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Epidemiological, Clinical, and Genomic Profile in Head and Neck Cancer Patients and Their Families. Biomedicines 2022; 10:biomedicines10123278. [PMID: 36552033 PMCID: PMC9775590 DOI: 10.3390/biomedicines10123278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Inherited cancer predisposition genes are described as risk factors in head and neck cancer (HNC) families. To explore the clinical and epidemiological data and their association with a family history of cancer, we recruited 74 patients and 164 relatives affected by cancer. The germline copy number alterations were evaluated in 18 patients using array comparative genomic hybridization. Two or more first-degree relatives with HNC, tobacco-associated tumor sites (lung, esophagus, and pancreas), or other related tumors (breast, colon, kidney, bladder, cervix, stomach carcinomas, and melanoma) were reported in 74 families. Ten index patients had no exposure to any known risk factors. Family members presented tumors of 19 topographies (30 head and neck, 26 breast, 21 colon). In first-degree relatives, siblings were frequently affected by cancer (n = 58, 13 had HNC). Breast cancer (n = 21), HNC (n = 19), and uterine carcinoma (n = 15) were commonly found in first-degree relatives and HNC in second-degree relatives (n = 11). Nineteen germline genomic imbalances were detected in 13 patients; three presented gains of WRD genes. The number of HNC patients, the degree of kinship, and the tumor types detected in each relative support the role of heredity in these families. Germline alterations may potentially contribute to cancer development.
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Jeong AR, Forbes K, Orosco RK, Cohen EEW. Hereditary oral squamous cell carcinoma associated with CDKN2A germline mutation: a case report. J Otolaryngol Head Neck Surg 2022; 51:5. [PMID: 35123577 PMCID: PMC8818223 DOI: 10.1186/s40463-022-00556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 01/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Germline CDKN2A mutations are a well-known cause of familial atypical multiple mole melanoma (OMIM #155601) and melanoma-pancreatic cancer syndrome (OMIM #606719). Increased risk of head and neck squamous cell carcinoma (HNSCC), particularly oral squamous cell carcinoma (OSCC) in those with germline CDKN2A mutations, has been described. However, screening for HNSCC is not a routine practice in patients with CDKN2A germline mutations and these mutations are not a conventional test for HNSCC patients without obvious risk factors. CASE PRESENTATION We describe a female with no smoking history who developed oral squamous cell carcinoma at age 39 and had a complex clinical course of recurrent multifocal squamous cell carcinoma (SCC) and carcinoma in situ of the oral cavity and oropharynx. Detailed family history demonstrated that her mother was diagnosed with OSCC and melanoma in her 40 s, and her maternal grandfather was diagnosed with metastatic melanoma in his 40 s. Genetic testing of the patient and her mother revealed CDKN2A c.301G>T mutation. She was referred to genetic counseling as well as to dermatology, gastroenterology, and neurology for cancer surveillance. She was treated with resections and has no evidence of disease 3 years after diagnosis. CONCLUSIONS We report a family with a CDKN2A c.301 G>T mutation who also have significant history of OSCC, adding to the growing body of literature suggesting increased risk of HNSCC, particularly OSCC, in CDKN2A germline mutation carriers. It is important to consider CDKN2A mutation testing in familial HNSCC and young patients without obvious risk factors. Moreover, surveillance for HNSCC should be routine practice in those with a CDKN2A germline mutation.
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Affiliation(s)
- Ah-Reum Jeong
- Division of Hematology and Oncology, Department of Medicine, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093-0960, USA
| | - Kimberly Forbes
- Division of Hematology and Oncology, Department of Medicine, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093-0960, USA
| | - Ryan K Orosco
- Division of Otolaryngology, Department of Surgery, University of California San Diego, La Jolla, CA, 92093, USA.,Moores Cancer Center, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ezra E W Cohen
- Division of Hematology and Oncology, Department of Medicine, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093-0960, USA. .,Moores Cancer Center, University of California San Diego, La Jolla, CA, 92093, USA.
