Comorbidity in patients with cancer of the head and neck: Prevalence and impact on treatment and prognosis

At the time of diagnosis, many patients with head and neck cancer have other medical conditions, referred to as comorbidity. These other medical conditions may affect treatment and prognosis. Several valid instruments are available to capture the individual comorbid ailments and their prognostic impact. Inclusion of comorbidity information will assist in the analysis of treatment effectiveness, quality of care assessment, and outcomes studies based on observational studies.

Head and neck cancer in primary care: presenting symptoms and the effect of delayed diagnosis of cancer cases

BACKGROUND

Little is known about the diagnosis of head and neck carcinoma in primary care. We sought to estimate the general prevalence of symptoms reported by patients with head and neck carcinomas and to determine the association between detection patterns of head and neck cancer cases in primary care and survival.

METHODS

In a cross-sectional survey, we used a questionnaire to estimate the general prevalence of symptoms associated with head and neck cancer from a sample of 5646 primary care visits in 25 randomly selected health centres over 4 weeks throughout Finland. A population-based retrospective cohort study involved the 221 patients resident in one primary health care district (population about 700,000) in whom head and neck carcinoma was diagnosed between Jan. 1, 1986, and Dec. 31, 1996. Data on the initial primary care visit, clinical characteristics and survival were obtained from patient charts.

RESULTS

Of 5646 visits to a primary care practitioner, 11% (617) were made because of the same symptoms as those initially reported by patients later found to have head and neck cancer. According to the cohort data, the detection rate of these carcinomas in primary care was 1 per 63,000 visits. At the initial visit of 221 patients later found to have cancer, 56% (123) received referrals, 24% (53) follow-up appointments and 20% (45) neither ("overlooked"). At 3 years, the risk of death was significantly higher among patients whose disease was overlooked (adjusted hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.03-3.45). The excess risk associated with being overlooked, however, was confined to subjects with tongue or glottic tumours (HR 4.25, 95% CI 1.59- 11.4) (number needed to harm 3.0, 95% CI 1.9-6.7).

INTERPRETATION

Despite the rarity of patients with head and neck carcinoma in primary care, patients with symptoms of these diseases and especially with symptoms of tongue and glottic carcinomas should be initially referred for further care or followed up.

The relationship between observer-based toxicity scoring and patient assessed symptom severity after treatment for head and neck cancer. A correlative cross sectional study of the DAHANCA toxicity scoring system and the EORTC quality of life questionnaires

BACKGROUND AND PURPOSE

Morbidity is an important issue in cancer research. The observer-based toxicity scoring system used by DAHANCA (the Danish head and neck cancer study group) has proved itself sensitive to differences in toxicity in a large randomised study, but like other toxicity scoring systems it has not been formally validated. Conversely, the EORTC quality of life questionnaire (QLQ) has been validated as a tool for collecting information about the consequences of disease and treatment on the well being of cancer patients. The purpose of this study was to examine the relationship between the two methods of side effect recording.

PATIENTS AND METHODS

One hundred and sixteen recurrence free patients with laryngeal (n=44), pharyngeal (n=34) and oral cavity (n=38) cancer attending follow-up after radiotherapy (n=83) or surgery (n=33) completed EORTC C30, the core questionnaire concerning general symptoms and function and EORTC H&N35 the head and neck specific questionnaire. The attending physicians in the follow-up clinic evaluated and recorded DAHANCA toxicity scores on the same patients.

RESULTS

The DAHANCA toxicity scoring system and the EORTC QLQ correlated with several clinical endpoints. The conceptually similar endpoints of the two methods correlated significantly. The objective endpoints of the DAHANCA scoring system were only correlated with quality of life endpoints to a very low degree. The DAHANCA toxicity scores had a low sensitivity (0.48-0.74) in detecting equivalent subjective complaints from the questionnaires and the observer-based scoring system severely underestimated patient complaints. A specific patient group where the DAHANCA score had a higher tendency to fail could not be detected.

