Download Squamous Cells prese..

Squamous Cells
Physiology:
Why is it important to Speech
Pathologists?
Presented by Kelly George
Outline
 Physiology
 What can go wrong
 Signs/Symptoms
 What these things cause
 What do we as Speech Pathologists
Squamous Cells
 Squamous refers to shape – flat except for
nucleus making it bulge a little
 Do not receive direct blood supply
 Oxygen and nutrients travel through other
cells to reach squamous layers
 These cells renew frequently
Types of Squamous (flat) Cells
 Simple – cells are flat, scale-like, in a
single layer supported by and underlying
basement membrane.
 Where – mesothelium that lines all body
cavities and covers all organs, and the
endothelium that makes up the walls of the
capillaries and the inner lining of blood
vessels and lung air sacs
 Function - protect
 Membrane - permeable
Types (cont.)
 Stratified – Flat & 2 or more layers
 Where –
 Non-keratinizing = wet surfaces receiving
significant wear and tear
 Inside mouth, esophagus, and anal canal
 Keratinizing = same morphology but outer layer
undergoes change to tough non-living layer of
keratin
 Function- protect
 Membrane - permeable
Vocal Fold Epithelium
 Stratified squamous
 Yes flat, but has microridges to increase
surface area
 Desmosomes help adhesion in deeper layers,
lesson closer to the surface to allow for
exfoliation
 Complete with nucleus, nucleolus, Golgi
Apparatus, rough endoplasmic reticulum,
lysosomes, mitochondria, and tonofiliments
that provide rigidity and resilience
Vocal Fold: Basement Membrane
 Transitional area between squamous and
lamina propria
 Secures the two layers together
 Disease: epidermolysis
 Genetic basis
 Leads to incomplete formation of anchoring
fibers
 Fatal – skin can’t stay on body
 Some cancers secrete enzymes that “eat
away” at the basement membrane, taking
away its natural barrier for tumor growth.
Basil Cell Layer
Vocal Fold: Lamina Propria
 Ground substance
 Contains fluid and insterstitial matrix
 Under normal conditions, fluid is limited
 Tissue injury causes accumulation of fluid from
capillaries - inflammation
 Fibroblasts
 Cells that synthesis most extracellular material
 Collagen, elastin, and ground substance
 Elastic fibers
 Run parallel to vocal fold edge
 Can stretch to approx. 2 x natural length and return to
natural shape
Vocal Fold: Lamina Propria (cont.)
 Collagenous fibers
 Also run parallel to vocal fold edge
 Gives resilience
 Fibronectin
 Adhesive functions – made of protein
 Important in wound healing
 Following injury, fibronectin is deposited on damaged collagen
serving as a scaffold for the tissue – lots of fibronectin in the lamina
propria indicates severe injury and reparation
 Not removed after healing – Found in Nodules, not in Polyps
 Capillaries
 Glands
 Serous
 Muous
Edema
 Water retention – abnormal insterstitial fluid
accumulation - can be seen in other parts of the body
many times
 What causes it
 Injury
 Hormones
 Renin – chemical reaction allowing angiotensin to constrict the
arterioles in the kidneys (and elsewhere) resulting in sodium
retention, causing H2O retention, and increasing arteriole pressure
 Norepinepherine also resulting in renal constriction
 Aldosterone – transports sodium and potassium through renal
tubular walls, and instead of getting rid of too much potassium, just
increases fluid to balance
 Birth control - progestin
 Liver/kidney disturbances
 Heart Failure – pulmonary edema
Edema – related to Voice
 Increased interstitial fluid in the lamina propria and the squamous
cells increases mass of the vocal folds – lowering voice
 Reinke’s Edema – swelling of the superficial layer of the Lamina
propria
 Often caused from smoking, Laryngo-pharyngeal reflux disease, and
straining to produce voice.
 High Sopranos can lose entire top octave
 Females may not appreciate lowering of voice if they depend on
using their voice for their job.
 Morning vs. Evening
 Wake up – arms and face
 Evening – legs and feet
 Gravity pulls it down, thus voice would probably be most effected in the
morning.
 After Cancer treatment, edema lasting 3 months or more suggests
residual cancer cells or a recurrent tumor developing.
Edema: What can people do?
 Lie down in day time – distributes more evenly – won’t help with the
voice.
 Avoid tight fitting clothes
 Exercise
 Include diuretic foods
 Anise, Celery, Onion, Parsley, Coffee or tea (unless caffeine is a
concern), Eggplant, Garlic, and Peppermint.
 Diuretic drugs may not be safe during pregnancy
 Birth Control
 Squamous cells on vocal folds same type as on cervix, thus very
sensitive to birth control hormone progestin
 New BC on market targeting women who experience weight gain while
on the pill – Yasmin – uses different form of progestin - drospironone
 Has diuretic properties
 However loss of too much water and sodium may raise potassium levels
 This can create severe heart concerns
 Those with kidney or liver disease should not take this
Nodules & Polyps
 Nodes – fibronectin deposits
 Polyps
 Primary injury in Lamina Propria
 Basement membrane not usually injured
 Reinke’s Edema
Keratinocyte Cancer:
Squamous Cell Carcinoma
 Happens all over the body: Along with Basal Cell
Carcinoma = the most common type of skin cancer (but
not most lethal = melanoma).
 Underrepresented in registries, and combined with BCC
in studies – little known about SCC incidence and
patterns specifically.
 Numbers rising about 3 – 10% each year
 One source: SCC most commonly found in head and neck in
Caucasians
 While another source said the reverse.
 In darker pigmented individuals (Africans, East Asians, South
Asians) often in areas of chronic injury or cutaneous irritation
 Leg ulcers, burn scars, skin infections, irritation from tight clothing
 Most often in lower extremities
SCC in Larynx
 Most tumors can be readily seen, palpated,
evaluated and biopsies easily taken.
 Early may appear as an nodule that won’t go
away or shallow ulcer with poorly defined edges
 Tumors may be exophytic or infiltrative and may
extend rapidly into underlying muscle tissue
causing fixation
 May result in fixation – difficulty with swallowing and
speech
 Tumors usually respond well to radiation therapy
if caught in time, especially if they are still limited
to the mucosa.
Cellular Changes
 Intracellular edema – due to protein imbalance within the










