squamous cell carcinoma, lung
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Epidemiology
- age > 50 years
- occurs predominantly in smokers
Pathology
- 50-65% arise in a major bronchus
- may also arise in upper airway or esophagus
- metastases to the brain (15%)
- hypercalcemia due to parathyroid hormone-related peptide
Genetics
- HERV-H 19p13.11 provirus ancestral Env polyprotein may be overexpressed
- other implicated genes (also see lung cancer)
Clinical manifestations
- occur early because of proximal bronchial involvement
- cough
- hemoptysis
- post-obstructive pneumonia from lobar/segmental collapse
- cerebellar ataxia (uncommon)
- epidermolysis bullosa (uncommon)
Laboratory
- sputum cytology
- centrally located endobronchial squamous cell carcinomas may exfoliate malignant cells into sputum
- serum calcium: hypercalcemia (25%)
- serum PTH low with hypercalcemia of malignancy
- serum PTH-related peptide high with hypercalcemia of malignancy
- serum glucose
- hypoglycemia from secretion of insulin-like polypeptide
- EGFR gene mutation (not indicated in smokers)[2]
- increased C-reactive protein in serum associated with increased risk for lung squamous cell carcinoma is smokers & former smokers, but not never smokers[5]
Diagnostic procedures
- see lung carcinoma
Radiology
- chest X-ray
- atelectasis (23%)
- obstructive pneumonitis (13%)
- hilar adenopathy (38%)
- cavitation (5-30%)
- 1/3 of cases present with peripheral lesions
- computed tomography of chest (image[4])
Management
- resection, radiation & chemotherapy
- platinum-based chemotherapy for resected stage II[2]
- platinum-based chemotherapy combined with gemcitabine*[2]
- 4-6 cycles
- platinum-based chemotherapy combined with paclitaxel/nab-paclitaxel + sintilimab[6]
- platinum-based chemotherapy combined with gemcitabine*[2]
- concurrent chemotherapy & radiation therapy over 6 weeks treatment of choice for patients with bulky or inoperable stage IIIA or IIIB disease[3]
- carboplatin + paclitaxel 4-6 cycles for metastatic SCC[3]
- avoid bevacizumab, risk of pulmonary hemorrhage in patients with SCC[3]
- platinum-based chemotherapy for resected stage II[2]
- maintenance chemotherapy
- switch-maintenance therapy with erlotinib only FDA-approved option for SCC
- pemetrexed not an option with SCC
- role of maintenance chemotherapy in metastatic SCC unclear
- laser bronchoscopy & endobronchial brachytherapy are palliative measures
- palliative chemotherapy with carboplatin & gemcitabine
- resectable brain metastasis is followed with whole brain radiation therapy
- palliative care consultation on diagnosis of metastases[2]
* switch gemcitabine to vinorelbine if patient develops TTP
More general terms
More specific terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 768
- ↑ Jump up to: 2.0 2.1 2.2 2.3 2.4 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021.
- ↑ Jump up to: 3.0 3.1 3.2 3.3 Lim MY Non-Small Cell Lung Cancer: 5 Management Challenges. Medscape. Nov 30, 2016 http://reference.medscape.com/features/slideshow/non-small-cell-lung-cancer
- ↑ Jump up to: 4.0 4.1 Conti L, Gatt S Images in Clinical Medicine: Squamous-Cell Carcinoma of the Lung. N Engl J Med 2018; 379:e17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30207918 https://www.nejm.org/doi/full/10.1056/NEJMicm1802514
- ↑ Jump up to: 5.0 5.1 Muller DC, Larose TL, Hodge A et al Circulating high sensitivity C reactive protein concentrations and risk of lung cancer: nested case-control study within Lung Cancer Cohort Consortium BMJ 2019;364:k4981 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30606716 https://www.bmj.com/content/364/bmj.k4981
- ↑ Jump up to: 6.0 6.1 Davenport L Triple Therapy for Squamous NSCLC Shows Real-World Clinical Benefit. Medscape. December 23, 2021 https://www.medscape.com/viewarticle/965488