CONCLUSION

The DAHANCA toxicity score is an effective instrument in assessing objective treatment induced toxicity in head and neck cancer patients but insensitive and non-specific with regard to patient assessed subjective endpoints. This weakness seems inherent in an observer-based scoring system, and will probably also apply to newer ones like CTCAE 3.0.

Adolescent melanoma: Risk factors and long term survival

AIMS

To report the adolescent melanomas with focus on differences in clinical characteristics, prognostic factors, disease free (DFS) and overall survival (OS) in comparison with adults.

METHODS

A single institution retrospective study in which 49 adolescent patients were compared to an adult group of 972 patients. The 10-year DFS, 10-year OS and prognostic factors were calculated for both groups.

RESULTS

The median age for the adolescent patients was 17 (range 12-19) years and 49 (range 20-93) years for the adult patients. Median follow-up time was 92 (range 4-366) months. Adolescent patients presented more often with locally advanced melanoma (p<0.01). The median Breslow thickness was 1.6 vs 2.0mm for the adults (p=0.075). Increasing age, ulceration, Breslow thickness, tumour location, male gender and stage at diagnosis were calculated to be negative prognostic factors for the adult group. In the adolescent group, only the stage at diagnosis was a significant negative predictor. The 10-year DFS and OS for the adolescent patients and adult group were not significantly different regarding AJCC stages I-III.

CONCLUSION

Although adolescent patients presented more often with locally advanced disease, there are no significant differences in the 10-year DFS and OS between adolescent and adult patients. In our series, we could not confirm the prognostic factors found in the adult group for the adolescent patients, except for the stage at diagnosis.

Glutathione S-transferase T1 null polymorphism and the risk for head and neck cancer

CONCLUSIONS

Inter-regional differences in the distribution of genetic polymorphisms in glutathione S-transferases (GSTs) exist, which may have significant effect on the outcome of other GST polymorphism studies. The GSTT1 null genotype appears to be involved in modulation of the risk for head and neck squamous cell carcinoma (HNSCC).

BACKGROUND

The risk of HNSCC is strongly associated with smoking of cigarettes and consumption of alcohol, resulting in a load of toxins/carcinogens. Detoxification of such exogenous harmful compounds often occurs by phase II enzymes such as GSTs. Proper functioning of these enzymes may be deficient due to the presence of particular genetic polymorphisms in these GSTs, and this may increase the risk for HNSCC. We compared the GSTT1, GSTM1 and GSTP1 genotype frequencies in two groups of healthy blood donors, collected from different but adjacent regions in the Netherlands, with those of a group of patients with HNSCC.

SUBJECTS AND METHODS

The GSTM1,GSTT1 and GSTP1 genotype frequencies in two Dutch Caucasian control populations (n = 207 and n = 285) from different but adjacent geographical regions (Maastricht and Nijmegen; distance, 125 km) and 185 patients with HNSCC from the Maastricht region were determined by PCR-related methods.

RESULTS

For the occurrence of the GSTT1 null genotype we found a significant difference (p=0.003) between the two control groups (20.3% vs 33.0% null genotype in the Nijmegen and Maastricht control groups, respectively). Since the HNSCC patients were collected from the Maastricht area, comparison with the Maastricht controls reveals a significant difference for GSTT1 null rates, which are lower in patients vs controls (OR = 0.49, CI = 0.32-0.76).

A randomized trial of an intervention to increase fruit and vegetable intake in curatively treated patients with early-stage head and neck cancer

