I-Squamous Cell Carcinoma: I-Hautkrebs Efunekayo Ukuhlonitshwa

ISquamous cell carcinoma (SCC) yindlela yesibini edumileyo yokugula kwesikhumba, ephuma kwiiseli ze-squamous ezimele iindawo eziphakathi nezangaphandle ze-epidermis. 8 yezigidi zeemeko ziqinisekiswa eUnited States ngonyaka, kwaye umngcipheko uqhuba ngokukhawuleza — ngokwezinye iimeko, ukwanda kwe-200% kwiiminyaka ezintathu ezidlulileyo ngenxa yokuguga kwabantu, ukungena kwe-UV, kunye nokwanda kokufumaneka. ISCC ibamba indawo ebalulekileyo phakathi kobunzima bokugula kwesikhumba: ibonakala kakhulu kwaye ngokubanzi ayinabungozi njengemelanoma, kodwa ibonisa ubungozi obukhulu ngakumbi kune-basal cell carcinoma ngenxa yokuba ineendlela zokuhamba.

Xa i-SCC isasazeka kwiindawo ze-lymph ezikufutshane okanye kwiingxenye ezikude, umphumo ubandakanya ukwehla kakhulu — i-SCC esasazekileyo inezinga lokuphila leminyaka emihlanu elingama-30-50%, kuxhomekeka kumgangatho wokusasazeka. Le ngqondo ivame ukuvela kwiindawo zesikhumba ezichaphazelekayo — ubuso, iindlebe, i-scalp, umqala, iinyawo, kunye neengalo — kodwa ingavela nakwiimilebe, ngaphakathi emlonyeni, kwiindawo zeengqumbo, nakwiindawo zokuhlala ezichaphazelekayo okanye ezivuthayo. I-SCC ivame ukuvela kwiindawo eziphambili, ngakumbi kwi-actinic keratoses, yenza kube yenye yeekhankanyiweyo ezithile ezinephawu elichanekileyo lokuba nepre-cancerous elivumela umnyango wokuthintela. Umjikelo ukusuka kwisikhumba esiqhelekileyo ukuya kumonakalo weLanga ukuya kwi-actinic keratosis ukuya kwi-SCC engeneleyo ubonisa ukuba kutheni ukhuselo lweLanga oluqhubekayo kubalulekile kuyo yonke iminyaka kwaye kutheni ukunyanga iindawo ze-pre-cancerous kuvimba ukuphuhliswa kwe-cancer.

Ukuchaphazeleka kwe-ultraviolet okukhulayo kukhulu kakhulu kwi-SCC — ngokungafani ne-melanoma, ebandakanya ukuchaphazeleka okukhulu kweLanga kunye ne-burns, i-SCC ibonisa ngakumbi kumjikelo we-UV ophakathi. Oku kwenza i-SCC ibonakale kakhulu kwiingcali zangaphandle, abantu abahlala kwiindawo eziphantsi, kunye nabantu abaneenkcubeko zeLanga ezide. Isikhumba esilula, iinwele ezilula, kunye neenwele eziluhlaza okanye eziluhlaza zikhupha umngcipheko ophezulu, kodwa i-SCC ibonakala kwiintlobo zonke zesikhumba.

Kubantu abaninzi abaninzi, i-SCC ivame ukuvela kwiindawo zeengqumbo ezichaphazelekayo, ukuchaphazeleka, okanye kwiindawo ezingachaphazelekanga, kwaye lezi i-SCC zihlala zikhula ngokukhawuleza. Ukungabikho kwemiphumo yokukhulisa umngcipheko: abamkeli be-organ transplant abathatha iimeko zokuphosa ubungqina baphosa umngcipheko ophindwe kabini ukuya kwangama-65-250 kwi-SCC xa kuthelekiswa noluntu olujolise, kwaye i-SCC zabo zihlala zikhula ngokukhawuleza kwaye zihlala zikhula. I-HIV/AIDS, i-chronic lymphocytic leukemia, kunye nezinye iimeko ezithintela umphumo zikhuphula umngcipheko.

