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Bellavance S, Khoury M, Bissada E, Ayad T, Christopoulos A, Tabet JC, Guertin L, Tabet P. Panendoscopy for Head and Neck Cancers: Detection of Synchronous Second Primary Cancers, Complications and Cost-Benefit Analysis: A Systematic Review. J Otolaryngol Head Neck Surg 2025; 54:19160216251316215. [PMID: 39957633 PMCID: PMC11831659 DOI: 10.1177/19160216251316215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 11/23/2024] [Indexed: 02/18/2025] Open
Abstract
IMPORTANCE In patients with head and neck squamous cell carcinoma (HNSCC), the discovery of a second synchronous primary cancer of the aerodigestive tract (SSPCA) significantly impacts management and prognosis. Recent advances in imaging have increasingly allowed for identifying SSPCA before performing panendoscopy, raising questions about the latter's role. OBJECTIVE To establish the incidence of SSPCA and panendoscopy's impact on management. Complications and costs associated with panendoscopy were also assessed. DESIGN Systematic review following the preferred reporting items for systematic reviews and meta-analysis guidelines. SETTING Operating room panendoscopy. PARTICIPANTS Identifiable HNSCC undergoing initial staging workup. INTERVENTION Panendoscopy under general anesthesia for SSPCA detection. MAIN OUTCOME MEASURES Incidence of SSPCA in HNSCC, change in management caused by panendoscopy, incidence of panendoscopy complications, costs for panendoscopy. RESULTS 51 studies were included (n = 19,914 patients). SSPCA was present in 6.4% (n = 467/7262) of all panendoscopies. Among patients who had a prior computed tomography (CT) of the neck and chest, a change in management resulting from SSPCA detected through panendoscopy occurred in only 1.1% of cases (n = 3/268), and in 0% of cases for those who had a positron-emission tomography-computed tomography (PET) (n = 0/544). The rate of major complications of panendoscopy was 0.7% (n = 58/8386). Only two recent studies in a private healthcare system reported panendoscopy costs ranging from $3802 USD to $17,296 USD. CONCLUSIONS The role of panendoscopy in the initial workup of HNSCC should be limited to confirming suspicious findings from initial CT or PET. The incidence of major complications for panendoscopy is low but carries a significant financial burden for patients in the private American healthcare system. More studies are needed to assess the cost-effectiveness of panendoscopies for SSPCA detection in a public healthcare system. RELEVANCE Confirms the lack of benefit for systematic panendoscopy for SSPCA detection in HNSCC patients when initial workup includes a CT of the neck and chest or PET.
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Affiliation(s)
- Samuel Bellavance
- Division of Otolaryngology—Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Michel Khoury
- Division of Otolaryngology—Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Eric Bissada
- Division of Otolaryngology—Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Tareck Ayad
- Division of Otolaryngology—Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology—Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Jean-Claude Tabet
- Division of Otolaryngology—Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Louis Guertin
- Division of Otolaryngology—Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Paul Tabet
- Division of Otolaryngology—Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
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Binmadi N, Subahi G, Alsharif M, Daous Y, Jamal B, Alshinkity H, Salleh Barefah A. Oral squamous cell carcinoma with synchronous follicular lymphoma: A rare case report. SAGE Open Med Case Rep 2024; 12:2050313X241233423. [PMID: 38419799 PMCID: PMC10901051 DOI: 10.1177/2050313x241233423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/01/2024] [Indexed: 03/02/2024] Open
Abstract
The occurrence of oral squamous cell carcinoma synchronously with lymphoma arising primarily in cervical lymph nodes is rare. Here, we report a case representing an infrequent finding. A 66-year-old male who was diagnosed with right mandibular squamous cell carcinoma and was subsequently found to have a nodal follicular lymphoma as a second malignancy. The patient underwent surgical resection for the oral squamous cell carcinoma with right selective neck dissection. The multidisciplinary team's postoperative treatment strategy involved adjuvant radiotherapy for the oral squamous cell carcinoma, while adopting a close follow-up approach for the follicular lymphoma. After an 18-month follow-up, there were no evidence of disease progression. This case report highlights the diagnostic challenges of synchronous primary malignancies occurring in the head and neck region. It also underscores the importance to conduct a comprehensive clinical and histopathological examination to rule out the possibility of synchronous neoplasms.
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Affiliation(s)
- Nada Binmadi
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Ghidaa Subahi
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Maha Alsharif
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Yara Daous
- Department of Anatomic Pathology, King Abdulaziz University Faculty of Medicine, Jeddah, Saudi Arabia
| | - Basem Jamal
- Department of Oral and Maxillofacial Surgery, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Hashim Alshinkity
- Department of Oral and Maxillofacial Surgery, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Ahmed Salleh Barefah
- Department of Hematology, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
- Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
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Saito M, Egami H, Kato T, Yokoyama E, Izumiyama K, Mori A, Morioka M, Kondo T, Tanei ZI. Synchronous colon cancer after treatment for rectal follicular lymphoma: A case report. Mol Clin Oncol 2022; 17:129. [PMID: 35832471 PMCID: PMC9264324 DOI: 10.3892/mco.2022.2562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/01/2022] [Indexed: 11/12/2022] Open
Abstract
Colorectal follicular lymphoma (FL) is rare. In addition, it is even rarer that colon cancer develops synchronously with colorectal lymphoma. The present study reports a case of sigmoid colon cancer that developed 6 months after endoscopic resection of rectal FL. A 71-year-old man with a history of developing mucosa-associated lymphoid tissue lymphoma in his stomach at age 48, right neck region at age 59 (the latter later modified as FL) and lung adenocarcinoma at age 60 now suffers from rectal FL. Endoscopic submucosal dissection (ESD) was performed at our hospital (Aiiku Hospital), and 6 months after the treatment, sigmoid colon cancer was confirmed by colonoscopy for the follow-up study. The patient was successfully curatively resected by ESD plus local resection and has survived without a recurrence for >3 years with no treatment. It was speculated that in the present case, cancer-related genes were changed as a carcinogenic mechanism due to decreased immune function associated with the onset of lymphoma.
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Affiliation(s)
- Makoto Saito
- Blood Disorders Center, Aiiku Hospital, Sapporo, Hokkaido 064-0804, Japan
| | - Hiroki Egami
- Department of Gastroenterology, Aiiku Hospital, Sapporo, Hokkaido 064-0804, Japan
| | - Takashi Kato
- Department of Gastroenterology, Aiiku Hospital, Sapporo, Hokkaido 064-0804, Japan
| | - Emi Yokoyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Hokkaido 064-0804, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Hokkaido 064-0804, Japan
| | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo, Hokkaido 064-0804, Japan
| | - Masanobu Morioka
- Blood Disorders Center, Aiiku Hospital, Sapporo, Hokkaido 064-0804, Japan
| | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo, Hokkaido 064-0804, Japan
| | - Zen-Ichi Tanei
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
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Al Laham O, Atia F, Ibrahim D, Shaheen J, Hokouk B. An exceedingly rare simultaneous incidental occurrence of synchronous primary malignancies; Invasive Ductal Carcinoma and Renal Cell Carcinoma in a male - A Case Report. Int J Surg Case Rep 2022; 96:107367. [PMID: 35785686 PMCID: PMC9284067 DOI: 10.1016/j.ijscr.2022.107367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Synchronous malignancies are defined as the emergence of one or more tumors which either occur simultaneously or within 6 months of each other. Populations older than 50 years of age are the most vulnerable. Documented prevalence rates of synchronous neoplasia are 4.5-11.7 %. To the best of our knowledge, ours is the first documented case of synchronous primary incidental occurrence of Invasive Ductal Carcinoma (IDC) and Renal Cell Carcinoma (RCC) in a Middle Eastern male. This type of co-occurrence must be borne in mind because such neoplastic occurrence is potentially fatal. Documentation is essential to raise awareness and to decrease the resultant morbidity and mortality. CASE PRESENTATION We present a case of a 61-year-old male who presented to our clinic with a 22-day-history of gradual, painless, and disproportionate hypertrophy of his left breast. CT scan revealed incidental breast and right kidney masses. Therapeutic intervention included a modified radical mastectomy with Sentinel lymph node excision along with right radical nephrectomy. CLINICAL DISCUSSION Treatment of our patient was multimodal. Accurate radiological studying together with clinical examination helped us in making a diagnosis. Treatment options for this pathology consist of a combination of surgery and/or adjuvant therapy. CONCLUSION Synchronous IDC and RCC are an extremely rare co-occurrence, especially in males, particularly Middle Eastern males, and more specifically, those presenting asymptomatically as incidental findings. It is vital to further document and study such cases to establish innovative surgical techniques, screening modalities for males, and to overcome the consequential morbidity and mortality.
