What is squamous cell carcinoma? What is squamous cell carcinoma with keratinization? Benign tumors from the surface epithelium are called papillomas, from the glandular epithelium - adenomas

Classification of epithelial tumors:

benign tumors of the epithelium (epitheliomas) and malignant (cancer, carcinoma);

by histogenesis:

from the integumentary epithelium (flat and transitional - papillomas and squamous and transitional cell carcinoma)

glandular epithelium (adenomas, adenomatous polyps and adenocarcinomas).

Benign tumors from the integumentary epithelium are called papillomas; those from the glandular epithelium are called adenomas.

Adenomas on the mucous membranes can have endophytic growth and are called flat adenomas; on the contrary, with exophytic growth, polyps are formed (adenomatous polyps).

Malignant tumors from the covering epithelium are squamous cell and transitional cell carcinoma, from the glandular epithelium - adenocarcinoma.

Based on organ specificity, epithelial tumors can be either organ-specific or organ-nonspecific.

Papillomas develop on the skin, mucous membranes of the bladder, esophagus, vagina, and less often in the bronchial tree. Therefore, papillomas belong to organ-nonspecific tumors. Macroscopically, the papilloma has a papillary surface. Papillomas are characterized by papillary growths of the integumentary epithelium with a fibrovascular core. In papillomas, signs of tissue atypia are found in the form of an increase in epithelial layers in the squamous epithelium, growing in the form of papillae.

Adenomas are benign neoplasms of glandular epithelium. They develop in organs whose parenchyma is represented entirely by epithelium (liver, kidneys, endocrine organs), as well as in tubular and hollow organs, the mucous membrane of which contains glands. Among adenomas, there are both organ-specific and organ-nonspecific tumors. Macroscopically it has the appearance of a finger-shaped outgrowth, a polyp with exophytic growth. With endophytic growth it is called flat adenoma. Depending on the structures that the glandular epithelium builds, the following histological types of adenomas are distinguished: tubular (tubular structures), trabecular (beam structures), alveolar, papillary (papillary), cystadenomas (cystic). An adenoma with developed stroma is called fibroadenoma and is found in some organs (breast, ovaries).

Squamous cell carcinoma develops in the same organs and tissues as papillomas from the precursor cells of squamous epithelium, as well as in foci of metaplasia. Most often, squamous cell carcinoma occurs in the skin, lungs, larynx, esophagus, cervix and vagina, and bladder. There are carcinoma in situ and invasive squamous cell carcinoma. Squamous cell carcinoma metastasizes primarily through the lymphogenous route, so the first cancer metastases are found in regional lymph nodes. At later stages, hematogenous metastases develop.

Adenocarcinoma is a malignant organ-nonspecific tumor of glandular epithelium, found in the stomach, intestines, mammary gland, lungs, uterus and other organs where there is glandular epithelium or glandular metaplasia of the epithelium is possible. Based on their histological structure, the following histological types of adenocarcinomas are distinguished: tubular (tubular structures), trabecular (beam structures), alveolar, papillary (papillary), cystadenomas (cystic). And the level of differentiation - highly, moderately and poorly differentiated tumors.

Depending on the nature of growth, which is determined by the ratio of parenchyma and stroma, adenocarcinomas include tumors with a poorly developed stroma - medullary cancer, solid cancer, as well as tumors with a developed stroma - scirrhous cancer. Adenocarcinoma metastasizes through the lymphogenous route, so the first cancer metastases are found in regional lymph nodes. At later stages, hematogenous metastases develop.

Types, diagnosis and treatment of epithelial ovarian tumor

There are many types of ovarian tumors. Only 2-4% are nonepithelial tumors. In most cases, patients are diagnosed with an epithelial type of pathological process. Moreover, these formations can develop both from the integumentary and glandular epithelium. In addition, they can be benign or malignant, or borderline. Epithelial ovarian tumors form from cells covering the outer surface of the organ.

Nonepithelial formations are uncommon. They can develop from different types of cells. For example, stromal formations are obtained from the cells of the ovarian base - structural tissues that produce female sex hormones. If the process of the appearance of a neoplasm involves cells that give rise to oocytes, it is called germinogenic. The most common benign nonepithelial tumors are fibromas. Among malignant tumors, granulosa cell neoplasm is considered the most common.

When the process is benign

Mature tumors form from glandular cells and appear as soft, rubbery nodules that are pinkish-white in color. Adenomas can develop in all glandular organs. If cysts are found in them, then these are cystadenomas.

Such epithelial ovarian tumors can develop at any age. However, they are mainly diagnosed in women. The neoplasm capsule consists of compacted connective tissue fibers. And its inner wall is lined with one row of cubic, cylindrical or flattened epithelial tissue.

Main varieties

Benign neoplasms can be either single-chamber or multi-chamber. And according to the condition of the internal surface, smooth-walled and papillary (papillary) cystadenomas are distinguished. The appearance of papillae is an unfavorable symptom that may indicate malignancy of the tumor. It should also be taken into account that papillae can be true or false. True ones are represented by epithelial protrusions. False papillae occur due to excessive proliferation of glandular cells.

There are several types of cystadenomas:

1. Epithelial tumor of the serous type is most often unilateral. It consists of one or more chambers and has a smooth surface. This formation is filled with serous fluid. Its inner surface is lined with flattened epithelium, sometimes there are papillae on it.
2. Mucinous cystadenoma has one or more chambers and can grow to a very large size. Such a cyst is lined by prismatic epithelium (it is similar to the tissue of the inner surface of the intestine), and its cavity is filled with mucus. Sometimes papillae form on the inner surface of the cavity. It is worth noting that when such a cyst ruptures, its cells can implant in the abdominal cavity.

Complications of benign tumors

Without timely diagnosis and therapy, there is a risk of developing serious complications:

• torsion of formation with necrosis of wall tissue;
• rupture, which is often accompanied by bleeding and painful shock;
• tumor suppuration.

When the contents of a cystadenoma enter the abdominal cavity, with a relatively favorable course, an adhesive process may begin to develop. With mucinous neoplasms, the jelly-like contents and fragments of the cyst can be implanted into the peritoneum. Rarely, tumor rupture can cause death. Therefore, treatment always involves its surgical removal.

Border type of formations

According to their main characteristics, epithelial borderline tumors resemble benign cysts. They develop mainly in young women. It is worth noting that such neoplasms can be serous and mucinous. However, the majority of patients with borderline tumors (approximately 65%) are of the serous type.

Features of development

Borderline epithelial ovarian tumor

In the lumen of such neoplasms, papillae are formed, the epithelium of which is characterized by excessively intense cell division and proliferation. Also, with borderline tumors there is no invasive growth, characteristic of malignant forms of ovarian tumors. At the same time, implants can develop (mainly in the pelvic organs). At their core, these are metastases of contact origin.

Unfortunately, there are no specific manifestations for formations of this type. Therefore, they are often discovered during a routine examination. Many women may also experience the following symptoms:

• pain or discomfort in the lower abdominal cavity;
• abdominal enlargement;
• marking bleeding;
• general weakness.

Treatment and prognosis

Since such epithelial ovarian tumors are mainly found in women of reproductive age, they are removed using organ-sparing surgery. This allows you to maintain fertility, the ability to get pregnant and give birth to healthy children. However, at the same time, it must be taken into account that after organ-conserving surgery, more than half of the patients develop relapses over time. If a woman is postmenopausal, extirpation of the uterus and appendages is recommended. Sometimes surgical treatment is complemented by conservative therapy.

It is worth noting that relapses of borderline tumors detected at stage 1 of development occur in approximately 15% of cases. But this does not affect the five-year survival rate - this indicator corresponds to 100%. The 10-year survival rate, depending on the characteristics of the tumor, decreases by 5-10%.

If the formation was detected at stages 2-4, then a directly proportional relationship arises: the higher the stage of the disease, the worse the prognosis becomes. There are also other factors that are important for survival. For example, the woman’s age and the presence of invasive implants. According to research, in the presence of non-invasive epithelial implants, relapses occur in every fifth patient, but the mortality rate does not exceed 7%.

Ovarian cancers

Immature malignant epithelial tumors consist of prismatic tissues and their structure resembles adenomas. However, they vary in shape and size, and always grow into surrounding tissues, destroying them.