cell and interstitially
Inflammatory cell infiltration
Increase of mucosal collagen
Wrinkling of basement membrane
“Disorganized” layering of the cells
Appearance of keratohyalin in the cells adjacent to the
basement membrane
Dispersing of nuclear chromatic
Multiple nucleoli with abnormal shapes
Lack of cellular maturation
Presence of mitotic figures near superficial layer
www.emedicine.com – excellent source of information
?
 If the squamous cells on the vocal folds are nonkeratinizing, then why is the laryngeal squamous
cell carcinoma a keratinocyte cancer?
 Keratosis = the production of keratin superficially in
the epithelium and is a normal process on the skin,
but not on a mucosal surface. Keratin appears dull
white, think or thick, and sometimes rough and
papillary. It does not rub off. (Leukoplakia)
 Note the word Leukoplakia has clinically become known for
non-white atypical specimens.
Keratosis
 Keratosis without atypia is usually benign
(as described in class) – can be callus like.
 Hyperkeratosis – redundant term used for
white horny projections from the vocal
folds. Often are recurring and are
considered well differentiated carcinomas.
 Keratosis with atypia – dry reddend,
thickend, roughend, or granular patches.
Needs to be removed to be tested.
Other terms:
 Carcinoma in situ
 Malignant cells present – confined to the epithelial layers
 Erythroplasia
 A superficial flat lesion that is red velvet in appearance and bleeds
easily.
 Represents atypia on the mucosal surface
 Is at least carcinoma in situ, and may be associated with invasive carcinoma
 Invasion
 Any pattern of malignant epithelial cells down to the basement
membrane
 May occur without surface abnormality
 Metaplasia
 The transformation of an adult cell type into another cell type – typically
glandular epithelium changes to squamous epithelium. Metaplasia
sometimes precedes squamous cell carcinoma.
Effects of Radiation Therapy
 If cancer returns, radiation may not be an option





because the tumor may be the result of cells that were
left over from the first course of radiation, and apparently
resistant to it.
Pain may be worse than that which results from surgery,
and the elderly seem not to tolerate the radiation well.
If done after laryngectomy, may prevent recurrence in
the stoma ( which is very bad!!!) if there is any thought of
undetected metastisis.
May cause significant edema (rare), usually edema
shows recurrence
May cause laryngeal chondritis and necrosis (rare)
Late sequelae may involve telangiectasis, subcuntaeous
fibrosis, or an immobile laryinx
 Genetics on the Squamous cells (in Nucleus)
 Genetic studies show that sporadic SCC’s have allelic loss on several
chromosomes, most of the sites for mutations are unknown.
 Environmental factors can initiate the mutations
 Tumor suppressor gene, TP53, mutated from UV rays with substitutions
of nucleic acids
 Thymine-thymine for Cytosine-Cytosine in the DNA – If this doesn’t kill
the cell itself
 In Sporadic cases, the mutation must be present at more than site
 Proteins in the membrane of the squamous cells have been found to
have tumor suppressing properties – if cell doesn’t produce these
proteins more susceptible to tumor
 Environmental irritants