Ukuphazamiseka kwe-human papillomavirus (HPV) kudlala indima kwi-SCC, ngakumbi kwiindawo zeengqumbo, kwiindawo ze-perianal, nasezindaweni ezithintela umphumo. Iintlobo ezithile ze-HPV (16, 18) zikhokelela ngqo kwi-squamous cells. Iingxaki ezichaphazelekayo, iindawo zeengqumbo, kunye neendawo zokuchaphazeleka zikhokelela kwi-SCC — i-Marjolin's ulcer ibonisa i-SCC ephuma kwiingxaki ezichaphazelekayo okanye kwi-scar ye-burn, ngokuqhelekileyo emva kweminyaka emininzi emva kokulimala kokuqala.

Ukuphazamiseka kwe-radiation kwiimeko ezithile kukhuphula umngcipheko we-SCC kwiindawo eziphathwayo. Ukuchaphazeleka kwi-arsenic, iikhemikhali ezithile zezimboni, kunye ne-coal tar derivatives kukhuphula umngcipheko. Irekhodi yomntu yokuba ne-cancer yesikhumba ikhulisa umngcipheko we-SCC, njengoko irekhodi ye-actinic keratoses.

Iimeko zejenetiki ezifana ne-xeroderma pigmentosum (ukuphazamiseka kwe-DNA repair) zikhupha umngcipheko ophakamileyo. Ukutshaya kuxhunyaniswa ngokukodwa ne-SCC ye-lip.

ISquamous cell carcinoma iboniswa kwiindlela ezininzi, kwaye ukwazi iindlela zayo ezahlukeneyo kubalulekile ukuze kufumaneke kwangoko. Ukuboniswa okudumileyo kukunxiba, i-nodule ebomvu, ngokuqhelekileyo enephepha eliqinileyo, elinokubukeka lomeleleyo, luhlaza, okanye lukhuni. Ngokungafani nepearl, ubungqina be-basal cell carcinoma, i-SCC ibonakala ikhululekile, ikhululekile, kwaye ibonakala ikhululekile.

I-lesion eqhelekileyo enephepha elinokubukeka lomeleleyo, elinokubukeka lukhuni, elikhula kancinci kancinci iboniswa, ngakumbi kwi-trunk nakwi-extremities. I-SCC ye-lip ivame ukuvela njengephakheji eqinileyo, elinokubukeka lukhuni, okanye elinokubukeka lukhuni elingaphezulu kwe-lower lip. Iphawu elibalulekileyo elabelana phakathi kwe-SCC presentations yindawo ebuhlungu engapholi — i-lesion ehlayo, ebonisa, ibonisa ukuba iyaphucuka, emva koko iphuka kwakhona rhoqo kwiiveki ukuya kwiinyanga.!!

Nanyani i-wound engapholiyo kwiindawo zesikhumba ezichaphazelekayo kufuneka ihlolwe. I-SCC ingavela njengokukhula okufana ne-wart, ukuphakama okukhanyayo kwe-keratin (i-cutaneous horn), okanye indawo yesikhumba esiqinileyo, esomeleleyo, esikhupha igazi xa i-skales zikhutshwa. Kwindlebe, i-SCC ivame ukuvela njenge-nodule ebuhlungu, elinokubukeka lukhuni kwi-helix okanye kwi-antihelix.

