Diagnosis of superficial esophageal cancer and dysplasia using endoscopic screening with a 2% lugol dye solution in patients with head and neck cancer

Abstract

Background Head and neck cancer (HNC) has a high incidence in Brazil, with cancer of the oral cavity being one of the five most common cancers among Brazilians. Alcohol and tobacco consumption may contribute to synchronous or metachronous HNC and esophageal cancer. The early detection of superficial esophageal cancer and dysplasia in asymptomatic patients with HNC, after successfully treating the primary cancer, may provide an effective cure. Methods A prospective study involving 60 patients with HNC was carried out at the State University of Campinas (UNICAMP) to screen for superficial esophageal cancer and dysplasia using endoscopy and a 2% lugol dye solution followed by biopsy of the suspicious areas. Results Five patients (8.3%) had superficial esophageal cancer, which was diagnosed as intraepithelial carcinoma in three of them (5.0%). In four patients, the superficial esophageal cancer was synchronous, and in one it was metachronous to HNC. Five patients (8.3%) had dysplasias in the esophageal epithelium (three were classified as mild and two as moderate). Conclusion These results demonstrate the value of endoscopic screening of the esophagus using lugol dye in patients with HNC, particularly because superficial esophageal cancer is extremely difficult to detect by conventional methods in asymptomatic patients. © 2000 John Wiley & Sons, Inc. Head Neck 22: 170–174, 2000.

Screening for oesophageal neoplasia in patients with head and neck cancer

“…This high percentage compares well or even surmounts the rates observed in previous studies (Makuuchi et al, 1996;Meyer et al, 1997;Fagundes et al, 1999;Tincani et al, 2000;Petit et al, 2001) and provides strong evidence for the efficacy of the screening protocol used in this study. Various alternative screening strategies have been described.…”

“…Patients who survived HNC are known to develop a second neoplasm with a risk of 3 -7% per year (Cooper et al, 1989;Sturgis and Miller, 1995). Prospective studies in Japan and recently in Brazil detected oesophageal squamous cell neoplasia in 5.1 -11.8% of HNC patients (Shiozaki et al, 1990;Makuuchi et al, 1996;Tincani et al, 2000). General surveillance of HNC patients is not yet recommended in Western countries, mainly due to a lack of adequate data from this part of the world (Agrawal and Wenig, 1998;Deleyiannis and Weymuller, 1998).…”

Oesophageal squamous cell neoplasia in head and neck cancer patients: upregulation of COX-2 during carcinogenesis

“…Oesophageal carcinogenesis and tumour progression require more detailed elucidation, particularly in high-risk groups. Patients with (previous) head and neck cancer (HNC) are a clinically important high-risk group with an 11.8 -16.6% risk of ESCC or intraepithelial neoplasia (Makuuchi et al, 1996;Tincani et al, 2000;Scherübl et al, 2002b). Thus, effective chemoprevention of oesophageal neoplasia is most desirable in these patients.…”

Oral cancer research with an emphasis on genomic analysis.

“…3). Although the incidences of oral cancers slightly differed in these reports, they are influenced by differences in race, life style, and environment 19,27,28) . For example, the incidence of oral cancer is high in male smokers, with a threefold higher incidence in patients with a smoking habit than in those without 19,27) .…”

“…Recently, dye staining has been applied to diagnosing oral lesions 27,36) . In this method, a specific dye is applied directly to the lesions to visualize early changes in the mucosal areas, which are not easy to see toluidine blue vital staining (Orascan) and the iodine reaction method are generally used 36) (Fig.…”