The leading cause of death in patients who have had curatively treated early-stage head and neck cancer is a second primary cancer of the upper aerodigestive tract (lung, esophagus, larynx, pharynx, and oral cavity cancers). Low fruit and vegetable intake has been associated with increased risk of primary head and neck cancer and the available data suggest that increasing intake following diagnosis may reduce the risk of a second primary cancer. The goal of this study was to develop and test an easily administered intervention to increase fruit and vegetable intake in these patients following diagnosis and treatment. The 6-month intervention was based on the Stage of Change model. Seventy-five early-stage head and neck cancer patients were randomized to either the intervention group or to the "blinded" control group, with diet change data available on 65 patients. Fruit and vegetable intake, assessed using a food frequency questionnaire, and plasma carotenoid concentrations were measured at baseline and at the end of the study period. The change in self-reported intake of fruit and vegetables (servings per day) over the study period was significantly greater (P = 0.009) in the intervention group (n = 35; +2.1) compared with the control group (n = 30; +0.5). Total plasma carotenoids, a biomarker of fruit and vegetable intake, increased by 70 nmol/L in the intervention group as compared with a reduction of 42 nmol/L in the control group, a relative difference of 12% (nonsignificant). An intervention that can be delivered in a physician's office resulted in a significant increase in intake of fruit and vegetables in early-stage head and neck cancer patients.

Risk of selected subsequent carcinomas in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study

PURPOSE

To determine the risk of subsequent carcinomas other than breast, thyroid, and skin, and to identify factors that influence the risk among survivors of childhood cancer.

PATIENTS AND METHODS

Subsequent malignant neoplasm history was determined in 13,136 participants (surviving > or = 5 years postmalignancy, diagnosed from 1970 to 1986 at age < 21 years) of the Childhood Cancer Survivor Study to calculate standardized incidence ratios (SIRs), using Surveillance, Epidemiology, and End Results data.

RESULTS

In 71 individuals, 71 carcinomas were diagnosed at a median age of 27 years and a median elapsed time of 15 years in the genitourinary system (35%), head and neck area (32%), gastrointestinal tract (23%), and other sites (10%). Fifty-nine patients (83%) had received radiotherapy, and 42 (59%) developed a second malignant neoplasm in a previous radiotherapy field. Risk was significantly elevated following all childhood diagnoses except CNS neoplasms, and was highest following neuroblastoma (SIR = 24.2) and soft tissue sarcoma (SIR = 6.2). Survivors of neuroblastoma had a 329-fold increased risk of renal cell carcinomas; survivors of Hodgkin's lymphoma had a 4.5-fold increased risk of gastrointestinal carcinomas. Significantly elevated risk of head and neck carcinoma occurred in survivors of soft tissue sarcoma (SIR = 22.6), neuroblastoma (SIR = 20.9), and leukemia (SIR = 20.9).

CONCLUSION

Young survivors of childhood cancers are at increased risk of developing subsequent carcinomas typical of later adulthood, underscoring the importance of long-term follow-up and risk-based screening. Follow-up of the cohort is ongoing to determine lifetime risk and delineate individual characteristics that contribute to risk.

An assessment of risk factors for the development of a second primary malignancy in the head and neck

This retrospective database study of 44,862 patients who had a history of a primary head and neck malignancy was conducted to identify any clinical variables that may predict the occurrence of a second primary head and neck malignancy. During a mean follow-up of 42.2 months, a second head and neck primary developed in 941 of these patients (2.1%). Statistical analyses revealed that a higher incidence of a second primary was associated with increased age and a location of the first primary in the larynx/hypopharynx, the oropharynx, a major salivary gland, or the nasopharynx. A lower incidence was associated with the presence of cervical nodal disease or treatment of the first primary with radiation therapy. Factors that had no effect on the risk of a second primary included sex, the size of the first primary tumor, a first-primary site in the oral cavity, and treatment of the first primary with cancer-directed surgery. The risk of a second primary head and neck cancer remained constant for at least 10 years.

Population-based analysis of lymphatic mapping and sentinel lymphadenectomy utilization for intermediate thickness melanoma

BACKGROUND AND OBJECTIVES

Lymphatic mapping and sentinel lymphadenectomy (LM/SL) is the nodal staging procedure of choice for patients with intermediate thickness melanoma. We hypothesize that a significant portion of these patients are not undergoing LM/SL. We explore factors that influence use of LM/SL.

METHODS

Analysis was performed of all incident cases of invasive cutaneous melanoma in North Carolina between January 1, 1999 and December 31, 2001.

