Synchronous and metachronous head and neck carcinomas

Abstract

Background. The incidence of head and neck cancer is increasing. To improve the survival of head and neck cancer patients, an effective program of screening and/or chemoprevention of second malignancies is essential. An analysis of the incidence, time to development, and risk factors of second malignant tumors in head and neck cancer patients can contribute to the design of effective screening and chemoprevention programs. Methods. Eight hundred, fifty‐one patients with initial squamous cell carcinoma of the larynx (n = 224), tonsils (n = 189), pyriform sinus (n = 165), oral cavity (n=129), mobile tongue (n = 72), and base of tongue (n = 72) treated from 1978 to 1990 were analyzed for the presence of a second malignancy after initial therapy. Of these 851 patients, 544 (64%) were documented smokers and 35 (4%) were nonsmokers. No smoking information was available for 272 patients. Four hundred, fifty‐four patients (53%) were consumers of alcohol and 64 patients (8%) were nondrinkers. Alcohol consumption information was not available for 333 patients. Results. One hundred, sixty‐two (19%) second head and neck carcinomas occurred in the original 851 patients. Sixty‐six patients (41 %) had synchronous tumors, and 96 patients (59%) had metachronous tumors. The probability of developing a second metachronous cancer 5‐years after undergoing treatment for the initial head and neck cancer was 22%. Borderline statistical significance was observed in the 5‐year second cancer incidence based on the site of the initial primary cancer (46% for the base of tongue, 34% for the pyriform sinus, 23% for the larynx, 18% for the oral cavity, 15% for the tonsils, and 10% for the mobile tongue). Tobacco smoking (3% for nonsmokers vs. 26% for ⩽ 20 pack‐years vs. 42% for >20 and ⩽ 40 packs/year vs. 30% for > 40 packs/year of smoking) and the consumption of alcohol (5% for nondrinkers vs. 32% for drinkers) were both statistically significant in predicting the likelihood of developing a second malignancy. Multivariate analysis revealed that the two independent variables that influenced the occurrence of a second metachronous cancer were the anatomic site of the original primary cancer and patient age. The survival rate after the second cancer was influenced significantly by the site of the second cancer (20% for a second head or neck cancer, 3% for a second esophageal cancer, and 2% for a second lung cancer). Continued smoking (20% for nonsmokers vs. 5% for smokers) and continued alcohol consumption (27% for nondrinkers vs. 6% for drinkers) also adversely influenced the survival after the occurrence of a second cancer. Conclusions. This study confirms the high rate of second cancers in patients with initial head and neck malignancies. The development of a second malignancy is almost always fatal. Screening programs and chemoprevention trials should be directed toward cancer patients with initial head and neck cancers. Only the small subset of nonsmokers and nondrinkers should be excluded from such trials.

Oral Hybrid Verrucous Carcinoma: A Clinical Study

“…Parallel to their report 8.1 % of patients in current study presented with second primary, considering the limited median follow up period of 32 months in our series; this proportion might certainly increase. Development of second primary was associated with poorer outcome in oral hybrid VC as revealed in current series, this finding were parallel to the study by Schwartz et al [15] and Hordyk, G. J., et al [16] who reported poor prognosis in head and neck carcinomas associated with second primary cancer.…”

Management of the Patients with Hypopharyngeal Cancer: Eight-Year Experience of Miyagi Cancer Center in Japan

“…The incidence of multiple primary cancers of the hypopharynx has been reported to be approximately 10% -20% in Japan (Ogawa et al 1999), and the estimated 5-year metachronous cancer incidence rate has been found to be 34.4% (Schwartz et al 1994). In our study, 23 out of 74 patients had multiple primary cancers (31%).…”

“…Although radical surgery with subsequent reconstruction of the cervical esophagus by free jejunum transfer has become a relatively easy procedure for advanced cancer recently, the survival rate in such cases remains fairly poor. In hypopharyngeal cancer, there are various problematic issues such as the high frequency of distant metastasis, occurrence of multiple primary cancers (Schwartz et al 1994;Ogawa et al 1999), choice of therapy such as radiation and surgery for the primary lesion, therapy for retropharyngeal lymph node (Hasegawa and Matsuura 1994), and indication for contralateral elective neck dissection (Nishijima et al 1991;Anderson et al 1996;Lassaletta et al 2002). We thought that these many problems are compound and make survival rate decline.…”

Multiple oral squamous epithelial lesions: are they genetically related?

“…The hypothesis was supported by subsequent clinical and molecular studies (Chung et al 1993;Buller et al, 1998;Sozzi et al, 1995). The SPTs in patients with HNSCC have become an important clinical issue because of the increasing incidence of SPTs in head and neck cancer and the negative impact of such tumors on long-term survival of patients (Vokes et al, 1993;Jones et al, 1995;Schwartz et al, 1994). It is important to learn more about the molecular mechanisms of developing of SPTs to establish new strategies to treat patients with HNSCC and to prevent SPT development.…”