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Chan SH, Chiang J, Ngeow J. CDKN2A germline alterations and the relevance of genotype-phenotype associations in cancer predisposition. Hered Cancer Clin Pract 2021; 19:21. [PMID: 33766116 PMCID: PMC7992806 DOI: 10.1186/s13053-021-00178-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/15/2021] [Indexed: 02/08/2023] Open
Abstract
Although CDKN2A is well-known as a susceptibility gene for melanoma and pancreatic cancer, germline variants have also been anecdotally associated with a broader range of neoplasms including neural system tumors, head and neck squamous cell carcinomas, breast carcinomas, as well as sarcomas. The CDKN2A gene encodes for two distinct tumor suppressor proteins, p16INK4A and p14ARF, however, the independent association of germline alterations affecting these two proteins with cancer is under-appreciated. Here, we reviewed CDKN2A germline alterations reported among individuals and families with cancer in the literature, specifically addressing the cancer phenotypes in relation to the molecular consequence on p16INK4A and p14ARF. While melanoma is observed to associate with variants affecting both p16INK4A and p14ARF transcripts, it is noted that variants affecting p14ARF are more frequently observed with a heterogenous range of cancers. Finally, we reflected on the implications of this inferred genotype-phenotype association in clinical practice and proposed that clinical management of CDKN2A germline variant carriers should involve dedicated cancer genetics services, with multidisciplinary input from various healthcare professionals.
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Affiliation(s)
- Sock Hoai Chan
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
| | - Jianbang Chiang
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore.
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, 169857, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore.
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Padua PF, Lin CC, Chien HT, Young CK, Kuo CF, See LC, Luo SF, Huang LH, Huang SF. Familial Aggregation of Head and Neck Cancer in Taiwan. Laryngoscope 2020; 131:806-812. [PMID: 32820835 DOI: 10.1002/lary.28992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/02/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Head and neck cancer (HNC) incidence has been increasing worldwide. We investigated the familial aggregation of developing HNC if a first-degree relative (FDR) is affected in a large database. METHODS This retrospective study utilized Taiwan National Health Insurance Database to assemble a cohort of all registered beneficiaries from 1997 to 2013 and identified diagnosed HNC patients with affected FDRs. RESULTS Of the 55,916 individuals diagnosed with HNC, 566 (1.01%) had affected FDRs. There were 525 (0.56%) males and 41 (0.05%) females. Age of onset of HNC was found to be earlier for those with an affected FDR at the fourth decade of life compared to the general population. The adjusted relative risks (RRs) of an individual with an affected FDR to develop HNC is 2.04 (95% confidence interval [CI], 1.85-2.26): 2.07 (95% CI, 1.88-2.29) if the affected relative was male, and 1.74 (95% CI, 1.31-2.30) if the affected relative was female. The greatest risk to develop HNC is if the affected individual is a twin with adjusted RR 33.04 (95% CI, 12.89-84.69). This is followed by an affected sibling at RR (95% CI) 3.46 (1.68-7.13), offspring at RR 2.28 (95% CI, 1.94-2.69), and parent at RR 1.66 (95% CI, 1.48-1.87). CONCLUSION Familial tendency of HNC proves the probable contribution of genetic factors to develop cancer. In areca quid endemic region, there is a high likelihood that both environmental and genetic factors work in synergy to develop HNC. LEVEL OF EVIDENCE 3 Laryngoscope, 131:806-812, 2021.