RESULTS

Three thousand four hundred and thirty-six cases of melanoma were reported for 1999-2001. Two hundred and seventy-three cases (8%) were excluded due to metastases. Nine hundred and sixteen cases (29%) were excluded because the T classification was not reported. Of the remaining cases, 1,242 (55%) were intermediate thickness (T2-3); 48% (596/1,242) underwent LM/SL. Subjects >or=60 years old were less likely to receive LM/SL than subjects <60 years (39% vs. 55.4%, P < 0.001). Subjects with head/neck primary tumors were less likely to receive LM/SL than other subjects (33% vs. 51%, P < 0.001). Subjects with T3 tumors were more likely to receive LM/SL than those with T2 tumors (54% vs. 42%, P < 0.001).

CONCLUSIONS

Half of all patients with intermediate thickness melanoma in North Carolina do not receive LM/SL. Use of LM/SL varies by patient age and primary tumor site. Further investigation is warranted to explore these differences.

Analysis of unknown primary carcinomas metastatic to the neck: diagnosis, treatment, and outcomes

Metastatic squamous cell carcinoma presenting in the neck from an unknown primary site represetns 2% to 6% of head and neck cancers. Optimal management of these cases remains controversial and continues to evolve with experience. We performed a retrospective analysis involving patients treated for unknown primary squamous cell carcinomas with metastases to cervical lymph nodes who presented to either the University of Kentucky or the Veterans Affairs Hospital of Lexington, Kentucky, from 1990 to 2000. Thirty-five out of 173 patients met inclusion criteria for carcinoma of unknown primary. The following data subsets were analyzed: age, gender, smoking and alcohol use, family history, diagnostic studies performed, radiation dose, surgical intervention, number and location of pathologic nodes, presence or absence of extracapsular extension, time between surgery and radiation, disease-specific and overall survival, response to treatment, emergence of a primary tumor, and duration of follow-up. Overall and disease-specific survivals were analyzed using, the Kaplan-Meier method and the log-rank test was used to assess differences in survival curves. The actuarial 5-year overall and disease-specific survival of all patients in this study was 54% and 63%, respectively. At 10 years, the overall survival declined to 37% with a disease-specific survival rate of 49%. The 5-year survival rates stratified by nodal stage were 80% for N1 patients, 64.7% for N2, 55.6% for N3, and 0% for any M disease. These rates declined to 60% for N1, 52.9% for N2, 11.1% for N3, and 0% for any M disease at 10 years (p<.0001). The presence of extracapsular spread, increased number of positive lymph nodes, and eventual discovery of a primary tumor did not significantly decrease survival in this series. The mean follow-up period for patients in this study was 54.8 months. We continue to refine our diagnostic and treatment strategies in this group of patients in an effort to improve long-term survival and reduce patient morbidity.

Cosmetic results of histographically controlled excision of non-melanoma skin cancer in the head and neck region

BACKGROUND

Beside the primary goal of complete eradication, the cosmetic result is an important aspect of the treatment of non-melanoma skin tumors especially in the head and neck region.

PATIENTS AND METHODS

From 1990 to 2000, we treated a total of 5,227 large basal cell carcinomas (BBC) and 1,189 squamous cell carcinomas (SCC) in the head and neck region by surgical excision in 4,239 inpatients at the Department of Dermatology, University of Tübingen. The procedure used in all patients was a conservative excision controlled by complete three dimensional histology of all margins (3D-histology) and specifically targeted follow-up surgery where required (histographic surgery). As part of the prospective tumor follow-up, we asked the treating outdoor physician one and four years later to evaluate the results of our surgical procedures.

RESULTS

Of the 5,565 follow-up questionnaires sent back, 4,868 contained answers regarding the cosmetic result. The data from both answers were pooled. In 1,972 (40,5 %) patients the cosmetic result was evaluated as "excellent", in 1,992 (40,9%) as "good", in 662 (13,6%) as "satisfactory", in 191 (3,9%) as "mediocre" and in 51 (< 1,0%) as "poor". In 697 of the responses, the physician did not comment the cosmetic results or the patient was lost for follow up.

