Squamous Cell Carcinoma

00:01 Let's take a look at another non-small cell lung cancer and this time we come to our squamous cell. A squamous is extremely associated with smoking. Here once again you tell me again how many nodule? We can walk through this quicker now. One nodule, because it’s primary.

00:17 This one however is located just like which one of the other? When compared to the other two, your small and your adenoma, centrally located was seen with? Good, small. Squamous here as well. Hilar mass. What’s hilar means? Think about the hilum of the lung. So that’s where you would find it. Arising from the bronchus associated with cavitation. So if we’re by the bronchus and such then what the heck is going on here? Metaplasia took place, maybe smoking. Up in the bronchi you have what kind of cells? Columnar, ciliated.

00:51 Right. And if you’re going to smoke, how is the tube going to protect itself? It first undergoes metaplasia, dysplasia and then it gives rise to squamous cell cancer.

01:01 What is the major paraneoplastic that you’re going to find here? Your patient is going to appear as following: “Hey, doc, I’m coughing out blood, and it’s foamy.” Okay, haemoptysis.

01:11 Next, you find that the patient is telling " I headache and not feeling too well." Okay. “And when I go to the bathroom, nothing is coming out.” Hmm, take a look at calcium levels, they’re elevated. You take a look at the PTH levels, severely depressed. Really? What am I talking about? PTHrP. So, the symptoms that I gave you, well this is lung cancer, there is going to be haemoptysis, destruction of the bronchi and such, hypercalcemia results in stupor and headache. The hypercalcemia slows down the GI system, constipation.

01:48 And then I also told you PTH levels were low. Dr. Raj, you just told me it’s a paraneoplastic and increase in PTH, Oh, yes. I forgot to see the rP. So, you have an increase in PTHrP, you have an increase in calcium. Tell me where this related peptide is coming from? RP.

02:08 It’s coming from that nodule that was located centrally, by the mediastinum. Right. And where is your PTH coming from? Oh yes, that's right. By the thyroids. So therefore, if you have hypercalcemia, what is it going to tell these parathyroids to do? Shut down PTH. Low PTH, increase PTHrP, hypercalcemia.

02:32 Histology, whenever you hear squamous, what are you thinking about? Those lovely keratin pearls, right? You’re always thinking about those squamous. Maybe perhaps you gave your loved ones keratin pearls. I’m joking, it’s not very nice. And then you have intercellular bridges. That also is your squamous. You gotta have fun a little bit, right? Just say maybe perhaps you’re thinking about giving your, you proposed to your loved one with a signet ring. Oh, Dr. Raj, stop it. Okay, I will. Move on.