What organs are affected by squamous cell carcinoma. Squamous cell carcinoma: features, types of the disease. Squamous cell carcinoma of the larynx

Valery Zolotov

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Squamous cell carcinoma is a malignant tumor characterized by an aggressive course and rapid development. It usually starts on the mucous membrane or skin.

Squamous cell carcinoma is divided into 3 types, high, moderate and low differentiated, the most common is moderately differentiated. The higher the differentiation, the more optimistic the prognosis, since the disease develops more slowly.

Squamous cell carcinoma of the skin accounts for about 25% of all skin cancers. Of these, almost 75% of the disease manifests itself in the area of ​​the face, head or. It is mainly found in persons over sixty-five years of age. Slightly more in males.

This disease in six percent of cases can affect the nearest lymph nodes, and sometimes even bones and. In this form, the pathology tends to increase rapidly, pain may also occur, therefore, if you do not know what is the cause of pain in a particular part of the body, we advise you to immediately consult a doctor.

The symptoms of this disease are as follows:

1. There are several forms of squamous cell carcinoma, ulcerative is characterized by sharply raised edges surrounding the ulcer along the perimeter. Visually, such an ulcer may resemble a crater, in addition, spotting may be observed. This type of oncological disease progresses rather quickly, increasing not only in breadth, but also in depth;
2. visually, the formation on the skin may resemble cabbage. The surface of the inflammation has a bumpy base, the base is wide. The color can be varied, from brown to red. Ulcers or erosion may occur on the surface of the tumor;
3. the latter type is characterized by a plaque-like shape, bloody discharge and tubercles on the surface of the tumor. It spreads very quickly, while at first only the surface of the skin is affected, and then the internal organs are exposed.

This pathology can appear on many parts of the body, but most often it can be found:

• red border of the lips;
• larynx;
• cervix;
• esophagus;
• oral cavity.

Squamous cell carcinoma of the larynx represents about 60% of diseases of this organ. There are two types of this disease, infiltration-ulcerative cancer has a more progressive form. may be as follows.

1. change in voice (manifested in its hoarseness or complete loss of it - aphonia);
2. difficulty breathing (may overlap due to growth);
3. pain when swallowing;
4. cough (occurs due to irritation of the walls of the larynx);
5. hemoptysis;
6. sensation of a foreign object in the larynx.

It is very important for the manifestation of these signs or just pain or discomfort in the larynx to consult a doctor for a diagnosis.

• bleeding from the vagina outside of menstruation;
• pain in the cervical region during intercourse, as well as bleeding after it;
• violation of urination;
• constant aching pains in the lower abdomen.

Features of prostate cancer

The male body is susceptible to a similar disease, namely squamous cell carcinoma of the prostate gland.

The prostate or in another way the prostate gland is an organ responsible for the male reproductive system. There are two types of cancer of the prostate gland, if the cancer arose from the glandular epithelium - it is called adenoma, if from the flat - this type of cancer is called squamous cell. Symptoms of prostate pathology include the following:

1. increased urination at night;
2. feeling of incomplete emptying of the bladder;

In the early stages, it is very difficult to distinguish cancer from prostate adenoma, only over time in the bladder area, and weight loss can also be noticed.

There are several types of prostate diseases.

Metastases develop and spread by lymphogenous and hematogenous pathways. To detect this type of oncology in the early stages, modern methods are used.

One of them is the introduction of the PSA antigen and subsequent determination of its level in the blood. If there is a suspicion of a disease of prostate cancer, a biopsy is performed - a control examination to establish the disease.

Finally

If you find out that you have squamous cell carcinoma - do not panic, this type of cancer, although unusual, is still cancer.

And in our time, medicine is quite effectively fighting it. Many methods of fighting cancer tumors have been developed, radiation, chemotherapy are only the most famous. In addition, if you are in the initial stage, then we want to please you, the probability of a complete cure is close to one hundred percent.

At later stages, the prognosis is also quite favorable, you should not immediately write out a death sentence to yourself, there is always a chance of a cure, even at the last stage there is always a chance that the situation will change.

The main thing is to understand how important it is to go through the procedures that your doctor has prescribed for you and always attend them. In this case, the carcinoma can be defeated.

Even if you cannot be cured completely, medicine can stop the progression of the disease and it does not matter what kind of cancer, moderate or low differentiated, laryngeal carcinoma or anything else.

It's important to know! Do not neglect the procedure for an annual physical examination, this will allow you to identify possible diseases that have appeared in the early stages.

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(PCC) is the second most common type of skin cancer, which accounts for 16% of all cases of malignant neoplasms of the skin.
The most important risk factors for squamous cell carcinoma skin exposure are sun exposure and skin type.
Less common predisposing factors are exposure to chemicals, human papillomavirus and burns.

Morbidity squamous cell carcinoma increases with age, which is associated with the cumulative effects of solar radiation.
Squamous cell carcinoma metastases are observed in 2-6% of cases.

Squamous cell carcinomas, which metastasize, most often occur on mucous membranes, lips, or areas of chronic skin inflammation.
In our country, about 2500 people die annually from squamous cell carcinoma.

Squamous cell carcinoma- malignant tumor of keratinocytes. Most squamous cell carcinomas occur at the site of actinic keratosis. Squamous cell carcinoma is usually characterized by local spread, but sometimes metasgassing to regional lymph nodes and distant metasgassing is observed. The foci associated with the human papillomavirus are localized on the penis, labia or in the periungual region.

Squamous cell carcinoma diagnosis

The only reliable diagnostic method is biopsy from suspicious lesions (thickened, indurated, ulcerated, or crusty) showing signs of sun exposure. In case of suspicious lesions, even in areas protected from the sun, a biopsy is also required.

Squamous cell carcinoma often appears as a focus of persistent ulceration, crusting, hyperkeratosis, and erythema, especially on skin with signs of sun damage. Less common types of squamous cell carcinoma are:

Marjolin's ulcer is squamous cell carcinoma of the extremities that develops in chronic skin ulcers or burn scars.

Keira erythroplasia is a squamous cell carcinoma in situ of the penis or vulva associated with an infection with the human papillomavirus. This lesion can progress to advanced invasive squamous cell carcinoma of the penis.

