involve inspecting the skin, mouth, genitals, or other areas where SCC commonly occurs.

Biopsy

If suspicious lesions are identified during the clinical examination, a biopsy is typically performed. A small sample of tissue is taken from the suspicious area for laboratory analysis. The biopsy helps confirm the diagnosis and determine the specific type and characteristics of the cancer.

2. Histopathological examination

The biopsy specimen is examined under a microscope by a pathologist. This detailed analysis helps confirm the presence of squamous cell carcinoma, assess the grade of the cancer, and identify any specific features that may guide treatment decisions.

Imaging studies

In cases where SCC may have spread to nearby lymph nodes or other organs, imaging studies such as CT scans, MRI, or PET scans may be conducted to assess the extent of the disease.

Endoscopy

For SCC occurring in the respiratory or digestive tracts, endoscopic procedures may be performed. This involves using a thin, flexible tube with a camera to visualise the interior of the affected organ and obtain additional biopsy samples if necessary.

Human Papillomavirus (HPV) testing

In cases of SCC in the anogenital or oropharyngeal areas, testing for high-risk strains of HPV may be conducted, as certain subtypes of HPV are associated with an increased risk of SCC.

Once the diagnosis is confirmed, the healthcare team may conduct additional tests to determine the stage of the cancer. Staging helps guide treatment decisions and provides information about the extent of the disease.

The specific diagnostic approach may vary based on the location of the SCC and individual patient factors.

Here's an overview of the main treatment options for SCC:

Surgery

This is the most common treatment for SCC, especially for early-stage tumours. Different surgical techniques may be used, depending on the size and location of the tumour. These include:

• Mohs micrographic surgery: This specialised technique removes thin layers of tissue at a time while examining them under a microscope to ensure all cancerous cells are removed. Mohs surgery minimises tissue removal and preserves healthy skin.
• Excisional surgery: This involves removing the tumour and a small margin of surrounding healthy tissue.
• Curettage and electrodessication: This technique uses scraping and burning to remove small, superficial SCCs.

Radiation therapy

This treatment uses high-energy beams to kill cancer cells. It may be used alone or in combination with surgery, particularly for larger tumours or those located in sensitive areas.

Chemotherapy

This treatment uses drugs to kill cancer cells. Chemotherapy is not commonly used for SCC but may be recommended for advanced or metastatic cases.

Other treatments

• Cryotherapy: This freezes and destroys cancer cells with liquid nitrogen. It is typically used for small, superficial SCCs.
• Photodynamic therapy: This uses a light-activated drug to kill cancer cells. It may be used for SCCs that are not easily accessible with surgery.

Managing side effects from treatment and providing emotional support are crucial aspects of SCC management. The doctor may recommend pain management strategies, counselling, and other supportive services.

If left untreated, squamous cell carcinoma of the skin can damage nearby healthy tissue, potentially spreading to lymph nodes or other organs, although fatality is not common.

The risk of the cancer spreading increases if it:

• Grows extensively or deeply.
• Involves mucous membranes, like the lips.
• Develops in individuals with a weakened immune system, which can be caused by conditions such as chronic leukaemia or the use of immunosuppressive medications after an organ transplant.

While we can't completely eliminate the risk of squamous cell carcinoma, taking proactive steps significantly reduces one’s chances of developing it. Here are some key preventive measures:

Sun Protection

• Minimise UV exposure: Limit direct sunlight, especially during peak hours (10 am to 4 pm). Seek shade, wear protective clothing (hats, long sleeves), and apply broad-spectrum sunscreen with SPF 30 or higher generously and reapply every two hours, especially after swimming or sweating.
• Avoid tanning beds: Artificial UV radiation from tanning beds significantly increases skin cancer risk.

Skincare

• Regular self-examinations: Regularly check skin for any new or changing moles, freckles, or growths. Pay close attention to areas exposed to the sun and report any suspicious changes to your doctor immediately.
• Avoid skin irritants: Harsh soaps, abrasive scrubs, and excessive sunburns can damage skin. Practise gentle cleansing and moisturising to maintain healthy skin barriers.

Lifestyle Habits

• Smoking cessation: Smoking weakens the immune system and significantly increases the risk of squamous cell carcinoma. Quitting smoking is essential for overall health and skin cancer prevention.
• Healthy diet and exercise: Maintain a balanced diet rich in fruits, vegetables, and whole grains, and engage in regular physical activity. Both contribute to overall well-being and may influence cancer risk.

Medical Awareness

• Regular skin cancer screenings: Schedule regular checkups with your doctor or dermatologist, particularly if you have a family history of skin cancer or other risk factors.

Additional factors

• Occupational hazards: Individuals exposed to certain chemicals or radiation at work may require additional protective measures and regular monitoring.
• Immunosuppression: People with compromised immune systems due to medications or medical conditions may require specific preventative strategies.