CONCLUSION

With respect to both long term safety and cosmetic outcome, tumor surgery with 3D-histology of excisional margins has set very high quality standards in the treatment of non-melanoma skin cancer of the head and neck area.

Segundos tumores primarios en el cáncer escamoso de cabeza y cuello

INTRODUCTION

The development of second primary tumors (SPT) in patients with head and neck squamous cell carcinoma (HNSCC) has become an increasingly important factor in clinical treatment decisions.

PURPOSE

To define favourable clinical characteristics for overall survival, in patients with SP head and neck cancer.

MATERIAL AND METHOD

Records of 633 patients with SCC treated from 1984 to 2004 were reviewed to describe clinical characteristics of the SPT.

RESULTS

The overall incidence of SPT was 11%. The incidence of the index tumors was as follows: supraglottic cancer 21% and oral cancer 16%. The most common SPT occurred in head and neck area in 47%, lung in 32% and esophagus in 11%. Second primary was associated with a poor 5 years survival in patients with HN-SCC (23 versus 53% in control group).

CONCLUSION

Because of the high rate of second primary tumors, protocols including chemoprophylaxis should be investigated. Prevention and early detection are indicated.

Using cancer registry data for survival studies: the example of the Ontario Cancer Registry

BACKGROUND AND OBJECTIVES

The Ontario Cancer Registry (OCR) is a population-based tumor registry created to provide data for epidemiologic research and for cancer surveillance. Recently it has been used for health services research. The objective of this project was to assess the quality of the OCR data that is used in survival analysis.

METHODS AND DESIGN

Clinical information for 898 patients with squamous carcinoma of the head and neck including index tumor site, date of diagnosis, vital status, date of death, and cause of death from a prospective database at the Kingston Regional Cancer Center is compared to the same data elements in the OCR for the same patients.

RESULTS

There is no statistically significant difference in disease-specific survival between the information from the two databases (log rank P = .89). The OCR captured and correctly assigned index tumor site for 81.4% (detection rate). The site assignment was accurate 90.9% of the time (confirmation rate), there was agreement on vital status (dead vs. alive) for all but one patient, and there was excellent agreement on date of death. However, cause of death (cancer vs. noncancer) based on death certificates had a 31% error rate.

CONCLUSION

Researchers can be confident in the survival analysis generated from data in this registry, but need to be aware of potential sources of error.

Chewing of betel, areca and tobacco: perceptions and knowledge regarding their role in head and neck cancers in an urban squatter settlement in Pakistan

The link of betel, areca and chewable tobacco with head and neck cancers is clearly established. Fifty eight percent of the global head and neck cancers occur in South and Southeast Asia, where chewing of betel, areca and tobacco are common. This study was carried out to establish the pattern of use of Paan, Chaalia, Gutka, Niswar, Tumbaku and Naas among population of squatter settlement of Karachi and to determine the perceptions and knowledge regarding their role in the etiology of head and neck cancers. It was a cross-sectional study, performed at Bilal colony in Karachi. Through systematic sampling, 425 subjects [a male and female from a household] were interviewed with a structured questionnaire. Knowledge regarding etiology of head and neck cancers was classified in ordinals of "good", "some" and "poor", for each substance separately, while practices were classified into "daily user", "occasional user" and "never user". About 40% of the participants were chewing at least one item [betel, areca or tobacco products] on daily basis. This prevalence was 2.46 times higher among males than females and 1.39 times higher among adolescents than adults. At least 79% of the participants were classified as having poor knowledge about the carcinogenicity of each of these items. Knowledge increased with age and level of education. Health hazards of these items were poorly recognized and about 20% perceived at least one of these items to be beneficial. Positive attitudes were seen regarding the steps to curb the production, business and consumption of these substances. In conclusion, prevalence of chewing of betel, areca and tobacco among adults and adolescents is high. Deficiency in knowledge and wrong perception of favorable effect of chewing products is common. Besides curtailing the availability of chewing products, correct knowledge regarding its ill-effects should be inculcated among population to decrease the burden of head and neck cancers.

