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lung cancer is a malignant tumor with the highest incidence and mortality rates worldwide. About 30% of the pathological types are squamous cell carcinoma, and more than 70% are in the middle and late stages when they are discovered. Advanced squamous cell carcinoma has no chance of radical surgery, and due to the lack of effective targeted drugs, the treatment methods are very limited. Currently, chemotherapy is the main treatment method for advanced lung squamous cell carcinoma, but the clinical efficacy has been in the platform stage for a long time. Although immunotherapy has brought new hope for advanced lung squamous cell carcinoma, it is difficult to achieve widespread application due to the limited benefit population and high price. Therefore, early detection, early diagnosis and early treatment are needed for lung squamous cell carcinoma, which is related to the prognosis of patients and is the key to improving patient survival.
Lung squamous cell carcinoma belongs to non-small cell lung cancer. Among all types of lung cancer, the highest incidence is lung adenocarcinoma, followed by lung squamous cell carcinoma. Squamous cell carcinoma mostly occurs in the large bronchial. More than 90% of patients with pulmonary squamous cell carcinoma have had a history of smoking for many years. Of course, second-hand smoke, severe air pollution, or lung diseases such as chronic lung diseases, chronic obstructive pulmonary pulmonary fibrosis can induce squamousization of cells from the lung bronchials, thereby causing lung squamous cell carcinoma.
. PET/CT, as the current mainstream detection device, integrates two imaging technologies, can provide anatomical and metabolic information, and gradually becomes the main diagnostic means for clinical non-small cell lung cancer.
Today we review the relevant knowledge of lung squamous cell carcinoma through 
cases that have been confirmed as lung squamous cell carcinoma through .
case
medical history summary
male, 54 years old, coughing for more than 1 month, CT was found to have space in the lungs. Smoking for 30 years. I have no special symptoms.
PET/CT image
PET/CT diagnosis
. The upper lobe of the right lung has a huge irregular clumpy soft tissue lesion, uneven density, and a circular FDG metabolism is significantly abnormally increased. It is considered to be a malignant lesion with central necrosis, which is consistent with right lung squamous cell carcinoma with obstructive pneumonia.
. Multiple enlarged lymph nodes on the right hilar, right supraclavicular, mediastinum (1R, 2R, 4R, 7 groups), showed abnormal increase in FDG metabolism to varying degrees, and were all considered lymph node metastasis.
or above lesions meet: T4N3M0, stage III c (UICC/AJCC, 2018, 8th edition, lung cancer TNM stage).
case 2
medical history summary
male, 66 years old, coughing for more than one month with chest tightness. CT found that the left lung was occupied.
PET/CT image
PET/CT diagnosis
. Irregular clumpy soft tissue lesions in the upper hilar area of the left upper pulmonary lung, lobular shape, burrs can be seen at the edge, the lesion locally protrudes into the mediastinum, bronchial stenosis of the upper lobe of the left lung, and obstruction, and the lesion showed uneven FDG metabolism abnormally increased. Combined with pathology, it is consistent with the left upper pulmonary squamous cell carcinoma with distal obstructive pneumonia and atelectasis.
2. Multiple enlarged lymph nodes in the left hilar area and mediastinum (5 groups), showing abnormal increase in FDG metabolism to varying degrees, which is considered lymph node metastasis. lesions above
are consistent with: T4N2M0, Phase IIIB (UICC/AJCC, 2018, 8th edition TNM stage).
cases 3
medical history summary
Male, 68 years old, was treated for chest tightness, shortness of breath and back pain in the front and back of the chest. CT was found to have a place-occupying lesion in the left lung.
CEA: 6.05↑ (0-5)
Ca199:57.11↑ (＜35)
ferritin: 608↑ (30-400)
PET/CT image
PET/CT diagnosis
1. The subpleural clumped soft tissue lesion of the dorsal segment of the lower lobe of the left lung is uneven in density, with abnormal increase in circular FDG metabolism. Combined with pathology, it conforms to left lung squamous cell carcinoma and adjacent pleural infiltration.
2. Many small stripe-shaped and nodular soft tissue lesions in the remaining areas of the left pleura, showing abnormal increase in FDG metabolism to varying degrees, and are mostly considered as pleural metastatic lesions. Trace effusion in the left thoracic cavity.
3. Multiple lymph node metastasis on the left hilar and mediastinum (4L group), and retroperitoneal.
4. Multiple nodules and isodenal lesions in the parenchyma of both kidneys, showing significant abnormal increase in FDG metabolism to varying degrees, which is considered to be multiple metastatic tumors of both kidneys.
or above lesions meet: T4N2M1c, stage IVB (UICC/AJCC, 2018, 8th edition of lung cancer TNM stage).
case 4
medical history summary
male, 60 years old, has a history of smoking for many years, has recently coughed with blood in sputum, and CT was found to occupy the left lung. No abnormalities were found in the ECT bone scan.