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Affiliation(s)
- Paula Francezca Padua
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial, Linkou branch, Taoyuan, Taiwan
| | - Chia-Chen Lin
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial, Linkou branch, Taoyuan, Taiwan
| | - Hui-Tzu Chien
- Department of Nutrition and Health Sciences, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Chi-Kuan Young
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial, Keelung branch, Keelung, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lu-Hsiang Huang
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial, Linkou branch, Taoyuan, Taiwan.,Department of Public Health, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
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5
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Bertonha FB, Barros Filho MDC, Kuasne H, Dos Reis PP, da Costa Prando E, Muñoz JJAM, Roffé M, Hajj GNM, Kowalski LP, Rainho CA, Rogatto SR. PHF21B as a candidate tumor suppressor gene in head and neck squamous cell carcinomas. Mol Oncol 2015; 9:450-62. [PMID: 25454821 PMCID: PMC5528662 DOI: 10.1016/j.molonc.2014.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/22/2014] [Accepted: 09/23/2014] [Indexed: 01/12/2023] Open
Abstract
A significant association between DNA losses on 22q13.31 and head and neck squamous cell carcinomas (HNSCC) was previously reported by our group. Our data indicated that PHF21B gene, mapped on 22q13.31 and encoding a protein with function of chromatin-mediated transcriptional regulation, might be a putative tumor suppressor gene. To test this hypothesis, gene copy number was assessed in 75 HNSCC and 49 matched peripheral blood samples. PHF21B losses were detected in 43 tumors and were significantly associated with patients with familial history of cancer (P < 0.0001); i.e., 36/43 cases showed a positive family history of cancer and 22/36 had first-degree relatives with cancer (P = 0.049). In attempt to investigate other mechanisms for PHF21B loss of function, DNA sequencing was performed and no mutations were detected. We next evaluated the gene expression levels after inhibition of DNA methylation in nine HNSCC and breast carcinoma cell lines. Additionally, PHF21B expression levels were evaluated in colon cancer HCT116 cells as well as in its counterpart DKO (double knockout of DNMT1 and DNMT3B). The higher expression levels of PHF21B gene detected in DKO cells were inversely correlated with the DNA methylation. Further, DNA methylation in the specific promoter-associated CpG Island was investigated. Interestingly, gene hypermethylation was detected in 13/37 tumors: 5/13 HNSCC cases had family history of cancer in first-degree relatives and 8/13 showed both, DNA methylation and PHF21B losses in the tumor sample. One patient had PHF21B loss in the peripheral blood cells and PHF21B methylation in the tumor sample. Additionally, overexpression of PHF21B in cell lines drastically reduces clonogenic and migratory abilities. These data suggest that PHF21B is a novel tumor suppressor gene that can be inactivated by genetic and epigenetic mechanisms in the human cancer.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Cell Line, Tumor
- Chromosomes, Human, Pair 22/genetics
- Chromosomes, Human, Pair 22/metabolism
- DNA Methylation
- DNA, Neoplasm/genetics
- DNA, Neoplasm/metabolism
- Epigenesis, Genetic
- Female
- Gene Expression Regulation
- Gene Knockdown Techniques
- Head and Neck Neoplasms/genetics
- Head and Neck Neoplasms/metabolism
- Head and Neck Neoplasms/pathology
- Humans
- Male
- Middle Aged
- Retrospective Studies
- Tumor Suppressor Proteins/biosynthesis
- Tumor Suppressor Proteins/genetics
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Affiliation(s)
- Fernanda Bernardi Bertonha
- International Center of Research and Training (CIPE), A. C. Camargo Cancer Center, Sao Paulo, SP 01.508-010, Brazil.
| | | | - Hellen Kuasne
- International Center of Research and Training (CIPE), A. C. Camargo Cancer Center, Sao Paulo, SP 01.508-010, Brazil.
| | - Patricia Pintor Dos Reis
- Department of Surgery and Orthopedics, Faculty of Medicine, UNESP - Sao Paulo State University, Botucatu, SP 18.618-970, Brazil.
| | - Erika da Costa Prando
- Department of Genetics, Institute of Biosciences, UNESP - Sao Paulo State University, Botucatu, SP 18.618-970, Brazil.
| | | | - Martín Roffé
- International Center of Research and Training (CIPE), A. C. Camargo Cancer Center, Sao Paulo, SP 01.508-010, Brazil.
| | - Glaucia Noeli Maroso Hajj
- International Center of Research and Training (CIPE), A. C. Camargo Cancer Center, Sao Paulo, SP 01.508-010, Brazil.
