Cancer is a serious threat to the health of our
society because of the incidence and death rates continue to creep up. In the
early decades of the 1950s, the main cause of death in the State China is an
infectious disease, tuberculosis and neonatal diseases. Cancer only position to
9 or 10 as the cause of death. The survey results showed 70 decades the death
rate from cancer has occupied the third position, the results of the final
decades of the 80's survey showed the number of cancer deaths in urban areas
reached 128.03 / 100,000 inhabitants, occupying 21.88% of all deaths, or top
position among the various causes of death.1
In 2012, worldwide there were 14.1 million new
cancer cases, 8.2 million cancer deaths and 32.6 million people living with
cancer (within 5 years after diagnosis). Up to now, the cause of cancer is
still unclear, various types of cancer has the particularity of each, are
influenced by age, gender, ethnicity, lifestyle genetic background and many
other factors.1
Carcinoma is a malignant growth that is derived from
epithelial cells. Squamous Cell Carcinoma or Squamous cell carcinoma (SCC) is a
malignant skin tumor cells derived from keratinocytes epidermis.1 SCC is a
common skin cancer cases no.2 after Basalioma, but SCC distant metastases can
lead to death. Known 2 forms of intra-epidermal shape and invasive forms.
Characteristics of malignancy based on the occurrence of aplasia, rapid growth,
invasion to the local network and the ability to hold metastasis, squamous cell
development faster and more often hold cell carcinoma metastasis compared
basal.1,2
Skin is an organ thin wide. Thick skin varies
between 0.5 to 1.5 mm depending on the location, age, nutrition, gender, and
ethnicity. There is a thin skin on the eyelids, penis, labium minor, and the
inside of the upper arm, whereas there is a thicker skin on the palms, soles of
the feet, back and buttocks. Skin of the palms and soles of the feet does not
contain sebaceous glands and hair. In adults, the skin surface area of about
1.5-2 m2.2,3
In closing, the skin protects the body from
mechanical trauma, radiation, chemical, and from infectious germs. Lactic acid
in sweat and amini acid change results keratinization maintain the skin surface
pH between 4-6 which will inhibit the growth of bacteria. However, some types
of streptococci and staphylococci can still live commensal layer of keratin,
hair estuary, and glands sebaseus.2,3,8
The skin also serves as the sense of touch because
it contains sensory nerve endings in the dermis. Body temperature regulation
function derived from the existence of two layers of dermis plexus of blood
vessels that flow is regulated by the autonomic innervation. It also regulates
the autonomic innervation of sweat gland function. Evaporation of sweat cools
the skin. 2,3,8
The skin consists of three parts, namely the
epidermis, basal membrane and dermis. The surface is called part of the
papillary dermis. The basal membrane is a bulkhead between the dermis and
epidermis, is formed of a special protein structure and function attaching
kedermis epidermis. Damage due to mechanical trauma or genetic defect or
disease in the synthesis of protein can cause the epidermis regardless of the
dermis. 2,3,8
quamous cell carcinoma is the second most prevalent
form of skin cancer after basal cell carcinoma, the frequency is increased in
the skin that are often exposed to sunlight and in old age. The highest
incidence in the age of 50-70 years, most often on the skin are in the tropics,
and the incidence of 2-3 times more men than women, perhaps it is because men
are more often exposed to sunlight.4,5Cancer growth is not confined
to the organ where it came from growing, but can spread keorgan other organs in
the body and almost no cancer can be cured spontaneously without treatment.2
Etiology of
squamous cell carcinoma is multifactorial and is closely related to lifestyle
and dietary habits in general (especially tobacco or tobacco in betel and
alcohol use) although other factors such as infectious material, material
damage carcinogen metabolism, damage enzymes that repair damaged DNA and the
combination of these factors also play a role in the occurrence of squamous
cell carcinoma.4,5,6
Factors that
play a role in the occurrence of squamous cell carcinoma, namely:
a) Gene Mutation
Mutations in
tumor suppressor genes (TSGs) that control cell growth is considered to be the
etiology of squamous cel carcionoma. Identify changes in chromosomes DNA
primarily chromosomes 3,9,11, and 17, respectively, which affects TSGs. TSGs
functions to control growth. TSGs mutation can eliminate the growth control
mechanisms. TSGs mutation may be associated with cytochrome P450 that play a
role in carcinogenesis of squamous cell carcinoma of the oral cavity. As is the
case with TSGs damage, cancer is also associated with damage to other genes
that affect growth, especially that play a role in the delivery of the cells
thereof are oncogenes, especially on chromosome 11 and chromosome genetic 17.