Serous papillary cystadenoma

This pathology mainly occurs in women over 50 years of age. Most often, only one ovary is affected.

Among the main differences between cystadenocarcinomas and benign formations, it is worth highlighting the pronounced atypicality of the cells:

• polymorphism of cells and their nuclei (they do not have the same size and shape);
• the kernels have a more intense color.

Features of differentiation

Adenocarcionmas come with varying degrees of differentiation, which is determined by the number of solid structures:

1. G1 tumors (highly differentiated) have a tubular or papillary growth pattern, and the percentage of solid areas in them does not exceed 5% of the total area.
2. With moderate differentiation (designated as G2), cribriform, acinar, and trabecular areas may appear. The solid component can vary from 5 to 50% of the area of ​​the neoplasm.
3. Tumors with low differentiation (G3) are characterized by an increase in the area of ​​solid structures. This figure exceeds 50%.

Cell division activity (mitotic index) does not determine the degree of differentiation. However, as a rule, as the grade of malignancy increases, mitotic activity begins to increase.

Types of pathological formations

1. Serous cystadenocarcinoma is characterized by papillary proliferation. Also, lesions with a solid structure are often identified. Over time, cancer cells begin to grow into the walls of the formation, capture its surface, and then move along the peritoneum, forming implantation metastases. Subsequently, ovarian tissue and nearby anatomical structures are involved in the process.
2. Mucinous cystadenocarcinoma is a malignant tumor that has the appearance of a cyst. It is formed from atypical cells that produce mucus. These cells form solid, cribriform, tubular structures. A characteristic feature of cystadenocarcinomas is necrosis of their tissues. In addition, if the tumor wall ruptures and the contents enter the peritoneum, cell implantation is possible. This complication is accompanied by the accumulation of a large amount of mucus in the abdominal cavity. It is produced by formation cells.

Treatment

Once a tumor is identified, surgical removal is prescribed. At the first stage in women of reproductive age, it is possible to reduce the scope of surgical intervention to preserve reproductive function. In other cases, complete removal of the uterus and its appendages is indicated. In addition, chemotherapy and radiation therapy will be required. Despite such aggressive treatment, epithelial tumors often recur.

Prognosis and survival

In 75% of cases, malignant neoplasms are detected only in late stages. Then there is already damage to the abdominal cavity and lymph nodes, and the appearance of distant metastases also begins to occur. If the tumor is detected at stage 1 (and this happens only in 20% of cases), the survival rate of patients is about 80-95%. With further development of the pathological process, the chances of recovery become even less. The five-year survival rate for stage 2 ranges from 40 to 70%, for stage 3 this figure decreases to 30%, and for stage 4 it does not exceed 10%.

After primary treatment of epithelial cancer, specialists evaluate the patient’s condition using a blood test for CA-125. Its level changes against the background of tumor progression or regression. In addition, this tumor marker makes it possible to detect tumor recurrence earlier than is possible using imaging diagnostic techniques.

Since many tumors are considered epithelial, an accurate diagnosis is made by histological examination. However, in order for therapy to be as effective as possible and the risk of relapse to be minimized, it is important to detect the pathological process as early as possible. Regular visits to the gynecologist and an ultrasound of the pelvic organs will help with this. But in addition to routine examinations, it is important to consult a specialist if you experience pain in the lower abdomen, uterine bleeding unrelated to menstruation, or other uncomfortable symptoms.

Methods, recovery and pregnancy after ovarian resection

Classification of ovarian cancer by stages

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What are epithelial tumors?

The most general principle of tumor classification involves classification depending on the organ, tissue or cell from which the tumor originates, that is, depending on histogenesis. In accordance with this principle, 6 groups of tumors are distinguished:

1. Epithelial tumors

1.1. Epithelial tumors without specific localization (organ-nonspecific).

1.2. Tumors of exo- and endocrine glands, as well as epithelial integuments (organ-specific).

2. Mesenchymal tumors

3. Tumors of melanin-forming tissue

4. Tumors of the nervous system and meninges

5. Tumors of the blood system

6. Mixed tumors, teratomas.

There is an opinion that the division of epithelial tumors, according to the classification, into organ-specific and organ-nonspecific is currently not justified, since organ-specific markers have been found for most epithelial tumors. However, another important conclusion follows from the division of tumors into organ-specific and organ-nonspecific. A malignant organ-nonspecific tumor in any organ can be either primary or secondary (that is, metastasis). For example, when we see squamous cell carcinoma in the lung, we have to decide: is this a primary cancer of the lung itself or is it a metastasis of another squamous cell carcinoma to the lung? But with regard to organ-specific tumors, such controversial questions do not arise. Because renal cell cancer in the kidney is always a primary tumor, and in other organs it is always a metastasis. Therefore, this gradation is still important to take into account in the process of making a diagnosis. This is of great importance for the morphological diagnosis of tumors. Below is a description of the most prominent representatives of tumors of each group. Epithelial tumors without specific localization (organ-nonspecific). Tumors of this type develop from squamous, transitional or glandular epithelium, which does not perform any specific function (specific to a particular organ). Neoplasms of this group are divided into benign, neoplasms in situ malignant, their varieties are given in table. 1.

Benign tumors without specific localization.

Benign epithelial tumors of this group include squamous and transitional cell papillomas and adenoma.

Squamous cell papilloma (from the Latin papilla - papilla) is a benign tumor of stratified squamous epithelium (Fig. 1). It has a spherical or polypoid shape, dense or soft, with a lobed surface (like cauliflower or raspberries), ranging in size from a millet grain to a large pea; located above the surface on a wide or narrow base.

It can be located anywhere where there is stratified squamous epithelium. These are the skin, oral cavity, pharynx, upper parts of the larynx and vocal folds, esophagus, cervix, vagina, vulva. However, it can also occur in places where there is normally no squamous epithelium - namely, in the bronchi and bladder. The formation of squamous cell papilloma in such cases occurs against the background of squamous cell metaplasia.

The tumor is built from a growing integumentary epithelium, the number of its layers is increased. In skin papilloma, keratinization of varying intensity can be observed. The stroma is well expressed and grows together with the epithelium. In papilloma, the polarity of the arrangement of epithelial cells, the differentiation of its layers, and the basement membrane are preserved. Tissue atypia is represented by uneven development of the epithelium and stroma and excessive formation of small blood vessels. There is no cellular atypia.

If there is pronounced fibrosis in the stroma of squamous cell papilloma, then it is called fibropapilloma, and if pronounced hyperkeratosis is observed on the surface, then keratopapilloma (Fig. 2). However, all these tumors are essentially the same thing. When injured, papilloma is easily destroyed and becomes inflamed. After removal, papillomas rarely recur, and sometimes (with constant irritation) they become malignant.

Transitional cell (urothelial) papilloma (from the Latin papilla - papilla) is a benign tumor of the transitional epithelium. It has a polypoid shape with a papillary surface (reminiscent of an anemone), located above the surface on a wide or narrow base.

It is located on mucous membranes covered with transitional epithelium (urothelium) - in the renal pelvis and ureters, bladder, prostate gland, urethra. Microscopically, it is a papillary tumor (Fig. 3) with loose fibrovascular stroma, a cover of urothelium, practically indistinguishable from normal, with clearly visible umbrella cells. Rare typical mitoses localized in the basal parts of the epithelium may occur.

In case of injury, just like squamous cell papilloma, it is easily destroyed and inflamed, and can cause bleeding in the bladder. The tumor has an extremely low risk of recurrence and malignancy; it recurs only in 8% of cases. In the bladder, it can occasionally be widespread (diffuse papillomatosis).