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Affiliation(s)
- Omar Al Laham
- Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria,Department of Surgery, Al Assad University Hospital, Damascus, Syria,Corresponding author at: Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria.
| | - Fareed Atia
- Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria,Department of Surgery, Al Assad University Hospital, Damascus, Syria
| | | | - Jack Shaheen
- Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria,Department of Surgery, Al Assad University Hospital, Damascus, Syria
| | - Bashir Hokouk
- Damascus University, Damascus, Syria,Department of Surgery, Al_Abbasieen Hospital, Damascus, Syria
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Sawaf T, Quereshy HA, Cabrera CI, Abrol A, Tamaki A, Thuener J, Li S. Incidence of synchronous malignancies found during triple endoscopy in head and neck cancer. Am J Otolaryngol 2022; 43:103349. [PMID: 34991020 DOI: 10.1016/j.amjoto.2021.103349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/13/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To investigate the incidence of synchronous malignancies identified during triple endoscopy in patients with head and neck squamous cell carcinoma. METHODS A retrospective chart review of patients from a tertiary academic medical center was performed. Patients with a primary head and neck squamous cell carcinoma who underwent triple endoscopy were included. Operative, radiographic, and pathology reports were reviewed to evaluate for the presence of synchronous malignancies in the aerodigestive tract diagnosed through endoscopy. Demographics, relevant medical history, including tobacco and alcohol use, and tumor characteristics were recorded. Univariate and multivariate regression analyses were conducted to assess for associations with synchronous malignancy on triple endoscopy. RESULTS 215 patients were reviewed, 164 of which had a biopsy-positive head and neck squamous cell carcinoma and underwent triple endoscopy. Synchronous lesions were found in 8 patients (4.9%). Of the synchronous lesions, only two were identified on esophagoscopy and bronchoscopy; the remaining six were found on direct laryngoscopy. Clinical comorbidities including smoking and alcohol history, tumor p16 status, and tumor stage were not associated with presence of synchronous lesions. A positive synchronous lesion on positron emission tomography was significantly correlated with finding a synchronous lesion on triple endoscopy (p = 0.006). CONCLUSION This study shows the incidence of synchronous lesions on triple endoscopy to be closer to 5%. While endoscopic examination can be useful in the anatomic characterization of head and neck malignancies, the low incidence of synchronous malignancies suggests that the need for triple endoscopy may be considered on a case-by-case basis.
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Ben Arie G, Shafat T, Belochitski O, El-Saied S, Joshua BZ. Treatment Modality and Second Primary Tumors of the Head and Neck. ORL J Otorhinolaryngol Relat Spec 2021; 83:420-427. [PMID: 34587611 DOI: 10.1159/000513617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 12/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Second primary tumors (SPTs) in head and neck cancer are thought to occur from premalignant lesions that are present at the time of the primary tumor diagnosis. The association of the modality used to treat the primary lesion with SPT occurrence is not clear. OBJECTIVE The aim of the study was to assess the incidence of SPTs in patients with head and neck malignancies, according to treatment modality. METHODS We conducted a retrospective cohort study. All patients who were treated at Soroka Medical Center between 2000 and 2013 for a head and neck squamous cell carcinoma were assessed. Data analysis included tumor site of the primary and second primary and treatment modality of the primary tumor. In addition, demographics as well as habits were recorded as well. RESULTS Of the 184 patients included in the cohort, SPT developed in 31 patients (17%) with a median time to diagnosis of 4.3 years. Smoking was reported in 74% of those with SPT and 78% of those without. The most common site for SPT was the lungs, with 13 cases, 42% of the total SPTs. Among patients who developed an SPT, for 12 of those with an index tumor in the oral cavity or oro-hypopharynx, 8 (67%) developed an SPT in the same location; for 18 of those with an index tumor in the larynx, 11 (61%) developed a SPT in the lungs and bronchi (p = 0.001). On multivariate analysis, the treatment modality used was not found to be associated with the occurrence of SPTs and the radiotherapy showed no protective or harmful effect (HR 0.64 p = 0.24). CONCLUSION Treatment modality used for head and neck cancer does not seem to be associated with the occurrence of SPTs.
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Affiliation(s)
- Gal Ben Arie
- Department of Medical Imaging, Soroka University Medical Center, Beer- Sheva, Israel
| | - Tali Shafat
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Olga Belochitski
- Department of Oncology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sabri El-Saied
- Department of Otolaryngology and Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ben-Zion Joshua
- Department of Otolaryngology and Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Li JJ, Chen BC, Dong J, Chen Y, Chen YW. Synchronous colonic mucosa-associated lymphoid tissue lymphoma found after surgery for adenocarcinoma: A case report and review of literature. World J Clin Cases 2020; 8:6456-6464. [PMID: 33392331 PMCID: PMC7760443 DOI: 10.12998/wjcc.v8.i24.6456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mucosa-associated lymphoid tissue (MALT) lymphoma is a subtype of non-Hodgkin lymphoma that is mainly involved in the gastrointestinal tract. The synchronous occurrence of colonic MALT lymphoma and adenocarcinoma in the same patient is extremely rare. We here report a case of synchronous colonic MALT lymphoma found on surveillance colonoscopy five months after surgery and chemotherapy for sigmoid adenocarcinoma. CASE SUMMARY A 67-year-old man was admitted because of hematochezia for two months. Colonoscopy suggested a colonic tumor before hospitalization. Abdominal computed tomography (CT) revealed local thickening of the sigmoid colon. The patient underwent a left hemicolectomy with local lymph node dissection. The histopathology revealed moderately differentiated adenocarcinoma and partially mucinous adenocarcinoma. The pTNM stage was T3N1Mx. The patient received chemotherapy with six cycles of mFOLFOX6 after surgery. Colonoscopy was performed five months later and revealed single, flat, polypoid lesions of the colon 33 cm away from the anus. Subsequently, the patient underwent endoscopic mucosal resection for further diagnosis. The pathological diagnosis was MALT lymphoma. Positron emission tomography /CT suggested metastasis. The patient refused further treatment and died ten months later. CONCLUSION Colonic MALT lymphoma may occur after surgery and chemotherapy for adenocarcinoma as a synchronous malignancy. Regular surveillance colonoscopy and careful monitoring after surgery are critical.
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Affiliation(s)
- Juan-Juan Li
- Department of Intensive Care Unit and Comprehensive Support, Wang-Jiang-Shan Branch of Zhejiang Provincial People's Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Bing-Chen Chen
- Department of Colorectal Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Jie Dong
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Yuan Chen
- Department of Pathology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - You-Wei Chen
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
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Weber L, Blachutzik O, Vielsmeier V, Andorfer K, Matthias C, Künzel J. [Evaluation of oesophagoscopy for staging and restaging of head and neck squamous cell carcinoma]. Laryngorhinootologie 2020; 100:111-119. [PMID: 32590847 DOI: 10.1055/a-1197-6978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Oesophagoscopy is important in diagnostic and follow up investigation in patients with head and neck squamous cell carcinoma (HNSCC). Second primary malignancies of the oesophagus have major impact on therapy of the primary tumour. Considering the low incidence of oesophageal second primaries and the serious complication of oesophageal perforation routine oesophagoscopy is being discussed. MATERIAL AND METHODS Incidence of oesophageal second primaries and complication rates in oesophagoscopy were identified in a systematic review. A retrospective analysis was performed in our own patient collective. To evaluate the current practice at German ENT Clinics a survey was conducted. RESULTS 1053 oesophagoscopies in 800 patients were analysed. In 800 patients seven (0.9 %) synchronous secondary malignancies of the oesophagus occurred. In 253 follow up oesophagoscopies five (2 %) metachronous secondary malignancies were discovered. 14 (1.3 %) complications were detected; oesophageal perforation was only detected in one case (0.1 %). There was no association of certain risk factors with the incidence of secondary malignancies. The review of literature showed an incidence of secondary malignancies for Europe/USA of 1.8 % and for Asia of 4.1 %. Incidence of oesophageal perforation was 0-0.2 %. Survey results showed routine oesophagoscopy in staging (100 %) and regularly in follow up (65.3 %). CONCLUSIONS Oesophagoscopy is a convenient method to detect secondary malignancies of the oesophagus. To allow a selection of patients developing secondary malignancies according to risk profiles further prospective multicentre studies are required.
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Affiliation(s)
- Lena Weber
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Germany
| | - Oliver Blachutzik
- Hals-Nasen-Ohrenklinik und Poliklinik, Johannes-Gutenberg-Universität Mainz, Germany
| | - Veronika Vielsmeier
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Germany
| | - Kornelia Andorfer
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Germany
| | - Christoph Matthias
- Hals-Nasen-Ohrenklinik und Poliklinik, Johannes-Gutenberg-Universität Mainz, Germany
| | - Julian Künzel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Germany
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Bronchoscopy in panendoscopy: review and assessment. The Journal of Laryngology & Otology 2015; 129:1220-3. [PMID: 26522182 DOI: 10.1017/s0022215115002856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the utility of bronchoscopy to identify synchronous primaries in head and neck cancer patients. STUDY DESIGN Case series with chart review. METHOD The charts of all patients undergoing bronchoscopy between January 2008 and December 2013 were reviewed. Only those undergoing bronchoscopy as part of panendoscopy for head and neck cancer were included. Operative reports, pathology reports and discharge summaries were reviewed for operative findings, complications and length of hospital stay. RESULTS A total of 404 charts were reviewed and 168 were included in the study. No synchronous primaries were identified. Bronchoscopy changed clinical management in one patient. There were no complications from bronchoscopy. CONCLUSION Bronchoscopy is a safe and well-tolerated procedure commonly performed in the investigation of head and neck cancer patients, but it adds little additional useful clinical information. Routine performance of bronchoscopy in this setting should be weighed against its added costs, and tailored to the individual patient.