Squamous cell carcinoma occurs in sun-exposed areas and mucous membranes. Most often localized to:
Face.
Lower lip.
Auricle.
The hairy part of the scalp.
The limbs, especially the arms.
Brushes.
Fingers.
Mucous membranes.

Biopsy for squamous cell carcinoma:
Deep tangential biopsy is an adequate diagnostic tool for most squamous cell carcinomas.
Trepanobiopsy is an alternative if pigmented or deep lesions are present.

Factors influencing metastasis of squamous carcinomas

The following factors are taken from the Guidelines for Physicians of Various Specialties on the Management of Patients with Primary Squamous Cell Carcinoma of the Skin.

Localization and metastasis of squamous cell carcinomas... The localization of the tumor significantly affects the prognosis of the disease. The localization zones are listed in the order of increasing metastatic potential.
1. Squamous cell carcinomas in areas of skin exposed to the sun, excluding lips and auricles.
2. Squamous cell carcinomas on the lip.
3. Squamous cell carcinomas on the auricle.
4. Tumors in areas of the skin closed from the action of the sun (for example, the perineum, sacral region, sole).
5. Squamous cell carcinomas at sites of radiation or heat trauma, functional fistulas, chronic ulcers, chronic inflammation or Bowep's disease, such as squamous cell carcinoma, arising at the site of a burn.

Size: diameter and metastasis of squamous cell carcinomas... The probability of recurrence of tumors with a diameter exceeding 2 cm is two times higher (15.2% versus 7.4%), and their metastasis is three times more likely than tumors of a smaller size (30.3% versus 9, 1%).

Size: depth of invasion and metastasis of squamous cell carcinomas... Tumors that spread to a depth of more than 4 mm (excluding the superficial layers of keratin) or infiltrate the subcutaneous tissue (Clarke invasion level V), more often recur and metastasize (the degree of metastasis is 45.7%) compared with thinner tumors. In tumors limited to the upper half of the dermis and having a depth of invasion of less than 4 mm, relapses and metastases are less common (metastatic rate 6.7%).

Histological differentiation and metastasis of squamous cell carcinomas... Poorly differentiated tumors have a poorer prognosis. Their local recurrence rate is twice as high and the likelihood of metastasis is three times higher than that of well-differentiated squamous cell carcinomas. Malignant tumors with a perineural component recur and metastasize most often.

Immunosuppression and metastasis of squamous cell carcinomas... Tumors in immunosuppressed patients have a poorer prognosis. The body's cellular immune response plays an important role in influencing both local invasiveness of squamous cell carcinomas and metastasis.

Previous treatment and therapy and metastasis of squamous cell carcinomas... The risk of local recurrence often depends on the method of treatment. Locally recurrent tumor is itself a risk factor for metastasis. The rate of local recurrence with Mohs micrographic surgery is significantly lower than with any other method of treatment.

Differential diagnosis of squamous cell carcinomas

Foci of actinic keratosis develop in areas exposed to sunlight and may progress to squamous cell carcinoma.
Bowen's disease, prior to tumor invasion across the basement membrane, is squamous cell carcinoma in situ.
Keratoacanthoma is characterized by the presence of a rapidly growing lesion, often with a crater filled with horny masses in the center. Keratoacanthomas can also be considered a type of squamous cell carcinoma.

Basal cell carcinoma cannot always be distinguished from squamous cell carcinoma by clinical signs alone.
Merkel cell carcinoma (neuroendocrine carcinoma of the skin) is a rare aggressive malignant neoplasm. It is most commonly seen on the face of older people with white skin. This disease may resemble squamous cell carcinoma and is diagnosed after biopsy.
Numular eczema is usually distinguished from squamous cell carcinoma by multiple, itchy, coin-shaped lesions that are transient.

Squamous cell carcinoma is a malignant neoplasm. The disease has been known since antiquity, and there is also information that in those days, at the initial stage of development, the tumor was removed. In a neglected 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, which covers all internal organs, and the skin is constantly renewed. The more intensively the process of cell division is carried out, 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 are spread through the bloodstream and the lymphatic system to other vital organs.

Carcinomas are found in different types, so they have been divided into groups. Sometimes the tumor is a mass 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, bronchi is called adenocarcinoma;
• squamous cell carcinoma develops from the flat layers of the epithelium, due to which 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.

Squamous cell carcinoma antigen scca is a tumor marker that can detect the presence of a tumor, including neoplasms of the head and neck. Squamous cell carcinoma has an 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. Perhaps even metastases are formed to nearby organs.

Before starting treatment, it is necessary to identify the exact cause, to determine what carcinoma is and how it affects the body in a particular case. Since cancer cells spread rapidly, 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 large quantities of alcoholic beverages;
• 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:

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

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

• previous therapy turned out to be ineffective;
• development of other benign tumor lesions in the body, including abnormalities associated with squamous cell metaplasia.

It should also be remembered that scca is increased 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 promoted 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, there are failures in the mechanism of recognition of mutated cells.

Diagnostics

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

• CT scan;
• general blood analysis;
• blood chemistry;
• biopsy;
• determination of the norm of tumor markers;
• endoscopic examination.

To identify at what stage of development is non-keratinizing squamous cell carcinoma or adenocarcinoma, an analysis of cytology is required. Based on the result of such a diagnosis, doctors establish further prognosis.

Research on tumor markers does not always give a true result. Even with renal failure, hypersensitivity can be found. Therefore, it is important for specialists to distinguish normal values ​​from malignant pathology.

Symptoms

Squamous cell carcinoma is divided into several stages:

1. The tumor does not cause any signs, 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 impressive in size, affects the nearby organs, but does not affect the cartilage tissue.
4. The last stage is characterized by numerous metastases, including in cartilage and bone tissues.

Carcinoma of the lungs and throat is sometimes accompanied by keratinization, the following symptoms occur:

• mucous discharge with blood from the larynx;
• persistent cough;
• high body temperature;
• a sharp decrease in weight.

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

Treatment

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

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

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

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

If there are primary signs of appearance and the diagnosis has shown the presence of an initial stage carcinoma, then the problem can be dealt with without any health consequences. However, such a tumor is most often found in an advanced form, the further prognosis will depend on the degree of body resistance, as well as on the location of the carcinoma.

Even now, the possibilities of modern medicine do not always help to cope with oncology. Cancer of this type is the most common; a huge number of people around the world die from such tumors every year.