Adenoma (from the Greek aden - gland, ota - tumor) is a benign tumor developing from the epithelium of the glands or from the single-layer cylindrical epithelium of the mucous membranes (nasal cavity, trachea, bronchi, stomach, intestines, endometrium, etc.). If an adenoma is found in a parenchymal organ, then, as a rule, it has the appearance of a well-demarcated node of soft consistency, and the tissue is white-pink when cut. The sizes vary - from a few millimeters to tens of centimeters. If the adenoma is located on the surface of the mucous membranes, then, as a rule, it is a polyp on a thin stalk. If the adenoma is macroscopically represented by a polyp, it is called adenomatous. Adenomatous polyps should be distinguished from hyperplastic polyps, which are not tumors, but can transform into adenomatous polyps, as well as from allergic polyps. Adenoma can also be represented by a cyst, in which case it is called cystadenoma. Cystadenoma is an adenoma with the presence of cysts (cavities). In this case, the cyst may precede the development of an adenoma (primary cyst) or arise in the tissue of an already formed tumor (secondary cyst). Cysts are filled with fluid, mucus, clotted blood, or mushy or dense masses. Cystadenomas are most common in the ovaries. Thus, adenomas have three macroscopic growth patterns: node, polyp and cystadenoma.

Adenoma has an organoid structure and consists of glandular epithelial cells that form various structures. Depending on the type of structures formed, they are distinguished: acinar (alveolar), developing from the parenchyma of the glands and forming structures similar to alveoli or acini; tubular, consisting of numerous tubules; trabecular, having a beam structure, and papillary, represented by papillary growths (Fig. 4). The epithelium remains complex and polar, located on the basement membrane. There are no signs of cellular atypia. Adenoma cells are similar to the cells of the original tissue in morphological and functional respects. An adenoma can develop into cancer.

Neoplasms in situ without specific localization.

Cancer “in situ” (carcinoma in situ, CIS, intraepithelial cancer, intraepithelial cancer, non-invasive cancer). Cancer in situ is a cancer within the epithelium, does not have the ability to invade/metastasize, but has the most comprehensive range of genetic abnormalities characteristic of cancer compared to neoplasia. With CIS, the growth and proliferation of atypical cells occurs within the epithelial layer, without moving into the underlying tissue. In such a situation, the tumor is the least dangerous for the patient, it does not metastasize and a complete cure is possible. However, CIS is extremely difficult to detect because it does not manifest itself in any way at the macroscopic level.

In different types of epithelium, carcinoma in situ looks different, and diagnostic criteria are different everywhere. Figure 5 shows for comparison images of normal epithelium (top row) and carcinoma in situ (bottom row) for squamous, transitional and glandular epithelium. Please note that in CIS there is a violation of the architectonics of the epithelium: the number of its layers increases, the differentiation of the epithelial layers is completely lost, and extremely pronounced nuclear atypia (polymorphism, nuclear hyperchromia), and a large number of mitoses are observed.

However, it is necessary to take into account that “cancer in situ” is only a stage of tumor growth; over time, the tumor becomes infiltrating (invasive), and can also recur if it is not completely removed.

Malignant tumors without specific localization.

Squamous cell (squamous, epidermoid) carcinoma is a malignant tumor of squamous epithelium. It develops more often in the skin and mucous membranes covered with squamous epithelium (oral cavity, pharynx, upper larynx, esophagus, rectum and anal canal, cervix, vagina, vulva). In mucous membranes covered with prismatic or transitional epithelium, squamous cell carcinoma develops only after previous squamous cell metaplasia of the epithelium (bronchi, bladder). The tumor consists of strands and nests of atypical squamous epithelial cells that grow into the underlying tissue, destroying it. Tumor cells can retain the ability to keratinize to varying degrees, which confirms the histogenesis of squamous cell carcinoma. Well-differentiated squamous cell carcinoma (keratinizing, G1) retains the ability to keratinize to the greatest extent, with formations resembling pearls (cancer pearls) consisting of horny substance appearing (Fig. 6), cellular atypia is moderate. Moderately differentiated squamous cell carcinoma (with a tendency to keratinization, G2) does not form cancer pearls, the accumulation of horny substance is observed in individual tumor cells, while the cytoplasm of such cells is more abundant and eosinophilic (Fig. 7), cellular atypia is moderate or severe. Poorly differentiated squamous cell carcinoma (non-keratinizing, G3) loses the ability to keratinize (Fig. 8). In G3 tumors, cellular atypia is most pronounced.

The predominant route of metastasis of squamous cell carcinoma is lymphogenous.

Transitional cell (urothelial) cancer is a malignant tumor of the transitional epithelium. Develops on mucous membranes covered with transitional epithelium (renal pelvis, ureters, bladder, prostate gland, urethra). As a rule, it has a papillary structure, so in the bladder during cystoscopic examination it resembles an anemone. The transitional epithelium covering the papillae shows both signs of tissue atypia (loss of umbrella cells, disruption of epithelial architecture, increase in the number of layers) and cellular atypia. Transitional cell carcinomas can also have varying degrees of differentiation (Gl, G2, G3).

Adenocarcinoma (glandular cancer) is a malignant tumor of the glandular epithelium of the mucous membranes and the epithelium of the excretory ducts of the glands. Therefore, it is found both in the mucous membranes and in the glandular organs. This adenogenic tumor has a structure similar to an adenoma, but unlike an adenoma, adenocarcinoma is characterized by cellular atypia and invasive growth. Tumor cells form glandular structures of various shapes and sizes, which grow into the surrounding tissue, destroy it, and their basement membrane is lost. The formation of atypical glandular structures, as well as the preservation of the ability to form mucus, are morphological features of adenocarcinoma that confirm its histogenesis. There are variants of adenocarcinoma: acinar - with a predominance of acinar structures in the tumor; tubular - with a predominance of tubular structures; papillary, represented by atypical papillary growths; trabecular - with a predominance of trabeculae; cribrous, forming lattice structures and solid, characterized by continuous growth, without the formation of any structures (Fig. 9). The predominant route of metastasis of adenocarcinoma is lymphogenous.

Adenocarcinoma can have different degrees of differentiation (Gl, G2, G3). The degree of differentiation depends on the number of solid structures in the tumor. Well-differentiated tumors (G1) are characterized by a predominantly tubular or papillary growth pattern; solid areas are absent or constitute no more than 5% of the tumor area (Fig. 10). Moderately differentiated tumors (G2) are characterized by the appearance of cribriform, acinar, or trabecular areas; the solid component occupies more than 5, but less than 50% of the tumor area. In poorly differentiated tumors (G3), solid structures make up more than 50% of the tumor area. Nuclear

polymorphism is usually significantly pronounced. Mitotic activity is not decisive for assessing the degree of differentiation, but, as a rule, it increases with increasing degree of malignancy.

There are special types of adenocarcinomas:

Mucosal (colloid, mucinous) cancer is adenocarcinoma, the cells of which have signs of both morphological and functional atypia (perverted mucus formation). Cancer cells produce huge amounts of mucus, forming so-called “mucus lakes.” Tumor cells and tumor complexes “float” in the mucus (Fig. 11). Signet ring cell carcinoma is an adenocarcinoma consisting of cells with a large amount of mucin in the cytoplasm, pushing the nucleus to the periphery and resembling a ring in shape (Fig. 12). An extremely aggressive tumor, has a poor prognosis, and metastasizes early.

Previously, medullary and fibrous cancers were identified as variants of the structure of adenocarcinomas, but today this position has been revised (see lecture on general oncology). However, the term “medullary carcinoma” is still used to refer to independent

nosological forms of some organ-specific tumors (medullary thyroid cancer, medullary breast cancer).

Also, small cell carcinoma was previously considered a variant of adenocarcinoma, but now it is classified as a neuroendocrine tumor and will be discussed further.

In addition to the described squamous cell, glandular and transitional cell carcinomas, there are mixed forms of cancer, consisting of the rudiments of two types of epithelium (squamous and columnar), they are called dimorphic cancers (for example, adenosquamous cell carcinoma).

Tumors of exo- and endocrine glands, as well as epithelial integuments (organ-specific).

These tumors are characterized by the fact that they develop from epithelial cells that perform a highly specialized function. At the same time, organ-specific tumors retain morphological, but sometimes also functional features inherent in a given organ. They are found both in exocrine glands and epithelial integuments, and in endocrine glands.

Tumors of exocrine glands and epithelial integuments

The types of these tumors are given in table. 2.