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Wang J, Pulido JS, O'Neill BP, Johnston PB. Second malignancies in patients with primary central nervous system lymphoma. Neuro Oncol 2014; 17:129-35. [PMID: 24948826 DOI: 10.1093/neuonc/nou105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare extranodal lymphoma with distinctive biological behaviors. The evolving treatment of PCNSL has greatly improved the outcome for patients with this disease and has stimulated interest in second malignancies (SMs) in patients diagnosed with PCNSL. METHODS The records of 129 cases of PCNSL at Mayo Clinic, diagnosed between January 1, 1988, and November 26, 2012, were reviewed. Data on clinical characteristics, laboratory parameters, treatments, outcomes, and SMs were collected. The mean follow-up time was 44.8 months (range, 0.5-240 months; median, 28.0 months). RESULTS Altogether, 28 cases with 30 (23.26%) SMs were identified. Twenty (15.50%) patients had prior or synchronous SM. Ten (7.76%) patients developed a subsequent primary cancer after PCNSL. The most common sites of prior or synchronous SMs were prostate (4/20), skin (4/20), and gastrointestinal (3/20). The most common site of the subsequent SM was skin (4/10). Two cases were identified with both prior SM and subsequent SM. CONCLUSIONS Second malignancies in cases with PCNSL were not uncommon and occurred in nearly a quarter of our cohort. Nonmelanoma skin cancers were frequently seen. Therefore, screening for SMs should also be considered in long-term follow-up of patients with PCNSL. In addition, the high incidence of subsequent cancer, synchronous cancer, and frequently seen nonmelanoma skin cancers may all indicate an immunosuppressed state in patients with PCNSL.
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Affiliation(s)
- Jun Wang
- Department of Hematology, First People's Hospital of Changde, Changde, China (J.W.); Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota (J.S.P.); Department of Neurology, Mayo Clinic, Rochester, Minnesota (B.P.O.); Division of Hematology, Mayo Clinic, Rochester, Minnesota (P.B.J.)
| | - Jose S Pulido
- Department of Hematology, First People's Hospital of Changde, Changde, China (J.W.); Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota (J.S.P.); Department of Neurology, Mayo Clinic, Rochester, Minnesota (B.P.O.); Division of Hematology, Mayo Clinic, Rochester, Minnesota (P.B.J.)
| | - Brian Patrick O'Neill
- Department of Hematology, First People's Hospital of Changde, Changde, China (J.W.); Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota (J.S.P.); Department of Neurology, Mayo Clinic, Rochester, Minnesota (B.P.O.); Division of Hematology, Mayo Clinic, Rochester, Minnesota (P.B.J.)
| | - Patrick B Johnston
- Department of Hematology, First People's Hospital of Changde, Changde, China (J.W.); Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota (J.S.P.); Department of Neurology, Mayo Clinic, Rochester, Minnesota (B.P.O.); Division of Hematology, Mayo Clinic, Rochester, Minnesota (P.B.J.)
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Sarma M, Borde C, Subramanyam P, Shanmuga Sundaram P. Random synchronous malignancy in male breast: a case report. J Breast Cancer 2013; 16:442-6. [PMID: 24454468 PMCID: PMC3893348 DOI: 10.4048/jbc.2013.16.4.442] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 12/11/2013] [Indexed: 11/30/2022] Open
Abstract
We report here a case of a random synchronous male breast malignancy in a patient with a known base of tongue malignancy that was incidentally detected on a whole body 18-fluorine deoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT). Patient was referred to us for PET/CT staging and radiotherapy planning for a poorly differentiated squamous cell carcinoma of base of tongue. Histopathologically, the incidentally detected breast lesion was proven to be an invasive ductal carcinoma. 18F-FDG PET/CT being a whole body imaging modality is known to detect a considerable number of synchronous primaries. Synchronous malignancies in the head and neck area and the upper aerodigestive tract are well established. However, synchronous malignancy in male breast is reportedly uncommon. Our case is unique for the fact that a random synchronous dual malignancy of base of tongue and breast in a male patient was detected during a whole body 18F-FDG PET/CT imaging.
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Affiliation(s)
- Manjit Sarma
- Department of Nuclear Medicine & PET CT, Amrita Institute of Medical Sciences (Amrita Vishwa Vidyapeetham), Cochin, Kerala, India
| | - Chaitanya Borde
- Department of Nuclear Medicine & PET CT, Amrita Institute of Medical Sciences (Amrita Vishwa Vidyapeetham), Cochin, Kerala, India
| | - Padma Subramanyam
- Department of Nuclear Medicine & PET CT, Amrita Institute of Medical Sciences (Amrita Vishwa Vidyapeetham), Cochin, Kerala, India
| | - Palaniswamy Shanmuga Sundaram
- Department of Nuclear Medicine & PET CT, Amrita Institute of Medical Sciences (Amrita Vishwa Vidyapeetham), Cochin, Kerala, India
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Synchronous Squamous Cell Carcinoma and Chronic Lymphocytic Leukemia of the Palate. J Craniofac Surg 2011; 22:348-50. [DOI: 10.1097/scs.0b013e3181f7e169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Devi P, Pattanayak L, Samantaray S. Synchronous adenocarcinoma and mucosa-associated lymphoid tissue lymphoma of the colon. Saudi J Gastroenterol 2011; 17:69-71. [PMID: 21196657 PMCID: PMC3099086 DOI: 10.4103/1319-3767.74455] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Mucosa-associated lymphoid tissue (MALT) tumors are a distinct subtype of non-Hodgkin's lymphoma. Synchronous appearance of adenocarcinoma and colonic MALT lymphoma in the same patient is quite rare. In the present report, we describe a 68-year-old female who presented with a history of bleeding per rectum. She had no history of fever, loss of weight or drenching night sweats. Rectal examination revealed no abnormality. Colonoscopy showed a large ulceroproliferative mass arising from the hepatic flexure, biopsy of which came out to be adenocarcinoma of colon. A right hemicolectomy was performed and microscopic study revealed the tumor type to be synchronous adenocarcinoma with lymphoma. The final diagnosis of this patient turned out to be a synchronous manifestation of both colonic adenocarcinoma and colonic MALT lymphoma. Although the patient remains asymptomatic two years after surgery, the case highlights the therapeutic dilemma that prevails in the definitive management in such scenarios.
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Affiliation(s)
- Padmalaya Devi
- Department of Surgical Oncology, A.H. Regional Cancer Centre, Cuttack, India
| | - Lucy Pattanayak
- Department of Radiation Oncology, A.H. Regional Cancer Centre, Cuttack, India,Address for correspondence: Dr. Lucy Pattanayak, 490/B, Santa Sahi, Canal Road, Bajrakabati, Cuttack, Orissa. E-mail:
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Joo YH, Jung CK, Sun DI, Kim MS. Synchronous laryngeal squamous cell carcinoma and Hodgkin lymphoma of the head and neck region. Auris Nasus Larynx 2009; 36:501-4. [DOI: 10.1016/j.anl.2008.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 09/18/2008] [Accepted: 10/07/2008] [Indexed: 11/24/2022]
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van der Haring I, Schaapveld M, Roodenburg J, de Bock G. Second primary tumours after a squamous cell carcinoma of the oral cavity or oropharynx using the cumulative incidence method. Int J Oral Maxillofac Surg 2009; 38:332-8. [DOI: 10.1016/j.ijom.2008.12.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 05/28/2008] [Accepted: 12/16/2008] [Indexed: 01/05/2023]
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Kim EB, Park Y, Park SJ, Kim DS, Kim JW, Seo HY, Sung HJ, Choi IK, Park KH, Oh SC, Choi CW, Kim BS, Kim YH, Kim JS, Shin SW, Kim CY, Jung KY. Clinical factors related to suspected second primary lung cancer development in patients with head and neck cancer. Cancer Res Treat 2008; 40:178-83. [PMID: 19688127 DOI: 10.4143/crt.2008.40.4.178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 11/11/2008] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The rate of second primary lung cancer development for patients with head and neck cancer (HNC) has been noted. The aim of our study was to evaluate the incidence and clinical features of suspected second primary lung cancer that developed in patients with primary HNC. MATERIALS AND METHODS We conducted a retrospective study of 469 patients who were newly diagnosed with HNC at the Korea University Medical Center between January 2000 and December 2006. RESULTS A total of 469 patients were included (389 men and 80 women). Eighteen patients (3.8%) had suspected second primary lung cancers. Statistically significant clinical variables for lung cancer development included the origin site for the primary HNC (oro-hypopharynx and larynx) (p=0.048), abnormal chest x-ray findings (p=0.027) and the histological HNC type (squamous cell carcinoma) (p=0.032). When the second primary lung cancers were combined with HNCs, the adjusted overall survival of patients with a second primary lung cancer was 16 months (p<0.001). CONCLUSIONS Considering the relative risk factors for a second primary lung cancer developing in patients with HNC, advanced diagnostic tools, such as chest CT or PET CT scan, should be applied for the early detection of a second primary lung cancer.