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A. C. Camargo Cancer Center, Sao Paulo, SP 01.508-010, Brazil; National Institute of Science and Technology in Oncogenomics (INCITO), Sao Paulo, SP 01.509-010, Brazil.
| | - Claudia Aparecida Rainho
- Department of Genetics, Institute of Biosciences, UNESP - Sao Paulo State University, Botucatu, SP 18.618-970, Brazil.
| | - Silvia Regina Rogatto
- International Center of Research and Training (CIPE), A. C. Camargo Cancer Center, Sao Paulo, SP 01.508-010, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, A. C. Camargo Cancer Center, Sao Paulo, SP 01.508-010, Brazil; Department of Urology, Faculty of Medicine, UNESP - Sao Paulo State University, Botucatu, SP 18.618-970, Brazil.
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6
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Genetic Susceptibility to Head and Neck Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2014; 89:38-48. [DOI: 10.1016/j.ijrobp.2013.09.034] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 01/28/2023]
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Aro K, Klockars T, Leivo I, Mäkitie A. Familial predisposition for salivary gland cancer in Finland. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2014; 7:7-11. [PMID: 24701124 PMCID: PMC3972079 DOI: 10.4137/cment.s13770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/02/2014] [Accepted: 02/06/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Salivary gland cancer (SGC) accounts for 3–5% of head and neck malignancies, and register-based studies estimate the familial proportion to be 0.15%. OBJECTIVE We studied familial predisposition for SGC in the genetically distinct Finnish population. PATIENTS AND METHODS We sent a patient questionnaire to 161 Finnish SGC patients, 86 of whom responded. RESULTS A total of 76% of the patients reported having one or more relatives with cancer, 30% two or more, and 9% three or more but only one patient reported having a relative with SGC. Tracing the birthplaces of the SGC patients’ grandparents showed no regional clustering suggestive of a founder effect. CONCLUSIONS Lack of familial SGC patients and the absence of a founder effect strongly suggest that familial predisposition for SGC is insignificant in the Finnish population. Various histological subtypes and the rarity of these neoplasms make it impossible to draw conclusions about site-specific association between SGC and other malignancies.
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Affiliation(s)
- Katri Aro
- Deparment of Otolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Tuomas Klockars
- Deparment of Otolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Ilmo Leivo
- Department of Pathology, University of Turku, Turku, Finland
| | - Antti Mäkitie
- Deparment of Otolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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8
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Scheckenbach K, Baldus SE, Balz V, Freund M, Pakropa P, Sproll C, Schäfer KL, Wagenmann M, Schipper J, Hanenberg H. RAD51C--a new human cancer susceptibility gene for sporadic squamous cell carcinoma of the head and neck (HNSCC). Oral Oncol 2013; 50:196-9. [PMID: 24315737 DOI: 10.1016/j.oraloncology.2013.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 10/28/2013] [Accepted: 11/13/2013] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Head and neck squamous cell carcinomas (HNSSCs) are one of the leading causes of cancer-associated death worldwide. Although certain behavioral risk factors are well recognized as tumor promoting, there is very little known about the presence of predisposing germline mutations in HNSCC patients. METHODS In this study, we analyzed 121 individuals with HNSCCs collected at our institution for germline alterations in the newly identified cancer susceptibility gene RAD51C. RESULTS Sequencing of all exons and the adjacent introns revealed five distinct heterozygous sequence deviations in RAD51C in seven patients (5.8%). A female patient without any other risk factors carried a germline mutation that disrupted the canonical splice acceptor site of exon 5 (c.706-2A>G). CONCLUSIONS As there are only a few publications in the literature identifying germline mutations in head and neck cancer patients, our results provide the first indication that paralogs of RAD51, recently described as mutated in breast and ovarian cancer patients, might also be candidates for genetic risk factors in sporadic squamous cell carcinomas of the head and neck.
