Squamous cell carcinoma (SCC) is a prevalent form of skin cancer that originates in the squamous cells, which are flat cells found in the outer layer of the skin. While often treatable in its earlier stages, the disease can progress to an advanced or “end-stage” form, presenting significant challenges for patients and healthcare providers. This advanced stage represents a profound shift in the disease’s behavior and management, moving beyond localized skin involvement to a more widespread and complex condition.
Defining End-Stage Squamous Cell Carcinoma
End-stage squamous cell carcinoma refers to a point where the cancer has spread extensively throughout the body, making it challenging to treat with conventional curative methods. This advanced stage is characterized by widespread metastasis, meaning cancer cells have traveled from the original skin tumor to distant organs or tissues. Common sites for this spread include the lungs, liver, bones, or brain.
The disease is classified as Stage 4 when it has spread to one or more distant organs. This differs significantly from earlier stages, such as Stage 0, where cancer cells are only in the top layer of the skin, or Stage 1 and 2, where the cancer may have grown deeper into the skin but has not spread to lymph nodes or distant organs. Stage 3 involves spread to nearby lymph nodes or underlying tissues like muscle or bone, but not yet to distant organs.
When SCC reaches this advanced stage, it is considered metastatic. Factors increasing the likelihood of metastasis include large tumor size, recurrence after initial treatment, nerve involvement, deep invasion into fat, muscle, or bone, and a weakened immune system.
Signs and Symptoms of Advanced SCC
When squamous cell carcinoma progresses to an advanced or end stage, the signs and symptoms extend beyond localized skin changes due to the spread of cancer to other parts of the body. While the primary skin lesion might still be present as a scaly red patch, firm nodule, or a sore that crusts over, new symptoms arise from the cancer’s presence in distant organs. These symptoms can be general or specific to the affected organ system.
General systemic symptoms include unexplained weight loss, persistent fatigue or weakness, and generalized pain. SCC on the face or neck is common, and the primary tumor’s location can influence initial signs.
If the cancer has spread to the lymph nodes in the neck or around the collarbone, a person might notice a painful or tender lump in these areas. Swallowing difficulties, a persistent sore throat, or changes in voice can occur if the cancer affects structures in the throat or esophagus. Metastasis to the lungs may cause respiratory issues such as persistent cough, shortness of breath, or chest pain.
When SCC spreads to the bones, it can lead to localized bone pain, tenderness, or even fractures. Neurological changes, such as headaches, seizures, or changes in mental status, may indicate metastasis to the brain. Liver involvement might manifest as abdominal pain, jaundice (yellowing of the skin or eyes), or unexplained swelling.
Treatment Approaches in Advanced Stages
Treatment goals for end-stage squamous cell carcinoma shift from achieving a cure to managing symptoms, slowing disease progression, and enhancing the patient’s quality of life. This approach is often referred to as palliative care, focusing on comfort and support rather than aggressive eradication of the disease. A multidisciplinary team of specialists, including oncologists, collaborates to develop a personalized treatment plan.
Pain management is a central component of palliative care, using various medications and techniques to alleviate discomfort. Nutritional support is also provided to counteract weight loss and maintain strength, which can involve dietary counseling, fortified foods, or supplements.
Systemic therapies, such as targeted therapies or immunotherapies, may be employed to slow the cancer’s growth. Immunotherapies like cemiplimab-rwlc (Libtayo®) and pembrolizumab (Keytruda®) work by harnessing the body’s immune system to identify and attack cancer cells. These treatments are often considered for patients with advanced SCC who may not be suitable candidates for surgery or radiation. Chemotherapy can also be used to slow spreading cancer and help relieve symptoms.
Radiation therapy is another approach used to manage symptoms and achieve local disease control in advanced cases. It can target tumors in the skin, lymph nodes, or other affected areas to reduce their size and alleviate pain or pressure. Supportive care measures, including psychological support and assistance with daily activities, complement medical treatments to improve overall well-being.
Prognosis and Outlook
The outlook for individuals with end-stage squamous cell carcinoma can vary, as it is influenced by several factors, including the extent of metastasis and the patient’s overall health.
While early-stage SCC generally has a high survival rate, this rate decreases significantly once the cancer has spread to distant lymph nodes or organs. For instance, once SCC has spread beyond the skin, the five-year survival rate may drop to less than 50 percent.
Prognosis is affected by the specific organs involved, and the size and depth of the primary tumor. Tumors on the face, scalp, fingers, toes, or those from an open wound, may have a higher likelihood of spreading and recurring. Despite challenges, treatments are available to manage the disease and improve quality of life.
While a definitive cure may not be possible at this advanced stage, ongoing research continues to develop new therapies that are improving outcomes for patients. The focus remains on personalized care, symptom management, and maintaining the best possible quality of life for as long as possible.