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Affiliation(s)
- Eui Bae Kim
- Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Watanabe N, Inohara H, Akahani S, Yamamoto Y, Moriwaki K, Kubo T. Synchronous squamous cell carcinoma and malignant lymphoma in the head and neck region. Auris Nasus Larynx 2006; 34:273-6. [PMID: 16949236 DOI: 10.1016/j.anl.2006.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Revised: 07/05/2006] [Accepted: 07/25/2006] [Indexed: 10/24/2022]
Abstract
Synchronous malignancy of squamous cell carcinoma (SCC) and malignant lymphoma (ML) in the head and neck region is extremely rare. Here, we report the case of a 57-year-old man with a right-sided neck mass; he was referred to our hospital in September 2001. A series of staging work-ups revealed that he was simultaneously affected by oropharyngeal SCC and nasopharyngeal ML. He underwent conventional radiotherapy, and both the primary tumors showed complete remission. The metastatic lymph nodes showed poor response to the radiotherapy, and the patient was surgically salvaged by modified radical neck dissection. Although systemic chemotherapy against ML was scheduled, he refused the treatment and died of disseminated ML. It is essential to determine the lesion that should be given priority treatment in case of double primary malignancies; this can be facilitated by determining the prognosis of each malignancy.
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MESH Headings
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Disease Progression
- Endoscopy
- Follow-Up Studies
- Humans
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/radiotherapy
- Lymphoma, B-Cell/surgery
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Lymphoma, Large B-Cell, Diffuse/surgery
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Nasopharyngeal Neoplasms/diagnosis
- Nasopharyngeal Neoplasms/pathology
- Neck Dissection
- Neoplasm Staging
- Oropharyngeal Neoplasms/diagnosis
- Oropharyngeal Neoplasms/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
- Noriko Watanabe
- Department of Otolaryngology, Osaka University School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan.
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Pesko P, Bjelovic M, Sabljak P, Stojakov D, Keramatollah E, Velickovic D, Spica B, Nenadic B, Djuric-Stefanovic A, Saranovic D, Todorovic V. Intraoperative endoscopy in obstructive hypopharyngeal carcinoma. World J Gastroenterol 2006; 12:4561-4. [PMID: 16874873 PMCID: PMC4125648 DOI: 10.3748/wjg.v12.i28.4561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To demonstrate the necessity of intraoperative endoscopy in the diagnosis of secondary primary tumors of the upper digestive tract in patients with obstructive hypopharyngeal carcinoma.
METHODS: Thirty-one patients with hypopharyngeal squamous cell carcinoma had been operated, with radical intent, at our Institution in the period between 1978 and 2004. Due to obstructive tumor mass, in 7 (22.6%) patients, preoperative endoscopic evaluation of the esophagus and stomach could not be performed. In those patients, intraoperative endoscopy, made through an incision in the cervical esophagus, was standard diagnostic method for examination of the esophagus and stomach.
RESULTS: We found synchronous foregut carcinomas in 3 patients (9.7%). In two patients, synchronous carcinomas had been detected during preoperative endoscopic evaluation, and in one (with obstructive carcinoma) using intraoperative endoscopy. In this case, preoperative barium swallow and CT scan did not reveal the existence of second primary tumor within esophagus, despite the fact that small, but T2 carcinoma, was present.
CONCLUSION: It is reasonable to use intraoperative endoscopy as a selective screening test in patients with obstructive hypopharyngeal carcinoma.
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Affiliation(s)
- Predrag Pesko
- Department of Esophagogastric Surgery, First Surgical University Hospital, Clinical Center of Serbia, Belgrade, Serbia and Montenegro
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Wolpoe ME, Goldenberg D, Koch WM. Squamous cell carcinoma of the sinonasal cavity arising as a second primary in individuals with head and neck cancer. Laryngoscope 2006; 116:696-9. [PMID: 16652073 DOI: 10.1097/01.mlg.0000206042.01192.4c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS Second primary tumors occur frequently in patients with head and neck carcinoma. This may be caused by generalized exposure to carcinogens resulting in "field cancerization" or to the individuals' generalized susceptibility to cancer. The paranasal sinuses are not commonly included in the sites considered at risk for this process. We therefore sought to assess the overall risk of contracting a primary cancer in this region after having a tumor elsewhere in the upper aerodigestive tract. STUDY DESIGN Retrospective. METHODS Two thousand four hundred seventy-five patients with squamous cell carcinoma of the upper aerodigestive tract were analyzed using a tumor registry at a tertiary care institution. RESULTS Five (0.2%) patients were identified as having a second primary in the sinonasal tract. The average interval between the index and second primary tumors was 28.4 (range 8-60) months. All five patients presented with symptoms typical of sinus inflammatory disease and had advanced sinus lesions at the time of diagnosis. These findings are typical of those with sinonasal carcinoma in that they present with nonspecific signs and symptoms and were diagnosed with locally advanced disease despite being in a surveillance program for their index cancer. CONCLUSIONS Although uncommon, the data reported here support inclusion of the sinonasal tract in these surveillance programs. This could result in earlier detection and greater opportunity for curative intervention.
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Affiliation(s)
- Matthew E Wolpoe
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA
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Lin K, Patel SG, Chu PY, Matsuo JMS, Singh B, Wong RJ, Kraus DH, Shaha AR, Shah JP, Boyle JO. Second primary malignancy of the aerodigestive tract in patients treated for cancer of the oral cavity and larynx. Head Neck 2005; 27:1042-8. [PMID: 16265657 DOI: 10.1002/hed.20272] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND We aimed to identify patterns and predictors of second primary malignancy (SPM) of the aerodigestive tract (SPMADT) in patients with squamous cell carcinoma of the oral cavity (SCCOC) and larynx (SCCL). METHODS One thousand two hundred fifty-seven patients from two existing databases were studied: 595 with SCCOC (1986-1995) and 662 with SCCL (1984-1998). The primary endpoint of interest was development of SPMADT, defined as a second primary neoplasm of the head and neck, esophagus, or lung. RESULTS The 5-year SPMADT rate was 8% in the SCCL versus 10% in the SCCOC subgroup. Lung SPM was more common in the SCCL group; head and neck SPM was more common in the SCCOC group. Smokers had a fivefold increased risk, whereas alcohol use was associated with a twofold increased risk of SPMADT. CONCLUSIONS The rates of SPMADT after treatment of SCCOC and SCCL are comparable, but the patterns are different. Smoking and alcohol use are independent predictors of SPMADT development.
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Affiliation(s)
- Karen Lin
- Head and Neck Service, Department of Surgery, P. O. Box 285, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York 10021, USA
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Nishiyama Y, Yamamoto Y, Yokoe K, Miyabe K, Ogawa T, Toyama Y, Satoh K, Ohkawa M. FDG PET as a procedure for detecting simultaneous tumours in head and neck cancer patients. Nucl Med Commun 2005; 26:239-44. [PMID: 15722904 DOI: 10.1097/00006231-200503000-00008] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIM The presence of simultaneous primary tumours in other regions affects the prognosis and management decisions of head and neck cancer patients. Therefore, early detection of these tumours is necessary. Recent improvements in positron emission tomography (PET) have made it possible to examine the patient's whole body. The present study was undertaken to evaluate the clinical contribution of whole-body PET using fluorodeoxyglucose (FDG) for head and neck cancer patients. METHODS Fifty-three consecutive patients with previously untreated head and neck cancer were examined. Whole-body FDG PET imaging was performed at 1 h after injection of (18)F-FDG. A 3-D acquisition was undertaken and iterative reconstruction was performed. The final diagnosis of simultaneous primary tumour was established by histological findings or clinical follow-up. RESULTS Of 53 patients, six (11%) had evidence of simultaneous primary tumour. In five of these six patients, simultaneous primary tumours (two gastric cancer; one colon cancer; one pancreatic cancer; one thyroid cancer) were found by FDG PET. One more patient was found to have prostate cancer on the basis of blood test but this was not detected by FDG PET. In none of the remaining 47 patients, were additional simultaneous primary tumours found by FDG PET or any of the other routine examinations or during follow-up. CONCLUSIONS The results of this study show a high rate of simultaneous primary tumour in patients with primary head and neck cancer. FDG PET appears to be a promising imaging modality for the detection of simultaneous tumours in head and neck cancer patients.
