(Editor’s note: This is the second in a series of special reports by the Baltimore Liberal Examiner, detailing the discovery, treatment, and recovery from oral cancer and things you as a potential cancer patient should know.)
So, what is a squamous cell?
All of your body cavities are lined with a kind of cell called “epithelial cells.” Go ahead. Check. Then go wash your hands.
According to that all-knowing font of knowledge, Wikipedia,
“Functions of epithelial cells include secretion, selective absorption, protection, transcellular transport and detection of sensation.”
So there they sit, in your body cavities, secreting, absorbing, protecting, transporting things from cell to cell and detecting things.
Squamous cells are the outer layer of the epithelium. They are flat, sort of scale like, and your epithelium — depending on which body cavity we’re talking about, may have one or more layers.
Squamous cell carcinoma (SCC), the crux of the biscuit in this story, is when these flat, scale like cells start growing and changing at an abnormal rate. The National Library of Medicine at the National Institutes of Health refers to SCC as a “non-melanoma skin cancer.”
As revealed in Part I of this series, Gail’s cancer is in the left tonsillar fossa — the small pit in the back of her mouth where her tonsil used to be. It was likely caused by smoking, although her husband Bill swears she quit 20 years ago. But skin cells have a long memory, and the damage to the cells done by the three-packs a day she was smoking was apparently enough to flip the switch on some DNA trigger that fired up a tumor in 2011.
On Feb. 13, 2012, Bill and Gail had their first visit with the ENT guy at the University of Maryland Medical Center. This doctor wanted his own CT scan, in addition to a Positron Emission Tomography scan or “PET” scan, in which the patient is given radioactive gluclose through an IV. The theory here is that cancer cells, like all cells subject to inflammation, will metabolize the sugar in larger amounts, making these areas show up as bright spots on a specialized scan.
The doctor also wanted to do an operative endoscopy — knock Gail out with anesthesia and really get in there with tubes and cameras and have a look around. Also, get some more tissue for the lab to examine.
Gail had the operative endoscopy on Feb. 17. They chunked out another 1 centimeter by half-centimeter by 0.1 centimeter slice and tested it. It came back as:
“Invasive squamous cell carcinoma, well differentiated, keratnizing.”
Bill said the doctor told them that the PET scan on Feb. 23 didn’t show much of anything, frankly. But the doctor explained, “…you tend to get more false negatives than false positives with these things.”
So, what is “invasive squamous cell carcinoma”.
Just what it says. When the cancerous tissue stays in the thin layer of squamous cells, it is called “carcinoma in situ.” When it has shown a propensity to branch out, our friends at Wikipedia call it an “invasive squamous cell carcinoma”,
Once the lesion has grown and progressed to the point where it has breached, penetrated, and infiltrated adjacent structures, it is referred to as “invasive” squamous cell carcinoma. Once a carcinoma becomes invasive, it is able to spread to other organs and cause a metastasis, or “secondary tumor”, to form.
And that’s never a good thing.
But what do they mean by “well-differentiated” and “keratinizing”?
Back to the Internet Tubes!
Well-differentiated lesions show prominent keratinization and may form “pearl-like” structures where dermal nests of keratinocytes attempt to mature in a layered fashion.
The good news here for Gail, if any is to be found? Poorly differentiated cells are far more aggressive than well-differentiated ones. Well-differentiated squamous cancer cells tend to grow more slowly than moderately- or poorly-differentiated ones.
Bill and Gail realize they are at the very beginning of a long, hazardous journey. But they have taken the first step. Next to come, removal of the tumor, examining the lymph nodes, staging the cancer, and planning the recovery.
They know there are no guarantees. But even with a potentially deadly diagnosis, Bill and Gail realize they are lucky.
They are lucky to live in a country with the best health care in the world, and they are lucky enough to have insurance to pay for it.
So many Americans with less deadly cancers and diseases will die today because they couldn’t afford decent health insurance here in “the land of the free.”
How is a cancer “staged”? That will be explained in Part III of this series.
To follow Bill and Gail through their cancer story, visit Famous Squamous.
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