Carcinoma de células escamosas de cabeça e pescoço (HNSCC): desvendando os mistérios do microambiente tumoral

Este artigo refere-se a uma revisao sobre o carcinoma de celulas escamosas de cabeca e pescoco (HNSCC), o qual esta envolvido em cerca de 90% dos cânceres de cabeca e pescoco,originado do revestimento escamoso da superficie das mucosas do trato aero digestivo superior,incluindo cavidade oral, faringe, laringe e trato sino nasal. Atualmente, o HNSCC apresenta-se como o sexto tipo de câncer mais comum no mundo, sendo que apenas 50% dos pacientes permanecem vivos por 5 anos, apos o diagnostico. Devido a sua distribuicao acelerada e alta prevalencia, este tipo de câncer tornou-se, nas ultimas decadas, uma das principais ameacas para a saude publica. Seu desenvolvimento e progressao vem ganhando um destaque especial,considerando-se as novas descobertas relacionadas a instabilidade no cerne da genomica e epigenomica, metabolomica, remodelamento celular e fatores de risco associados, principalmente com o envolvimento de infeccoes virais e, mais recentemente, aos aspectos imunologicos inerentes ao microambiente tumoral (TME), principalmente o perfil celular (fibroblastos associados ao câncer, linfocitos T reguladores, linfocitos e macrofagos com perfil imunossupressorTh2 e M2, respectivamente e neutrofilos associados ao tumor) e o perfil humoral (quimiocinas, citocinas imunossupressoras tais como TGF-B, IL-13, IL-10, proteinas responsaveis pela quebrada matrix extracelular–metaloproteases e fatores que contribuem para o desenvolvimento e progressao tumoral mediados pela angiogenese, tais como EGF e VEGF). Nos proximos anos, a compreensao da imunobiologia do HNSCC sera paralelamente acompanhada de importantes avancos na deteccao precoce de pacientes de alto risco, baseada na identificacao de biomarcadores,na manipulacao do sistema imune e na compreensao da farmacogenomica. This article refers to a review about head and neck squamous cell carcinoma (HNSCC), which involves about 90% of all head and neck cancers, originated from the squamous lining of the upperaero digestive tract, including the oral cavity, pharynx, larynx and sinonasal tract. Currently, it is known as the 6th most common cancer in the world and only 50% of patients will remain alive for5 years post-diagnosis. Due to its accelerated spreading and its high occurrence, this kind of cancerhas become, in the last decades, one of the major threats to public health. Its development and progression has been gaining special attention, considering the new findings associated to the coreinstability of genetic and epigenetic, metabolomics, cellular remodeling and associated risk factors,especially with the involvement of viral infections and, more recently, to the immunological aspects inherent from the tumor microenvironment (TME) particularly cell profiles (fibroblast associated with cancer, regulatory T cells, lymphocytes, and macrophages with immuno suppressive profile Th2and M2, respectively, and neutrophils associated with tumor) and humoral profile (chemokines, immuno suppressive cytokines such as TGF-B, IL-13, IL-10, proteins responsible for the breakdown of extracellular matrix- metallo proteinase and factors that contribute to the development and tumor progression mediated by angiogenesis, such as EGF and VEGF). In the upcoming years, under standing the immunobiology of head and neck squamous cell carcinoma will be accompanied simultaneous ly by important advances in the early detection of high-risk patients, based on the identification of biomarkers,on the manipulation of the immune system and on the understanding of the pharmacogenomics.