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Affiliation(s)
- Kathrin Scheckenbach
- Department of Otorhinolaryngology, Head and Neck Surgery, Heinrich Heine University, 40225 Düsseldorf, Germany.
| | - Stephan E Baldus
- Department of Pathology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Vera Balz
- Department of Otorhinolaryngology, Head and Neck Surgery, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Marcel Freund
- Department of Otorhinolaryngology, Head and Neck Surgery, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Petra Pakropa
- Department of Otorhinolaryngology, Head and Neck Surgery, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Christoph Sproll
- Department of Cranio-and-Maxillo Facial Surgery, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Karl-Ludwig Schäfer
- Department of Pathology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Martin Wagenmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Jörg Schipper
- Department of Otorhinolaryngology, Head and Neck Surgery, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Helmut Hanenberg
- Department of Otorhinolaryngology, Head and Neck Surgery, Heinrich Heine University, 40225 Düsseldorf, Germany; Pediatric Hematology/Oncology, Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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9
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Genome stability pathways in head and neck cancers. Int J Genomics 2013; 2013:464720. [PMID: 24364026 PMCID: PMC3834617 DOI: 10.1155/2013/464720] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 09/19/2013] [Accepted: 09/20/2013] [Indexed: 12/12/2022] Open
Abstract
Genomic instability underlies the transformation of host cells toward malignancy, promotes development of invasion and metastasis and shapes the response of established cancer to treatment. In this review, we discuss recent advances in our understanding of genomic stability in squamous cell carcinoma of the head and neck (HNSCC), with an emphasis on DNA repair pathways. HNSCC is characterized by distinct profiles in genome stability between similarly staged cancers that are reflected in risk, treatment response and outcomes. Defective DNA repair generates chromosomal derangement that can cause subsequent alterations in gene expression, and is a hallmark of progression toward carcinoma. Variable functionality of an increasing spectrum of repair gene polymorphisms is associated with increased cancer risk, while aetiological factors such as human papillomavirus, tobacco and alcohol induce significantly different behaviour in induced malignancy, underpinned by differences in genomic stability. Targeted inhibition of signalling receptors has proven to be a clinically-validated therapy, and protein expression of other DNA repair and signalling molecules associated with cancer behaviour could potentially provide a more refined clinical model for prognosis and treatment prediction. Development and expansion of current genomic stability models is furthering our understanding of HNSCC pathophysiology and uncovering new, promising treatment strategies.
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Cabanillas R, Astudillo A, Valle M, de la Rosa J, Álvarez R, Durán NS, Cadiñanos J. Novel germline CDKN2A mutation associated with head and neck squamous cell carcinomas and melanomas. Head Neck 2011; 35:E80-4. [PMID: 22083977 DOI: 10.1002/hed.21911] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2011] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The ability to identify individuals at increased risk of cancer is of immediate clinical relevance. Germline mutations in the CDKN2A locus, encoding the key tumor suppressor proteins p16/INK4A and p14/ARF, are frequently present in kindreds with hereditary cutaneous melanoma but have seldom been reported in families with genetic susceptibility to head and neck squamous cell carcinomas (HNSCC). METHODS We report the pedigree of a patient with an unusually high incidence of HNSCC and melanomas. CDKN2A mutation analysis was performed with standard capillary sequencing and multiplex ligation-dependent probe amplification. RESULTS A previously unreported germline CDKN2A mutation affecting only the p16/INK4A open reading frame, c.106delG (p.Ala36ArgfsX17), was detected in the proband. This mutation causes a premature termination codon. CONCLUSIONS Our report emphasizes the need to consider germinal CDKN2A mutations in the differential diagnosis of familial HNSCC and the importance of awareness of these tumors in carriers of CDKN2A mutations.
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Affiliation(s)
- Rubén Cabanillas
- Instituto de Medicina Oncológica y Molecular de Asturias, Asturias, Spain.