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Affiliation(s)
- Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
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Ritoe SC, Krabbe PFM, Kaanders JHAM, van den Hoogen FJA, Verbeek ALM, Marres HAM. Value of routine follow-up for patients cured of laryngeal carcinoma. Cancer 2004; 101:1382-9. [PMID: 15368326 DOI: 10.1002/cncr.20536] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Routine follow-up offered to patients with laryngeal carcinoma in The Netherlands consisted of 22 routine visits over a time period of 10 years after treatment. The primary aims of the follow-up were to detect cancer recurrence in asymptomatic patients and to achieve better survival outcome by reducing cancer-specific mortality rates. METHODS A longitudinal cohort study was performed to evaluate the effect of this follow-up schedule. Between January 1990 and January 1995, the authors studied all patients with primary laryngeal squamous cell carcinoma who were treated with intention to cure. For patients who developed cancer recurrence, all routine and extra visits were documented. Reported symptoms and physical evidence of tumor were mapped. RESULTS The patients complied with the follow-up protocol closely. In only 2% of all routine visits an asymptomatic cancer recurrence was found. There was no difference in survival and tumor mortality rates for patients with and without symptoms, despite the difference in whether the therapy applied had the intention to cure. It seemed that patients who developed tumor recurrence after therapy for laryngeal carcinoma received no benefit from screening for cancer recurrence detection. The lack of benefit for cancer detection screening among asymptomatic patients might be explained by unfavorable tumor biology parameters. CONCLUSIONS The routine follow-up program after treatment for laryngeal carcinoma did not lead to survival benefit for asymptomatic patients with tumor recurrence.
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Affiliation(s)
- Savitri C Ritoe
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Nijmegen, The Netherlands
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Mesurolle B, Mignon F, Meingan P, Domenge C, Vasile M, Sigal R. Head and neck cancer patients with pulmonary nodules: Value and role of CT-guided transthoracic needle aspiration biopsies. Head Neck 2003; 25:889-94. [PMID: 14603448 DOI: 10.1002/hed.10303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate transthoracic needle aspiration biopsies of pulmonary lesions in patients with squamous cell cancer of head and neck. METHODS Retrospective series of 85 patients with squamous cell cancer of head and neck cancer and pulmonary nodules who underwent CT-guided needle aspiration biopsy. RESULTS Diagnostic samples were obtained in 85% of patients. There were 8 benign and 77 malignant lesions. Among the 73 proved cases, 4 were false-negative cases. CT-guided biopsy had an accuracy of 81%, a sensitivity of 94%, and a negative predictive value of 60%. Accuracies were 68% for lesions of 20 mm or smaller and 89% for lesions greater than 20 mm. In a subset of 45 solitary lesions, among 30 positive biopsies, 15 were categorized as primary malignancies, 3 as metastatic, and 12 as indeterminate malignancies. CONCLUSIONS In head and neck cancer patients, the prevalence of thoracic malignancies is high when a pulmonary lesion is detected. CT-guided biopsy of pulmonary lesion is an accurate procedure. However, a third of positive biopsies were categorized as indeterminate malignancies.
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Affiliation(s)
- Benoît Mesurolle
- Department of Radiology, Institut Gustave-Roussy, 39 rue Camille Desmoulins, F-94805 Villejuif Cedex, France.
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Raghavan U, Quraishi S, Bradley PJ. Multiple primary tumors in patients diagnosed with hypopharyngeal cancer. Otolaryngol Head Neck Surg 2003; 128:419-25. [PMID: 12646847 DOI: 10.1067/mhn.2003.98] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE There have been few series to report on the incidence of multiple primary tumors associated with hypopharyngeal cancer. A unique consecutive patient group in a closed community who were treated by a single surgeon was available. The incidence and effect of multiple primary tumors were unknown. STUDY DESIGN We sought to assess (1) the incidence of multiple primary tumors among patients with hypopharyngeal cancer who were treated at a tertiary center, (2) the incidence of synchronous and metachronous tumors, and (3) the location of these multiple primary tumors and their effect on patient survival. METHODS We conducted a retrospective study of case notes of 150 consecutive patients with hypopharyngeal malignancy treated by a single surgeon between 1983 and 1998. Information was compiled from the patients' medical records and death data from the Family Health Services Authority. RESULTS Thirty-four patients had multiple primary tumors (22.6%). There were 22 men and 12 women; piriform fossa tumor was seen in 21 men and 6 women, and postcricoid space tumor was seen in 6 women and 1 man. Second primary tumors were synchronous in 7 patients, subsequent to hypopharyngeal tumor in 5 patients, and antecedent to hypopharyngeal tumor in 14 patients. Eight patients had 2 primary tumors, of which 4 were synchronous, 4 were subsequent, and 8 were antecedent to hypopharyngeal malignancy. On the last review (2001), 3 patients were alive, and 31 had died: 17 had died from primary malignancy, 11 from another malignancy, and 3 from unrelated causes. CONCLUSION The presence of second primary tumors in hypopharyngeal cancer is higher than previously reported, and their presence had a significant effect on the patients' survival.
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Affiliation(s)
- Ullas Raghavan
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Nottingham, UK
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Mariette C, Fabre S, Balon JM, Finzi L, Chevalier D, Triboulet JP. [Oesophageal cancer in patients with head and neck cancers: therapeutic implications]. ANNALES DE CHIRURGIE 2002; 127:757-64. [PMID: 12538096 DOI: 10.1016/s0003-3944(02)00893-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM OF THE STUDY To determine therapeutic and prognostic implications of an associated head and neck primary cancer in patients undergoing oesophagectomy for squamous cell carcinoma of the oesophagus. PATIENTS AND METHODS Between 1982 and 2000, 868 patients with oesophageal cancer were operated in our institution, including 78 (9%) who underwent oesophagectomy for associated oesophageal and head and neck cancers; the latter was synchronous (n = 52) or anterior metachronous (n = 26). Influence of head and neck cancer on the treatment of oesophageal carcinoma was analysed retrospectively in terms of surgical therapeutic strategy and survival. RESULTS Oesophageal resection consisted of oeso-pharyngolaryngectomy (n = 14, 17.9%), subtotal oesophagectomy (n = 62, 79.5%) and cervical oesophagectomy (n = 2, 2.6%). Radical resection (R0) was obtained in 85% of cases. Postoperative mortality rate was 5 % (4/78). Main complications were pulmonary (18% = 14/78) and anastomotic leaks (14% = 11/78), all of them cervical. Follow-up (mean = 25 +/- 27 months) was complete for all 78 patients. Five-year survival after R0 resection was 25%. Survival pronostic factors were denutrition, complete resection, and pT status of oesophageal tumor. CONCLUSION In patients with associated carcinomas of oesophagus and head and neck, agressive treatment -including an oesophagectomy- allowed a 5-year survival rate more than 25% without increased mortality or morbidity rates, compared with patients operated on for isolated oesophageal carcinoma.
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Affiliation(s)
- C Mariette
- Service de chirurgie digestive et générale, hôpital Claude-Huriez, CHRU, place de Verdun, 59037 Lille cedex, France
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Ritoe SC, Krabbe PFM, Jansen MMG, Festen J, Joosten FBM, Kaanders JHAM, van den Hoogen FJA, Verbeek ALM, Marres HAM. Screening for second primary lung cancer after treatment of laryngeal cancer. Laryngoscope 2002; 112:2002-8. [PMID: 12439170 DOI: 10.1097/00005537-200211000-00017] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS As a result of smoking, patients who have received curative treatment for laryngeal cancer run a high risk of developing lung cancer. Therefore, these patients enter a screening program that aims to detect lung cancer at an asymptomatic stage. The study evaluated whether screening for lung cancer by means of regular chest x-ray examinations contributed to prolonging survival. STUDY DESIGN A longitudinal follow-up study was performed to analyze the survival of patients who had received curative treatment for squamous cell laryngeal cancer and developed lung cancer during the follow-up period. METHODS Patients with lung cancer were divided into two groups: 1) patients with asymptomatic screen-detected lung cancer and 2) patients with complaints indicating lung cancer, whose tumor was detected in the interval between screening examinations by chest x-ray films. RESULTS In the complete group of patients with laryngeal cancer, no prognostic factors could be identified for developing lung cancer. There was no prolongation of survival in the screen-detected asymptomatic lung cancer patients. The median survival of both groups was 56 months (P =.57). The date of detection of the lung cancer was clearly brought forward by screening; a difference of 8 months was found between the median detection date of the two groups (P <.001). There was no difference in tumor-specific mortality between the two groups. CONCLUSION Screening by chest x-ray examination to detect lung cancer in an asymptomatic stage after curative treatment for squamous cell laryngeal cancer does not improve survival for patients who develop lung cancer.
