Squamous Cell Carcinoma of the Lungs

Symptoms, Diagnosis, Treatments, and Prognosis

Man smoking a cigarette in a park and coughing, on a spring day
What is squamous cell carcinoma of the lungs and how is it treated?. South_agency/E+/Getty

Squamous cell carcinoma of the lungs is one form of non-small cell lung cancer. Non-small cell lung cancers account for about 80 percent of lung cancers, and of these, roughly 30 percent are squamous cell carcinomas.


Squamous cell carcinoma begins in the tissue that lines the air passages in the lungs. It is also known as epidermoid carcinoma. Most squamous cell carcinomas of the lungs are located centrally, usually in the larger bronchi that join the trachea to the lung.

Squamous cell carcinomas are linked more strongly with smoking than other forms of non-small cell lung cancers and are more common in men than in women. They tend to be slow-growing, and due to their location are often found earlier than other forms of lung cancer.The incidence of squamous cell carcinoma of the lungs has been decreasing in recent years, whereas another form of lung cancer, adenocarcinoma has been increasing. It is thought by some that the addition of filters to cigarettes allows smoke to be inhaled more deeply into the lungs where adenocarcinomas tend to occur.


Common symptoms of lung cancer include a persistent cough, coughing up blood, and wheezing. Since squamous cell carcinomas tend to be located near the large airways, they often cause symptoms earlier than other forms of lung cancer. Obstruction of the airway can lead to infections such as pneumonia, or collapse of part of a lung (atelectasis).

Squamous cell carcinoma is the most common cause of something known as Pancoast syndrome or superior sulcus syndrome. Pancoast syndrome is caused by lung cancers that begin near the top of the lungs and invade structures nearby. Symptoms often include shoulder pain that radiates down the inside of the arm, weakness or prickly sensations in the hands, flushing or sweating on one side of the face, and a droopy eyelid (Horner’s syndrome).

Individuals with squamous cell carcinoma are also more likely to experience an elevated calcium level (hypercalcemia) which can result in muscle weakness and cramps. Hypercalcemia is one of the symptoms of paraneoplastic syndrome and is caused by a tumor secreting a hormone-like substance that raises the calcium level in the blood.


Squamous cell carcinoma of the lungs is often first suspected when abnormalities are seen on an x-ray. Further evaluation may include:

Depending upon the results, your doctor will usually want to obtain a sample of tissue (lung biopsy) to confirm the diagnosis and will order further tests to check to see if your cancer has spread.


Squamous cell carcinoma of the lungs is broken down into 4 stages:

  • Stage 1 – The cancer is localized within the lung and has not spread to any lymph nodes
  • Stage 2 – The cancer has spread to lymph nodes or the lining of the lungs, or is in a certain area of the main bronchus
  • Stage 3 – The cancer has spread to tissue near the lungs
  • Stage 4 – The cancer has spread (metastasized) to another part of the body

Doctors also use another, more confusing way to decide upon the stage of a lung cancer. In this they look at the size of the tumor (represented by a T), whether nodes are affected, where and how many (represented by an N), and whether or not the tumor has spread (metastasized) to regions of the body outside of the lungs, or to the other lung (represented by an M). For example, your doctor may describe your lung cancer as T3N2S0. This is explained further in the following article:


    Squamous cell carcinoma of the lung is strongly associated with smoking, but other causes can contribute as well.


    Depending upon the stage of squamous cell carcinoma of the lungs, treatment may include surgery, chemotherapy, radiation therapy, or a combination of these. Many clinical trials are in progress looking for new ways to treat this cancer and to help decide which treatments are most effective.


    When lung cancer is caught in the early stages, surgery may offer a chance to cure the disease.


    Chemotherapy may be used alone, in conjunction with radiation therapy, or following surgery for lung cancer. Squamous cell carcinoma of the lungs responds somewhat differently than other lung cancers such as adenocarcinoma to chemotherapy medications. Common medications used initially with this type of cancer include Platinol (cisplatin) and Gemzar (gemcitabine). For those who respond to treatment, continuous (maintenance treatment) with Tarceva (erlotinib) or Alimta (pemetrexed) may be used.