Hepatocellular adenoma (hepatoma) is a benign tumor that develops from hepatocytes, consisting of layers and strands of tumor cells. It occurs in the form of one or more nodes, usually yellowish in color. Although they can also appear in men, hepatocellular adenomas most often appear in women taking oral contraceptives, the tumors quickly disappear when they are stopped. Hepatocellular adenomas are clinically significant when they are located subcapsular and therefore tend to rupture, especially during pregnancy (under the influence of estrogens), causing dangerous intraperitoneal bleeding. In the pathogenesis of hepatomas, hormonal stimulation and the presence of mutations in the HNF1 a gene are of great importance. In rare cases, hepatomas transform into hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is a malignant tumor developing from hepatocytes, accounting for approximately 5.4% of all cancers. However, in some populations, HCC is the most common type of cancer. The highest incidence is found in Asia (76% of all HCC) and Africa. In more than 85% of cases, HCC occurs in countries with a high incidence of hepatitis B. In these regions, infection begins in infancy through vertical transmission from mother to fetus, which increases the risk of developing HCC in adulthood by approximately 200 times.

There are three main etiological factors associated with HCC: viral infection (hepatitis B and C), chronic alcoholism, non-alcoholic steatohepatitis. Other risk factors include tyrosinemia, α-1-antitrypsin deficiency, and hereditary hemochromatosis. It has been proven that the presence of hepatitis B virus DNA in hepatocytes increases the number of chromosomal aberrations: deletions, translocations and duplications.

HCC may present as a single large nodule involving almost an entire lobe of the liver (massive form), several isolated nodules (nodular form), or as a diffuse infiltrative cancer that does not form distinct nodules (diffuse form). The tumor is built from atypical hepatocytes forming tubules, acini or trabeculae (tubular, acinar, trabecular, solid cancer). Tumor cells often contain bile in the cytoplasm, which is considered a sign of organ specificity of HCC. All types of HCC are prone to invasion of vascular structures. Often HCC produces a large number of intrahepatic metastases, and occasionally long, serpentine tumor masses - “tumor thrombi” - invade the portal vein, impeding blood flow, or the inferior vena cava, growing even into the right side of the heart.

Death in HCC occurs from: 1) cachexia, 2) bleeding from gastrointestinal or esophageal varices, 3) liver failure with hepatic coma, or, rarely, 4) tumor rupture with bleeding. The 5-year survival rate for patients with large tumors is extremely low, with most patients dying within the first two years of the disease.

In the liver, organ-nonspecific adenocarcinoma from the epithelium of the bile ducts - cholangiocarcinoma - can also develop.

Benign tumors include adenomas, and malignant tumors include variants of renal cell carcinoma. Small solitary renal cell adenomas, originating from the epithelium of the renal tubules, are quite often (from 7% to 22%) found at autopsy. Most often they have a papillary structure and therefore are called papillary in most international classifications.

Renal cell carcinoma has several variants: clear cell, papillary, chromophobe and collecting duct carcinoma (Bellini ducts). Previously, due to the yellow color of kidney tumors and the similarity of tumor cells with light cells of the adrenal cortex, they were called hypernephromas (hypernephroid cancer). It has now been established that all these tumors originate from the epithelium of the renal tubules.

The main subtypes of renal cell carcinoma are as follows (Fig. 13):

1) Clear cell renal cell carcinoma (CLRC). The most common type, accounting for 70% to 80% of all renal cell adenocarcinomas. The tumors have a solid structure, consist of cells with light or granular cytoplasm (the cytoplasm becomes light due to the high content of vacuoles with lipids) and do not have areas of papillary structure. Clear cell carcinoma, unlike other forms of renal cell carcinoma, is characterized by the presence of foci of necrosis and hemorrhage. 98% of these tumors are characterized by loss of the VHL gene (3p25.3). The second surviving allele of the VHL gene undergoes somatic mutations or inactivation triggered by hypermethylation. These facts confirm that the VHL gene acts as a tumor suppressor gene in the development of SPCC. Metastasizes predominantly by hematogenous route.

2) Papillary carcinoma. Accounts for 10% to 15% of all renal cell carcinomas. Forms papillary structures. These tumors are not associated with deletions in Zp. Unlike clear cell carcinoma, papillary carcinoma often shows multicentric growth from the onset of the disease. Metastasizes predominantly by hematogenous route.

Chromophobe carcinoma. It accounts for 5% of renal cell carcinomas and consists of cells with a clearly visible cell membrane and clear eosinophilic cytoplasm, usually a halo around the nucleus. This type of cancer appears to originate from intercalary collecting duct cells and has a favorable prognosis compared with clear cell and papillary cancers.

Carcinoma of the collecting ducts (ducts of Bellini). Represents approximately 1% or less of renal epithelial neoplasms. These tumors originate from the collecting duct cells in the medulla of the kidney. Histologically, these tumors are characterized by the presence of nests of malignant cells in a fibrous stroma. Usually localized in the medulla.

Nephroblastoma (embryonic nephroma, embryonic kidney cancer, Wilms tumor) is a malignant tumor; most common in children and adolescence (see Diseases of childhood).

Breast tumors are very diverse and often develop against the background of dishormonal benign dysplasia.

Benign epithelial tumors include adenoma and intraductal papilloma. However, most often in the mammary gland there is a benign tumor of mixed structure - fibroadenoma, which has the appearance of an encapsulated node with a lobular structure and a dense consistency. Proliferation of both glandular structures and components of the connective tissue stroma is characteristic. In this case, the proliferating stroma can overgrow the intralobular ducts (pericanalicular fibroadenoma) or grow into them (intracanalicular fibroadenoma). The group of neoplasms in situ of the breast includes ductal carcinoma in situ (intraductal carcinoma, non-infiltrating ductal carcinoma) and lobular carcinoma in situ (intra-lobular carcinoma, non-infiltrating lobular carcinoma).

Non-infiltrating ductal carcinoma (ductal “carcinoma in situ”, intraductal carcinoma, ductal CIS) can have a different histological structure (solid, papillary, acneiform and cribriform), but its main feature is that it grows only within the ducts, without going beyond into the surrounding stroma . Ductal CIS typically occurs multicentrically but is usually limited to one segment of the gland. In the acne form, intraductal growths of anaplastic epithelium undergo necrosis and calcification. These necrotic masses of the tumor are squeezed out of the mammary gland ducts during the incision in the form of whitish crumbling plugs (which is why the cancer is called acne-like). Ductal CIS, if left untreated, becomes invasive.

Non-infiltrating lobular cancer (lobular carcinoma in situ, intralobular carcinoma, lobular CIS) occurs monocentrically or multicentrically. Develops in an unchanged lobule or against the background of dishormonal benign dysplasia. It may progress to an invasive form of cancer.

Types of invasive breast cancer include infiltrating ductal and infiltrating lobular cancer, as well as Paget's disease of the breast. Infiltrating ductal breast cancer, the most common form of cancer, can grow in one or more nodes. Histologically, it is characterized by the presence of tubular, trabecular or solid structures with varying degrees of nuclear atypia. The earliest metastases are usually found in the axillary lymph nodes.

Infiltrating lobular breast cancer is a rarer form of cancer; it consists of relatively small cells compared to ductal cancer, which are united in peculiar chains (“trains”). Chains of cells in lobular cancer can form peculiar concentric structures called “owl eyes” around normal breast ducts. The prognosis for lobular cancer is more favorable compared to ductal cancer.

Today, breast cancer is the only malignant tumor for which immunohistochemical testing is mandatory to determine the sensitivity of the tumor to antitumor therapy. The study is carried out with 4 markers: estrogen receptors (ER), progesterone receptors (PgR), proliferation marker (Ki67), HER2/neu oncoprotein. The level of expression of these markers determines the sensitivity of the tumor to hormonal therapy (ER, PgR), cytostatic therapy (Ki67) and targeted therapy with Trastuzumab (HER2/neu).

Paget's disease (Paget's cancer) of the breast is characterized by three signs: eczematous lesions of the nipple and areola; the presence of large, light cells in the epidermis of the nipple and areola; damage to the large ducts of the mammary gland. In the thickened and somewhat loosened epidermis, peculiar light tumor cells called Paget cells are found. They lack intercellular bridges and are located in the middle sections of the germinal layer of the epidermis, but can also reach the stratum corneum. Paget's cancer of the nipple can be combined with infiltrating ductal or lobular cancer (primary multiple synchronous tumors, see above).

