According to medical statistics, up to 90% of cases of malignant gastric neoplasms are squamous cell carcinoma of the esophagus. The prognosis for such a diagnosis directly depends on at what stage the disease was detected. The best prospects are for those who turned to the clinic on time and have the opportunity to resort to the latest treatment methods.
General categorization
The classification of cases into groups was introduced based on the nuances of the structure of atypical cells. Highly differentiated squamous cell carcinoma of the esophagus, as well as cases with moderate and low differentiation, are distinguished. For the first type, keratinization processes are more characteristic. The progress of the disease is accompanied by the formation of horn pearls. Gradually, signs of keratinization become more pronounced: the phenomenon spreads from the periphery to the central part. Polymorphism of cells and nuclei for this form of the disease is characteristic only to a very small extent.
One of the varieties of the described category of pathology is verrucous cancer. The frequency of its occurrence is quite low. This form of neoplasm is characterized by a papillary type of distribution.
Low-grade squamous cell carcinoma of the esophagus is a form of the disease, which is often characterized by a complete lack of keratinization. Perhaps the presence of only weak signs of such a violation. In contrast to the variant considered above, the atypical nature of the cells is quite pronounced, polymorphism is inherent in them. Finally, a moderately differentiated squamous cell carcinoma of the esophagus is a form that is an intermediate between those described.
Forms and Types
It is known that in the framework of one pathological condition, the appearance of cells of different levels of differentiation is possible. Sometimes a spindle cell scenario of the development of pathology is revealed in patients. As the name implies, the neoplasm in this case is formed by cells similar in shape to a spindle. For this type of squamous cell carcinoma of the esophagus, there is a similarity with sarcoma, which can lead to an incorrect diagnosis. To clarify the phenomenon, it is necessary to study tissue samples under an electron microscope in order to determine the epithelial nature of the malignant region. A study of a sufficiently large volume of samples will certainly make it possible to identify areas that give an accurate idea of the nature of the disease. For this, light microscopy methods are used.
Another form of squamous invasive esophageal cancer is similar to cutaneous basal cell carcinoma. Such a variety is quite rare, formed by monomorphic structures close to basaloid. Such a tumor is characterized by clear boundaries. It is possible to dilute basaloid cells with horn pearls. In some areas, cysts, cords can form. This allows you to compare the picture of the disease with basal cell carcinoma of the mucous type, adenoid.
Forms and types: rare and not very
In some cases, squamous cell carcinoma of the esophagus is formed by foci, accompanied by necrotic processes of the eosinophilic type. Around such foci, a thin layer of atypical structures is observed. This form is somewhat similar to the basal, diagnosed in the anal canal.
A highly differentiated form often develops by fields, complexes, and for a low degree of differentiation, a diffuse type of growth and discomplexity are more characteristic.
Case Nuances
Studying various theories, summarizing statistics, summarizing clinical data on the treatment of squamous cell carcinoma of the esophagus, scientists have found that the level of response to radiation therapy usually depends on the degree of differentiation inherent in a particular case. True, the scientific papers published at present are quite contradictory; there are no reliable and undeniable data on the typical course of the disease.
It has been established that radiation therapy for squamous cell carcinoma of the esophagus leads to strong changes in tumor structures. There is a possibility of complete death of atypical cells. Fibrosis fields are formed, individual foci - lymphoplasmacytic infiltrate, and the surface turns into a necrotic site. In many cases, the fibrous region becomes the area of localization of horny masses, granulomas, and dystrophic cells, which are characterized by hyperchromic nuclei. In some cases, patients who underwent radiation treatment of squamous cell carcinoma of the esophagus have one of two types of eosinophilic cytoplasm: homogeneous, with vacuoles.
If in the future atypical cells begin to grow again, the regions preserved from the first episode have numerous figures of mitosis, and when examined, they look anaplastic.
Curious information and important nuances
From medical statistics it is known that squamous cell carcinoma of the esophagus (keratinizing and not being that) is more likely to develop in people of old age. Among patients, clinics on average more than men. In the age group under 30 years of age, malignant neoplasms in the esophagus are extremely rare. The cause of the cancer process is malignancy of healthy cells. The disease is often localized in the lower part of the esophagus or the middle section of the organ.
The first symptom that allows you to suspect something is wrong with your health is the difficulty in swallowing. Gradually, the condition progresses, and at a late stage, squamous cell carcinoma of the esophagus (with keratinization and without it) becomes the reason of the inability to take even soft food. Against the background of this phenomenon, the patient loses weight.
Development and dissemination of the process
At the first stage, the disease does not manifest itself with significant symptoms, so the patient is unlikely to suspect a health problem. It is possible to detect squamous cell carcinoma of the esophagus (non-keratinizing, keratinizing) only if the person undergoes a preventive examination or comes to the clinic with other diseases, during the refinement of which he was sent for a specialized checkup. Instrumental techniques that help establish the presence of atypical cells: CT, ultrasound, endoscopy.
With squamous cell carcinoma of the esophagus, survival depends on the level of progress of the condition. The worst prognosis is for people who seek help in the fourth stage: there are no known cases that would have ended in a complete cure. To clarify the level of development, samples of degenerated tissues are taken for histological analysis. In the last stages, the disease spreads to nearby tissues and organs - this is characteristic of all malignant processes. Damage to the trachea, vascular system, bronchi is possible. Metastases are detected not only in the sternum, but also in remote areas of the body.
Classes and Varieties
The system for dividing into low-, high-, moderately differentiated squamous cell carcinoma of the esophagus (with and without invasion) was indicated above. In addition, it is customary to classify all cases as exophytic, when propagation occurs in the lumen of the organ, and endophytic, when atypical cells spread in the thickness of the organ or submucosal layer. With a mixed variant of the development of the disease, all layers of the walls of the esophagus simultaneously suffer. This form is characterized by the rapid appearance of numerous ulcers and an active necrotic process.
