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Q. What is the prognosis of recurrent squamous cell carcinoma?

Answered by
Dr. Arvind Guru
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 24, 2017 and last reviewed on: Aug 10, 2022

Hi doctor,

My father has been a patient of recurrent local squamous cell carcinoma. In the last one and half years, he has been operated for cystoprostatectomy and urethrectomy with an ileal conduit for urine bypass followed by lymphonodectomy. After all these surgeries, he had a recurrence seven months back. So, the sinus tract was operated and second line chemotherapy with Carboplatin and Gemcitabine was given. The MRI showed very good improvement. A week ago, he underwent a penectomy, scrotectomy, and a surgery of the pelvic bone. I have attached the recent biopsy report. How should we proceed?

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Hi,

Welcome to icliniq.com.

I have reviewed the information and the biopsy report (attachment removed to protect patient identity). Please understand that this pathological report is incomplete, so it is difficult to advise you the further course of therapy. In fact, further therapy will depend on your father's health condition. For most cancers, if there is a recurrence, that by itself indicates a poor prognosis. Same is the case here, there was cancer that got operated and then came back, we call it recurrence. In your father's case, the risk of this happening was dependent on the original site of cancer and the details of surgery performed, which are not mentioned in your report or the provided information.

Your biopsy shows there is metastasis to the bone that has been removed. This is a very serious thing, it means the tumor has already spread far and wide. There will be many tiny deposits all over his body that are not visible right now but will become evident after some time. Only chemotherapy can take care of those, and that also just to some extent. In essence, it is a very bad sign. Since you mentioned your father has already received second-line chemotherapy, there are two options available.

1) If your father's body can tolerate it, then chemotherapy drugs at the same time with radiation can be tried.

2) If the body cannot tolerate or he decides enough is enough, then best is supportive care.

Kindly attach the MRI reports, both before the first surgery and before this surgery and the patient's discharge summary and operative notes, if you need more specific information. I know that is not a good news, but I think you people and your doctor did their best.

Thank you doctor,

I have attached three MRI reports. What more can be done?

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Hi,

Welcome back to icliniq.com.

Thanks a lot for providing this information, and attaching the PET, CT, and MRI reports (attachments removed to protect patient identity).

  • It does make me more aware of the original disease, treatment given, and progress of the disease as well. However, my interpretation of the pathological report stays more or less the same. But, now I can explain that better to you.
  • This is rare cancer, and the five years survival for such a patient treated at best centers in the world is around 40 %. That means out of 100 patients with this cancer only 40 will be alive, five years after the diagnosis.
  • Most likely, it was advanced cancer at the time of diagnosis, and it had invaded surrounding structures. I say most likely as none of the imaging reports mentioned at what stage the cancer treatment was started, and none of the MRI or PET scan attached is before the first surgery, and pathological report of the first surgery and the intraoperative details of the surgery are missing.
  • Depending on the stage of the disease, for this cancer the possibility of surviving five years without the disease coming back ranges from less than 25 % to a maximum of 70 %. These surgery details and previous imaging will not change anything now at this stage, so if you do not have them, never mind.
  • The cancer is a type of squamous cell carcinoma, for which chemotherapy alone usually does not help much after the surgery. Unless combined with radiation for some tumors that could not be removed completely. That is why alternative chemotherapy was given, and surgery was done for recurrence.
  • In the MRI reports, there is no indication of cancer reaching the bone, but in the surgical specimen taken out, bone of the pelvis was found to be invaded by cancer. It is important to note that it was not a direct invasion like an army invading a border. It was more like some tumor cells slipped out of the tumor into the blood vessels and made a nest in the bone nearby (this is called metastasis).
  • Now the question is, what chemotherapy? The simple answer is whatever the patient can tolerate because anyways it is not going to help much. These cancer cells that survived the previous courses of chemotherapy are going to be resistant to many drugs and are very difficult to control. So, it is a lost battle that we have to fight, just because we have to do something to prolong the fight. But to win it will be a miracle.
  • So most likely, after discharge from the hospital, there will be repeat tests and maybe some chemotherapy with uncertain benefit, but only if the patient can tolerate. In my opinion, he is too weak by his given weight and height.

I wish I could have been in a position to help. But hope you understood the above. Talk to your doctor about the information mentioned above. Follow-up if you want any clarification after you discuss the plan with your doctor.

For more information consult a surgical oncologist online --> https://www.icliniq.com/ask-a-doctor-online/surgical-oncologist


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