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Affiliation(s)
- Savitri C Ritoe
- Department of Otorhinolaryngolgy-Head and Neck Surgery, University Medical Center Nijmegen, The Netherlands
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Abstract
Epithelial tumors develop through a multistep process driven by genomic instability frequently associated with etiologic agents such as prolonged tobacco smoke exposure or human papilloma virus (HPV) infection. The purpose of the studies reported here was to examine the nature of genomic instability in epithelial tissues at cancer risk in order to identify tissue genetic biomarkers that might be used to assess an individual's cancer risk and response to chemopreventive intervention. As part of several chemoprevention trials, biopsies were obtained from risk tissues (i.e., bronchial biopsies from chronic smokers, oral or laryngeal biopsies from individuals with premalignancy) and examined for chromosome instability using in situ hybridization. Nearly all biopsy specimens show evidence for chromosome instability throughout the exposed tissue. Increased chromosome instability was observed with histologic progression in the normal to tumor transition of head and neck squamous cell carcinomas. Chromosome instability was also seen in premalignant head and neck lesions, and high levels were associated with subsequent tumor development. In bronchial biopsies of current smokers, the level of ongoing chromosome instability correlated with smoking intensity (e.g., packs/day), whereas the chromosome index (average number of chromosome copies per cell) correlated with cumulative tobacco exposure (i.e., pack-years). Spatial chromosome analyses of the epithelium demonstrated multifocal clonal outgrowths. In former smokers, random chromosome instability was reduced; however, clonal populations appeared to persist for many years, perhaps accounting for continued lung cancer risk following smoking cessation.
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Affiliation(s)
- W N Hittelman
- Department of Experimental Therapeutics, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
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Kohmura T, Hasegawa Y, Matsuura H, Terada A, Takahashi M, Nakashima T. Clinical analysis of multiple primary malignancies of the hypopharynx and esophagus. Am J Otolaryngol 2001; 22:107-10. [PMID: 11283824 DOI: 10.1053/ajot.2001.22566] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Because the capability to control squamous cell carcinomas of the head and neck has improved recently, the phenomenon of multiple primary malignancies of that region is now recognized with increasing frequency. We reviewed cases of multiple primary squamous cell carcinomas of the hypopharynx and esophagus with regard to their frequency, incidence, and prognosis. PATIENTS AND METHODS We reviewed 104 cases of hypopharyngeal cancer to determine (1) if and when esophageal cancer occurred, (2) the classification of multiple tumors as metachronous or synchronous, and (3) tumor histology. RESULTS In most cases of the metachronous type, esophageal cancer followed hypopharyngeal cancer within less than 3 years. Most cases of hypopharyngeal cancer were at an advanced stage, in contrast to esophageal cancer, which were all early stage. These cases had a poor prognosis despite various treatments causing local disease to be well controlled. Endoscopic esophageal mucosal resection was found to be an effective treatment for esophageal cancer, especially in superficial types. CONCLUSIONS The prognosis and mild systemic damage after endoscopic esophageal mucosal resection compare favorably with surgery, radiation, or systemic chemotherapy.
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Affiliation(s)
- T Kohmura
- Department of Otorhinolaryngology, Nagoya University School of Medicine, 65 Tsurumai Showaku Nagoya, 466-8560, Japan
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Stoeckli SJ, Zimmermann R, Schmid S. Role of routine panendoscopy in cancer of the upper aerodigestive tract. Otolaryngol Head Neck Surg 2001; 124:208-12. [PMID: 11226943 DOI: 10.1067/mhn.2001.112311] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients with squamous cell carcinoma of the aerodigestive tract routinely undergo panendoscopy to detect possible synchronous second primary tumors. The aim of our study was to assess the incidence of synchronous and metachronous second primary tumors and to refine the role of panendoscopy. The charts of 358 patients evaluated by means of panendoscopy during work-up of a first primary squamous cell carcinoma of the upper aerodigestive tract were reviewed. The incidence of a second primary tumor was 16.2%, with 6.4% being synchronous and 9.8% being metachronous. In only 3.1% of all patients, a synchronous tumor was clinically silent and only revealed by means of the panendoscopy. The synchronous tumors were mainly in the oral cavity, pharynx, or larynx (61%), whereas the metachronous tumors were most likely in the lung (57%). Despite the low incidence of synchronous second primary tumors, we still recommend panendoscopy for assessment of the primary tumor and as a training field for residents.
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Affiliation(s)
- S J Stoeckli
- ENT Department, University Hospital Zürich, Frauenklinikstrasse 24, CH-8091 Zürich, Switzerland
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Gleeson M, Herbert A, Richards A. Management of lateral neck masses in adults. BMJ (CLINICAL RESEARCH ED.) 2000; 320:1521-4. [PMID: 10834900 PMCID: PMC1118107 DOI: 10.1136/bmj.320.7248.1521] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- M Gleeson
- Department of Otolaryngology and Skull Base Surgery, Guy's Hospital, London SE1 9RT.
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31
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Keyes JW, Chen MY, Watson NE, Greven KM, McGuirt WF, Williams DW. FDG PET evaluation of head and neck cancer: value of imaging the thorax. Head Neck 2000; 22:105-10. [PMID: 10679897 DOI: 10.1002/(sici)1097-0347(200003)22:2<105::aid-hed1>3.0.co;2-n] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Patients with primary tumors of the head and neck have been reported to have a high rate of synchronous primary tumors of the upper aerodigestive tract. This study was performed to determine whether inclusion of the thorax in the scan volume would be diagnostically useful for positron emission tomography (PET) with [F-18] fluorodeoxy-D-glucose (FDG) in patients with primary tumors of the head and neck. METHODS FDG PET scans from the midcranium to the diaphragm were obtained on 56 patients with a variety of head and neck tumors on initial examination before definitive therapy. PET findings in the chest were correlated with results of all other imaging studies, biopsy results, and clinical follow-up. RESULTS In nine studies (16%), areas of increased FDG uptake in the chest were seen and were judged to be tumors. Six of these probably were false-positive results, although one of these six may have been unconfirmed true positives. Of the three confirmed true-positive studies, two were obvious from other routine studies. In only one case did the PET study reveal a significant lesion not found by means of routine evaluation, resulting in a case-finding yield of 2%. If the unconfirmed possible true-positive results are included, the case-finding yield increases to 4%. CONCLUSIONS No compelling indication was seen for including the chest in PET studies of patients with head and neck cancer.
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Affiliation(s)
- J W Keyes
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1088, USA
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Martins AS. Multicentricity in pharyngoesophageal tumors: argument for total pharyngolaryngoesophagectomy and gastric transposition. Head Neck 2000; 22:156-63. [PMID: 10679903 DOI: 10.1002/(sici)1097-0347(200003)22:2<156::aid-hed7>3.0.co;2-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Pharyngoesophageal tumors pose a challenge to surgical management, and there is controversy in the literature as to the best procedure to be used. Advantages and disadvantages are mentioned for total pharyngolaryngoesophagectomy and gastric transposition (PLE>), free jejunal transplants, and free forearm flaps. One of the arguments for PLE> is the persistence or subsequent occurrence of multiple primaries in a field cancerization region. Multiple tumors in the head and neck/esophagus/lung axis have been reported. However, despite extensive investigation, there is little information on specific multicentricity in patients treated with PLE> for pharyngolaryngoesophageal carcinomas. METHODS A clinicopathological study was undertaken in 35 consecutive patients who underwent PLE> for pharyngoesophageal cancer to evaluate synchronicity, multicentricity, and metachronicity. Only in situ and invasive carcinomas were considered. The findings were compared with the reports in the literature. RESULTS Thirty-eight tumors were diagnosed preoperatively, with the main indications for PLE> being tumors located in the esophagus or hypopharynx (32 patients) and larynx (three patients). After the surgical treatment, 21 patients had single primaries (60%) and 14 (40%) had 25 multiple primaries in addition to their main primaries (total of 60 tumors in the whole group). Synchronous, previous metachronous and subsequent metachronous carcinomas occurred in 26%, 17%, and 8.5% of the instances, respectively. Twenty of the 25 multicentric carcinomas were invasive (80%). Either the main primaries or the multicentric carcinomas were located in the esophagus or hypopharynx (91.5% and 60%, respectively). Other sites included the larynx, oropharynx, oral cavity, and lung. CONCLUSION The incidence of multicentric tumors in patients with pharyngoesophageal carcinomas may favor total PLE> as the procedure of choice, because it includes all the condemned upper pharyngolaryngoesophageal mucosa.
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Affiliation(s)
- A S Martins
- Head And Neck Service, Department of Surgery, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil.
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Pellanda A, Grosjean P, Leoni S, Mihaescu A, Monnier P, Pasche P. Abrasive esophageal cytology for the oncological follow-up of patients with head and neck cancer. Laryngoscope 1999; 109:1703-8. [PMID: 10522946 DOI: 10.1097/00005537-199910000-00028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The occurrence of a second primary cancer in the esophagus in patients with head and neck squamous cell carcinoma is frequent and is associated with a poor prognosis. The aim of this study was to evaluate the yield of abrasive esophageal cytology as a means of screening for metachronous cancer of the upper aerodigestive tract. STUDY DESIGN We retrospectively reviewed the results of abrasive esophageal cytology performed twice yearly for the screening of patients with prior head and neck cancer. METHODS From 1987 to 1996, 320 patients treated for head and neck cancer underwent 1,673 abrasive cytology examinations of the esophagus during a mean follow-up period of 4 years. Cytological results were classified as negative, suspect, or positive for malignancy. RESULTS Twenty-five patients without symptoms had one or more suspect or positive cytologic findings, leading to 29 endoscopic examinations. These revealed 20 premalignant or early malignant lesions of the esophagus (2 dysplasias, 18 squamous cell carcinomas), 2 glandular carcinomas, and 10 clinically unsuspected oral or pharyngeal carcinomas. In seven patients, positive cytological results were associated with clinically visible head and neck cancer. Of the 34 patients with suspect cytological results for malignancy, 10 had no evidence of tumor at endoscopy and 24 had no endoscopic examination because of refusal or because suspected cells were not found in additional examinations. Negative results on cytological examination were found for 254 patients throughout their follow-up, and none of them developed esophageal cancer during a mean follow-up period of 3 years. CONCLUSIONS For patients with head and neck cancer, abrasive sponge cytology is useful for detecting esophageal cancer at an early stage. In addition, it may reveal unsuspected second primaries or recurrences in the head and neck region.