Kwisikhumba, ingavela njengephakheji engapholiyo okanye indawo yokukhula kwiindawo ezingenamahluko okanye ezincinci. Iimpawu ezikhumbuza umngcipheko ophakamileyo ziquka ukukhula ngokukhawuleza, ubungakanani obukhulu (ngaphezulu kwe-2cm), indawo kwiindlebe, i-lip, okanye i-temple, ukungena kwiindawo ezijulileyo (ukuphakanyiswa okubonakalayo kwi-tissue engaphantsi), ubuhlungu okanye ubuhlungu, kunye neempawu zokungena kwi-perineural ezifana nokungaboni, ukungaboni, okanye ubuthathaka bemisipha kule ndawo. Umjikelo ukusuka kwi-actinic keratosis ukuya kwi-SCC ungaba mncane — i-AK ethatha ubukhulu, ibonisa ubuhlungu, okanye ibonisa umphakamo ophakamileyo ungase ube phambili kwi-SCC engeneleyo kwaye ifuna i-biopsy.

Ukwahlula kwe-SCC kuxhomekeke kumjikelo wokunyanga kunye nokubikezela umphumo. I-American Joint Committee on Cancer (AJCC) yahlula i-SCC ngokubheka ubungakanani be-tumor, ubunzulu bokungena, indawo, kunye neempawu ze-pathological. I-SCC yeMphakathi I ibonisa iitumu ezincinci ezingaphantsi kwe-2cm ngaphandle kweempawu eziphezulu, kunye neendlela zokuphola eziphakamileyo ezingaphezu kwe-95% ngonyango olufanelekileyo.

Iitumu zeMphakathi II zikhulu kune-2cm okanye zineempawu eziphezulu ze-pathological (ukungafani kakuhle, ukungena kwi-perineural, ubunzulu obungaphezulu kwe-6mm okanye kwi-subcutaneous fat) kodwa zihlala zikhona, zineendlela zokuphola eziphakathi kwe-70-90%. I-Mphakathi III ibonisa ukungena kwiindawo ze-lymph ezikufutshane, umphumo we-minyaka emihlanu wehla ukuya kwi-40-60%. I-Mphakathi IV ibonisa ukungena kude, ibonisa umphumo we-minyaka emihlanu ophakathi kwe-20-30%.

Iimpawu eziphezulu ezibuhlungu umphumo ziquka ubungakanani be-tumor obungaphezulu kwe-2cm, ubunzulu obungaphezulu kwe-6mm okanye ukungena kwi-subcutaneous fat, ukungena kwi-perineural (i-cancer ikhulisa kwi-nerve sheaths, ibangela ubuhlungu, ukungaboni, okanye ubuthathaka), ukungafani kakuhle, indawo kwiindlebe okanye kwi-lip (ezine-2-3x umngcipheko ophakamileyo wokungena kunezinye iindawo), ukungabikho kwemiphumo, kunye nokuphinda emva kokunyanga ngaphambili. Umjikelo wokungena kwi-SCC ye-cutaneous jikelele ungama-2-5%, kodwa kwiimeko eziphezulu umngcipheko uphakamisa kakhulu — i-SCC ye-lip ingena kwi-14% yeemeko, kwaye i-SCC kwiimeko ezithintela umphumo ingena kakhulu. Ukuqonda umjikelo wakho ophakathi kokuphila kukhokela umgangatho wokunyanga: i-SCC encinci, ehlukeneyo kwi-forearm inganyanyiswa ngokufanelekileyo ngonyango oluqhelekileyo, ngelixa i-SCC engafani kakuhle kwiindlebe enokungena kwi-perineural ifuna i-Mohs surgery, i-radiation engaphezulu, kunye nokujolisa ngokukhethekileyo kwi-metastasis.

Iindlela zokwelapha i-SCC zixhomekeke kwiimpawu ze-tumor kunye nokwahlulwa kwemingcipheko. Ukususa ngesandla okujolise kwiimida ezichongiweyo (4-6mm kwiitumu ezineengozi eziphantsi, ezibanzi kwiitumu ezineengozi eziphezulu) kufanelekile kwi-SCC ezininzi, kunika iiphesenti zokuphiliswa ezingaphezulu kwe-92% kwiindawo zokuqala. I-sample ithunyelwa kwi-examination ye-pathological ukuze kuqinisekiswe imida ecacileyo.