Classification of epithelial tumors:

benign tumors from the epithelium (epithelioma) and malignant (cancer, carcinoma);

by histogenesis:

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

glandular epithelium (adenomas, adenomatous polyps and adenocarcinomas).

Benign tumors from the integumentary epithelium are called papillomas, from the glandular epithelium - adenomas.

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

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

By organ-specificity, tumors from the epithelium can be both organ-specific and organ-nonspecific.

Papillomas develop on the skin, mucous membranes of the bladder, esophagus, vagina, less often in the bronchial tree. Therefore, papillomas are organ-specific tumors. Macroscopically, papilloma has a papillary surface. Papillomas are characterized by papillary growths of the integumentary epithelium with a fibrovascular rod. In the papillomas, signs of tissue atypism are found in the form of an increase in the layers of the epithelium in the squamous epithelium, which grows in the form of papillae.

Adenomas are benign neoplasms from the glandular epithelium. They develop in organs, the parenchyma of which is represented entirely by the 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-specific tumors. Macroscopically, it looks like a finger-like outgrowth, a polyp with exophytic growth. With endophytic growth, it is called a flat adenoma. Depending on the structures that the glandular epithelium builds, the following histological types of adenomas are distinguished: tubular (tubular structures), trabecular (bar structures), alveolar, papillary (papillary), cystadenomas (cystic). Adenoma with a developed stroma is called fibroadenoma and is found in some organs (in the mammary gland, ovaries).

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

Adenocarcinoma is a malignant organ-specific tumor from the glandular epithelium that occurs in the stomach, intestines, mammary gland, lungs, uterus and other organs where there is glandular epithelium or glandular metaplasia of the epithelium is possible. According to the 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 - high, moderate and poorly differentiated tumors.

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

Varieties, diagnosis and treatment of ovarian epithelial tumors

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

Non-epithelial formations are rare. They can develop from different types of cells. So, for example, stromal formations are obtained from the cells of the base of the ovaries - structural tissues that produce female sex hormones. If the cells that give rise to oocytes are involved in the process of the appearance of a neoplasm, it is called germ cell. The most common benign non-epithelial tumors are fibroids. Among malignant tumors, the most common is granulosa cell neoplasm.

When the process is benign

Mature tumors form from glandular cells and appear as soft, pinkish-white elastic nodes. 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 are both single-chamber and multi-chamber. And according to the state of the inner surface, smooth-walled and papillary (papillary) cystadenomas are distinguished. The appearance of papillae is an unfavorable symptom that may indicate a malignant tumor. It should also be borne in mind that the papillae can be true and false. True ones are represented by epithelial protrusions. False papillae result from excessive proliferation of glandular cells.

There are several types of cystadenomas:

1. A serous epithelial tumor 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 a flattened epithelium, sometimes there are papillae on it.
2. Mucinous cystadenoma has one or more chambers and can grow to very large sizes. Such a cyst is lined with a prismatic epithelium (it looks like the tissues 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 be implanted in the abdominal cavity.

Complications of benign tumors

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

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

When the contents of the cystadenoma enters the abdominal cavity, with a relatively favorable course, an adhesion process may begin to develop. With mucous neoplasms, jelly-like contents and cyst fragments can be implanted to the peritoneum. In rare cases, tumor rupture can be fatal. Therefore, treatment always involves its removal by surgery.

Border type of formations

The main characteristics of epithelial borderline tumors resemble benign cysts. They develop mainly in young women. It should be noted that such neoplasms can be serous and mucinous. However, the majority of patients with borderline tumors (approximately 65%) have a serous type.

Development features

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 multiplication. Also, with borderline tumors, there is no invasive growth characteristic of malignant forms of ovarian formations. At the same time, implants can develop (mainly in the area of ​​the pelvic organs). In essence, these are metastases of contact origin.

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

• pain or discomfort in the lower abdomen;
• enlargement of the abdomen;
• spot bleeding;
• general weakness.

Treatment and prognosis

Since such epithelial ovarian tumors are mainly found in women of reproductive age, they are removed by organ-preserving surgery. This allows you to maintain fertility, the ability to become pregnant and give birth to healthy children. However, at the same time, it should be borne in mind that after organ-preserving surgery, more than half of the patients develop relapses over time. If a woman is in the postmenopausal period, 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 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 forecasts become. 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 data, 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 are composed of prismatic tissues, and their structure resembles adenomas. However, they differ in shape and size, and also always grow into the surrounding tissues, destroying them.

Serous papillary cystadenoma

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

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

• polymorphism of cells and their nuclei (they do not have the same size and shape);
• the kernels are more intensely colored.

Differentiation features

Adenocarcinomas are 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), cribrous, 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%.

The activity of cell division (mitotic index) does not determine the degree of differentiation. However, as a rule, with an increase in the degree of malignancy, mitotic activity begins to increase.

Varieties of pathological formations

1. Serous cystadenocarcinoma is characterized by papillary growth. Also, foci with a solid structure are often detected. 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. In the future, the process involves ovarian tissue and adjacent anatomical structures.
2. Mucinous cystadenocarcinoma is a malignant tumor that looks like a cyst. It is formed from atypical mucus-producing cells. These cells form solid, cribrous, tubular structures. A characteristic feature of cystadenocarcinomas is tissue necrosis. In addition, if the wall of the tumor ruptures and the contents enter the peritoneum, then 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 its formation cells.

Treatment

After detecting a tumor, its surgical removal is prescribed. At the first stage in women of reproductive age, it is possible to reduce the volume of surgery to preserve fertility. In other cases, complete removal of the uterus and its appendages is shown. In addition, chemotherapy and radiation therapy will be required. Despite such aggressive treatment, epithelial neoplasms often relapse.

Predictions and survival

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

After the initial treatment of epithelial cancer, the patient's condition is assessed by specialists 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 neoplasm recurrence earlier than is possible using imaging diagnostic techniques.

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

Methods of conducting, recovery and pregnancy after ovarian resection

Classification of ovarian cancer by stage

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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-NON-specific).