Remember, early detection and prompt treatment are crucial in managing squamous cell carcinoma effectively. By incorporating these preventive measures and remaining vigilant about your skin health, you can significantly reduce your risk of developing this cancer and ensure optimal well-being.

How common is squamous cell carcinoma?

Squamous cell carcinoma is one of the most prevalent forms of skin cancer, and its incidence is relatively high. It is more common than melanoma but less aggressive.

Where on my body can I get squamous cell carcinoma?

Squamous cell carcinoma can occur anywhere on the body, but it most commonly develops on sun-exposed areas like:

• Face, particularly the lips, ears, and nose
• Scalp
• Neck
• Hands and arms
• Legs

It can also appear on mucous membranes, like the inside of the mouth, lips, and genitals.

Can squamous cell carcinoma spread to other parts of the body?

Yes, squamous cell carcinoma can metastasize (spread) to other parts of the body, especially if not treated promptly. Early detection and treatment are crucial to prevent spread.

What are the side effects of the treatments for squamous cell carcinoma?

The side effects of treatment depend on the specific type of treatment used. Some common side effects include:

• Surgery: Scarring, infection, pain, bleeding.
• Radiation therapy: Skin redness, itching, fatigue, nausea, hair loss in the treated area.
• Chemotherapy: Fatigue, nausea, vomiting, hair loss, mouth sores, increased risk of infection.
• Targeted therapies: These are newer treatments with side effects still being studied, but potential issues include skin reactions, diarrhoea, fatigue, and high blood pressure.

How soon after treatment will I feel better?

The recovery time varies depending on the type and extent of treatment. Improvement may be gradual, and full recovery can take weeks to months.

How serious a condition is squamous cell carcinoma?

While any cancer is serious, squamous cell carcinoma is generally considered treatable, especially if caught early. When detected and treated in its early stages, the cure rate is very high. However, if left untreated, it can become more serious and spread to other parts of the body.

What can I expect if I have squamous cell carcinoma?

The diagnosis and treatment of squamous cell carcinoma will involve several steps:

• Diagnosis: Your doctor will examine your skin, perform a biopsy if necessary, and may order additional tests to determine the stage of the cancer.
• Treatment plan: You'll discuss different treatment options with your Squamous cell carcinoma Doctor, considering factors like the stage of the cancer, your overall health, and personal preferences.
• Treatment: Depending on the plan, you may receive surgery, radiation therapy, chemotherapy, targeted therapy, or other treatments.
• Follow-up care: After treatment, you'll need regular checkups to monitor for recurrence.

What is stage 4 squamous cell carcinoma?

Stage 4 squamous cell carcinoma indicates that the cancer has spread to distant organs or lymph nodes. Treatment at this stage may involve a combination of therapies to manage symptoms and slow the progression.

Is squamous cell carcinoma fully curable?

The curability of squamous cell carcinoma depends on the stage at diagnosis. When caught early, the cure rate is very high. However, the chances of cure decrease as the stage progresses. Even in advanced stages, treatment can help manage the disease and improve symptoms.

What type of biopsy is used for squamous cell carcinoma?

The most common type of biopsy for squamous cell carcinoma is a punch biopsy, which involves removing a small, circular sample of the tissue for examination under a microscope. Other types of biopsies, like shave biopsies or incisional biopsies, may be used in specific situations.

What is the difference between squamous cell carcinoma and basal cell carcinoma?

What is the best treatment for squamous cell carcinoma?

Unfortunately, there's no single "best" treatment for squamous cell carcinoma. The most effective approach depends on several factors specific to the patient’s situation:

Factors influencing treatment:

• Stage of the cancer: Early stages offer minimally invasive options like surgery or local therapies, while advanced stages might require combinations like surgery, radiation, and chemotherapy.
• Location of the tumour: Sensitive areas like the face might require specialized techniques for cosmetic preservation.
• Size of the tumour: Larger tumours may necessitate more aggressive treatment.
• Overall health and medical history: Underlying conditions or previous treatments could influence treatment options.
• Personal preferences: You have a say in your plan, and your doctor will discuss the risks and benefits of each option.

Therefore, the "best" treatment is highly individualised. Consulting a dermatologist or oncologist specialising in skin cancer is crucial to determine the optimal plan.

Reviewed by Dr. Pramod Kumar Julka, Vice Chairman - Cancer Care / Oncology, Gynecologic Oncology, Hematology Oncology, Head & Neck Oncology, Musculoskeletal Oncology, Neuro Oncology, Paediatric (Ped) Oncology, Thoracic Oncology, Uro-Oncology, Gastrointestinal & Hepatobiliary Oncology, Medical Oncology, Breast Cancer on 25-Jan-2024.