Organ-specific tumors of the uterus are neoplasms originating from the chorion (placental villi). Traditionally, these include hydatidiform mole (complete, partial, invasive), choriocarcinoma and some other rare neoplasms.

Hydatidiform mole is an abnormal placenta and is characterized by the presence of edema and cystic degeneration of some or all of the villi and varying degrees of trophoblast proliferation. There are complete and incomplete hydatidiform moles. With a complete hydatidiform mole, the embryo/fetus is usually absent, and swelling of the vast majority of the villi occurs with trophoblast proliferation. Partial hydatidiform mole is characterized by a combination of enlarged edematous villi and normal villi, as well as the presence of an embryo/fetus.

Destructive (invasive) hydatidiform mole is characterized by the presence of edematous chorionic villi in the thickness of the myometrium, in the uterine blood vessels, and also outside the uterus. Sometimes it can lead to uterine rupture. A destructive hydatidiform mole can transform into chorionepithelioma.

Hydatidiform mole is considered a form of pregnancy with chromosomal abnormalities, prone to malignant transformation, but not itself a tumor. At the same time, hydatidiform mole is traditionally considered in the section of uterine tumors and even has its own code in the ICD-O classification. Thus, partial and complete hydatidiform moles are coded /0, and invasive hydatidiform moles are coded /1.

Gestational chorionepithelioma (chorincarcinoma) is a malignant tumor of trophoblast cells that develops after a complete hydatidiform mole (50% of cases), after a spontaneous miscarriage (25%), from the remnants of the placenta after a normal birth (22.5%) and after an ectopic pregnancy (2, 5%). The tumor has the appearance of a variegated spongy node in the myometrium. It consists of atypical elements of cyto- and syncytiotrophoblast. There is no stroma in the tumor, the vessels look like cavities lined with tumor cells, and therefore hemorrhages are frequent. Most often, the tumor metastasizes hematogenously to the lungs, brain and liver. Lymphogenic metastases are not typical. The tumor actively produces human chorionic gonadotropin, the level of which increases significantly in the blood serum and serves as a serological marker for diagnosis and monitoring.

Skin tumors are very numerous and arise both from the epidermis and from skin appendages: sweat and sebaceous glands, glands of hair follicles. These tumors are divided into benign and malignant. The most important of them are syringoadenoma, hidradenoma, trichoepithelioma and basal cell carcinoma (basalioma). Syringoadenoma is a benign tumor of the epithelium of the sweat gland ducts. Hidradenoma is a benign tumor of the secretory epithelium of the sweat glands with papillary outgrowths of the epithelium. Trichoepithelioma is a benign tumor of hair follicles or their embryonic elements. Characterized by malformed hair follicles and squamous epithelial cysts filled with horny substance.

Basal cell carcinoma (basalioma) is a tumor with local destructive growth, often recurs, but extremely rarely metastasizes; localized most often on the neck or face; looks like a plaque or deep ulcer. If basal cell carcinoma is localized on the chin and has the appearance of a deeply penetrating ulcer with uneven edges and hyperemia along the periphery, it is called ulcus rodens. The tumor is often multiple. Constructed of small round, oval or spindle-shaped cells with a narrow rim of basophilic cytoplasm (dark cells), reminiscent of the basal cells of the epidermis, but lacking intercellular bridges. The cells are arranged in cords or solid nests, in which formations similar to skin appendages may appear. Basalioma is extremely characterized by a morphological phenomenon called “palisade-shaped arrangement of nuclei.” In this case, the nuclei of cells on the periphery of tumor complexes line up parallel to each other, like boards in a front garden fence, which is reflected in the name of the morphological phenomenon. Basalioma is one of the most common skin tumors.

Malignant tumors that develop from skin appendages include cancer of the sweat glands, cancer of the sebaceous glands and cancer of the hair follicles. These tumors are rare.

Ovarian tumors are diverse and, depending on their origin, are divided into epithelial, sex cord stromal tumors and germ cell tumors; they can be benign or malignant. In this section, we will examine only epithelial tumors of the ovary; tumors of the sex cord stroma and germ cell tumors will be discussed in the topic “Diseases of the female genital organs.”

Serous cystadenoma is an epithelial benign tumor of the ovary, often unilateral. It is a cyst, sometimes large in size, with a smooth surface. On a section it has a whitish appearance, consists of one or more cavities filled with serous fluid. Cysts are lined with flattened epithelium similar to the epithelium of the serous membranes (hence the tumor takes its name), sometimes forming papillary structures on the inner surface of the cyst.

Mucinous cystadenoma is a benign epithelial tumor, unilocular or multilocular, usually unilateral. It can reach very large sizes and weights (up to 30 kg). The cysts are lined with high prismatic epithelium, reminiscent of intestinal epithelium and containing mucus in the cytoplasm; the formation of papillary structures in the lumen of the cyst is possible.

Borderline epithelial tumors of the ovary (<серозная пограничная опухоль, муцинозная пограничная опухоль) по своим макроскопическим характеристикам похожи на доброкачественные аналоги. Часто развиваются у женщин в молодом возрасте. Гистологически формируют сосочковые структуры в просвете кист, однако отличаются наличием высокой пролиферативной активности в эпителии сосочков. При этом инвазивный рост отсутствует. При пограничных опухолях яичника на брюшине (преимущественно малого таза) могут возникать так называемые импланты, которые по сути представляют собой метастазы, возникающие контактным путем. Прогноз при пограничных опухолях яичника относительно благоприятный.

Serous cystadenocarcinoma is an epithelial malignant tumor, one of the most common forms of ovarian cancer. Papillary growths of anaplastic epithelium predominate, and foci of a solid structure often appear. Tumor cells grow into the wall of the cyst, spread over its surface and move to the peritoneum, and invasive growth into the ovarian tissue and adjacent anatomical structures is observed.

Mucinous cystadenocarcinoma) is a malignant mucinous tumor of the ovary. Macroscopically it also appears as a cyst. Consists of atypical cells that secrete mucus; cells form tubular, solid, cribriform structures; Necrosis of tumor tissue is characteristic. In some cases, the wall of the tumor cyst ruptures, its contents spill into the abdominal cavity, and pseudomyxoma peritonei develops. In this case, implantation of mucinous cystadenocarcinoma cells into the peritoneum is possible; A large amount of mucus secreted by cells accumulates in the abdominal cavity.

Tumors of the thyroid gland are diverse, since each of its cells (A, B and C) can be the source of the development of benign (adenoma) and malignant (cancer) tumors.

Thyroid adenomas are varied. Follicular adenoma develops from A- and B-cells, is similar in structure to the thyroid gland, and consists of small (microfollicular) and larger (macrofollicular) follicles. Solid adenoma arises from C cells that secrete calcitonin. The tumor cells are large, with light oxyphilic cytoplasm, growing among colloid-filled follicles. Thyroid cancer most often develops from a previous adenoma. Histologically, it is represented by several types.

Papillary cancer ranks first in frequency among all malignant epithelial tumors of the thyroid gland (75-85%). It occurs more often in older women. It is believed that the risk of papillary thyroid cancer increases sharply with exposure to ionizing radiation, and its connection with hyperestrogenism is discussed. The tumor is represented by papillary structures covered with atypical epithelium. The nuclei of tumor cells in papillary cancer have the characteristic appearance of “ground watch glasses,” that is, they are oval in shape, clear in the center, have a dark rim along the periphery, and often overlap each other. The tumor can grow into the capsule of the thyroid gland.

Follicular cancer is the second most common type of thyroid cancer, accounting for 10-20% of all cases. More common in older women. The incidence of follicular cancer is higher among people with insufficient dietary iodine intake, so it is believed that nodular endemic goiter may predispose to follicular cancer. It is also assumed that it may arise from a follicular adenoma of the thyroid gland. In follicular cancer, mutations in oncogenes of the RAS family (most often NRAS) are often detected.

It is represented by atypical follicular cells that form small follicles that contain colloid. Vascular invasion and ingrowth into the gland capsule occur. Lymphogenous spread of the tumor is not typical; on the contrary, hematogenous metastases to the bones often occur.