1.2. Tumors of the 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-specific 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-specific tumor in any organ can be either primary or secondary (i.e., metastasis). For example, when we see squamous cell carcinoma in the lung, then we have to decide the question: we have a primary cancer of the lung itself or is it a metastasis of another squamous cell carcinoma into the lung? And with regard to organ-specific tumors, such contradictory questions do not arise. Because renal cell carcinoma in the kidney is always a primary tumor, and in other organs it is always 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-specific). Tumors of this type develop from flat, transitional or glandular epithelium that does not perform any specific function (specific to a particular organ). Neoplasms of this group are divided into benign, neoplasms in situ are malignant, their varieties are given in table. 1.

Benign tumors without specific localization.

The benign epithelial tumors of this group include squamous and transitional cell papillomas and adenomas.

Squamous papilloma (from Latin papilla - papilla) is a benign tumor from stratified squamous epithelium (Fig. 1). It has a spherical or polypoid shape, dense or soft, with a lobular 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 a stratified squamous epithelium. These are the skin, oral cavity, pharynx, upper larynx and vocal folds, esophagus, cervix, vagina, vulva. However, it can also occur in places where squamous epithelium is normally absent - namely, in the bronchi and bladder. The formation of squamous cell papilloma in such cases occurs against the background of squamous metaplasia.

The tumor is built from a growing integumentary epithelium, the number of its layers is increased. In the papilloma of the skin, keratinization of varying intensity can be observed. The stroma is well expressed and grows with the epithelium. In the papilloma, the polarity of the location of the epithelial cells, the differentiation of its layers, and the basement membrane are preserved. Tissue atypism is represented by uneven development of the epithelium and stroma and excessive formation of small blood vessels. Cellular atypism is absent.

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. In case of injury, the papilloma is easily destroyed and inflamed. After removal of the papilloma, in rare cases they recur, sometimes (with constant irritation) they become malignant.

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

It is located on the 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 a loose fibrovascular stroma, a cover of the urothelium, practically indistinguishable from normal, with well-distinguishable umbellate cells. Rare typical mitoses with localization in the basal epithelium may occur.

In case of injury, as well as squamous cell papilloma, it is easily destroyed and inflamed, bleeding in the bladder can occur. The tumor has an extremely low risk of recurrence and malignancy, recurring 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 that develops from the epithelium of the glands or from the single-layer columnar epithelium of the mucous membranes (nasal cavity, trachea, bronchi, stomach, intestines, endometrium, etc.). If the adenoma is found in the parenchymal organ, then, as a rule, it looks like a well-delimited node of soft consistency; the tissue is white-pink on the cut. Sizes are different - 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 with a thin stalk. If the adenoma is macroscopically represented by a polyp, then 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 a cyst, in which case it is called cystadenoma. Cystadenoma is an adenoma with cysts (cavities). In this case, a cyst may precede the development of an adenoma (primary cyst) or occur in the tissue of an already formed tumor (secondary cyst). Cysts are filled with fluid, mucus, clotted blood, mushy or dense masses. Cystadenomas are most common in the ovaries. Thus, adenomas have three macroscopic growth options: node, polyp, and cystadenoma.

The adenoma has an organoid structure and consists of cells of the glandular epithelium, which form various structures. Depending on the type of structures formed, they are distinguished: acinar (alveolar), which develops from the parenchyma of the glands and forms 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 retains its complexity and polarity and is located on the basement membrane. There are no signs of cellular atypia. The cells of the adenoma are similar to the cells of the original tissue in morphological and functional respects. Adenoma can degenerate 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 cancer within the epithelium, does not have the ability to invade / metastasize, but is characterized by the most complete spectrum of genetic disorders characteristic of cancer in comparison with neoplasia. In CIS, the proliferation of atypical cells occurs within the epithelial layer, without transferring to the underlying tissue. In such a situation, the tumor is the least dangerous for the patient, it does not give metastases and a complete cure is possible. However, CIS is extremely difficult to detect because it does not appear at all at the macroscopic level.

In different types of epithelium, carcinoma in situ looks different, everywhere there are different diagnostic criteria. Figure 5 shows, for comparison, images of normal epithelium (top row) and carcinoma in situ (bottom row) for squamous, transitional and glandular epitheliums. 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 an extremely pronounced nuclear atypia (polymorphism, nuclear hyperchromia), a large number of mitoses are observed.

However, it should be borne in mind that "cancer in place" is only a stage of tumor growth; over time, the tumor becomes infiltrating (invasive), it can also recur if it is not completely removed.

Malignant tumors without specific localization.

Squamous cell (squamous, epidermoid) cancer is a malignant tumor from 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 the previous squamous metaplasia of the epithelium (bronchi, bladder). The tumor consists of strands and nests of atypical squamous cells growing 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. Highly differentiated squamous cell carcinoma (keratinizing, G1) retains the ability to keratinize to the greatest extent, while formations appear resembling pearls (cancerous pearls), consisting of horny matter (Fig. 6), cell atypia is moderate. Moderately differentiated squamous cell carcinoma (with a tendency to keratinization, G2) does not form cancerous 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), cell atypia is moderate or severe. Poorly differentiated squamous cell carcinoma (non-keratinizing, G3) loses its ability to keratinize (Fig. 8). In G3 tumors, cell atypia is most pronounced.

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

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

Adenocarcinoma (glandular cancer) is a malignant tumor from 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 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 produce mucus are morphological features of adenocarcinoma, confirming its histogenesis. There are variants of adenocarcinoma: acinar - with a predominance of acinar structures in the tumor; tubular - with a predominance of tubular structures in it; papillary, represented by atypical papillary growths; trabecular - with a predominance of trabeculae; crimson, 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. Highly differentiated tumors (G1) are characterized predominantly by tubular or papillary growth, solid areas are absent or make up no more than 5% of the area of ​​the neoplasm (Fig. 10). Moderately differentiated tumors (G2) are characterized by the appearance of cribrous, acinar, or trabecular areas; a solid component occupies more than 5, but less than 50% of the tumor area. In poorly differentiated tumors (G3), solid structures account for more than 50% of the tumor area. Nuclear

polymorphism is usually significant. Mitotic activity is not decisive for assessing the degree of differentiation, but, as a rule, it increases with an increase in the degree of malignancy.

There are special types of adenocarcinomas:

Mucous (colloid, mucinous) cancer is adenocarcinoma, the cells of which have signs of both morphological and functional atypism (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 - adenocarcinoma, consisting of cells with a large amount of mucin in the cytoplasm, pressing the nucleus to the periphery and resembling a ring in shape (Fig. 12). An extremely aggressive tumor, has a poor prognosis, and early metastases.