U-Mohs micrographic surgery unika umphumo ophezulu wokuphiliswa (97-99% kwi-SCC zokuqala) kunye nokugcina umphunga omkhulu ngokujonga i-100% yemida yokusebenza ngexesha lenqubo. U-Mohs ubaluleke kakhulu kwi-SCC ezisemva, ezindleleni, emlonyeni, ezandleni, nasezithweni; kwiitumu ezinkulu okanye ezinamandla; kwiitumu ezineemida ezingacacanga; kwi-SCC eziphindaphindayo; kunye neetumu kwiimfuno zokunciphisa umphunga. Ubuchule bokujonga yonke imida yokusebenza ngexesha lokwenyani, hayi ukulawula umphunga omncinci njengoko kwenziwa ukususa okujolise, kubangela umphumo ophucukileyo kaMohs.

Kubantu abangafanelanga ukuhlinzwa ngenxa yeempawu zempilo, ukwelashwa ngombane kunika enye indlela esebenzayo, ifezekisa iiphesenti zokuphiliswa ze-90% kwi-SCC ezincinci, zokuqala. Ukukhanya kusebenza njengokwelapha emva kokuhlinzwa kwiimpawu ezineengozi eziphezulu ezifana nokuhlaselwa kwe-perineural okanye imida efanelekileyo xa ukususwa kungafanelekanga. Ukucoca kunye ne-electrodesiccation kungafanelekela i-SCC ezincinci, ezineengozi eziphantsi kwiindawo ezingabalulekanga.

Kwi-SCC eziphucukileyo, ezingasusi, okanye ezinamathuba, ukwelashwa kwe-systemic immunotherapy kunye ne-checkpoint inhibitors kutshintshile umhlaba wokwelapha. U-Cemiplimab (Libtayo) kunye no-pembrolizumab (Keytruda) bavunyelwe kwi-SCC eziphucukileyo kwaye bafezekisa umphumo ophakathi kwe-40-50%, unika umphumo obalulekileyo kubantu abaninzi ababe neendlela ezimbalwa. Ukukhupha (i-regimens esekwe kwi-cisplatin) kusemthethweni kodwa kunokusebenza okuncinci kwaye kunobungozi ngakumbi kune-immunotherapy.

Ukuphuculwa okujolise kwi-EGFR inhibitors (cetuximab) kunika enye indlela ye-systemic. Kwi-SCC eziphucukileyo ezingafanelanga ukuhlinzwa okanye ukukhanya, ukuhlolwa kwe-multidisciplinary tumor board kuqinisekisa ukucwangciswa kokwelapha okufanelekileyo.

Nanyani na ukwanda okutsha okanye okuguqukayo kwi-skin exhaswe ilanga kudinga ukuhlolwa ngochwepheshe, kodwa iimpawu ezithile zifuna ingqalelo engxamisekileyo. I-sore engaphilanga emva kweveki ezi-3-4 kufuneka ihlolwe — ukungaphilanga okuqhubekayo kukhumbuza i-SCC.!! Ukukhula ngokukhawuleza kwe-lesion yesikhumba kwiintsuku ukuya kwiiveki kubonisa inkqubo enobungozi efuna i-biopsy ngokukhawuleza.

' Ukuba unembali ye-actinic keratoses kwaye enye iba nzima, ibuhlungu ngakumbi, okanye ikhulisa isiseko esiphakamileyo, oku kungabonisa ukunyuka kwi-SCC. Nanyani na ukwanda emlonyeni, kwi-ore, okanye kwi-temple eqhubeka ngaphezu kweveki ezimbalwa kufuneka ibiyopsywe — le mikhondo ibamba umngcipheko ophakamileyo we-metastatic kwaye ifuna ukuhlolwa kwangaphambili. Ukungaboni, ukuvutha, okanye ukuncipha kwemisipha kufutshane ne-lesion yesikhumba kubonisa ukuhlaselwa kwe-perineural kwaye kudinga ukuhlolwa ngokukhawuleza.