Solid (medullary) cancer is histogenetically associated with C-cells, which is proven by the presence of calcitonin in the tumor and the similarity of the ultrastructure of tumor cells with C-cells. In the tumor stroma, amyloid is detected, which forms a tumor

MALIGNANT EPITHELIAL TUMORS

Cancer can develop in any organ where epithelial tissue is present and is the most common form of malignant tumors. It has all the signs of malignancy. Cancer, like other malignant neoplasms, is preceded by precancerous processes. At some stage of their development, the cells acquire signs of anaplasia and begin to multiply. They have clearly expressed cellular atypia, increased mitotic activity, and many irregular mitoses. However, all this occurs within the epithelial layer and does not extend beyond the basement membrane, i.e. there is no invasive tumor growth yet. This very initial form of cancer is called “cancer in situ,” or carcinoma in situ. Early diagnosis of pre-invasive cancer allows timely appropriate, usually surgical, treatment with a favorable prognosis.

Most other forms of cancer are macroscopically shaped like a nodule with indistinct boundaries that blend into the surrounding tissue. Sometimes a cancerous tumor diffusely grows into an organ, which at the same time becomes denser, the walls of hollow organs become thicker, and the lumen of the cavity decreases; often the cancerous tumor is revealed, and therefore bleeding may occur. Based on the degree of decline in signs of maturity, several forms of cancer are distinguished.

Squamous cell carcinoma develops in the skin and mucous membranes covered with squamous epithelium: in the oral cavity, esophagus, vagina, cervix, etc. Depending on the type of squamous epithelium, there are two types of squamous cell carcinoma - keratinizing And non-keratinizing. These tumors belong to differentiated forms of cancer. Epithelial cells show all signs of cellular atypia. Infiltrating growth is accompanied by disruption of cell polarity and complexity, as well as destruction of the basement membrane. The tumor consists of strands of squamous epithelium that infiltrate the underlying tissue, forming complexes and clusters. In squamous cell keratinizing cancer, atypical epidermal cells are located concentrically, retaining the ability to keratinize. Such keratinized nests of cancer cells are called “ cancer pearls."

Squamous cell carcinoma can also develop on mucous membranes covered with prismatic or columnar epithelium, but only if, as a result of a chronic pathological process, its metaplasia into stratified squamous epithelium has occurred. Squamous cell carcinoma grows relatively slowly and gives lymphogenous metastases quite late.

Adenocarcinoma- glandular cancer that occurs in organs that have glands. Adenocarcion includes several morphological varieties, some of which belong to differentiated, and some to undifferentiated forms of cancer. Atypical tumor cells form glandular structures of various sizes and shapes without a basement membrane or excretory ducts. Tumor parenchyma cells show nuclear hyperchromia, many irregular mitoses, and stromal atypia. Glandular complexes grow into the surrounding tissue, without being limited by anything from it, destroy lymphatic vessels, the lumens of which are filled with cancer cells. This creates conditions for lymphogenous metastasis of adenocarcinoma, which develops relatively late.

Solid cancer. In this form of tumor, cancer cells form compact, randomly located groups, separated by layers of stroma. Solid cancer refers to undifferentiated forms of cancer; it exhibits cellular and tissue anaplasia. The tumor quickly infiltrates surrounding tissues and metastasizes early.

Small cell carcinoma is a form of extremely undifferentiated cancer consisting of small, round, hyperchromatic cells resembling lymphocytes. Often, only through the use of special research methods can it be established that these cells are epithelial. Sometimes the tumor cells become somewhat elongated and resemble grains of oats (oat cell carcinoma), sometimes they become large (large cell carcinoma). The tumor is extremely malignant, grows quickly and gives early extensive lymphatic and hematogenous metastases.

Carcinoma is a malignant tumor that can cause damage to internal organs and skin epithelial cells. Squamous cell carcinoma is one of the varieties of this tumor, most often located on the cervix and is one of the most severe and dangerous oncological pathologies that arise in a woman’s reproductive system.

Previously, the occurrence of such tumors was observed in older women, but in recent years, squamous cell carcinoma of the cervix has become more common in women under 40 years of age.

Squamous cell carcinoma begins to develop when tissue that comes into contact with the external environment is damaged. Modern medicine cannot yet give an exact answer about the general reasons that prompted the occurrence of this pathology. The processes that can trigger the mechanisms for the occurrence of such a violation include the following factors:

• hormonal disorders;
• heredity;
• viral infection;
• exposure to industrial carcinogens.

Squamous cell carcinoma is a malignant neoplasm of epithelial tissue. Cancer cells can be localized in the lungs, on the cervix in women, in the larynx, on the skin and other places. Characteristic manifestations of the disease are the rapid growth of cancer cells and penetration into nearby tissues due to metastases.

The pathological process can be observed in both sexes, regardless of age.

The disease is diagnosed after a comprehensive examination, including the following procedures:

• radiography;
• CT scan;
• bronchoscopy;
• cytological analysis of sputum or smear;
• colposcopy;
• tissue biopsy and histological examination.

The squamous cell carcinoma antigen SCCA, which is produced in epithelial cells, is very important in the study. Molecular weight - 45–55 kilodaltons. The substance should not leave the cellular space. In cancer, the antigen content increases significantly.

The prognosis depends on the stage of cancer, the patient’s condition, and age. Metastatic cancer leads to death in most cases.

Etiology

Squamous cell carcinoma is an oncological disease with an aggressive course. The pathological process begins in the skin or mucous layer of the epithelium, spreads to the lymph nodes, neighboring tissues and organs, destroying their anatomical structure and functional activity.

The main causes of cancer:

• radioactive exposure - when working in nuclear production, in the process of abusing diagnostic procedures with x-rays);
• aggressive environmental influences - if a person lives near industrial facilities;
• the presence of viruses (,), erosion and polyp - provoke squamous cell, at risk are women who neglect contraceptives and abuse frequent abortions;
• deficiency of immunological functions of the body;
• long-term nicotine addiction;
• pathological processes in the lungs and bronchi caused by, and;
• taking medications with immunosuppressive effects;
• work in enterprises with increased occupational hazards - in mines, chemical facilities and metallurgy;
• age 1 the risk of getting sick is higher after 50–65 years.

Skin pathological conditions increase the risk of malignant neoplasms.

Classification

Squamous cell carcinoma has several varieties. The disease has two forms of spread:

• invasive;
• microinvasive.

According to the degree of cell differentiation, the following are distinguished:

1. Keratinizing form. It grows slowly, forms from limited structures and has a greyish-white shiny surface. The structure is differentiated; there are particles with keratinization, which are located on the outside of the tumor, forming a yellowish edging. The most common location is the surface of the skin. This form of cancer is the most favorable.
2. Non-keratinizing form. The presence of a cluster of undifferentiated cell structures is characteristic. The highest percentage of malignancy. The lesion grows quickly and spreads to nearby tissues. The favorite location is mucous tissue; it is very rarely found on the skin.
3. Poorly differentiated form. It consists of spindle-shaped cell structures and resembles sarcomatous formations. The degree of malignancy is high - it grows and spreads quickly.
4. Glandular form. Localized in the uterus or lung tissues. The structure of the neoplasm contains squamous epithelium and glandular structures. The tumor is growing rapidly, the prognosis is unfavorable.

When invasive carcinoma is diagnosed, the tumor has a high risk of spreading to adjacent tissues and lymph nodes. The prognosis for the non-invasive form of carcinoma is more favorable.

Symptoms

Squamous cell carcinoma manifests itself in different ways: in addition to the main symptomatic manifestations of cancer, particular features of the location of the pathological process are added.

Main features:

• fast fatiguability;
• weight loss;
• decreased appetite;
• headache.

With cervical cancer, hemorrhages from the genital tract are possible during sexual intercourse, douching or examination by a gynecologist. With the increase and spread of the cancer process, the appearance of genitourinary fistulas is noted.

Local symptoms:

• changes in the skin and mucous membranes - redness, swelling, thickening;
• hemorrhages in organs;
• severe cough or cough with sputum containing blood;
• pain;
• nausea;
• severe itching;
• hoarse voice;
• dizziness.