Earlier, medullary and fibrous cancers were isolated as variants of the structure of adenocarcinomas, but today this position has been revised (see the 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, earlier, small cell carcinoma was 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 cylindrical), they are called dimorphic cancers (for example, adenoplastic cell carcinoma).

Tumors of the 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 functional features inherent in this organ. They are found both in the exocrine glands and epithelial integuments, and in the endocrine glands.

Tumors of the exocrine glands and epithelial integuments

The varieties of these tumors are shown 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 appear in men as well, hepatocellular adenomas most often appear in women taking oral contraceptives, and when they stop using, the tumors quickly disappear. Hepatocellular adenomas are of clinical importance when located under the capsule 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 gene are of great importance. In rare cases, hepatomas transform into hepatocellular carcinoma.

Hepatocellular (hepatocellular) cancer (HCC) - a malignant tumor that develops from hepatocytes, accounts 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, the infection begins in infancy due to the vertical route of transmission from the mother to the fetus, which increases the risk of developing HCC in adulthood by about 200 times.

There are three main etiological factors associated with HCRP: viral infection (hepatitis B and C), chronic alcoholism, non-alcoholic steatohepatitis. Other risk factors include tyrosinemia, a-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 can be represented by one large nodule covering almost the entire lobe of the liver (massive form), several isolated nodules (nodular form), or as diffuse infiltrative cancer that does not form clear nodules (diffuse form). The tumor is built from atypical hepatocytes that form tubules, acini or trabeculae (tubular, acinar, trabecular, solid cancer). Tumor cells often contain bile in the cytoplasm, which is considered a sign of the organ-specificity of HCC. All types of HCC are prone to invasion of vascular structures. HCC often produces a large number of intrahepatic metastases, and occasionally long, serpentine tumor masses - "tumor thrombi" - invade the portal vein, obstructing blood flow, or the inferior vena cava, even growing into the right heart.

Death in HCC occurs from: 1) cachexia, 2) bleeding from varicose veins of the gastrointestinal tract or esophagus, 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.

An organ-specific adenocarcinoma from the epithelium of the bile ducts - cholangiocarcinoma - can also develop in the liver.

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

Renal cell carcinoma has several variants: clear cell, papillary, chromophobic and collecting duct carcinoma (Bellini's duct). Earlier, 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 (RCC). The most common type, accounting for 70% to 80% of all renal cell adenocarcinomas. 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 papillary areas. For clear cell carcinoma, in contrast to other forms of renal cell carcinoma, the presence of foci of necrosis and hemorrhage is very characteristic. 98% of these tumors are characterized by a loss of the VHL gene (3p25.3). The second remaining allele of the VHL gene undergoes somatic mutations or inactivation triggered by hypermethylation. These facts confirm that the VHL gene plays the role of a tumor suppressor gene during the development of SPCR. Metastasizes mainly 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 exhibits multicentric growth from the onset of the disease. Metastasizes mainly by hematogenous route.

Chromophobic carcinoma. It accounts for 5% of renal cell carcinomas and consists of cells with a well-defined cell membrane and light eosinophilic cytoplasm, usually a halo around the nucleus. This cancer appears to be derived from intercalated collecting duct cells and has a favorable prognosis compared to clear cell and papillary cancers.

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

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

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

Benign epithelial tumors include adenoma and intraductal papilloma. However, most often in the mammary gland there is a benign tumor of a mixed structure - fibroadenoma, which looks like an encapsulated node of a lobular structure, of 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 intralobular ducts (pericanalicular fibroadenoma) or grow into them (intracanalicular fibroadenoma). The group of neoplasms in situ of the mammary gland includes ductal carcinoma in situ (intraductal carcinoma, non-infiltrating ductal carcinoma) and lobular carcinoma in situ (intralobular carcinoma, non-infiltrating lobular carcinoma).

Non-infiltrating ductal carcinoma (ductal "cancer in place", intraductal cancer, ductal CIS) can have a different histological structure (solid, papillary, acne-like and cribriform), but its main feature is its growth only within the ducts, without going outside into the surrounding stroma ... Ductal CIS usually occurs in a multicentric manner, but is usually limited to one segment of the gland. With an acne-like form, intraductal growths of anaplastic epithelium undergo necrosis and calcification. These necrotic tumor masses are squeezed out when cut from the ducts of the mammary gland in the form of whitish crumbling plugs (which is why the cancer is called acne-like). Ductal CIS in the absence of treatment becomes invasive.

Non-infiltrating lobular carcinoma (lobular lobular carcinoma, intralobular carcinoma, lobular CIS) arises monocentrically or multicentrically. It develops in an unchanged lobule or against the background of dyshormonal benign dysplasia. A transition to an invasive form of cancer is possible.

Varieties 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 - a rarer form of cancer, consists of relatively small cells in comparison with ductal cancer cells, which are united into peculiar chains ("trains"). Chains of cells in lobular cancers can form concentric structures called "owl's eyes" around the normal ducts of the breast. Lobular cancer has a more favorable prognosis than ductal cancer.

Today, breast cancer is the only malignant tumor for which an immunohistochemical study is required 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 is used to determine 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 symptoms: eczematous lesions of the nipple and areola; the presence of large, light cells in the epidermis of the nipple and areola; defeat of the large ducts of the mammary gland. In the thickened and somewhat loosened epidermis, there are peculiar light tumor cells, called Paget cells. They are devoid of intercellular bridges, are located in the middle sections of the growth layer of the epidermis, but can also reach the stratum corneum. Paget's cancer of the nipple can be combined with an infiltrating duct 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 cystic drift (complete, partial, invasive), choriocarcinoma and some other rare neoplasms.

Vesicular drift is an abnormal placenta and is characterized by the presence of edema and cystic degeneration of part or all of the villi and varying degrees of trophoblast proliferation. Allocate complete and incomplete cystic skid. With a complete cystic drift, the embryo / fetus is usually absent, edema of the vast majority of villi occurs with trophoblast proliferation. Partial bladder drift is characterized by a combination of enlarged edematous villi and normal villi, as well as the presence of an embryo / fetus.

