This comprehensive guide aims to break down SCC (Squamous cell carcinoma (SCC) is a form of cancer that impacts the skin or other tissues, including the mouth, oesophagus, or lungs) in simple terms, covering what it is, why early detection matters, and the basics of causes, symptoms, and treatment options. Let’s dive into the world of SCC to help you grasp its essentials without overwhelming complexity.
At its core, SCC is a class of skin cancer that develops in the squamous tissues, the flat cells found on the skin’s surface. These cells form the outer layer of the skin and mucous membranes, making SCC a cancer that can manifest in various locations, from the skin to the lining of organs. As the second most common form of skin cancer, SCC arises from the uncontrolled growth of these cells, often triggered by exposure to ultraviolet (UV) radiation or other environmental factors. Understanding the nature of SCC, its growth patterns, and the potential areas of occurrence is crucial for developing effective prevention and management strategies.
In the next parts of this blog, we’ll break down Squamous Cell Carcinoma into manageable pieces, making it easier for you to understand and take charge of your skin health. Stay with us for a practical guide to navigating the world of SCC.
Table of Contents
What Is Squamous Cell Carcinoma?
The skin is the largest organ of the human body & acts as a protective barrier between the internal organs & the external environment. It consists of 3 main layers: the epidermis, dermis, & subcutaneous tissue.
1. Epidermis: The upper layer of the skin, the epidermis, is composed of several sub-layers. The top layer, the stratum corneum, includes dead skin cells acting as a protective barrier. The deeper layers contain living cells, including keratinocytes, melanocytes, and immune cells.
2. Dermis: Beneath the epidermis is the dermis, a thicker layer that includes blood vessels, nerve endings, hair follicles, & sweat glands. Collagen and elastin fibres provide structural support and elasticity to the skin.
3. Subcutaneous tissue: The deepest layer, the hypodermis or subcutis, comprises fat and connective tissue, offering insulation and cushioning.
Origins of squamous cells and their role in the body:
Squamous cells are a kind of epithelial cell found in various tissues, including the skin. They are flat and scale-like in shape, forming a protective layer on the body’s surfaces. In the skin, squamous cells are predominant in the epidermis, particularly in the stratum spinosum layer. These cells play a vital part in maintaining the integrity of the skin barrier, defending against external threats such as pathogens and environmental factors.
How squamous cell carcinoma develops:
Squamous cell carcinoma (SCC) is a kind of skin cancer that starts from the uncontrolled growth of squamous cells. The development of SCC is often linked to prolonged exposure to ultraviolet (UV) radiation from the sun or tanning beds, which can damage the DNA within these cells.
The process typically involves the following steps:
1. UV Exposure: Prolonged exposure to UV radiation causes genetic mutations in the squamous cells’ DNA.
2. Precancerous Lesions: Over time, these mutations may lead to the development of precancerous lesions, such as actinic keratosis, characterised by scaly patches on the skin.
3. Progression to SCC: Some precancerous lesions may progress to squamous cell carcinoma (SCC) if left untreated. SCC is characterised by the uncontrolled growth of abnormal squamous cells, which form a tumour.
4. Metastasis: In advanced stages, SCC may invade nearby tissues and, in some cases, metastasise to other body parts, although this is less common than in different types of skin cancer.
Early detection & treatment are crucial in managing squamous cell carcinoma, often involving surgical removal of the tumour and, in some cases, additional therapies such as radiation or chemotherapy. Regular skin examinations and protection against UV radiation can help limit the risk of developing squamous cell carcinoma.
Staging & Prognosis Of Squamous Cell Carcinoma
To determine how advanced SCC is, doctors use a staging method that ranges from 0 to 4. The stage of SCC depends on the size of the tumour, the presence of high-risk features, and whether it has invaded nearby structures or lymph nodes. Lymph nodes are tiny glands that filter lymph fluid and help fight infections. The stage of SCC also affects the treatment options and the prognosis (outlook) for the patient.