    Radiation Therapy

    Radiation therapy may be used to treat cancer or to control symptoms related to the spread of cancer. Radiation may be given externally, or internally (brachytherapy) in which radioactive material is delivered to a precise area of the lungs during a bronchoscopy.

    Targeted Therapy (Anti-EGFR Antibody)

    You may have heard about the use of targeted drugs to treat EGFR mutations in lung adenocarcinoma. EGFR, or epidermal growth factor receptor, is a protein involved in driving the growth of a cancer. Squamous cell carcinoma of the lungs may also be treated by targeting the EGFR pathway, but by a different mechanism. Instead of targeting EGFR mutations, anti-EGFR antibodies are a class of drugs used to bind to EGFR on the outside of cancer cells. When EGFR is thus bound, the signaling pathway which tells the cell to grow is halted. Portrazza (necitumumab) was approved in 2015 to use along with chemotherapy for advanced squamous cell cancers.


     In  2015 a new treatment was approved for people with this disease.  The medication Opdivo (nivolumab) is a form of immunotherapy, and can be thought of simplistically as a treatment that enhances our body's own immune system to fight cancer.  If may help to think of your immune system as a car.  The "brakes" are controlled by a protein called PD-1.  Opdivo in this analogy works to block PD-1-- the brakes--allowing the immune system to fight against the cancer without interference--in essence, taking the brakes off the car. The treatment is currently approved for people with metastatic squamous non-small cell lung cancer whose cancer has progressed during or after standard platinum-based chemotherapy.  (Platinum-based chemotherapy refers to a chemotherapy regimen including Platinol (cisplatin) or Paraplatin (carboplatin).


    Squamous cell lung cancers are further divided into 4 subtypes by what they look like under a microscope and how they behave. These include:

    • Primitive
    • Classical
    • Secretory
    • Basal

    We know there are survival differences between these subtypes but are just learning about how each type may respond differently to different drugs. Most subtypes respond to at least one of the commonly used chemotherapy drugs. An exception may be secretory squamous cell lung cancer. This subtype is less sensitive to commonly used chemotherapy drugs because it tends to be slower growing (and chemotherapy is often most effective on fast-growing cancers since it targets dividing cells).


    The overall 5-year survival rate for lung cancer is sadly only about 15%. For early-stage disease, especially when surgery can remove the tumor, the survival rate is much higher.


    A diagnosis of squamous cell carcinoma of the lungs is frightening and you may feel very alone. Allow your loved ones to support you. Many people have no idea how to react towards someone who is diagnosed with cancer. Letting people know specific things they can do to help may ease their anxiety, as well as fill your need for extra support at this time. Ask questions. Consider joining a lung cancer support group either through your cancer center or online. Talking with others who have “been there” can make the world seem a little smaller.


    American Cancer Society. FDA Approves Opdivo (nivolumab) for Lung Cancer. 03/05/15. http://www.cancer.org/cancer/news/news/fda-approves-opdivo-nivolumab-for-lung-cancer

    College of American Pathologists. Lung: Squamous Cell Carcinoma. Accessed 10/30/12. http://www.cap.org/apps/docs/reference/myBiopsy/LungSquamousCellCarcinoma.pdf

    Sheth, S. Current and emerging therapies for patients with advanced non-small cell lung cancer. American Journal of Health-System Pharmacy. 2010. 67(1 Suppl 1):S9-14.

    Wu, P. et al. Gene-expression data integration to squamous cell lung cancer reveals drug sensitivity. British Journal of Cancer. 2013 Sep 3. (Epub ahead of print)

    Yasufuku, K. Early diagnosis of lung cancer. Clinics in Chest Medicine. 2010. 31(1):39-47.

    Continue Reading