Damage which includes a reduction of chromosomes 3,9,11 and 17 and play a role
in inactivation of TSGs, especially P16 and TP53.8,9
b) Alcohol
Heavy alcohol
user is a risk factor for oral cancer. Alcohol contains carcinogens or
prokarsinogen, including contaminants of nitrosamines and urethane besides
ethanol. Ethanol is metabolized by alcohol-dehydrogenase and by cytochrome P450
into acetaldehyde which is karsinogen.Alkohol dehidroginase oxidize ethanol to
acetaldehyde which is cytotoxic and produces free radicals and DNA base
hydroxylation. Cytochrome P450 can activate prokarsinogen environment. 8.9
c) Tobacco
Tobacco contain
potential carcinogens include nitrosamines (nicotine, Polycylic aromatic
hydrocarbons, nitrodicthanolamine, nitrosoproline and polonium. Tobacco smoke
contains carbon monoxide, thicynate, hydrogen cyianide, nicotine and
metabolites of this content. Activities gluatation S-transferase (GST) to be
damaged, thereby reducing the capacity detoksikasi karsonogen tobacco. Smoking
and other tobacco use way associated with 70-80% of cases of oral cancer.
Smoking, heat generated, ingredients, and the pipes are factors that irritate
the mucosa of the mouth. 8.9
d) Diet
Diets low in
fruits and vegetables have contributed to the occurrence of cancer. Fruits and
vegetables contain antioxidants which bind harmful molecules that cause gene
mutations can prevent cancer. 8.9
e) infectious
material
Herpes virus and
papilloma virus can be found in some cases of squamous cell carcinoma. HPV is
mainly a role in cancers of the oropharynx. 8.9
Squamous cell
carcinoma usually occurs at age 40-50 years. The earliest lesions that occur
are squamous epithelial dysplasia, with the heaviest forms of carcinoma in
situ. At this stage may or may not be seen thickened white patches
(leukoplakia). However, most invasive lesion with varying depths while in
diagnosis. The degree of differentiation varies, mostly good differentiated.7,8
The main
deployment is through the lymph carcinoma. Cervical lymph nodes affected early.
Metastasis through blood vessels occurs in late phase.
Leukoplakia is a
term for a lesion that looks flat, white in the mouth or genital mucous membranes.
In most cases only a hyperkeratosis (thickening of the keratin layer) as a
result of chronic irritation. On the other circumstances seem epithelial
dysplasia, and is considered a precancerous lesion. Therefore, leukoplakia
should settle biopsi.7
Squamous Cell
Carcinoma clinically can be classified into two, namely: 2,5,8
1. Squamous Cell
Carcinoma in situ (Bowen Carsinoma)
Squamous Cell
Carcinoma is limited to the epidermis and occurs in a variety of skin lesions
that have been there before as solar keratosis, chronic radiation keratosis,
hydrocarbons keratosis, arsenic keratosis, cornua cutanea, bowen disease, and
eritroplasia Queyrat. Squamous Cell Carcinoma in situ can settle in the
epidermis Waku long-term and unpredictable. Can penetrate to the basal layer of
the dermis and will metastasize through lymph node regional.6,7
2. Invasive
Squamous Cell Carcinoma
Invasive Squamous
Cell Carcinoma Squamous Cell can evolve from Carcinoma in situ and can also be
of normal skin. Squamous Cell Carcinoma both emerging invasive Squamous Cell
Carcinoma of the in situ, premalignant lesions or normal skin, usually in the
form of small nodules with unclear boundaries, tinted the color of the skin or
slightly erythematous. Its surface is soft at first, but over time evolved into
verukosa or papillomatous. Ulceration usually appears at the center of the
tumor, may happen sooner or later, often before tumors 1-2 cm in diametre.
Tumor surface may be granular and bleed easily, while the edge of the ulcer is
usually elevated and hardened and can be found crusting.
Histopathological
malignancy grading according Borders squamous cell carcinoma by comparing cells
that differentiate good and atypical, namely: 2,5,8
i. Gx: Grading
differentiation can not be checked
ii. G1:
well-differentiated more than 75% (well differentiated)
iii. G2:
differentiate more between 50 -73%
iv. G3:
differentiate more between 25-50% (poor differentiated)
v. G4:
well-differentiated less than 25% (undifferentiated)
Speed sequence
invasive and metastatic squamous cell carcinoma are as follows:
1. The tumor
that grows on the skin of normal (de novo): 30%
2. tumor
preceded by precancerous abnormalities (radio dermatitis, cicatricial, ulcers,
sinus fistula): 25%
3. Actinic
keratosis: 2%
G. Clinical
Stage
Clinical
stage in SCC determined based on AJCC TNM staging, 2008. SCC modifications can
be divided into four stages, namely: 9
1. Stage I (T1
N0 M0)
2. Stage II (T2
N0 M0 or T3 N0 M0)
3. Stage III (T4
N0 M0 or Tany N1 M¬0)
4. Stage IVA
(Tany Nany M1)
With criteria:
T1: tumor size ≤
2 cm in the largest dimension
T2: Tumor size
2-5 cm in the largest dimension
T3: tumor
size> 5 cm in the largest dimension
T4: Tumor
invades ektradermal inner structure (eg, cartilage, muscle, or bone)
N0: No regional
lymph nodes metastasis
N1: There are
regional lymph nodes metastasis
M1: distant
metastasis
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