Destructive (invasive) cystic drift 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 rupture of the uterus. Destructive cystic drift can transform into chorionepithelioma.

Vesiculate motility is considered a form of pregnancy with chromosomal abnormalities, prone to malignant transformation, but is not a tumor in itself. At the same time, cystic drift is traditionally considered in the section of uterine tumors and even has its own code in the ICD-O classification. Thus, partial and complete bladder drifts have a code / 0, and invasive bladder drifts have a / 1 code.

Gestational chorionepithelioma (chorincarcinoma) is a malignant tumor from trophoblast cells that develops after complete cystic drift (50% of cases), after spontaneous miscarriage (25%), from placenta residues after normal delivery (22.5%) and after ectopic pregnancy (2, 5%). The tumor looks like a variegated spongy node in the myometrium. It consists of atypical elements of the 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 by the hematogenous route to the lungs, brain and liver. Lymphogenous metastases are uncommon. The tumor actively produces chorionic gonadotropin, the level of which is significantly increased 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 the appendages of the skin: sweat and sebaceous glands, glands of hair follicles. These tumors are classified as benign or malignant. The most important of these are syringoadenoma, hydradenoma, trichoepithelioma and basal cell carcinoma (basalioma). Syringoadenoma is a benign tumor from the epithelium of the sweat gland ducts. Hydradenoma is a benign tumor from 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 the horny substance.

Basal cell carcinoma (basal cell carcinoma) - a tumor with local destructive growth, often recurs, but rarely gives metastases; localized more often on the neck or face; looks like a plaque or deep ulcer. If the basalioma is localized on the chin, it looks like a deeply penetrating ulcer with uneven edges and hyperemia along the periphery, it is called ulcus rodens. The tumor is often multiple. It is built of small rounded, oval or fusiform cells with a narrow rim of the basophilic cytoplasm (dark cells), resembling the basal cells of the epidermis, but lacking intercellular bridges. The cells are arranged in strands or solid nests in which formations similar to skin appendages can appear. For basalioma, a morphological phenomenon called "palisade-like arrangement of nuclei" is extremely characteristic. In this case, the nuclei of cells on the periphery of the tumor complexes line up parallel to each other, like boards in the fence of a front garden, which is reflected in the name of the morphological phenomenon. Basalioma is one of the most common skin tumors.

Cancer of the sweat glands, cancer of the sebaceous glands and cancer of the hair follicles are distinguished among the malignant tumors developing from the appendages of the skin. 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 analyze only epithelial tumors of the ovary, tumors of the sex cord stroma and germ cells will be discussed in the topic "Diseases of the female genital organs".

Serous cystadenoma is an epithelial benign tumor of the ovary, often one-sided. It is a cyst, sometimes large, smooth from the surface. In section, it has a whitish appearance, consists of one or more cavities filled with serous fluid. The cysts are lined with a 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, unicameral or multicameral, usually unilateral. It can reach very large sizes and weights (up to 30 kg). The cysts are lined with high prismatic epithelium resembling the intestinal epithelium and containing mucus in the cytoplasm; the formation of papillary structures in the lumen of the cyst is possible.

Borderline epithelial ovarian tumors (<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, foci of solid structure often appear. Tumor cells invade the cyst wall, spread along its surface and pass to the peritoneum, there is an invasive growth in the ovarian tissue and adjacent anatomical structures ..

Mucinous cystadenocarcinoma) is a malignant mucinous tumor of the ovaries. Macroscopically also presents as a cyst. Consists of atypical mucus-secreting cells; cells form tubular, solid, cribrous structures; tumor tissue necrosis is characteristic. In some cases, the wall of the tumor cyst ruptures, its contents are poured into the abdominal cavity, and a pseudomyxoma of the peritoneum develops. In this case, it is possible to implant mucinous cystadenocarcinoma cells along the peritoneum; a large amount of mucus secreted by the cells accumulates in the abdominal cavity.

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

Thyroid adenomas are diverse. Follicular adenoma develops from A- and B-cells, is close in structure to the thyroid gland, consists of small (microfollicular) and larger (macrofollicular) follicles. Adenoma solid arises from C cells that secrete calcitonin. Tumor cells are large, with light oxyphilic cytoplasm, and grow among follicles filled with colloid. Thyroid cancer develops most often from anterior adenoma. Histologically, it is represented by several species.

Papillary cancer ranks first in frequency among all malignant epithelial tumors of the thyroid gland (75-85%). It is more common in women as they get older. It is believed that the risk of papillary thyroid cancer is sharply increased by exposure to ionizing radiation, and its relationship with hyperestrogenism is discussed. The tumor is represented by papillary structures covered with atypical epithelium. The nuclei of tumor cells in papillary cancer have a characteristic appearance of "ground-in watch glasses", that is, they have an oval shape, enlightenment in the center, a dark rim along the periphery and are often superimposed on each other. The tumor may grow into the thyroid capsule.

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

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

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

MALIGNANT EPITHELIAL TUMORS

Cancer can develop in any organ with epithelial tissue and is the most common form of malignant tumors. He 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. Cellular atypism is clearly expressed in them, mitotic activity is increased, and there are many irregular mitoses. However, all this occurs within the epithelial layer and does not extend beyond the basement membrane membrane, i.e. there is no invasive tumor growth yet. This very early form of cancer is called "carcinoma in situ, or carcinoma in situ." Early diagnosis of preinvasive cancer allows timely appropriate, usually surgical, treatment with a favorable prognosis.

Most other forms of cancer are macroscopically in the form of a knot with fuzzy boundaries that merge with the surrounding tissue. Sometimes a cancerous tumor diffusely grows into an organ, which at the same time becomes denser, the walls of the hollow organs become thicker, and the lumen of the cavity decreases, often a cancerous tumor is expressed, and therefore bleeding may occur. According to the degree of decline in the 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 are classified as differentiated forms of cancer. Epithelial cells are all signs of cellular atypism. Infiltrative growth is accompanied by a violation of the polarity and complexity of the cells, as well as the destruction of the basement membrane. The tumor consists of strands of squamous epithelium, infiltrating the underlying tissues, forming complexes and clusters. In squamous cell keratinizing cancer, atypical cells of the epidermis are arranged concentrically, retaining the ability to keratinize. Such keratinized nests of cancer cells are called " crayfish 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 rather late.