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11
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da Silva SD, Ferlito A, Takes RP, Brakenhoff RH, Valentin MD, Woolgar JA, Bradford CR, Rodrigo JP, Rinaldo A, Hier MP, Kowalski LP. Advances and applications of oral cancer basic research. Oral Oncol 2011; 47:783-91. [PMID: 21802978 DOI: 10.1016/j.oraloncology.2011.07.004] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 07/01/2011] [Accepted: 07/05/2011] [Indexed: 12/19/2022]
Abstract
Cancer of the oral cavity accounts for almost 3% of cancer cases in the world. The incidence varies widely reflecting geographic differences in exposure to risk factors. The recent rise in younger age groups and females seen in many countries is of particular concern. Treatment and management of complications, locoregional recurrence and further primary tumors result in high morbidity and mortality especially when the disease is advanced stage at initial diagnosis. Progress in cancer research has provided abundant new knowledge about cellular processes and molecular biology underlying oral carcinogenesis and tumor progression. The present review attempts to summarize the current most widely-used research approaches and their application in the prevention, diagnosis, effective treatment, and improved outcome of oral cancer.
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Affiliation(s)
- Sabrina Daniela da Silva
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Canada
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12
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Searching for metachronous tumours in patients with head and neck cancer: the ideal protocol! Curr Opin Otolaryngol Head Neck Surg 2010; 18:124-33. [PMID: 20234214 DOI: 10.1097/moo.0b013e3283374ccf] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW As treatment changes in the management of head and neck cancer, patients are reportedly living longer; therefore, their death may be due to comorbidity, metastatic disease or the development of a metachronous second primary tumour (MSPT). This review describes recent developments in the identification of MSPTs of head and neck cancer, oesophagus and lung, and suggests/recommends an 'ideal surveillance protocol'. RECENT FINDINGS The rate of MSPT development ranges between 6 and 9% annually for life. Improved accuracy in the detection of mucosal asymptomatic premalignant and early cancer has been enhanced by incorporating fluorescence spectroscopy in addition to modern flexible endoscopic techniques in the outpatient setting. Newer imaging has replaced old techniques (chest radiograph, barium swallow, etc.) by using radiotracer PET-computed tomography to detect local tumour activity. Further advances are anticipated in optical diagnostics and the incorporation of radiopharmaceuticals with labelled antibodies to enhance PET imaging, thus making tumour identification more accurate. Genetic classification of head and neck cancer has already identified high-risk patient groups, thereby allowing expensive tumour screening techniques to be used selectively and specifically. Patients who continue to smoke and abuse alcohol must be helped and encouraged to quit. SUMMARY It is now possible to review traditional follow-up policy for treated head and neck cancer patients, to encourage the implementation of an evidence-based surveillance protocol, to identify only patients who are at high-risk of developing a MSPT, to incorporate modern targeted expensive tumour screening and to allow treatment of early cancer and effective treatment, thereby improving patients' quality of life and increasing survival.
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13
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Vinarsky V, Fine RL, Assaad A, Qian Y, Chabot JA, Su GH, Frucht H. Head and neck squamous cell carcinoma in FAMMM syndrome. Head Neck 2010; 31:1524-7. [PMID: 19360740 DOI: 10.1002/hed.21050] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Germline mutations at the INK4a/p16 locus are implicated in several human cancer syndromes, including familial atypical multiple mole melanoma (FAMMM) syndrome, FAMMM-pancreatic cancer (FAMMM-PC) syndrome, and in familial head and neck cancer syndrome. METHODS We present an individual with a family history of melanoma and pancreatic cancer who had multiple dysplastic nevi, squamous cell carcinoma of the tongue at age 22, multiple melanomas, a second squamous cell cancer of the tongue at age 40, and ultimately a pancreatic cancer. RESULTS We demonstrate a germline mutation in INK4a and loss of heterozygosity at this locus in his HNSCC tissue. CONCLUSIONS This report suggests that INK4a germline mutations associated with FAMMM/FAMMM-PC can also be associated with HNSCC. We conclude that HNSCC in young individuals should prompt clinicians to obtain a family history and consider that the patient may have a germline p16 defect that could predispose them to other cancers, including melanoma and pancreatic cancer.
