Radio Necrosis

This is a major complication following the use of radiotherapy on cancerous tumours when normal tissue is destructed. Necrosis means the death of cells in bones, organs, and soft tissues.

Radiotherapy is common method used to treat cancer, but it can also affect the rest of the body as the tissue in the surrounding area is also exposed.

Tissue damage begins once the patient is exposed to the radiation beam. The damage starts to interfere with the normal processes of supplying blood to the irritated areas, causing the tissue to change.

If a surgeon attempts to repair the damaged tissues, he or she may confront numerous complications. When attempting a skin graft, the surgeon has to connect to tissues that are ischemic (where there is a restricted blood supply) which means the tissue may heal with difficulty or not at all.

Radio necrosis develops in four stages:

• Acute clinical period (first six months) : No clinical signs may arise during the first few months unless tissue therapy has exceeded its radiation tolerance limits.
  
• Sub acute clinical period (second six months) : The recovery from acute radiation damage ends and permanent damage becomes evident.
  
• Chronic clinical period (second to fifth year) : Further damage occurs and the most significant problems arise due to chronic deterioration of the microvasculature and tissue damage.
  
• Late clinical period (after five years) : Physicians should be alert to signs of new cancers at this stage as soft tissue radio necrosis develops quite slowly. Very few recognisable skin changes arise during first six to 12 months after radiation damage.

Squamous Cell Carcinoma

This is an uncontrolled growth of abnormal cells arising in the squamous cells - the thin, flat cells that make up the outer layer of the skin (the epidermis).

Squamous Cell Carcinomas (SCCs) often look like scaly red patches, open sores, or elevated growths with a central depression.

This is the one of the major forms of skin cancer as they are usually found in areas frequently exposed to the sun due to increasing UV exposure on the skin over time.

For this reason, they more commonly found in people with an outdoor profession/lifestyle, the elderly or those with a fair complexion susceptible to burning.

However, SCCs can also occur in other tissues such as; lips, mouth, oesophagus, urinary bladder, prostate, lung, vagina, and cervix.

The symptoms of an SCC can vary but it begins as a small nodule and, as it enlarges, the centre becomes necrotic and sloughs and the nodule turns into an ulcer. This usually presents itself as an ulcerated lesion with hard, raised edges.

The tumour itself may be in the form of hard plaque often with tiny blood vessels. It can lie below the level of the skin and eventually invades the underlying tissue.

Squamous Cell Carcinomas are usually investigated through a biopsy and classified under a microscope to determine the subtype.

They are generally treated by surgical excision although there is the option to use topical chemotherapy and radiotherapy. Radiotherapy is usually used as treatment in patients for whom surgery is not feasible.

The common prognosis of Squamous Cell Carcinoma is positive with less than 4% of cases spreading to other parts of the body. Some particular forms of SCCs have a higher, though still positive long-term outcome.