Adenocarcinoma- glandular cancer that occurs in organs with glands. Adenocarcinoma includes several morphological varieties, some of which are classified as differentiated, and some are classified as undifferentiated forms of cancer. Atypical tumor cells form glandular structures of various sizes and shapes without a basement membrane and excretory ducts. In the cells of the tumor parenchyma, hyperchromia of the nuclei is expressed, there are many irregular mitoses, there is also atypism of the stroma. The glandular complexes grow into the surrounding tissue, without being limited to anything from it, destroying the 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. With this form of tumor, cancer cells form compact, randomly located groups, separated by stromal layers. Solid cancer refers to undifferentiated forms of cancer, in it cellular and tissue anaplasia is expressed. The tumor quickly infiltrates the surrounding tissue and metastases early.

Small cell carcinoma is a form of highly undifferentiated cancer made up of small, round, hyperchromic cells that resemble lymphocytes. Often, it is only through the use of special research methods that it is possible to establish the belonging of these cells to epithelial ones. Sometimes tumor cells stretch out a little and become similar to oat grains (oat cell carcinoma), sometimes they become large (large cell carcinoma). The tumor is extremely malignant, grows rapidly and early gives extensive lymph and hematogenous metastases.

A malignant neoplasm that forms from the epithelium and mucous membranes is squamous cell carcinoma. This oncology is developing rapidly and is quite aggressive. It is formed in the skin or mucous membrane, and then the tumor affects local lymph nodes and penetrates into nearby organs and tissues, disrupting their structure and performance. The result of this course of the disease is multiple organ failure and death.

Overview of Squamous Cell Carcinoma

Squamous cell carcinoma develops from epithelial cells. And since a cancer cell looks flat under a microscope, a tumor that consists of many such cells is called "squamous cell carcinoma". Since the epithelium is widespread in the body, squamous cell tumors can begin to form in almost any organ.

There are two types of epithelium - keratinizing (this is the entire set of skin integuments) and non-keratinizing (human mucous membranes - the surface of the nose, mouth, stomach, esophagus, vagina, throat, etc.). In addition to epithelial cells, neoplasms of this type can also form in other organs - from cells that have undergone metaplasia (they were reborn first into epithelium-like ones, then into cancerous ones).

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Squamous cell carcinoma - to whom it occurs

Note! This oncology is diagnosed in about 25% of all types of cancers of the skin and mucous membranes. In most cases (75%), the tumor is located on the skin of the face or scalp.

The majority of patients with this diagnosis are men after 65 years. It was also noted that squamous cell carcinoma (squamous cell carcinoma) is more common among Caucasians, more often fair-skinned and red-haired. Children with this type of oncology rarely get sick if there is a genetic predisposition.

Causes and risk factors

There are some factors that contribute to the onset of squamous cell carcinoma:

• heredity (genetic predisposition);
• smoking, drinking alcohol;
• UV radiation;
• ionizing radiation;
• taking immunosuppressants;
• improper nutrition;
• work in hazardous production;
• bad ecology;
• infections;
• age.

In addition, there are other types of tobacco - chewing, snuff, their use can increase the risk of oncology of the lips, tongue, and organs of the nasopharynx.

1. A component of all alcoholic beverages - ethyl alcohol can cause the development of malignant tumors.

Important! Alcohol increases the permeability of cells to various carcinogens. This is also confirmed by the fact that alcoholics are most often diagnosed with oncology of the oral cavity, larynx, pharynx - that is, in those organs that are in direct contact with ethyl alcohol.

The risk of oncology increases in those who combine alcohol with smoking (or other way of using tobacco).

Important! The risk is higher for residents of megalopolises, due to the fact that the number of vehicles is much higher here, and exhaust gases containing soot are more concentrated in the city air;

1. It has already been scientifically proven that some types of infections (viruses) can be a provocateur of the appearance of squamous cell carcinoma. These viruses are:

• human papillomavirus (multilayer koilocytosis), which is capable of causing the development of benign tumors on the skin and mucous membranes - papillomas, condylomas, and causing various intraepithelial types of neoplasia, becomes;
• HIV (Human Immunodeficiency Virus) affects the human immune system, which can lead to the development of AIDS and a decrease in the body's antitumor defenses.

1. Age. With age, a person's immune system function decreases and becomes impaired and the recognition of mutated cells worsens, which means that the risk of squamous cell carcinoma increases.

In addition to the above risk factors that contribute to the occurrence of squamous cell carcinoma, there are so-called precancerous conditions. They, while not malignant neoplasms themselves, increase the chances of getting cancer. These precancerous conditions are classified as obligate and facultative.

Obligatory states include:

Facultative precancerous conditions include diseases in which the appearance of squamous cell carcinoma is not necessary, but the risk of its occurrence is quite high.

Such diseases include:

• cutaneous horn. It is a hyperkeratosis (thickening of the stratum corneum of the epidermis). The development of oncology with this disease can occur in 7-15% of cases;
• senile keratosis. The main reason for the appearance is ultraviolet rays, which affect bare skin. The age of patients is over 60. The risk of this cancer is up to 25% of cases;
• keratoacanthoma. Age category - after 60 years. It is located on the skin of the face or the back of the hands in the form of a round formation with a depression in the center with horny masses;
• contact dermatitis. It occurs when the skin is exposed to chemicals, is characterized by local inflammation, swelling and redness. With a long process, the formation of squamous cell carcinoma is possible.

Remember! Precancerous conditions can develop into cancer over time, but if treated during the treatment, the risk of getting cancer decreases. This rule can be attributed to both obligate precancerous conditions and optional.

Metastasis

• chest pain. They can occur in the late stages of cancer development, when the tumor squeezes the nearby tissues of the body and organs;
• swallowing disorder (dysphagia). The growth of a tumor into the lumen interferes with the movement of food - at first only solid, and later liquid and even water;
• regurgitation. Pieces of food can get stuck in an overgrown tumor, which regurgitate after a while;
• bad breath appears with necrosis (decay) of the tumor and the addition of infection;
• bleeding occurs when the circulatory system of the esophagus is destroyed. Vomiting of blood appears, and blood clots are found in the stool. This symptom is life-threatening and requires urgent medical attention.