Stage 0 SCC
Stage 0 SCC is also called carcinoma in situ or Bowen disease. It means there are abnormal cells in the top layer of the skin or tissue, but they have not become cancerous yet. Stage 0 SCC may or may not be visible on the skin or tissue. If it is visible, it may look like a red or white patch, a scaly or rough spot, or a change in colour or texture. Stage 0 SCC is usually treated with surgery, topical creams, or other methods to remove or destroy the abnormal cells.
Stage 1 SCC
Stage 1 SCC means that there are cancerous cells in the skin or tissue, but they are small and have not spread to any lymph nodes or other body parts. The tumour is 2 centimetres (cm) or less in diameter and has less than two high-risk features. High-risk features are factors that increase the chance of recurrence (cancer coming back) or metastasis (cancer spreading). Some examples of high-risk features are:
– The tumour is thicker than 2 mm or has developed into deeper layers of the skin (Clark level IV or higher)
– The tumour is growing around a nerve
– The tumour is located on the ear or lip
– The tumour cells are poorly differentiated or undifferentiated (they do not look like normal skin cells)
Stage 1 SCC is usually treated with surgery to remove the tumour & some surrounding normal tissue (called a margin). Sometimes, radiation therapy or chemotherapy may also be used.
Stage 2 SCC
Stage 2 SCC means that the tumour is larger than 2 cm in diameter, has two or more high-risk features, and has not metastasised to any lymph nodes or other body parts. Stage 2 SCC may cause more discomfort or pain than stage 1 SCC and may be more noticeable on the skin or tissue. Stage 2 SCC is usually treated with surgery to remove the tumour and a wider margin of normal tissue. Radiation therapy or chemotherapy may also be used before or after surgery to reduce the risk of recurrence or metastasis.
Stage 3 SCC
Stage 3 SCC means that the tumour has grown into nearby structures, such as bones, muscles, or organs, or has spread to one or more nearby lymph nodes. The tumour may be any size and have any number of high-risk features. Stage 3 SCC may cause symptoms such as difficulty swallowing, breathing, speaking, or hearing, depending on location. Stage 3 SCC is usually treated with a combination of surgery, radiation therapy, and chemotherapy. Sometimes, targeted therapy or immunotherapy may be used as well.
Stage 4 SCC
Stage 4 SCC means that the cancer has moved to distant parts of the body, like the lungs, liver, bones, brain, or other organs. The tumour may be any size and have any number of high-risk features. Stage 4 SCC may cause symptoms such as weight loss, fatigue, pain, coughing up blood, seizures, or other problems related to the affected organs. Stage 4 SCC is usually treated with palliative care to relieve symptoms & improve quality of life. Some patients may also receive chemotherapy, targeted therapy, immunotherapy, or clinical trials.
Prognosis Of Squamous Cell Carcinoma
The prognosis of squamous cell carcinoma is based on many factors, such as:
– The stage of cancer
– The location and size of the tumour
– The presence of high-risk features
– The type and grade of the tumour cells
– The patient’s age and general health
– The response to treatment
In general, the earlier SCC is diagnosed and treated, the better the outcome. According to some studies, the five-year survival rate for stage 0 and stage 1 SCC is over 95%. However, this rate drops significantly for stage 2 (80%), stage 3 (60%), and stage 4 (20%) SCC.
The survival rate is an estimate based on statistics from large groups of patients. It does not reflect the individual situation of each patient. Some patients may live longer or shorter than the average, depending on their specific circumstances. Therefore, it is important to talk to your doctor about your prognosis and treatment options.
Squamous Cell Carcinoma Treatments
Treatment options for SCC depend on several factors, such as the tumour’s location, size, stage, and subtype, as well as the patient’s age, general health, and preferences. The main treatment modalities for SCC include surgery, radiation therapy, chemotherapy, immunotherapy, and targeted therapy. We will discuss each of these medical treatments in detail and provide an overview of their costs in India.
1) Surgery
Surgery is the most common treatment for SCC, especially when the tumour is small, localised, & has not spread to nearby lymph nodes or distant organs. Surgery involves eliminating the tumour along with a margin of nutritious tissue around it to ensure the complete removal of cancer cells. The type and extent of surgery depend on the location and size of the tumour. Some common surgical procedures for SCC include:
– Excision: This is a simple procedure where the surgeon cuts out the tumour with a scalpel or a sharp knife and stitches the wound closed.
