Quick question...my husband's pathology report noted that his SCC BOT is keratinizing. What's the difference between that and non-keratinizing?

Hi, I think Keratinising is advantageous.
From my reading I understand that non keratinising metastasises more readily.
I would much prefer to have keratinising.
I'm sure someone with more knowledge that me will come along to help answer this question.
Tammy

Hard to explain without being a pathologist, and getting into other areas, some I have difficulty with, but believe their talking about the histology features of the oropharynx as being Keratinized or Non Keratinized Squamous Cell Carcinoma as it may apply to HPV positivity and negativity, effecting the nuclei or not, which Non Keratinized is mostly associated with HPV, so having non keratinized SCC of the oropharynx has a positive prognostic benefit. It's also used in describing the tumor invasiveness, maybe as it applies to being HPV, as most are poorly differentiated are. The terms are also used in other conditions, areas of the body, even non cancer, being keratiinized or non Keratinized as Keratinization is one of the outermost cells replaced by keratin.

I'm not sure if I got this right, and surely it doesn't explain it all or that easily. I'll leave it also to someone with more knowledge to explain it.

From NIH but in 1995:

"Patients with keratinizing squamous-cell cancers (World Health Organization [WHO] type 1) had a higher incidence (76%) of locally advanced tumors than those with nonkeratinizing (WHO type 2) and undifferentiated (WHO type 3) cancers (55%). The former group of patients had a lower incidence (29%) of lymph node metastases than the later group (70%). Primary tumor was controlled in 62% and neck nodes were controlled in 82% of all patients. Primary tumor control rates were 29% in patients with keratinizing squamous-cell cancers and 79% in those with nonkeratinizing and undifferentiated cancers (P = .001). Nodal control rates were 76% for keratinizing squamous-cell cancer and 85% for nonkeratinizing and undifferentiated cancers (P = .001). The incidence of distant metastases was 6% in patients with keratinizing squamous-cell cancer and 33% in those with nonkeratinizing and undifferentiated cancers (P = .001). Patients with keratinizing squamous-cell cancers, even though they had a lower incidence of lymphatic and distant metastases, had a poorer survival rate because of a higher incidence of deaths from uncontrolled primary tumors and nodal metastases. The 5-year survival rates were 35% for all patients, 6% for those with keratinizing squamous-cell cancers, and 51% for nonkeratinizing and undifferentiated cancers respectively (P=.001)"

From 2015:

"It is well established that nonkeratinizing squamous cell carcinoma (SCC) of the oropharynx is causally related to transcriptionally active human papillomavirus (HPV) and has better survival as compared with carcinomas with a keratinizing phenotype (KSCC). Although the great majority of KSCCs are unrelated to HPV, transcriptionally active HPV is detected in a minority of oropharyngeal cases. To date, it has not been established whether the HPV status in KSCC also confers a survival advantage as it does in HPV-related nonkeratinizing SCC. This study compares clinical outcomes between patients with HPV-positive versus HPV-negative oropharyngeal KSCC. Among a total of 54 cases, 7 (13%) were diffusely and strongly positive for p16. HPV E6/E7 RNA was positive in 5 of the 6 (83%) p16-positive cases that were tested and in only 1 of the 47 (2%) p16-negative cases. Only 1 of the 7 (14%) p16-positive patients developed disease recurrence and died in the follow-up period. Kaplan-Meier survival analysis showed significantly better overall and disease-specific survival in the p16-positive than in the p16-negative patients (P=0.01 and 0.046, respectively). These data, although with relatively small patient numbers, suggest that HPV-related SCC in the oropharynx is associated with highly favorable outcomes, regardless of the keratinizing or nonkeratinizing phenotype."

So it sounds like keratinizing actually tends to indicate a poorer prognosis

Remember it's only statistics. I was T2N2bMO, BOT too. We didn't check for HPV back then but almost all BOT is. All we can do is keep going forward.

Paul, Uptown and myself have all been classified as having a poor prognosis. Uptown was in hospice where medical teams had told him he should stop fighting. He is NOT the type to take that lying down and never quit trying to get well. That was several years ago and he is still here able to post and help others. Paul has been thru more than most of our members and still has his ongoing issues but he's still here too. I was told to get my affairs in order in 2009 and Im still here 7 1/2 years later. This just goes to show you no matter what the diagnosis is, there are some patients who surprise the doctors and somehow manage to survive even with the very worst odds. Dont let the word keratizing make you lose hope! Its just a word.