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A - MSRA Cancer Care [1] > [5] Squamous Cell Carcinoma > Flashcards

[5] Squamous Cell Carcinoma Flashcards

1
Q

What is squamous cell carcinoma?

A

A malignant tumour that arises from the keratinising cells of the epidermis or its appendages

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2
Q

How does squamous cell carcinoma spread?

A

It is locally invasive, and has the potential to metastasise to other organs in the body

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3
Q

What are the risk factors for squamous cell carcinoma?

A
  • Chronic UVR exposure
  • Susceptibility to UV light exposure
  • Chemical carcinogens
  • HPV infection
  • Ionising radiation
  • Immunodeficiency
  • Chronic inflammation
  • Genetic conditions
  • Pre-malignant conditions
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4
Q

What is the result of chronic UVR exposure increasing the risk of squamous cell carcinoma?

A

High rates in countries like Australia

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5
Q

Other than living in hot countries, what can cause increased UVR exposure?

A
  • Frequent holidays in the sun
  • Outdoor occupations
  • Leisure pursuits
  • Use of tanning beds
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6
Q

Give 2 examples of things that indicate a susceptibility to UV light exposure

A
  • Fair skin

- Blonde/red hair

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7
Q

Give 3 examples of chronic inflammation that can increase risk of SCC

A
  • Chronic ulcers
  • Osteomyelitis
  • Lupus vulgaris
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8
Q

Give 2 examples of genetic conditions that increase risk of SCC

A
  • Xeroderma pigmentosum

- Albinism

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9
Q

Give an example of a pre-malignant condition that increases the risk of SCC

A

Bowen’s disease

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10
Q

How might SCC present?

A
  • Indurated nodular keratinising or crusted tumour, that may ulcerate
  • Ulcer without evidence of keratinisation
  • Reddish skin plaque
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11
Q

Is the clinical appearance of SCC variable?

A

Yes, very

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12
Q

What are the differentials for SCC?

A
  • Keratocanthoma
  • BCC
  • Malignant melanoma
  • Solar keratosis
  • Pyogenic granuloma
  • Seborrhoeic warts
  • Plantar warts or verrucas
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13
Q

What are the primary investigations for SCC?

A
  • Visual inspection

- Removal for histology where necessary

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14
Q

What types of biopsy may be used in SCC?

A
  • Excisional biopsy

- Incisional or punch biopsy

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15
Q

What happens in an excision biopsy?

A

The whole lesion is excised

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16
Q

When is an excision biopsy used in SCC?

A

Small lesions that are accessible and not in cosmetically sensitive areas, or near to vital structures

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17
Q

Under what anaesthesia are excision biopsy for SCC carried out?

A

Local anaesthesia for most lesions

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18
Q

How much should be taken in excision biopsy for SCC?

A
  • Full thickness of skin

- Wide margins

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19
Q

Why should the full thickness of the skin be taken in SCC?

A

Determine depth of spread

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20
Q

Why should the excision be well wide of margins in SCC?

A

To achieve clearance

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21
Q

What happens in incisional or punch biopsy?

A

Part of the lesion is excised

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22
Q

When is incisional or punch biopsy used in SCC?

A

When the lesion is large, in cosmetically sensitive areas, or close to vital structures

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23
Q

What may investigations be required for in advanced SCC?

A

To assess the extent of disease

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24
Q

What investigations may be done to assess extent of disease in advanced SCC?

A
  • CT or MRI scanning

- Histological examination of clinically enlarged nodes

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25
Q

How can histological examination of clinically enlarged nodes be carried out?

A

Fine needle aspiration or excisional biopsy

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26
Q

When should you consider a 2WW for SCC?

A

For people with a skin lesion that raises suspicion of squamous cell carcinoma

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27
Q

What is Tis in SCC?

A

Carcinoma in situ

28
Q

What is T1 in SCC?

A

Tumour 2cm or less

29
Q

What is T2 in SCC?

A

Tumour >2cm but <5cm

30
Q

What is T3 in SCC?

A

Tumour >5cm

31
Q

What is T4 in SCC?

A

Tumour invading deeper extra dermal structures

32
Q

What is N1 in SCC?

A

Regional lymph node spread

33
Q

How is SCC staged?

A

0 - IV

34
Q

What is stage 0 in SCC?

A

Tis, N0, M0

35
Q

What is stage I in SCC?

A

T1, N0, M0

36
Q

What is stage II in SCC?