– Mohs surgery: This is a specialised technique where the surgeon eliminates thin layers of tissue one by one and examines them under a microscope until no cancer cells are seen. This allows for the precise removal of the cancer tumour while sparing as much healthy tissue as possible.
– Curettage and electrodesiccation: This involves scraping off the tumour with a curette (a sharp, spoon-shaped instrument) & then destroying any dwelling cancer cells with an electric needle.
– Cryosurgery: This involves freezing and killing the tumour cells with liquid nitrogen.
– Laser surgery: This involves using a high-intensity beam of light to vaporise or cut out the tumour.
The surgery cost for SCC in India varies depending on the type of procedure, the hospital, and the surgeon’s fees. Generally, it ranges from Rs. 25,000 to Rs. 2,00,000 (USD 325 to USD 2600).
2) Radiation therapy
This is a treatment that utilises high-energy rays or beams to kill cancer cells or restrict them from growing. Radiation therapy can be used as a major treatment for SCC when surgery is not possible or desirable, such as when the tumour is large, located in a difficult area (such as the eyelid or lip), or has spread to nearby lymph nodes. Radiation therapy can also be utilised as an adjuvant treatment after surgery to limit the risk of recurrence or as a palliative treatment to relieve symptoms such as pain or bleeding.
The cost of radiation therapy for SCC in India depends on the type of radiation, the number of sessions, and the hospital charges. Generally, it ranges from Rs. 1,00,000 to Rs. 3,00,000 (USD 1300 to USD 3900).
3) Chemotherapy
This medical treatment uses drugs to kill cancer cells or stop them from growing. It can be used as a primary treatment for SCC when it has spread to distant organs or when other treatments are not effective or suitable.
The cost of chemotherapy for SCC in India varies depending on the type of drugs, the dosage, the frequency, and the hospital fees. Generally, it ranges from Rs. 50,000 to Rs. 80,000 (USD 650 to USD 1100) per cycle.
4) Immunotherapy
Immunotherapy is a treatment that uses substances that stimulate or enhance the body’s natural defences to fight cancer. Immunotherapy can be used as a primary treatment for SCC when it has spread to distant organs or when other treatments are not effective or suitable. Immunotherapy can also be used as an adjuvant treatment after surgery or radiation therapy to limit the risk of recurrence or as a palliative treatment to relieve symptoms.
The cost of immunotherapy for SCC in India depends on the type, dosage, frequency, and hospital charges. Generally, it ranges from Rs. 1,50,000 to 4,55,000 (USD 1830 to USD 5550) per session.
5) Targeted therapy
This therapy uses drugs to target specific genes, proteins, or pathways involved in the growth & survival of cancer cells. It can be used as a primary treatment for SCC when it has spread to distant organs or when other treatments are not effective or suitable. It can also be used as an adjuvant medical treatment after surgery or radiation therapy to reduce the possibility of recurrence or as a palliative treatment to relieve symptoms.
The cost of targeted therapy for SCC in India varies depending on the type of drugs, the dosage, the frequency, and the hospital fees. Generally, it ranges from Rs. 1,00,000 to Rs. 2,50,000 (USD 1300 to USD 3250) per cycle.
Squamous Cell Carcinoma Treatment Cost In India
The cost of SCC treatment in India varies depending on the type of treatment, the hospital, the doctor, and other factors. The average price ranges from Rs 10,000 to Rs 2,50,000. However, this is only an estimate and may not reflect the actual cost for each case.
SCC treatment in India is generally affordable and accessible compared to many other countries. However, it is important to consult a qualified and experienced doctor who can recommend the best treatment option for each case. It is also advisable to compare the cost and quality of different hospitals and doctors before making a final decision.
Causes & Risk Factors Of Squamous Cell Carcinoma
While the exact cause of SCC is not always clear, several factors are known to increase the risk of developing this type of cancer. Here are some causes & risk factors associated with squamous cell carcinoma:
1. Ultraviolet (UV) Radiation Exposure:
– Sun Exposure: Prolonged exposure to UV radiation from the sun is a substantial risk factor for SCC. This includes both chronic sun exposure and intense, intermittent sun exposure (such as sunburns).
