Squamous carcinoma of the larynx and hypopharynx in children: a distinct clinical entity?

Pediatric head and neck squamous cell carcinoma: Patient demographics, treatment trends and outcomes

OBJECTIVES

To examine patient demographics, temporal and treatment trends, and survival outcomes of pediatric non-nasopharyngeal head and neck squamous cell carcinomas using the National Cancer Database.

METHODS

The National Cancer Database was queried for pediatric patients (age 0-19 years) diagnosed with squamous cell carcinoma of the head and neck (including oral cavity, oropharynx, nasal cavity, larynx, hypopharynx, and salivary glands) from 2004 to 2013.

RESULTS

Of 159 patients identified, the majority had oral cavity SCC (55%). There was no discernable change in incidence trends over the study period with the number of cases per year ranging from 10 to 20 (R² = 0.174). The predominant treatment regimen for the nasal cavity was trimodality (surgery, radiation, and chemotherapy) treatment (29%), chemotherapy and radiation for the oropharynx (40%), and surgery alone for salivary gland (47%), oral cavity (44%), and larynx (22%). The 5-year overall survival for the entire cohort was 74% and by subsite: oral cavity (66%), oropharynx (68%), nasal cavity (75%), and larynx (95%). Laryngeal disease had statistically significant longer survival when compared to oral cavity (p = .031) or oropharynx (p = .029).

CONCLUSION

Although pediatric non-nasopharyngeal head and neck squamous cell carcinomas are rare, practitioners should be aware of this entity and consider it in the differential diagnosis of pediatric malignancies.

Pediatric laryngeal cancer with 5-year follow up: case report

Larynx cancer is the commonest malignancy of upper aerodigestive tract. However, laryngeal cancer is extremely rare in childhood since these tumors are generally not suspected in the differential diagnosis of hoarseness, dysphagia and/or progressive airway obstruction in children; diagnosis can be made relatively late. In this report we would like to present a case of advanced stage pediatric laryngeal carcinoma who was treated with chemoradiotherapy and remained well on her 5-year follow-up.

Squamous carcinoma of the hypopharynx in children in Sénégal: between disarray and enigma

INTRODUCTION

The squamous carcinoma of the hypopharynx constitutes the first reason of hospitalization in our department. Different studies have been realized about it and showed an epidemiological profile characterized by the young age of the patients and the predominance of female.

OBJECTIVES

To specify the place of the children in hypopharynx cancers. To evaluate the epidemiological criteria and the difficulties in the management.

MATERIALS AND METHODS

Retrospective study of 11 years (1995-2005). Collection of the data concerning the epidemiology, clinical and paraclinical findings, the treatment, and the evolution was carried out at the University Department of Otorhinolaryngology in Dakar (Sénégal).

RESULTS

15 charts of children have been collected. They presented in the majority of the cases, an advanced cancer, with 93% of T3T4. The lesion was localized at the retro-cricoid area in 4 cases, the pyriform sinus in 3 cases, the oesophagus junction in 2 cases, and the posterior wall in 1 case. In 5 cases the lesion was spreading to the totality of the hypopharynx. No case of smoking or alcohol has been noted. The anemia has been noted in 86.7% of the cases. A case of papillomatosis of the mouth and lips has been noted. The treatment was for most of cases as symptomatic, like tracheotomy with or without gastrostomy. The evolution was fatal with 11 deaths (73.33%).

DISCUSSION

Our set is the richest set through the world of hypopharyngeal cancers in children. The Plummer-Vinson syndrome noted in 86.7% of the cases and the viral infection by HPV could play a role in the genesis of this cancer.

CONCLUSION

The cancer of the hypopharynx essentially affects the young women in Sénégal without alcohol or tobacco consumption. It does not save the children, with an awful prognosis, however. So, it is imperative to organize a vast campaign of information of the populations on the bad prognosis of this cancer and to lead a large-scale epidemiological investigation, to get a better understanding of this cancer in our country.

Hypopharyngeal cancer

Hypopharyngeal cancers are usually squamous cell carcinomas (SCCs) that has the worst prognosis among the head and neck cancers. Overall, 5-year survival rate remains poor despite recent improvements in diagnostic imaging, radiation and chemotherapy, and improved surgical techniques. Hypopharyngeal cancers tend to present with advanced primary disease, and nodal metastasis is highly likely. The most important features determining prognosis are the size and extent of local spread of the primary carcinoma and the extent of involvement of regional lymph nodes. Distant metastasis at presentation is more common in hypopharyngeal cancers than in other head and neck cancers. Poor survival rate is partly due to emergence of second primary cancers but also to development of distant metastasis. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) remain the mainstay of initial radiological evaluation of hypopharyngeal cancer. Imaging usually results in upstaging of the tumor at presentation. Meticulous evaluation of the extent of the primary tumor with attention to spread to the subsites of the hypopharynx, larynx, and cartilage invasion are necessary for accurate staging. After surgery and radiation therapy, it is difficult with CT and MR to differentiate residual and recurrent tumor from edema and scarring. Fluorine 18-fluoro-deoxy-glucose -positron emission tomography (FDG-PET) has high sensitivity in detection of occult, residual, and recurrent tumors but has low specificity. Combined PET and CT increase specificity and are increasingly being used to image posttreatment cases. Other newer imaging modalities such as diffusion-weighted imaging (DWI), MR spectroscopy, and MRI with superparamagnetic iron oxide (SPIO) contrast agent are reported to be useful and should be used more widely in difficult cases.

Hypopharyngeal squamous cell carcinoma in a child

Squamous cell carcinoma of the hypopharynx is extremely rare in children. We present a 13-year-old girl with squamous cell carcinoma of the hypopharynx whose father was a coal-miner and a heavy smoker.