Endoscopic Screening for Second Primary Tumors of the Esophagus Among Head and Neck Cancer Patients

Abstract

Malignancies of the head and neck (HN) region and esophagus are among the most common cancers worldwide. Due to exposure to common carcinogens and the theory of field cancerization, HN cancer patients have a high risk of developing second primary tumors (SPTs). In our review of 28 studies with 51,454 HN cancer patients, the prevalence of SPTs was 12%. The HN area is the most common site of SPTs, followed by the lungs and esophagus, and 13% of HN cancer patients have been reported to have esophageal high-grade dysplasia or invasive carcinoma. The prognosis of HN cancer patients with concomitant esophageal SPTs is poor, and therefore identifying esophageal SPTs as early as possible is of paramount importance for risk stratification and to guide the treatment strategy. Image-enhanced endoscopy, especially using narrow-band imaging endoscopy and Lugol’s chromoendoscopy, has been shown to improve the diagnostic performance in detecting esophageal neoplasms at an early stage. Moreover, the early detection and minimally invasive endoscopic treatment of early esophageal neoplasm has been shown to improve the prognosis. Well-designed prospective studies are warranted to establish appropriate treatment and surveillance programs for HN cancer patients with esophageal SPTs.

Clinical Value of Endoscopic Esophageal Screening in Head and Neck Squamous Cell Carcinoma Patients

“…22 Among the various SPMs, EC is one of the most common, with prevalence rates of 0% to 31.5%, (average 0.9%). 21 The prevalence of EC varies among studies due to differences in study design, the primary sites of HNSCC, and the prevalence of HPV-related HNSCC. 22,23 Several studies found the risk of second primary EC to be higher in the hypopharyngeal region compared to other subsites, 21,24 and the incidence of SPMs was lower in HPV-related HNSCC compared to non-HPV-related HNSCC.…”

“…The upper aerodigestive epithelium is the most common site of SPMs due to field cancerization, indicating exposure to similar carcinogens in cigarette smoke, alcohol, and betel nuts 22 . Among the various SPMs, EC is one of the most common, with prevalence rates of 0% to 31.5%, (average 0.9%) 21 . The prevalence of EC varies among studies due to differences in study design, the primary sites of HNSCC, and the prevalence of HPV‐related HNSCC 22,23 .…”

“…The role of routine endoscopic esophageal screening in HNSCC is controversial. Some studies have reported that esophagoscopy had a low cancer‐detection rate and did not improve outcomes, 17‐19 whereas others have advocated routine esophagoscopy for early detection, particularly of oropharyngeal and hypopharyngeal cancers 15,20,21 . No large cohort study has explored this issue and the impact of routine esophagoscopy on the survival outcomes of HNSCC patients remains unclear.…”

Oral Squamous Cell Carcinoma and Concomitant Primary Tumors, What Do We Know? A Review of the Literature

“…Routine screening in the work-up and follow-up of patients with OSCC could detect more early-stage SPTs. The diagnosis of SPTs may impact the management and treatment of tumors [ 34 ].…”

McKeown Versus Ivor‐Lewis Esophagectomy for Patients with a History of Total Pharyngolaryngectomy: A Comparison Study

“…According to a previous report, the incidence of second primary EC in patients with HNC is 9.7% [3]. Although there were no well-designed prospective studies to establish appropriate surveillance programs for second primary EC in HNC patients, several previous studies recommended routine screening esophagogastroduodenoscopy (EGD) for the early detection of metachronous EC in patients with a history of HNC [4][5][6].…”