Clinical phenotype of South African children with neurofibromatosis 1

Forty-eight children with neurofibromatosis 1 presenting between 2000 and 2004 were reviewed for their clinical phenotype, and data were compared with published reports. The median age at presentation was 4 years (range 10 days to 12 years). The male to female ratio was similar (22 male:26 female). There were frequencies of café au lait spots, axillary freckling, Lisch nodules, and new mutations comparable to those cited in the literature. Fewer patients had neurofibromas (4%), but more patients had plexiform neurofibromas of the head and neck (16%). Three patients of the 22 who had neuroimaging had optic gliomas (14%). The most consistent disability, with maximum impact, related to the patient's cognitive level of functioning. School problems, defined as learning and behavioral problems observed in the classroom, were reported in 70% of school-aged children (n = 21), compared with international figures of 29.8% to 45%. This high prevalence has reinforced the clinic service policy of formal neuropsychology assessments in all children with reported school problems. In addition, earlier referral of children to the service (preschool n = 18) has enabled formal developmental assessments and planning of specific educational placement to optimize learning. This is the first description of the neurofibromatosis 1 phenotype from the African continent. The multidisciplinary approach to management has proved beneficial in the South African context. The combined clinic has resulted in a holistic approach to patient care, early detection of pathology, consistent therapies across the specialties, and better patient attendance and compliance. (J Child Neurol 2006;21:63-70).

Cardiovascular and respiratory complications after major head and neck surgery

BACKGROUND

Our aim was to gain insight into the incidence rates for, distribution of, and risk factors of postoperative cardiovascular and respiratory complications in major head and neck surgery.

METHODS

We performed a retrospective review of 469 patients who had undergone primary major head and neck surgery. Outcome measures were incidence rates, risk factors, and distribution over time for postoperative cardiovascular and respiratory complications. A multivariate analysis was performed.

RESULTS

The incidence rates for cardiovascular and respiratory complications were 57 of 469 (12%) and 50 of 469 (11%), respectively. The incidence rate for heart failure exceeded that for pneumonia. The peak incidence for cardiovascular complications was on the first postoperative day; for respiratory complications, on the second postoperative day. Risk factors for cardiovascular complications were age, pulmonary disease, alcohol abuse, and tumor location; risk factors for respiratory complications were pulmonary disease, previous myocardial infarction, and American Society of Anesthesiologists (ASA) grade.

CONCLUSION

In this study, the incidence rates for cardiovascular and respiratory complications were very similar. The first postoperative day was crucial with regard to cardiovascular complications. Age and chronic pulmonary diseases were the common risk factors for cardiovascular and respiratory complications.

[Current trends in head and neck squamous cell carcinomas]

Squamous cell carcinomas of the head and neck remain frequent in France with an evolving epidemiology. Progress was observed both in diagnostic and treatments. Increasing possibilities of curative treatment should be provided within next years through surgery, radiotherapy, chemotherapy and target therapies as well as high performance imaging modalities and molecular biology and tumoral markers. Surgical techniques have improved function preservation while non surgical means have increased efficacy through chemo-radiotherapy. Assessment of optimal sequential therapeutic strategies is required, including both oncologic efficacy and quality of life.