The best prognosis of survival in squamous cell carcinoma of the esophagus is superficial. A tumor is an erosive area or plaque formed on the esophageal wall. Such a neoplasm does not grow to very large sizes. The prognosis is significantly worse with a deeply invasive form. Malignancy covers the deep tissue in the esophagus. In the pictures, such a tumor is similar in shape to a fungus or forms in the form of a deep ulcer. The process is characterized by the rapid spread of metastases in the respiratory and cardiac systems.
Types and cases: nuances of forms
The study of neoplasms with the help of modern tools usually allows you to get a picture of herpes zoster. As a rule, cancer cells form a ring on the inner surface of the esophagus. Gradually, malignancy spreads over large areas, the lumen of the organ narrows, and a typical clinical picture forms.
In some cases, cancer develops in the form of a polyp.
It was established that in women, the disease often begins to progress in the lower part of the esophagus, gradually growing up. Men are more likely to form atypical cells of the transition region of the esophagus into the stomach.
Keratinization: is there or not?
The non-cornified form is usually accompanied by a violation of the digestive system due to a decrease in the lumen of the esophagus. Problems accompany the swallowing process - this applies not only to food intake, but also to the gastrointestinal tract of saliva. From time to time, the patient is inherent in regurgitation.
The keratinizing type of the disease transforms the mucous membranes of the esophagus. Cells become corneal, the walls become dry, the clinical picture is significantly aggravated. The neoplasm is rapidly increasing, but the slow formation of the vascular wall leads to insufficient cellular nutrition. This provokes necrotic areas. Endoscopic examination allows you to identify them in the form of zones of ulceration.
Relentless statistics: what awaits the patient?
The detection of the disease in the primary stages is associated with the best opportunities for a positive outcome. The patient is shown complex therapy. Five-year survival on average is about 80%. In the future, further work is possible if the profession does not require significant physical effort.
If cancer is detected at an advanced stage, studies can identify distant metastases, treatment is possible only with very great difficulty. Even the use of the most effective and modern methods does not always help to achieve at least some meaningful progress.
Where did the trouble come from?
So far, doctors have not been able to find out all the reasons that can provoke squamous cell cancer of the esophagus. As a rule, a disease develops if a person is affected by several carcinogenic factors. The larger this group, the greater the likelihood of tissue malignancy.
Statistics show that squamous cell cancer of the esophagus is more often found in smokers, whose experience is decades. Tobacco is rich in carcinogens that accumulate on the esophagus walls and provoke atypical changes in cells. On average, the risk of cancer with long-term smoking experience is four times higher than in other groups.
With no lesser dangers associated with frequent and abundant drinking. Such drinks burn the mucous membranes of the esophagus, provoking the growth of the epithelium, which can go according to the atypical scenario. The occurrence of a squamous form of malignant disease in chronic alcoholics is 12 times higher than among other groups.
Factors and nuances: what matters?
The big dangers of squamous cell carcinoma are associated with poor nutrition and irrational food. Frequent use of salty, hot, pickled, overly spicy - all this can cause a malignant process. Negatively affect the walls of the esophagus dishes rich in moldy fungi. The negative factor is the lack of fresh plant products. All these features of the daily diet are most characteristic for residents of the Central Asian region and the Far East, as well as some Siberian regions. Statistics confirm that among these people, the incidence of cancer of the esophagus is higher than in other areas, tens, and sometimes even hundreds of times.
Another nuance that can become an impetus for malignancy is a burn of the surface of an organ, provoked by the ingress of too hot a substance or a chemically active compound. Sometimes a burn that provokes cancer is chronic damage due to the frequent use of too hot dishes. Cases are known when, against the background of accidental penetration of concentrated alkali into the gastrointestinal tract after a few years, a malignant neoplasm was detected in a person.
Risk and hazard groups
There is a higher likelihood of malignancy of tissues with a lack of vitamins in the body. With vitamin deficiency, the mucous layers do not receive retinol and tocopherol, without which normal functioning and development are impossible. These vitamins form the protective layer of the esophagus. If their lack is observed for a long time, gradually the cellular structures degenerate.
It is known that those with close relatives who have had cancer are more likely to get cancer. Hereditary predisposition is a factor that must be taken into account without fail. It was found that mutation of the p53 gene causes the generation of abnormal protein structures that inhibit the natural protective functions of esophageal cells. Against the background of such a process, the probability of malignant degeneration is significantly higher.
Diagnoses and Dangers
It is known that in the predominant case in patients with squamous cell carcinoma of the esophagus, infection with the papilloma virus is detected. Scientists suggest that HPV may be one of the triggers for malignancy.
Esophagitis is suspected as a precursor to cancer. A pathological condition leads to regular ingestion of hydrochloric acid in the esophagus. This negatively affects the mucosa, irritates it and can provoke the transformation of cells. Esophagitis is often observed against the background of excess weight and gastric diseases. It can lead to a complication in medicine known as Barrett's esophagus. This term describes the progress of the disease with the degeneration of multilayer epithelial structures into cylindrical.
First manifestations
You can suspect that you need to visit a doctor if a person loses weight dramatically, which is accompanied by problems if swallowed. Possible cachexia. The patient feels weak. Dysphagia was first observed when trying to consume solid food, and stabilization can be achieved if the products are actively washed down with liquid. Gradually, the condition worsens, there is a difficulty in eating cereals and soups. Dysphagia is the main and constant manifestation of a malignant neoplasm in the esophagus. Gradually, it becomes more pronounced.