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Affiliation(s)
- A Pellanda
- Department of Otorhinolaryngology-Head & Neck Surgery, Centre Hospitalier Universitaire Voudois, Lausanne, Switzerland
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Tan L, Greener CC, Seikaly H, Rassekh CH, Calhoun KH. Role of screening chest computed tomography in patients with advanced head and neck cancer. Otolaryngol Head Neck Surg 1999; 120:689-92. [PMID: 10229594 DOI: 10.1053/hn.1999.v120.a91767] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The presence of pulmonary metastases significantly alters the treatment of patients with head and neck cancers. Currently, a chest radiograph (CXR) is used as a screening examination, although a chest CT (CCT) can detect smaller lesions. The aim of this study was to evaluate the benefit of CCT as a screening tool in patients with newly diagnosed advanced head and neck cancers. METHOD New patients with stage III and IV head and neck squamous cell carcinomas were enrolled in this prospective study from August 1994 to December 1995. Twenty-five patients underwent CXR ($71) and CCT ($597) within 2 weeks of diagnosis of the index cancer. RESULTS In 20 patients neither the CXR nor the CCT showed any evidence of pulmonary malignancy. Two patients had normal CXRs but possible metastases on CCT. Both the pulmonary lesions resolved on follow-up evaluation. Two patients had suspicious lesions on CXR, 1 of whom had a normal CCT. The second patient underwent CT-guided biopsy which was negative for malignancy. Both the CXR and CCT of the final patient, who had a bronchogenic carcinoma, were suspicious. CONCLUSION In 2 patients CCT detected suspicious lesions missed on CXR, although neither revealed malignancy. Three patients with suspicious CXRs would have had CCTs anyway. Thus 22 of 25 CCTs done at the additional cost of $13,314 did not add to the sensitivity of the screening for pulmonary metastasis or second lung primary.
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Affiliation(s)
- L Tan
- Department of Otolaryngology, UTMB, Galveston, Texas, USA
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Ayshford CA, Walsh RM, Watkinson JC. Reconstructive techniques currently used following resection of hypopharyngeal carcinoma. J Laryngol Otol 1999; 113:145-8. [PMID: 10396564 DOI: 10.1017/s0022215100143403] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is no general consensus as to the best method of reconstruction following total laryngopharyngectomy for hypopharyngeal carcinoma. The aim of this study is to attempt to establish the current practice amongst British ENT Consultants and to ascertain the reasons for their choice of reconstructive technique. An anonymous questionnaire was sent to 546 consultants in the UK and the results of 363 (66.5 per cent) were analysed. One hundred and twenty-eight (35.3 per cent) consultants replied that they performed surgery for hypopharyngeal carcinoma. Sixty-five (50.8 per cent) performed a stomach pull-up procedure, 23 (18 per cent) used a jejunal free flap, 36 (28.1 per cent) used both and four (3.1 per cent) used other techniques. In the stomach pull-up group, the main reasons given for their choice were because there was no lower resection margin (48 out of 65) and because of tradition in the way they were trained (37 out of 65). In the group using the jejunal free flap, lower morbidity (18 out of 23) and mortality (14 out of 23) were the main reasons for their choice. The questionnaire also found that amongst the 60 consultants who would consider using a jejunal free flap, the majority (39) aimed for a lower clearance margin of 2-4 cm, while 17 aimed for > 4 cm clearance. This study provides a good indication of the current practice in the UK of reconstruction following resection for hypopharyngeal carcinoma. It appears that the stomach pull-up remains the most commonly used method of reconstruction, but the jejunal free flap is becoming increasingly more popular because of its lower morbidity and mortality.
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Affiliation(s)
- C A Ayshford
- Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK
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Tian D, Feng Z, Hanley NM, Setzer RW, Mumford JL, DeMarini DM. Multifocal accumulation of p53 protein in esophageal carcinoma: evidence for field cancerization. Int J Cancer 1998; 78:568-75. [PMID: 9808524 DOI: 10.1002/(sici)1097-0215(19981123)78:5<568::aid-ijc7>3.0.co;2-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A systematic characterization of the cancerization field of esophageal carcinoma based on p53 protein accumulation has not been reported previously. The present report presents such a study based on 50 specimens of esophageal squamous-cell carcinoma from northern China. To gain insight into the etiology of this disease among the 50 subjects, DNA was analyzed for a polymorphism of the aldehyde dehydrogenase-2 (ALDH2) gene, which has been associated with increased risk for esophageal cancer among alcohol-consuming patients in Japan. However, the frequency of this polymorphism among our subjects, 30% (15/50), was within published control frequencies for this allele, suggesting that this allele may not play a role in the etiology of esophageal cancer in this northern Chinese population. Immuno-histochemical staining showed that 66% of the tumors were p53+. Of 420 pieces near or adjacent to p53+ tumors, p53+ cells were present among 64% of basal-cell hyperplasia (BCH), 70% of dysplasia (DYS) and 88% of carcinoma in situ (CIS). Of 216 pieces near or adjacent to p53- tumors, p53+ frequencies were 25% of BCH, 25% of DYS and 0% of CIS. The proportion of BCH cells that were p53+ decreased at increasing distance from the tumor (p = 0.006). The sporadic distribution of p53+ cells and the distribution and frequency of p53+ precursor lesions support the view that accumulation of p53 protein is multifocal and occurs in precursor lesions in early stages of esophageal carcinogenesis.
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Affiliation(s)
- D Tian
- Environmental Carcinogenesis Division, US Environmental Protection Agency, Research Triangle Park, NC 27711, USA
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38
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Singh I, Yadav SP, Singh S, Dhanuka B, Sharma RC. Multiple tumors in head and neck region. Indian J Otolaryngol Head Neck Surg 1997; 49:388-90. [PMID: 23119336 PMCID: PMC3450912 DOI: 10.1007/bf02994658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- I Singh
- Departments of Otolaryngology and Ophthalmology, Medical College and Hospital, 124 001 Rohtak
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39
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Martin-Granizo R, Naval L, Castro P, Goizueta C, Muñoz M. Quintuple cancers: report of a case with triple cancers in the head and neck. J Craniomaxillofac Surg 1997; 25:153-7. [PMID: 9234095 DOI: 10.1016/s1010-5182(97)80007-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The incidence of multiple primary cancers is increasing. We report a case of quintuple cancers, two located in the genitourinary tract and three arising on the upper aerodigestive tract, two synchronous squamous cell carcinomas of the oral mucosa and another on the larynx. We also present a brief review of the literature.
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Affiliation(s)
- R Martin-Granizo
- Department of Oral & Maxillofacial Surgery, University Hospital de la Princesa, School of Medicine, Autónoma University of Madrid, Spain
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40
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Mercader VP, Gatenby RA, Mohr RM, Fisher MS, Caroline DF. CT surveillance of the thorax in patients with squamous cell carcinoma of the head and neck: a preliminary experience. J Comput Assist Tomogr 1997; 21:412-7. [PMID: 9135650 DOI: 10.1097/00004728-199705000-00014] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Our goal was to determine the number of malignancies detected by thoracic CT in patients with head and neck squamous cell carcinoma (SCCA) in three clinical settings. METHOD We retrospectively examined 168 thorax CT scans in 93 patients with head and neck SCCA and determined the number of malignancies (second primary cancers or metastasis) (a) at the time of diagnosis of the primary neck tumor (57 patients), (b) at approximately yearly intervals following treatment of the primary cancer (93 examinations in 43 patients), and (c) at the time of local/regional recurrence of the neck neoplasm (18 patients). RESULTS CT detected malignancy in 9 of 57 patients examined during diagnosis of the neck tumor, in 9 of 43 patients during follow-up, and in 6 of 18 patients evaluated at the time of local/regional neck recurrence. CONCLUSION Chest CT demonstrates a high number of additional malignancies in patients presenting with advanced SCCA of the head and neck.