Cancer develops over time. Stages (stages) of development of malignant formation:

1. Zero stage. The primary focus is not detected, there are no metastases in the lymph nodes and organs.
2. First stage. The tumor is no more than 5 cm with no metastases.
3. Second stage. The size of the neoplasm exceeds 5 cm, the lesion grows into nearby tissues, there are no metastases.
4. Third stage. The presence of metastases only in the lymph nodes is typical.
5. Fourth stage. The size of the carcinoma varies, and there are metastases in distant organs.

If a person exhibits the above symptoms, they should undergo examination.

Diagnostics

After the patient comes to the clinic, the doctor examines the medical history, listens to complaints, examines the patient and sends him for additional procedures:

• colposcopy;
• X-ray of the lungs;
• CT scan;
• bronchoscopy;
• cytological analysis of smears, sputum;
• tissue biopsy;
• checking the amount of SCC antigen in the blood.

SCC antigen is a tumor marker that makes it possible to diagnose cancer in the cervix, nasopharynx, esophagus, lungs, and ear.

The antigen allows a specialist to identify cancer cells, establish the multiple form of the tumor, and the number of foci of metastases in the body. If the concentration is more than 1.5 ng/ml, the patient is diagnosed with cancer in 95%. The SCC level increases significantly during treatment as a result of the breakdown of pathological cells.

Completing a full range of medical diagnostics makes it possible to identify pathology, determine the degree of development of the lesion and select effective therapy.

Treatment

Squamous cell carcinoma involves a course of:

• chemotherapy - the use of antitumor drugs;
• radiation therapy - irradiation of the tumor with gamma rays.

In some cases, surgical intervention is prescribed in the initial stages of the disease. Surgeons remove the tumor and metastases, and subsequent chemotherapy or radiation therapy will get rid of the remaining pathological cells.

When the carcinoma is located on the surface and is small in size, electrocoagulation, photodynamic therapy or cryotherapy are used.

After the course of treatment, the patient is registered at the oncology clinic and undertakes to periodically visit the attending physician to monitor the condition.

Prognosis for squamous cell carcinoma depends on the person’s age, stage and location of the carcinoma:

• Cervical cancer of the first stage - 90% survival rate, second - 60%, third - 35%, fourth - 10%.
• Pulmonary malignant tumor. Survival rate in the first stage is up to 40%, in the second - from 15 to 30%, in the third - 10%.
• For skin carcinoma of the first, second and third stages, the survival rate is 60%, the fourth - 40%.

Carcinoma in the early stages is more treatable and the risk of relapse is much lower.

Possible complications

A large number of cancer patients die due to the late stage of detection of the cancer process. The diagnosis can cause the following complications:

Squamous cell carcinoma is a malignant neoplasm. The disease has been known since ancient times, and there is also information that in those days, at the initial stage of development, the tumor was removed. In an advanced state, treatment was considered pointless.

Characteristics of the disease

Squamous cell carcinoma is the most common disease among other types of oncology. This feature can be explained because the epithelial layer that covers all internal organs and the skin is constantly renewed. The more intense the process of cell division, the greater the likelihood of a malfunction or mutation, which leads to the formation of cancer.

Cells resulting from such mutations begin to divide rapidly. In a short time, with the participation of such a mechanism, a malignant tumor is formed, from which metastases spread through the bloodstream and lymphatic system to other vital organs.

Carcinomas come in different types, so they have been divided into groups. Sometimes the tumor is a formation with numerous nodes, and in some cases the carcinoma grows inward, forming ulcers. Neoplasms are divided into the following types:

• damage to the mucous membranes of the stomach, prostate, intestines, and bronchi is called adenocarcinoma;
• squamous cell carcinoma develops from flat layers of the epithelium, which is why carcinoma of the cervix and larynx is formed;
• There are also mixed forms of oncological formations, when both mucous membranes and flat layers of epithelial tissues are affected.

The squamous cell carcinoma antigen scca is a tumor marker that allows one to detect the presence of a tumor, including neoplasms of the head and neck. Squamous cell carcinoma has increased sensitivity to this antigen even at the initial stage of development. After surgery to remove the tumor, a sharp decrease in this sensitivity can be observed.

If after surgery or chemotherapy a high rate is still observed, then the disease continues to progress. It is possible that metastases may even form in nearby organs.

Before starting treatment, it is necessary to identify the exact cause, determine what carcinoma is and how it affects the body in a particular case. Because malignant cells spread quickly, therapy should be started as early as possible.

Causes

Squamous cell carcinoma occurs due to the following factors:

• hereditary predisposition;
• irradiation with ultraviolet rays;
• tobacco smoking abuse;
• drinking alcoholic beverages in large quantities;
• lack of proper nutrition;
• daily work with pesticides;
• environmental problems;
• infectious damage to the body;
• age after 50 years.

Cervical carcinoma occurs for the following reasons:

• onset of sexual activity in early adolescence;
• frequent change of sexual partners throughout life;
• the presence of sexually transmitted infectious diseases, including the herpes virus and human papillomavirus;
• use of an intrauterine device as a means of contraception;
• traumatic injury to the vagina during natural childbirth, as well as abortion;
• hormonal disruption of the body as a result of uncontrolled medication use;
• disorders associated with age-related changes in the mucous membranes;
• decrease in protective functions.

The use of SCC antigen for squamous cell carcinoma allows you to determine the further course of treatment. Why does the antigen increase, the reasons for such deviations:

• previous therapy was ineffective;
• development in the body of other benign tumor lesions, including deviations associated with squamous metaplasia.

It should also be remembered that scca is elevated only in the presence of a pathological process in the body. In a healthy person, the indicator does not exceed the norm.

Adenocarcinoma and squamous cell carcinoma are favored by the patient's advanced age – after 65 years. This feature is associated with the loss of the body’s protective functions. Especially if exposure to sunlight occurs, the surface of the skin undergoes significant changes. In addition, failures occur in the mechanism for recognizing mutated cells.

Diagnostics

How squamous cell carcinoma is diagnosed depends on the location of the tumor and the signs of presentation. This disease is determined in the following ways:

• CT scan;
• general blood analysis;
• blood chemistry;
• biopsy;
• determination of tumor marker norms;
• endoscopic examination.

To determine at what stage of development non-keratinizing squamous cell carcinoma or adenocarcinoma is, a cytology analysis is necessary. Based on the results of this diagnosis, doctors establish further prognosis.

Testing for tumor markers does not always give a true result. Even with renal failure, increased sensitivity may be detected. Therefore, it is important for specialists to distinguish normal indicators from malignant pathology.

Symptoms

Squamous cell carcinoma is divided into several stages:

1. The tumor does not cause any symptoms, the diameter does not exceed 2 cm, and is localized on the surface of the skin.
2. There is an increase in size, penetration of the tumor into the deep layers, and primary metastases appear.
3. The neoplasm is of impressive size, affects nearby organs, but does not affect cartilaginous tissue.
4. The last stage is characterized by numerous metastases, including in cartilage and bone tissues.

Carcinoma of the lungs and throat in some cases is accompanied by keratinization, the following symptoms occur:

• mucous discharge with blood from the larynx;
• persistent cough;
• high body temperature;
• sudden weight loss.

When the lungs and pharynx are affected, other chronic diseases immediately worsen. The inflammatory process in the body cannot be stopped with conventional cough medications.

Treatment

Because the carcinoma grows rapidly and shows signs of germination, it is removed surgically. In addition, the following methods are used:

• chemotherapy, radiation therapy;
• laser exposure;
• immunotherapy.

If lung carcinoma is detected, the prognosis will depend on the size and location of the tumor. The tumor marker analysis will be of great importance.

Sometimes it becomes necessary to remove bronchial glands, and it is necessary to control the lines of bronchial resection and the lesion. Small tumors are eliminated with chemotherapy.

If primary signs of appearance are observed and diagnosis shows the presence of early-stage carcinoma, then the problem can be dealt with without any health consequences. However, most often such a tumor occurs in an advanced form; further prognosis will depend on the degree of the body’s resistance, as well as on the location of the carcinoma.

Even now, the capabilities of modern medicine do not always help cope with oncology. This type of cancer is the most common; such tumors kill a huge number of people around the world every year.