CEA: 6.6↑(0-5)
PET/CT image
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PET/CT diagnosis
1. Irregular clumpy soft tissue lesions at the bronchial opening of the upper lobe of the left lung, which is unclear from the hilar lymph nodes, and shows a significant abnormal increase in FDG metabolism. Combined with pathology, it is consistent with upper lung squamous cell carcinoma with hilar lymph node metastasis, obstructive pneumonia and atelectasis.
2. Multiple mild calcified lymph nodes in the mediastinum and right hilar area, showing abnormal increase in FDG metabolism to varying degrees. Considering inflammatory hyperplasia of lymph nodes, it is recommended to undergo regular follow-up examinations.
or above lesions meet: T2bN1M0, stage IIB (UICC/AJCC, 2018, 8th edition of lung cancer TNM stage).
case five
medical history summary
male, 54 years old, coughing for more than 1 month, CT was found to have space in the lungs. Smoking for 30 years. I have no special symptoms.
PET/CT image
PET/CT diagnosis
1. The bronchial wall in the middle section of the right lung thickens, forming striped soft tissue lesions, showing a significant abnormal increase in FDG metabolism, combined with pathology, in line with bronchial squamous cell carcinoma in the middle section of the right lung.
2. Multiple enlarged lymph nodes in the hilar area and mediastinum (1R, 4, 5, and 7 groups), showed abnormal increase in FDG metabolism to varying degrees, and are mostly considered as lymph node metastasis.
or above lesions meet: T2aN3M0, stage IIIB (UICC/AJCC, 2018, 8th edition of lung cancer TNM stage).
discussion
pulmonary squamous cell carcinoma is extremely concealed and is more difficult to detect than adenocarcinoma
This issue reviews hundreds of cases of squamous cell carcinoma in recent days. It is very regrettable that no relatively early patients were found. Most of them were from stage II, and there were relatively many of them in stage III and IV. Because most squamous cell carcinomas are central lung cancer, most central lung cancer occurs in the large bronchus, close to the hilar, and in addition to the bronchus, there are also pulmonary arteries, pulmonary veins, lymph nodes..., so the hilar area "gathers" a lot of tissues, so it is more hidden. Lung adenocarcinoma is mostly in the peripheral zone, and chest CT is easy to detect. Even if CT is performed for lung squamous cell carcinoma, it is easy to miss diagnosis in very early stages.
Compared with lung adenocarcinoma, most squamous cell carcinoma grows relatively fast
This is related to cell atypicality. The incidence of lung squamous cell carcinoma is declining, but after squamous cells develop and develop cancer, the tumor tissue doubling time of lung squamous cell carcinoma is only 75-90 days. That is to say, if you discover the lesion, its growth rate will increase in geometrical multiples, and the lesion will double in 3 months. This is why many people will find huge soft tissue tumors after coughing worsens for several months.
Surgery trauma
Early stage lung squamous cell carcinoma patients can achieve cure through surgical treatment and other methods. Therefore, cancer is found in the early stage of cancer and received treatment as much as possible, which is more beneficial to the patient's health. However, we know that the large bronchus in the hilar area where central lung cancer generally grows, many cases require lobe resection or total pulmonary resection on the affected side. For early stage adenocarcinoma, we can choose wedge cutting and segment cutting. Therefore, the scope of surgical resection of most squamous cell carcinoma is much larger than that of peripheral lung adenocarcinoma.
Imaging manifestations
Lung squamous cell carcinoma cells mostly spread and grow along the long axis of the bronchial tract, which can replace the normal respiratory mucosal epithelium. Therefore, a series of phenomena caused by bronchial blockage may occur in the early stage. Squamous cell carcinoma is often manifested as a cluster of tumor cells growing, with a relatively smooth and round surface.
Lung adenocarcinoma is often manifested as growing along the alveolar wall, which can be infiltrated in the wall, and is manifested as invasion of the lung stent structure. The surface of the lesions of adenocarcinoma often has small lobes and protrusions, and the edges are mostly not smooth, which can be accompanied by deep lobe division.
PET/CT and lung squamous cell carcinoma
PET/CT are non-invasive imaging devices that integrate different imaging technologies and can provide information on both anatomy and metabolism. Compared with individual CT examinations, multi-directional tomography images can be obtained at one time, reducing motion artifacts, avoiding the respective disadvantages of PET and CT, and having unique advantages.
includes:
(1) to improve diagnostic efficacy;
(2) to improve stage accuracy;
(3) to effectively monitor the treatment effect and provide treatment plans;
(4) provides precise target area positioning information for later radiotherapy.
Scholars have reported that 18-FDG PET/CT SUVmax can be used to evaluate the tumor activity of lung cancer, and the SUVmax of squamous cell carcinoma is higher than that of adenocarcinoma (P <>
The last sentence: Regarding tumor prevention, it means early detection, early physical examination, maintain a healthy life, and exercise more to improve immunity.