Iilayini ezikhulayo kufutshane ne-skin cancer okanye indawo ye-skin cancer yangaphambili zifuna ukuhlolwa ngokukhawuleza kwi-metastasis. Kubantu abane-immunosuppression (abamkeli be-organ transplant, abantu abane-HIV, abantu abathatha iimeko zokunciphisa umphunga), nayiphi na ukwanda okutsha kwesikhumba kudinga umngcipheko ophantsi we-biopsy ngenxa yokuphakama kwe-SCC kunye nokuziphatha okungqongqo kule ndidi. Ukuba ubenayo i-SCC yangaphambili, qhubeka uqaphele — umngcipheko wokuphuhlisa i-SCC ezongezelelweyo uphakamile, kwaye ukufumanisa kwangaphambili kwezinto ezintsha okanye ukuphindaphinda kubalulekile.

I-squamous cell carcinoma iyakwazi ukuphila kakhulu xa ifunyanwa ngexesha, kodwa ingaba yingozi empilweni xa ifumaniswa kamva. I-Skinscanner inika isixhobo sokuhlola esifikelelekayo esinokunceda ukufumanisa i-lesions ezithile phakathi kokuhlolwa kwezikhumba ngochwepheshe. I-AI yethu ifundiswe ukuba ibone iimpawu zokubona ezihambelana ne-SCC — i-nodules eziqinileyo ezineendawo ezithambileyo okanye ezine-crusted, i-sore ezingaphilanga, kunye neenguqu ezincinci ezihlukanisa i-cancer ephuhlisayo kwiindawo ezingenacala.

Ngokuthatha umfanekiso we-lesions ezikhathazayo, ufumana uhlalutyo olukhawulezayo olukhumbuza iimpawu ezifunekayo ukuhlolwa kwe-dermatologic. Kubantu abaneengozi eziphezulu — abantu abaninzi abaninzi abane-sun exposure, abantu abane-immunosuppression, nabani na onembali ye-skin cancer okanye ye-actinic keratoses — ukulandelela rhoqo iindawo ezixhaswe ilanga kudala inkqubo yokuhlola efumanisa utshintsho ngexesha. Ukubhaliswa kweveki kwe-skin yakho kukuvumela ukuba ufumane ukwandiswa okukhawulezayo, utshintsho lwesurface, okanye ukuphuhliswa kwe-lesion entsha okwenziwa kancinci ukuze kuphumeze ukungaboni kodwa kubonakala ngokucacileyo kwiifoto ezithathwe kwiiveki ezahlukeneyo.

I-Skinscanner ibaluleke kakhulu ekuhloleni i-actinic keratoses ezaziwayo, njengoko ukutshintsha ukusuka kwi-pre-cancer ukuya kwi-SCC engenelelayo kungaba kuncinci — ukwandiswa, ukwanda kokuthambeka, okanye ukuphuhliswa kwesikhumbuzo esiphakamileyo kungabhalwa kwiingxelo zeefoto ngaphambi kokuba uqaphele utshintsho ebomini bemihla ngemihla. Kwiindawo ezinzima ukufumaneka njenge-scalp, i-ore, kunye ne-back apho i-SCC ivame ukuvela, ukuba nomhlobo ukuthatha le mifanekiso yeendawo ukuze kuhlolwe i-AI kugcwalisa umgca obalulekileyo ekuhloleni. I-Skinscanner ayikhumbuzi i-cancer — kuphela i-biopsy ingaqinisekisa ngokuchanekileyo ukuxilongwa kwe-SCC — kodwa inika isikhumbuzo sokuqala esikukhuthazayo ukuba ufune ukuhlolwa ngochwepheshe okungasindisa ubomi bakho.