Melanoma: etiology, treatment, and dental implications

Melanoma is one of the most serious skin cancers. It arises from neural crest-derived melanocytes located in the epidermis or dermis of the skin. Melanoma also can arise from melanocytes located in other regions of the body such as the eye, meninges, digestive tract, mucosal surfaces, or lymph nodes. There are no proven causes of melanoma but the most commonly associated factor is episodic exposure to the sun. Melanoma is a common cancer that has been increasing in incidence for the last 35 years. The median age at the time of diagnosis is 53 years. It is much more common in whites than in people of color. Five-year survival rates for melanoma of the skin have been increasing since 1976. There are four types of melanoma: superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lintiginous melanoma. Clinical signs indicating possible melanoma are asymmetry, border irregularity, color variation, increase in diameter, elevation, ulceration, and bleeding of pigmented lesions. Histopathologic findings (tumor thickness, tumor invasion), surface ulceration, spread to lymph nodes, and distant metastases are used to project patient prognosis. Treatment consists of surgical excision, lymph node dissection, limb perfusion, regional chemotherapy infusion, radiation, intralesional immunotherapy, systemic chemotherapy, and/or interferon-alpha, depending on the staging of the melanoma. Oral melanomas are rare; however, approximately 20% of all melanomas are found in the head and neck region. The role of the dentist is to be alert for changes in pigmented lesions of the oral mucosa and skin of the head and neck. Lesions suspected of melanoma must be biopsied, which usually involves referral of the patient.

Facial disfigurement in patients with head and neck cancer: The role of social self-efficacy

This study investigated the moderating role of social self-efficacy (i.e., the belief that one is capable of exercising control over the reactions and openness of other people) with respect to the link between facial disfigurement and psychological and n = 76) as well as their physicians. In line with the hypotheses, the results revealed that the degree of facial disfigurement, as judged by patients as well as their physicians, was positively related to psychological distress and distress in reaction to unpleasant behavior of others, but only when patients did not feel self-efficacious in social encounters. Furthermore, social self-efficacy mitigated the positive link between facial disfigurement as judged by patients and social isolation.

Trends of head and neck cancers in urban and rural India

BACKGROUND

The sub-site predilection of head and neck squamous cell carcinoma (HNSCC) reflects the risk profile of a community and there are suggestions that these are changing over time.

OBJECTIVE

To determine the change in head and neck cancer in rural and urban populations in India.

METHODS

Cancer registry data of an urban and a rural population were reviewed over a period of 13 and 11 years, respectively. Age adjusted rates (AAR) and age specific incidence rates were used for data analysis.

RESULTS

Oral cancers formed the majority of the head and neck cancers with a predilection for tongue, except in rural males, in whom the pharynx was the predominant sub-site. Overall there was a reduction in the incidence of HNSCC, which was more pronounced in urban females and rural males (p< .001). Among the sub-sites, oral cavity cancers showed a decreasing trend in urban females (p< .01) and rural males (p< .01). However, the trend was towards increase of incidence of tongue cancers. Pharyngeal cancer showed reduction in urban females (p< .01), whereas it increased in rural females. The recent increase in incidence of young adults with HNSCC reported in developed countries was not observed.

CONCLUSIONS

Overall, incidence of HNSCC is reducing. This may be attributed to the decreased prevalence of tobacco use. The increase in incidence of tongue cancer may suggest factors other than tobacco and alcohol in its genesis.

Oral health needs of the head and neck radiotherapy patient: 1. Epidemiology, effects of radiotherapy and role of the GDP in diagnosis

Head and neck cancer represents a heterogeneous group of neoplasms affecting a number of sites in the aerodigestive tract, histologically primarily epithelial in type. Most are sensitive to a treatment regime of ablative surgery followed by radiotherapy. The incidence in Ireland of head and neck cancers is approximately 11.8 per 100,000 population and is the 8th commonest cancer in males and the 16th in females. Many of these cancers will manifest with oral signs and symptoms thus placing the GDP in the unique position of being able to detect and positively influence outcomes: the GDP also has a vital, proactive role to play in supportive care before, during and following surgery and radiotherapy.

CLINICAL RELEVANCE

The aim of this paper is to review the rationale for the different treatment modalities and the oral/dental side-effects of each.