A

T2/T3, N0, M0

37
Q

What is stage III in SCC?

A

T4, N0, M0, or any T, N1, M0

38
Q

What is stage IV in SCC?

A

Any T, any N, M1

39
Q

What are the management options for SCC and its precursors?

A
  • Complete surgical excision
  • Curettage and cautery/electrodessication
  • Cryotherapy/cryosurgery
  • Topical treatment
  • Photodynamic therapy
  • Electrochemotherapy
  • Radiotherapy
40
Q

What is the standard effective treatment for SCC?

A

Complete surgical excision

41
Q

What should be done with all excised specimens in SCC?

A

Sent for histopathological examination

42
Q

What happens in curettage and cautery/electrodessication for SCC?

A

A curettage is used to remove soft tissue from the tumour. The base of the tumour is then destroyed, either by hyfrecation or cautery

43
Q

When can curettage and cautery/electrodessication be used to treat SCC?

A

Small (less than 1cm) in situ SCCs and pre-cancerous lesions

44
Q

What are the advantages of curettage and cautery/electrodessication for SCC?

A
  • Safe and well tolerated
  • Provides good cosmetic outcomes
  • Suitable for patients with multiple lesions
45
Q

What are the disadvantages of curettage and cautery/electrodessication for SCC?

A

Histology may be difficult to interpret, and the margins of excision cannot be assessed optimally

46
Q

What is cryotherapy/cryosurgery used for in SCC?

A

Small in situ SCCs and pre-cancerous lesions

47
Q

What is the advantage of cryotherapy/cryosurgery for SCC?

A

Cost effective

48
Q

What is the disadvantage of cryotherapy/cryosurgery for SCC?

A

Histology not available unless incisional biopsy is taken

49
Q

What is topical treatment used for in SCC?

A

Pre-malignant lesions

50
Q

What topical treatments can be used for pre-malignant lesions?

A
  • Imiquimod 5% cream

- Flurouracil

51
Q

What is imiquimod 5% cream used for in pre-malignant lesions?

A

Treat actinic keratosis

52
Q

What is fluorouracil used for in SCC?

A

Superficial malignant and pre-cancerous lesions

53
Q

What happens in electrochemotherapy for SCC?

A

Chemotherapy drugs are given, either IV or directly into tumour, then shortly after drug administration brief and intense electric pulses are delivered around or directly into the tumour, using either surface plates or needle electrodes

54
Q

What is the limitation of electrochemotherapy for SCC?

A

Evidence of it’s efficacy is limited

55
Q

When is radiotherapy a useful treatment in SCC?

A
  • In patients who are unable or unwilling to undergo surgery
  • Advanced, inoperable disease
  • Palliation
56
Q

What are the cure rates for skin lesions in SCC?

A

Over 90% for most skin lesions

57
Q

What is the limitation of radiotherapy for SCC?

A
  • Long term cosmetic outcome is inferior to surgery

- Same area cannot be treated twice

58
Q

What is the result of radiotherapy not being able to be used twice in the same area for SCC?

A

If there is recurrence, surgery is used, and surgery may be more difficult than if the lesion had been removed surgically to start with

59
Q

What is the role of radiotherapy in advanced, inoperable SCC?

A

Can be curative

60
Q

When does radiotherapy have a role in palliation in SCC?

A
  • Large, inoperable, or recurrent SCC

- Inoperable mets in lymph nodes

61
Q

What factors affect the metastatic potential of SCC?

A
  • Site
  • Diameter
  • Depth
  • Poor histological differentiation
  • Host immunosuppression
  • Locally recurrent ideas
62
Q

Order sites of SCC from most to least likely to metastasise?

A
  1. Sun-exposed areas
  2. Lip
  3. Ear
  4. Non-sun exposed sites
  5. Areas of radiation or thermal injury
63
Q

How does diameter affect the risk of metastasis of SCC?

A

Tumours greater than 2cm in diameter are twice as likely to reoccur locally, and 3 times as likely to metastasise

64
Q

How does the depth affect the risk of metastasis of SCC?

A

Tumours greater than 4mm in depth, or extending down into subcutaneous tissue are more likely to recur and metastasise than thinner tumours

65
Q

What is the overall mortality rate of SCC?

A

<5%

66
Q

What is the 5 year survival rate of SCC when distant metastases are present?

A

25-40%

A - MSRA Cancer Care [1] (47 decks)

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