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Affiliation(s)
- V P Mercader
- Department of Diagnostic Imaging, Temple University Hospital, Philadelphia, PA 19140, USA
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41
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Hsieh WC, Chen YM, Perng RP. Temporal relationship between cancers of the lung and upper aerodigestive tract. Jpn J Clin Oncol 1997; 27:63-6. [PMID: 9152791 DOI: 10.1093/jjco/27.2.63] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We retrospectively reviewed the chart records at the Veterans General Hospital-Taipei for the period between January 1985 and December 1994 to examine the temporal relationship between cancers of the lung and upper aerodigestive tract. A total of 56 patients (54 males, 2 females) with histocytologically proven double primary cancers, with either lung cancer or upper aerodigestive tract cancers appearing first, were found. Squamous cell carcinoma was the most frequent histologic type of lung cancer (squamous 57%, adenocarcinoma 27%, poorly differentiated carcinoma 9%, small cell lung cancer 7%). The incidence of lung cancer patients with upper aerodigestive tract cancer was 0.9% (56/6412). There was no significant difference in the occurrence of upper aerodigestive tract cancer between non-small cell and small cell lung cancer (P > 0.05). However, the incidence of squamous cell lung cancer with upper aerodigestive tract cancer was higher than that of non-squamous cell lung cancer (P < 0.05). With regard to the location of lung cancer, the right lung was more commonly affected than the left (P < 0.001). The locations of upper aerodigestive tract cancers in these lung cancer patients were as follows: larynx 24, nasopharynx 11, esophagus 10, hypopharynx 4, pharyngeal tonsils 2, oral cavity 5. Most upper aerodigestive tract cancers were diagnosed before lung cancer (36/56, 64%), and lung cancer was diagnosed within 3 years in more than half of cases after the diagnosis of upper aerodigestive tract cancer (58.3%). Most lung cancers that preceded upper aerodigestive tract cancer were at an early stage at diagnosis (stage I 4, stage Illa 1), whereas the others, appearing either synchronously or after the diagnosis of upper aerodigestive tract cancer, were mostly at the late stage. There was no difference in survival between lung cancer patients with upper aerodigestive tract cancer and those without (P > 0.05).
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Affiliation(s)
- W C Hsieh
- Chest Department, Veterans General Hospital-Taipei, Taiwan, ROC
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42
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Ribeiro U, Posner MC, Safatle-Ribeiro AV, Reynolds JC. Risk factors for squamous cell carcinoma of the oesophagus. Br J Surg 1997. [PMID: 8983603 DOI: 10.1002/bjs.1800830905] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cancer of the oesophagus has great diversity in geographical distribution and incidence. The rate of oesophageal cancer has been increasing in some areas and the reasons for this are not clear. This review outlines fascinating epidemiological aspects and the risk factor for squamous cell carcinoma of the oesophagus. While in the Western world the effects of alcohol and tobacco are substantial preconditions, worldwide other factors, such as diet, nutritional deficiencies, environmental exposure and infectious agents (especially papillomavirus and fungi), play a significant role. Chronic irritation of the oesophagus appears to participate in the process of carcinogenesis, particularly in patients with thermal and/or mechanical injury, achalasia, oesophageal diverticulum, chronic lye stricture, radiation therapy, injection sclerotherapy and gastric resection before the appearance of oesophageal tumour. The association of Plummer-Vinson syndrome, coeliac disease, tylosis and scleroderma with oesophageal cancer has also been reviewed.
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Affiliation(s)
- U Ribeiro
- Department of Surgery, University of Pittsburg Medical Center, Pennsylvania, USA
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43
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Ribeiro U, Posner MC, Safatle-Ribeiro AV, Reynolds JC. Risk factors for squamous cell carcinoma of the oesophagus. Br J Surg 1997. [PMID: 8983603 DOI: 10.1046/j.1365-2168.1996.02421.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cancer of the oesophagus has great diversity in geographical distribution and incidence. The rate of oesophageal cancer has been increasing in some areas and the reasons for this are not clear. This review outlines fascinating epidemiological aspects and the risk factor for squamous cell carcinoma of the oesophagus. While in the Western world the effects of alcohol and tobacco are substantial preconditions, worldwide other factors, such as diet, nutritional deficiencies, environmental exposure and infectious agents (especially papillomavirus and fungi), play a significant role. Chronic irritation of the oesophagus appears to participate in the process of carcinogenesis, particularly in patients with thermal and/or mechanical injury, achalasia, oesophageal diverticulum, chronic lye stricture, radiation therapy, injection sclerotherapy and gastric resection before the appearance of oesophageal tumour. The association of Plummer-Vinson syndrome, coeliac disease, tylosis and scleroderma with oesophageal cancer has also been reviewed.
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Affiliation(s)
- U Ribeiro
- Department of Surgery, University of Pittsburg Medical Center, Pennsylvania, USA
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44
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Ribeiro U, Safatle-Ribeiro AV, Posner MC, Rosendale B, Bakker A, Swalsky PA, Kim R, Reynolds JC, Finkelstein SD. Comparative p53 mutational analysis of multiple primary cancers of the upper aerodigestive tract. Surgery 1996; 120:45-53. [PMID: 8693422 DOI: 10.1016/s0039-6060(96)80240-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tumors arising in the upper aerodigestive tract (UAT) are often associated with predisposing factors that place the patient at risk for development of multiple synchronous or metachronous tumors. The aim of this study was to evaluate p53 as a susceptibility gene in UAT malignancy. METHODS Seventeen patients with 41 separate primary tumors involving esophagus (n = 15), larynx (n = 14), pharynx (n = 6), lung (n = 2), mouth (n = 2), and tongue (n = 2) were analyzed for the presence and specific genotype of p53 point mutation. Immunohistochemical staining of p53 and topographic genotyping consisting of polymerase chain reaction amplification and direct sequencing of p53 exons to 5 to 8 were performed. RESULTS Eleven tumors were metachronous (6 months to 11 years), and 11 were synchronous. We found p53 point mutations in 19 (46.3%) of 41 tumors in exons 8 (n = 11), 7 (n = 4), 5 (n = 3), and 6 (n = 1). Tumors possessed either wild-type p53 or a single type of point mutation. Metastases displayed the identical genotype of its primary tumor in all cases. Most importantly, p53 genotype was found to be completely discordant between separate primary tumors for the same patient. CONCLUSIONS Complete discordance in p53 genotype between separate primary UAT cancers strongly indicates that p53 is not functioning as a susceptibility gene in this setting.
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Affiliation(s)
- U Ribeiro
- Department of Surgery, University of Pittsburgh, Pa, USA
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45
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Hao SP. Four synchronous malignancies of the upper aerodigestive tract--management of an unusual case. Am J Otolaryngol 1996; 17:207-9. [PMID: 8827282 DOI: 10.1016/s0196-0709(96)90062-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- S P Hao
- Department of Otolaryngology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
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Wang LD, Zhou Q, Hong JY, Qiu SL, Yang CS. p53 protein accumulation and gene mutations in multifocal esophageal precancerous lesions from symptom free subjects in a high incidence area for esophageal carcinoma in Henan, China. Cancer 1996. [DOI: 10.1002/(sici)1097-0142(19960401)77:7<1244::aid-cncr3>3.0.co;2-i] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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47
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Kurita H, Kurashina K. Vital staining with iodine solution in delineating the border of oral dysplastic lesions. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 81:275-80. [PMID: 8653460 DOI: 10.1016/s1079-2104(96)80326-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The borders of dysplastic lesions of the oral mucosa are often vaguely delineated. The purpose of this study was to determine if vital staining with an iodine solution can precisely delineate the boundary of superficial spread of dysplastic or malignant epithelium. STUDY DESIGN Thirty-seven biopsies were obtained from 18 patients with possible malignant lesions of the oral mucosa. Deviations between the clinical boundary obtained with vital staining and the histopathologic boundary determined in hemotoxylin-eosin-and lectin-stained sections were measured with light microscopy. RESULT The clinical boundaries defined with the vital staining agreed well with the pathologic border lines and were in error by less than 3 mm. CONCLUSION This result suggests that vital staining with an iodine solution has great potential in determining the extent and precise borders of the dysplastic epithelium. A 5-mm border of normal tissue peripheral to the iodine-positive area would be adequate for the complete removal of the dysplastic epithelium.
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Affiliation(s)
- H Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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48
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Brochet F, Bairati I, Roy J, Gélinas M, Nabid A, Têtu B, Mâsse B, Meyer F. Incidence et facteurs de risque de seconds cancers primaires chez les patients traités pour un premier cancer du pharynx. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/0924-4212(96)81344-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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49
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Prévention des seconds cancers primaires par supplémentation vitaminique chez les patients traités pour un cancer ORL. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/0924-4212(96)81345-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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50
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Sturgis EM, Miller RH. Second primary malignancies in the head and neck cancer patient. Ann Otol Rhinol Laryngol 1995; 104:946-54. [PMID: 7492066 DOI: 10.1177/000348949510401206] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
With improvements in locoregional control, the problem of second primary malignancies is rapidly being pushed to the forefront of head and neck oncology. While the constant long-term risk for the head and neck cancer patient has been well established, efforts at prevention, early detection, and treatment have been somewhat futile. Recent advances in genetic predisposition, biomarkers, photodiagnostic imaging, and differentiation therapy may soon offer improved outcomes. The literature is reviewed and current research is presented regarding the history, epidemiology, etiology, diagnosis, and treatment of second primary malignancies.
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Affiliation(s)
- E M Sturgis
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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