Polymorphisms of methionine synthase and methionine synthase reductase and risk of squamous cell carcinoma of the head and neck: a case-control analysis

Although tobacco and alcohol use are the major risk factors, folate deficiency has been implicated in the risk of squamous cell carcinoma of the head and neck (SCCHN). We hypothesized that polymorphisms of methionine synthase (MTR) and methionine synthase reductase (MTRR) in the folate metabolic pathway are associated with SCCHN risk. In a hospital-based case-control study of 721 SCCHN cases and 1,234 controls of non-Hispanic Whites, frequency matched by age, sex, and smoking status, we genotyped the MTR A2756G and MTRR G66A polymorphisms. We found that the MTR variant AG and AG/GG genotypes were associated with a significantly increased SCCHN risk [adjusted odd ratio (OR), 1.31; 95% confidence interval (95% CI), 1.07-1.60 for AG and OR, 1.28; 95% CI, 1.05-1.56 for AG/GG] compared with the AA genotype. In contrast, the MTRR variant AA genotype was associated with a significantly decreased SCCHN risk (OR, 0.68; 95% CI, 0.52-0.90) compared with the 66GG genotype. When the two polymorphisms were evaluated together by the number of risk alleles, the SCCHN risk was significantly increased in a dose-dependent manner (P(trend) = 0.002). The risk of SCCHN was 1.47 (95% CI, 1.08-1.99) for one risk allele, 1.67 (95% CI, 1.23-2.27) for two risk alleles, and 1.74 (95% CI, 1.18-2.54) for three or four risk alleles compared with the wild-type (0 risk allele) genotype. In conclusion, our data provide evidence that support the association between the MTR A2756G and MTRR G66A polymorphisms and SCCHN risk and that these two polymorphisms may have a joint effect on risk of SCCHN.

Second primary malignancy of the aerodigestive tract in patients treated for cancer of the oral cavity and larynx

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.

Predictors and prevalence of paraganglioma syndrome associated with mutations of the SDHC gene

CONTEXT

Paraganglioma syndrome includes inherited head and neck paragangliomas (HNPs) and adrenal or extra-adrenal pheochromocytomas and are classified according to the susceptibility genes SDHB, SDHC, and SDHD. In contrast with those with germline mutations of the SDHB and SDHD genes, clinical and genetic data on patients with mutations of SDHC are scarce.

OBJECTIVE

To determine the prevalence and clinical characteristics of SDHC mutation carriers compared with patients with SDHB and SDHD mutations and with sporadic cases.

DESIGN, SETTING, AND PATIENTS

Genetic screening for SDHC mutations in an international HNP registry of 121 unrelated index cases and in 371 sporadic cases from a pheochromocytoma registry, conducted January 1, 2001, until December 31, 2004. Identified index cases and affected relatives were clinically evaluated.

MAIN OUTCOME MEASURES

Prevalence of and clinical findings for SDHC mutation-associated HNPs vs those with SDHB and SDHD mutations.

RESULTS

The prevalence of SDHC carriers was 4% in HNP but 0% in pheochromocytoma index cases. None of the SDHC mutation carriers had signs of pheochromocytoma. We compared HNPs in 22 SDHC mutation carriers with the HNPs of SDHB (n = 15) and SDHD (n = 42) mutation carriers and with 90 patients with sporadic HNPs. Location, number of tumors, malignancy, and age were different: more carotid body tumors were found in SDHC (13/22 [59%]) than in sporadic HNPs (29/90 [32%], P = .03), as well as fewer instances of multiple tumors in SDHC (2/22) than in SDHD (24/42; P<.001), 0 malignant tumors in SDHC vs 6/15 in SDHB (P = .002), and younger age at diagnosis in SDHC than in sporadic HNPs (45 vs 52 years; P = .03).

CONCLUSIONS

Patients with HNP, but not those with pheochromocytoma, harbor SDHC mutations in addition to those in SDHB and SDHD. In total, more than one quarter of HNP patients carry a mutation in 1 of these 3 genes. Head and neck paragangliomas associated with SDHC mutations are virtually exclusively benign and seldom multifocal. Analysis for germline mutations of SDHC is recommended in apparently sporadic HNP to identify risk of inheritance.