This article will help you read and understand your pathology report for squamous carcinoma in situ of the larynx.
by Jason Wasserman, MD PhD FRCPC, reviewed on March 10, 2020
This article will help you read and understand your pathology report for squamous carcinoma in the larynx. Read this article if you want to know more about squamous carcinoma in situ in the oral cavity.
The anatomy of the larynx
When we breathe, air travels from our mouth and nose to our lungs. On its way to the lungs, air passes through a part of the throat called the larynx. You cannot see your larynx because it starts at the very back of the tongue.
Most of the larynx is a hollow tube filled with air. The larynx helps us breathe and create sound when we talk. For this reason, diseases involving the larynx often make it difficult to breathe or talk normally.
The larynx is divided into three sections from top to bottom and each section is made up of smaller parts. Most pathology reports will describe the sections or parts of the larynx examined.
Supraglottis – The supraglottis is the first section of the larynx. The supraglottis includes the following smaller parts:
Glottis – The glottis is the second section and it is in the middle of the larynx. The glottis includes the following smaller parts:
Subglottis– The subglottis is the third and last section of the larynx. It has no smaller parts.
The inner surface of the larynx is lined by cells called squamous cells. These cells form a barrier on the surface of the larynx called the epithelium. The tissue below the epithelium is called stroma.
What is squamous carcinoma in situ (CIS)?
Squamous carcinoma in situ is a type of non-invasive type cancer. Squamous carcinoma in situ starts from the squamous cells that cover the inner surface of the larynx. Another name for squamous carcinoma in situ is severe squamous dysplasia.
If left untreated, squamous carcinoma in situ almost always turns into a type of invasive cancer called squamous cell carcinoma. Squamous carcinoma in situ can start in any part of the larynx although the most common location is the vocal cord.
The most common cause of squamous carcinoma in situ in the larynx is smoking. Other causes include excessive alcohol consumption, immune suppression, and prior irradiation. Smoking in particular causes the squamous cells to undergo an abnormal pattern of development which results in a process called keratinization. Because of this, some pathology reports will describe this condition as “keratinizing squamous dysplasia”.
The diagnosis of squamous carcinoma in situ can only be made after a tissue sample is examined under the microscope. Compared to normal, healthy squamous cells, the abnormal cells in an area of squamous carcinoma in situ are larger, darker, and disorganized. Pathologists use the word hyperchromatic to describe cells that look darker than normal cells. Large clumps of genetic material called nucleoli may also be seen in the nucleus of the abnormal cells.
The abnormal cells in squamous carcinoma in situ are only seen in the epithelium. This is different from squamous cell carcinoma where the abnormal cells are also seen in the stroma below the epithelium. The movement of abnormal cells from the epithelium into the stroma is called invasion. Your pathologist will carefully examine your tissue sample to make sure there is no evidence of invasion before making the diagnosis of squamous carcinoma in situ.
The diagnosis of squamous carcinoma in situ is usually made after a small sample of tissue is removed in a procedure called a biopsy. The biopsy is usually performed because you or your doctor saw an abnormal looking area of tissue during an examination of your throat. Your pathology report will probably say what part of the larynx was sampled in the biopsy.
Most patients with squamous carcinoma in situ will be offered surgery to removed the area of disease.
This is the size of the tumour measured in centimeters. Tumour size will only be described in your report after the entire tumour has been removed. The tumour is usually measured in three dimensions but only the largest dimension is described in your report. For example, if the tumour measures 2.0 cm by 1.5 cm by 1.2 cm, your report will describe the tumour as being 2.0 cm.
A margin is any tissue that was cut by the surgeon in order to remove the tumour from your body. Whenever possible, surgeons will try to cut tissue outside of the tumour to reduce the risk that any cancer cells will be left behind after the tumour is removed.
Your pathologist will carefully examine all the margins in your tissue sample to see how close the tumour cells are to the edge of the cut tissue. Margins will only be described in your report after the entire tumour has been removed.
A margin is considered positive when there are tumour cells at the very edge of the cut tissue. A negative margin means there were no tumour cells at the very edge of the cut tissue. If all the margins are negative, most pathology reports will say how far the closest tumour cells were to a margin. The distance is usually described in millimeters.
A positive margin is associated with a higher risk that the tumour will come back (recur) in the same site after treatment.
Lymph nodes are small immune organs located throughout the body. Tumour cells can travel from the tumour to a lymph node through lymphatic channels located in and around the tumour. The movement of tumour cells from the tumour to a lymph node is called a metastasis.
Lymph nodes are not always removed for squamous carcinoma in situ. When lymph nodes are removed at the same time as the tumour, they are usually fro the neck and the procedure is called a neck dissection.
The lymph nodes removed usually come from different areas of the neck and each area is called a level. The levels in the neck include 1, 2, 3, 4, and 5. Your pathology report will often describe how many lymph nodes were seen in each level sent for examination.
Lymph nodes on the same side as the tumour are called ipsilateral while those on the opposite side of the tumour are called contralateral.
Your pathologist will carefully examine each lymph node for tumour cells. Lymph nodes that contain tumour cells are often called positive while those that do not contain any tumour cells are called negative. Most reports include the total number of lymph nodes examined and the number, if any, that contain tumour cells.
Because squamous carcinoma in situ is a non-invasive disease, it is very unlikely that cancer cells will be found in any of the lymph nodes examined.