– Tanning Beds: The use of tanning beds or lamps that emit UV radiation increases the risk of developing skin cancers, including SCC.
2. Fair Skin Type:
– Individuals with fair skin, light hair, and light-coloured eyes are more susceptible to the deadly effects of UV radiation. People with darker skin have more melanin, which provides some protection against UV damage.
3. Age:
– SCC is more common in older individuals, especially those over 50 years of age. However, it can occur in people of all ages.
4. Chronic Skin Inflammation:
– Long-term inflammatory conditions, such as chronic scars, burns, or inflammatory skin diseases, can increase the risk of SCC.
5. Immunosuppression:
– Weakened immune systems, either due to health conditions (e.g., HIV/AIDS) or medications that suppress the immune system (e.g., organ transplant recipients), can increase the risk of developing SCC.
6. Chemical Exposures:
– Prolonged exposure to certain chemicals, like arsenic, can elevate the risk of SCC.
7. Previous Skin Cancer:
– Individuals who have had previous cases of SCC or other kinds of skin cancer are at a higher possibility of developing new skin cancers, including SCC.
8. Genetic Factors:
– While rare, some genetic conditions, such as xeroderma pigmentosum, are related to a higher risk of skin cancers, including SCC.
9. Human Papillomavirus (HPV) Infection:
– Certain strains of HPV, a sexually transmitted virus, have been linked to an increased risk of SCC, especially in genital and anal regions.
10. Radiation Exposure:
– Previous exposure to ionising radiation, such as radiation therapy for other cancers, may contribute to the development of skin cancer.
Signs & Symptoms Of Squamous Cell Carcinoma
Here are some signs and symptoms associated with squamous cell carcinoma:
1. Skin Changes:
– Persistent Red, Scaly Patches: SCC often begins as red, scaly patches on the skin that may resemble a non-healing wound or sore.
– Open Sores or Ulcers: SCC can manifest as open sores that may crust or bleed.
2. Elevated Growths:
– Firm, Raised Nodules: SCC can appear as raised, firm nodules on the skin, which may have a rough or wart-like surface.
3. Changes in Existing Moles or Lesions:
– Changes in Color or Size: Existing moles or skin lesions may change in colour, size, or shape.
4. Tenderness or Pain:
– Pain or tenderness: SCC lesions may be tender to the touch or cause pain.
5. Bleeding or Oozing:
– Bleeding or oozing: SCC may bleed easily, and persistent bleeding may be a sign of an advanced stage.
6. Itching or Burning Sensation:
– Persistent Itching or Burning: Some individuals with SCC may experience persistent itching or a burning sensation in the affected area.
7. Regional Symptoms:
– Enlarged Lymph Nodes: If the cancer tumour has spread to nearby lymph nodes, you may notice enlarged and tender lymph nodes.
Diagnosis For Squamous Cell Carcinoma
To diagnose SCC, doctors usually perform a physical exam and a biopsy. A biopsy is a medical procedure that comprises taking a tiny sample of tissue from the suspicious area & examining it under a microscope. A biopsy can confirm if the cells are cancerous and what type of cancer they are.
Depending on the location and size of the SCC, doctors may also do other tests to check if the cancer has spread to surrounding lymph nodes or other organs. These diagnostic tests may include blood tests, imaging tests (such as X-rays, CT scans, or MRI scans), or endoscopy (a procedure that uses a thin tube with a camera to look inside the body).
Conclusion
In conclusion, Squamous Cell Carcinoma (SCC) is a form of skin cancer that arises from squamous cells. Its staging, causes, symptoms, and treatment options are crucial aspects to understand for both prevention and effective management. Early diagnosis plays a vital part in improving outcomes, emphasising the importance of regular skin checks and sun protection.
While various treatments are available, including surgery, radiation, and topical therapies, a comprehensive approach involving medical professionals and patient education is essential in combating SCC and promoting skin health. Overall, staying informed, practising sun-safe behaviours, and seeking timely medical attention are key in addressing squamous cell carcinoma.
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