Content

If a tumor appears on the skin, you should not exclude the development of oncology; as an option, it could be squamous cell carcinoma. Such a malignant neoplasm, in the absence of surgical intervention, can cause death in a patient at any age. At the initial stage, patients often confuse squamous cell keratinizing skin cancer with other dermatological diseases, and consult a doctor only in case of acute pain from a visualized focus of pathology.

What is squamous cell carcinoma

Essentially, it is a malignant tumor with aggressive development in the body, where epithelial cells and, over time, lymph nodes are involved in the pathological process. The characteristic disease often develops in adulthood and is more prevalent in men of pre-retirement age. Every year this diagnosis only gets younger, and the pathological process is preceded by a number of pathogenic factors, including human living conditions (society).

Symptoms

The pathological process develops rapidly and can lead to death. This is explained by the hidden course of the disease, its disguise as other, less dangerous diagnoses. In order to identify squamous cell cancer in a timely manner, it is necessary to collect anamnesis data and study the complaints of a clinical patient. Differential diagnosis is required to clarify the clinical picture. Below are symptoms characteristic of squamous cell cancer of different locations. So:

Causes

High-grade keratinizing squamous cell carcinoma or another form of oncology can be determined by performing a biopsy to identify epithelial cancer cells. However, it is important to find out the cause of the characteristic disease in order to significantly reduce the mortality statistics of the population from progressive oncology in the future. Factors provoking the disease are presented below:

• genetic predisposition (hereditary factor);
• chronic skin diseases;
• presence of bad habits;
• long-term decrease in general immunity;
• high dose ultraviolet radiation;
• poisoning with metals, vapors of toxic substances;
• the presence of carcinogens and chemicals in everyday food;
• social conditions;
• chronic nicotine and alcohol intoxication of the body;
• environmental factor;
• age-related changes in the body, gender;
• long-term use of toxic medications.

Classification of squamous cell carcinoma

Depending on the form and focus of the pathology, the following types of squamous cell cancer with characteristic signs are distinguished:

1. Plaque form. It can be characterized by the appearance of deep red bumps on the skin, which often bleed upon palpation.
2. Nodal form. The neoplasm is localized at the surface of the dermis, resembles a capsule in appearance, and is dense upon palpation.
3. Ulcerative form. These are so-called “craters” with raised edges, which have a loose structure and are prone to bleeding.

According to the pathological process, squamous cell carcinoma can be:

1. Horny. Occurs more often. After the mutation, the epithelial cells die, and the skin develops characteristic yellow or brown crusts.
2. Non-keratinizing. It is characterized by rapid growth, mutation of the cells of the spinous layer, the affected epithelium does not die.

Stages

Squamous cell cancer has five stages of development, which are found in equal proportions in extensive medical practice. The earlier a laboratory study of the suspected pathology is carried out, the greater the chances of a favorable clinical outcome. So, doctors identify the following stages of this cancer with characteristic signs:

1. Zero stage. The tumor is small, localized on the mucosa or in the upper layer of the epidermis. Does not give metastases.
2. First stage. The development of the tumor reaches up to 2 cm in diameter, while metastasis is not observed.
3. Second stage. The tumor exceeds 2 cm in size, grows into neighboring structures, but has not yet metastasized.
4. Third stage. A malignant tumor can extensively affect the walls of organs, muscles and blood vessels, and metastasizes to local lymph nodes.
5. Fourth stage. The last one is critical. In such a clinical picture, all internal organs are affected, systems are disrupted, there are a large number of metastases, and a high risk of death.

Diagnostics

The earlier squamous cell non-keratinizing cancer of the cervix or other organ is identified, the greater the chance of successful comprehensive treatment. The disease consists of the rapid division of cancer cells and infection of large areas of the dermis, its deep layers. Diagnosis consists of a laboratory study of multilayered areas, a clinical examination of the body to identify concomitant diseases and metastases. The main directions are as follows:

• endoscopy methods;
• CT scan;
• X-ray methods;
• Magnetic resonance imaging;
• laboratory studies of biological fluids;
• positron emission tomography;
• confocal laser scanning microscopy.

Squamous cell carcinoma antigen

This is a marker, a glycoprotein with a molecular weight of 48°kDa, identified from liver metastases during the diagnosis of squamous cell carcinoma of the cervix. It is a serum protease inhibitor that is normally expressed in squamous epithelium, predominantly in the epidermis. Its main sources are multilayered squamous epithelium of the bronchi, anal canal, esophagus, cervix, and skin. The half-life of squamous cell carcinoma antigen is at least 24 hours.

Treatment

Each clinical case is individual, so the patient requires a comprehensive diagnosis to understand what is happening in the body. Based on the results of a qualitative examination, the doctor prescribes treatment that combines surgical and conservative methods. In the first case, we are talking about the extermination of the pathogenic structure and excision of nearby tissues involved in the pathology. In the second - about the rehabilitation period using physiotherapeutic and conservative methods. Photos of what squamous cell cancer can lead to are shocking, so treatment is required on time.

Radiation therapy

Exposure to X-ray radiation is appropriate for small tumor sizes, as an independent method of intensive therapy for squamous cell cancer. In advanced clinical situations, radiation therapy is necessary for the purpose of preoperative preparation and postoperative recovery of the patient. In addition, this progressive method can remove metastases and improve the clinical outcome. Radiation therapy is indicated in courses, since malignant neoplasms of the dermis or deep layers of the skin can progress again.

Surgery

When implementing such a radical method of treating squamous cell cancer, the primary lesion and lymph nodes affected by metastases are removed. Doctors use special material, and the method itself is highly effective in combination with radiation therapy for excision of metastases and the stratum corneum of cells. If the tumor is large, irradiation of the affected tissue is required before surgery to narrow the pathology.

When implementing surgical methods for removing squamous cell cancer, the following directions are appropriate strictly for medical reasons: conization with curettage, removal of lymph nodes, extirpation, adjuvant chemotherapy and extended modified hysterectomy. The final choice is up to the specialist, but after the operation the patient is prescribed conservative intensive care methods to maintain general health at a satisfactory level.

Drug treatment

Conservative treatment of squamous cell cancer is more appropriate after excision of the affected tissue and involves local and oral administration. The main goal is to prevent complications of chemotherapy and radiation therapy and suppress side effects of the postoperative period. Medicines are prescribed individually, since potent medicines contain toxic components. If daily dosages are violated, the risk of intoxication of the affected organism increases.

Symptomatic treatment

This type of intensive therapy is not able to suppress the root cause of the disease, and its main task is to reduce the intensity of the expressed symptoms of oncology, or, as an option, to remove the pain syndrome. Especially for these purposes, oncologists recommend taking painkillers, including narcotic analgesics, sold in pharmacies strictly according to prescription. Additionally, hemostatic drugs and parenteral or enteral nutrition are prescribed. All concomitant pathologies that developed against the background of cancer are also treated conservatively.

Forecast

The clinical outcome of the disease depends on the stage of the pathological process and timely response measures. If squamous cell cancer has a diameter of up to 2 cm, there is no mechanical damage to the dermis, and adequate treatment is prescribed in a timely manner, the prognosis is favorable. Five-year survival is observed in 90% of all clinical presentations.

Diagnosis of infiltration of a characteristic neoplasm into the deep layers of the skin reduces the patient’s survival rate for the next five years. This figure is less than 50% for all clinical pictures, and in the presence of mechanical damage, extensive foci of metastasis formation - approximately 6-7%. The clinical outcome is unfavorable. With the fourth stage of the tumor, the patient may not live even a month, and he is prescribed only narcotic analgesics for pain relief.

Prevention

To avoid the development of squamous cell cancer, doctors report effective prevention measures, especially for patients at risk for inherited cancer. It is recommended to systematically carry out a comprehensive diagnosis of the body to identify dangerous neoplasms, and to respond in a timely manner to changes in the structure of the dermis. Additional preventive measures for all segments of the population are detailed below:

• complete abandonment of all bad habits, careful control of nutrition and habitual lifestyle;
• avoid prolonged exposure to the sun, dose the amount of ultraviolet rays to the top layer - the epidermis;
• promptly treat dermatitis of all types and eczema, since such diseases are accompanied by a precancerous condition of the skin.

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Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.