Rectal cancer

Squamous cell carcinoma of the rectum may present with the following symptoms:

• violation of the stool (diarrhea is replaced by constipation);
• after a bowel movement, a feeling of fullness in the intestines;
• feces in the form of a tape (tape feces);
• in the feces, impurities of blood, mucus or pus;
• soreness during bowel movements;
• pain in the abdomen and anus;
• incontinence of feces and gases (happens with advanced stages).

Cervical cancer

Usually, the factor that contributes to the development of squamous cell carcinoma of the cervix is ​​the human papillomavirus (present in 75% of women diagnosed with cervical cancer).

Low-grade squamous intraepithelial lesions have changes that are associated with papillomavirus infection of various types of dysplasia and intraepithelial cancer (cr in situ). Cytological examination allows one to judge the metaplasticity of the epithelium and helps to establish the correct diagnosis.

The symptoms of this type of disease are nonspecific and may be similar to those of other diseases of the genitourinary system:

• bleeding outside the menstrual cycle, pain during intercourse;
• lower abdominal pain;
• violation of the process of urination and defecation.

Vulvar cancer

Vulvar cancer has a variety of symptoms, but it can be almost asymptomatic until the last stages. Outwardly, a vulvar neoplasm looks like warts of a bright pink (red or white) hue.

The symptoms of the disease are:

• itching and irritation of a paroxysmal nature in the external genital area, mainly at night;
• ulceration of the external genital organs;
• pain and induration in the genital area;
• purulent (bloody) discharge from the genital fissure;
• edema of the pubis, vulva, legs (manifests itself in the later stages).

Diagnostics of oncology

The process of diagnosing squamous cell carcinoma consists of:

• personal examination by a doctor;
• instrumental research;
• laboratory research;
• biopsy.

Examination by a doctor includes a personal examination of the patient, in which the appearance of the neoplasm, its color and consistency, the presence of such formations in other parts of the body are examined.

The next stage of diagnosis is instrumental examination, which includes: thermography, endoscopic examination, confocal laser microscopy, MRI.

Thermography is a method of measuring the temperature at the site of a suspected tumor to help determine if there is cancer or not.

Endoscopic examination helps to examine more thoroughly the inner surface of the organ of interest.

Endoscopy is divided into:

• esophagoscopy;
• laryngoscopy;
• colposcopy.

Confocal laser scanning microscopy provides a multi-layer image of the upper layers of the skin and epidermis. The advantage of this method is that this type of diagnosis can be carried out without first taking material.

MRI helps to see a layer-by-layer image of various organs and tissues of the human body. For example, MRI will help to see the cancerous lesion of the cells of the lymphatic tissue in case of metastases.

If squamous cell (spinocellular) cancer is suspected, laboratory tests may be prescribed. A general analysis of blood and urine is prescribed to find out the general condition of the human body and identify concomitant diseases.

The main indicative studies can be considered a cytological study and.

For squamous cell type of oncology, a specific tumor marker is antigen. Its excess by 1.5 nanograms per ml may indicate the possible presence of squamous cell carcinoma in the body. But making a diagnosis only based on the results of a tumor marker is unacceptable, since an increase in this antigen can also be in precancerous skin diseases, in liver failure, and other skin diseases.

The cytological method studies the shape, size, structure and composition of a tumor cell, which is obtained in various ways. Micropreparations can serve as research material: scrapings from the oral cavity, imprints from skin neoplasms, vaginal discharge, sputum, etc.

A biopsy is the final stage of research on oncology. The material taken for research (biopsy) is specially processed and then examined under a microscope.

Squamous cell carcinoma treatment

The question of the use of any treatment for this type of oncology is decided by an oncologist. The main criteria in making such a decision are the age and general condition of the patient. Malignant tumors of small size are treated with curettage, electrocoagulation, cryodestruction. When a tumor is found in the scalp, the latter method is not used.

With chemosurgical therapy (Moh's method), the prognosis for squamous cell carcinoma is very favorable (99% of the effectiveness of treatment). This type of treatment is effective for tumors with indistinct boundaries. Separately, chemotherapy (topical drugs) is used for small tumors to prevent them from growing.

In the initial stages, radiotherapy is also highly effective. when the eye or nose area is affected (other methods may impair vision or damage nasal cartilage).

Traditional methods of treatment

With squamous cell cancer, you should not self-medicate and abandon traditional methods of therapy, but at the same time, with the permission of the attending physician, alternative methods can be used to alleviate the patient's condition.

Places affected by squamous cell (epidermoid) cancer can be treated with a tincture of birch buds, and verbena lotions also have a positive effect on the well-being. An ointment made from dried pomegranate seeds and honey is used to treat ulcers and plaques.

Disease prognosis and disease prevention

To achieve a high effect, it is very important to diagnose diseases on time and to carry out the treatment correctly. If the disease is detected in the early stages, the likelihood of cure is very high. After treatment, the patient is under the supervision of a physician throughout his life.

The prognosis of five-year survival in this type of oncology depends on the localization of the disease.

In case of lip oncology, the five-year survival rate at stage 1 of the disease is 90%, at stage 2 - 84%, at 3-4 stages - 50%. With a tumor of the larynx and esophagus at all stages, the prognosis of survival is about 10-20%. With skin neoplasms - at stages 1-2-3 - the survival rate is 60%, at 4 - 40%. With oncology of the intestine and stomach - at stage 1 - almost 100%, by 2 -80%, at 3 - 40-60%, at 4 - only 7%. In lung cancer, the prognosis of five-year survival at stage 1 is 30-40%, at 2 - 15-30%, at 3 - 10%, at 4 stages - 4-8%.

Preventive measures for oncology include:

• limiting the time spent in the sun in summer;
• do not abuse the visit to the solarium;
• timely treatment of dermatitis;
• using sunscreen (especially when going to the beach);
• attentive attitude to all kinds of changes on the skin (an increase in the size, shape and number of moles, birthmarks, etc.).

Question answer

What is Kangri cancer?

This is an oncology of the anterior abdominal wall, which is provoked by burns from a pot of coals worn by the inhabitants of the Himalayas.

What is Invasive Breast Cancer?

Breast cancer detected at non-initial stages is usually diagnosed as "invasive carcinoma". It is a rapidly progressive disease. The mutated cells try to spread faster outside the cancer-affected organ.