Smoking/tobacco & alcohol
Asbestos
Heavy metals
Chronic Irritation – GERD & LPRD
 Cessation of Smoking found to decrease chances for Lung Cancer,
but not Laryngeal Squamous Cell Carcinoma
HPV
 Human Papilloma virus may be found in 15%-50% of





Squamous cell carcinomas depending on where in the
body.
HPV is present in 90% of cervical cancers.
Beginning in the 1980’s, HPV was starting to be found in
oral squamous cell carcinomas.
HPV stops normal cell growth regulatory processes to
support the growth/survival of the virus.
Also targets TP53, which would self destruct mutated
cell.
Leads to immortal cells
Epstein-Barr Virus
 Main virus to cause Mono-Nucleosis
 A few studies have shown EB viral DNA in
squamous cell carcinoma cells.
 Further investigation is being conducted
As SLPs.
 We see patient much more often than the
doctors – may be the first to hear a complaint.
We need to be able to know if it is a concern.
 When dealing with the medical community, we
should be able to know language or at least be
able to know where to find the info.
 Patients may ask us what the doctor meant.
 The voice is delicate, and the cells are very
similar to many throughout the body. Voice may
be effected before symptoms elsewhere.
Works Cited
abcNews. (2002, November 20). The Skinny on Yasmin.
Retrieved April 4, 2003, from
http://printerfriendly.abcnews.com
BC Cancer Agency. (n.d.) Head & Neck – Squamous Cell
Carcinoma of the Larynx. Retrieved April 5, 2003, from
www.bccancer.bc.ca/HPI/CancerManagementGuidelines
Biology Primer. (n.d.). A Journey to the Bottom of the
World. Retrieved April 4, 2003, from
http://users.capu.net/~kwelch/pp/biology/primer.html
Family Practice Notebook (n.d.). Edema, Fluid Overload.
Retrieved April 5, 2003, from
http://www.fpnotebook.com/REN15.htm
Works Cited (cont.)
Gilbert, S. (n.d.). iVillage nutritionist. Bloating: Foods to Fight Water Retention.
Retrieved April 4, 2003, from http://www.parentsplace.com/expert/nutritionist
Guyton, A.C., M.D. (1981). Textbook of Medical Physiology. Philadelphia: W.B.
Saunders Co.
Hoffmann, D.L..,B.Sc. (n.d.) A Bachelor’s Degree in Herbal Sciences. Water
Retention – Edema. Retrieved April 5, 2003, from http://www.healthy.net
Myers, E.N., M.D., & Suen, J.Y., M.D. (1996). Cancer of the Head and Neck
(3rd ed). Philadelphia: W.B. Saunders Co.
N.A. (n.d.). Epithelium. Retrieved April 4, 2003, from
http://lifesci.rutgers.edu/~babiarz/epithe.htm
Sober, A.J., M.D., & Haluska, F.G. M.D., PhD. (2001). Atlas of Clinical
Oncology Skin Cancer. Hamilton: B.C. Decker Inc.
The Voice Disorders Centerat the Massacheucetts Eye and Ear
Infirmary, (n.d.). Reinke’s Edema. Retrieved April 7, 2003, from
http://www.voicedisordercenter.meei.harvard.edu/disorders/reinkes.
html
Titze, I.R. (Ed). (1993). Vocal Fold Physiology, Frontiers in Basic
Science. San Diego: Singular
Vaughan, C.W., M.D. (2002, May 7). Emedicine, Instant Access to the
Minds of Medicine. Pathology: Squamous Cell Carcinoma.
Retrieved April 5, 2003, from www.emedicine.com
Wang, C.C., M.D. (1990). Radiation Therapy for Head and Neck
Neoplasms: Indications, Techniques, and Results. Chicago: Year
Book Medical Publishers, Inc.