Head and neck squamous cell carcinoma in pregnant women

Abstract

Objective To investigate oral cancer in pregnant women, a rare but therapeutically challenging patient subset. Methods After IRB approval, an EMERSE search was used to identify all women treated at the University of Michigan from 1998–2010 with head and neck squamous cell carcinoma (HNSCC) during pregnancy. This identified four patients with tongue cancer. Biomarkers and HPV were assessed by immunohistochemistry and multiplex PCR/Mass spectrometry, respectively. Results Two patients responded well to therapy and are alive more than 10 years after diagnosis; two died of disease. All tumors overexpressed EGFR and Bcl-xL, three of four overexpressed c-Met, both tumors that progressed overexpressed p53. All tumors were negative for HPV, p16, ER, PR, and HER-2. Conclusions Biomarkers of aggressive tumors (high EGFR, Bcl-xL, c-Met; low p53) did not correlate with outcome. Additional studies are needed to determine whether perineural invasion, delay in diagnosis, and p53 overexpression are factors related to poorer survival.

Oral epithelial stem cells—Implications in normal development and cancer metastasis

“…Worldwide, the problem is far greater with new cases annually exceeding 640,000 (oralcancerfoundation.com). Traditionally a men’s illness, affecting six men for every woman, over the past 10 years that ratio has alarmingly become 2:1 also affecting younger patients [45]. Development of oral cancer proceeds through discrete molecular genetic changes that are acquired from the loss of genomic integrity after continued exposure to environmental risk factors.…”

Head and neck cancer during pregnancy

“…Squamous cell cancer (SCC) of the tongue (oral cavity) was the most frequent. 9,12,15,17,18 Only 26.6% of these patients experienced local or regional recurrence, and all those patients died of local or metastatic evolution at 2 years. The prevalence of oral cavity cancers has increased by 60% in adults younger than 40 years during the 1973-1997 period according to the SEER database.…”

“…Although symptoms of oral cancer in women in the peripartum were similar to those of cancers in a standard population, it is noteworthy that they were quite often mistaken even in the presence of a mass (such as granuloma), possibly because cancer was felt unlikely at that age and even more in that condition. 9 Human papillomavirus (HPV) exposure is another known risk factor for HNSCC, and among these tongue and tonsil carcinomas. Of those locally advanced tumors, 46.7% appeared in the first trimester of pregnancy.…”

“…Of note, symptoms had usually lasted for several months before diagnosis, and 51.7% of cases were locally advanced tumors at diagnosis. Though among the different cases showed in Table 1, the presence of HPV was only searched for four patients 9 and was negative. 9,12,15,17,18 Only 26.6% of these patients experienced local or regional recurrence, and all those patients died of local or metastatic evolution at 2 years.…”

“…However, non-coplanar treatments such as with robotic stereotactic irradiation must avoid beams directed onto the fetus. 5,9,15 In those cases, locally advanced disease was diagnosed, with a poor maternal prognosis at long term, and there was a need of aggressive therapy, with high-risk fetal toxicity. Planning of radiation therapy should be based on estimations of the size and term of pregnancy at the beginning of treatment as well as the expected change during the course of therapy.…”