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Affiliation(s)
- Vladimir Vinarsky
- Department of Medicine, Columbia University, New York Presbyterian Hospital, New York, New York, USA
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14
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Abstract
Despite advances in understanding the underlying genetics, squamous cell carcinoma of the head and neck (SCCHN) remains a major health risk and one of the leading causes of mortality in the world. Current standards of treatment have significantly improved long-term survival rates of patients, but second tumors and metastases still remain the most frequent cause of high mortality in SCCHN patients. A better understanding of the underlying genetic mechanisms of SCCHN tumorigenesis will help in developing better diagnostics and, hence, better cures. In this article we will briefly outline the current state of diagnostics and treatment and our understanding of the molecular causes of SCCHN.
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Affiliation(s)
- Amit M Deshpande
- School of Dentistry and Dental Research Institute, University of California Los Angeles, CA, USA.
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15
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Báez A. Genetic and environmental factors in head and neck cancer genesis. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, ENVIRONMENTAL CARCINOGENESIS & ECOTOXICOLOGY REVIEWS 2008; 26:174-200. [PMID: 18569329 DOI: 10.1080/10590500802129431] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) include squamous cell carcinomas of the oral cavity, pharynx, and larynx. Epidemiologic data suggest that the etiology and pathogenesis of HNSCC are influenced by environmental and lifestyle-related factors, such as tobacco use, ethanol consumption, papilloma virus infection, dietary factors and exposure to toxic substances. DNA repair systems and carcinogen-metabolizing enzymes can increase the risk for HNSCC but no definite causal mechanism has been demonstrated. There are several well-characterized entities that are associated with risk and prognosis of head and neck cancer, including Lynch-II syndrome, Bloom syndrome, Fanconi's anemia, xeroderma pigmentosum, ataxia telangiectasia, and Li-Fraumeni syndrome. This review aims to present the current status in our understanding of HNSCC and highlight controversies relating to the role of several factors in the genesis of the cancer.
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Affiliation(s)
- Adriana Báez
- Departments of Pharmacology and Otolaryngology, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico 00936-5067, USA.
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16
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Goldstein AM, Stacey SN, Olafsson JH, Jonsson GF, Helgason A, Sulem P, Sigurgeirsson B, Benediktsdottir KR, Thorisdottir K, Ragnarsson R, Kjartansson J, Kostic J, Masson G, Kristjansson K, Gulcher JR, Kong A, Thorsteinsdottir U, Rafnar T, Tucker MA, Stefansson K. CDKN2A mutations and melanoma risk in the Icelandic population. J Med Genet 2008; 45:284-9. [PMID: 18178632 DOI: 10.1136/jmg.2007.055376] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Germline CDKN2A mutations have been observed in 20-40% of high risk, melanoma prone families; however, little is known about their prevalence in population based series of melanoma cases and controls. METHODS We resequenced the CDKN2A gene, including the p14ARF variant and promoter regions, in approximately 703 registry ascertained melanoma cases and 691 population based controls from Iceland, a country in which the incidence of melanoma has increased rapidly. RESULTS We identified a novel germline variant, G89D, that was strongly associated with increased melanoma risk and appeared to be an Icelandic founder mutation. The G89D variant was present in about 2% of Icelandic invasive cutaneous malignant melanoma cases. Relatives of affected G89D carriers were at significantly increased risk of melanoma, head and neck cancers, and pancreatic carcinoma compared to relatives of other melanoma patients. Nineteen other germline variants were identified, but none conferred an unequivocal risk of melanoma. CONCLUSIONS This population based study of Icelandic melanoma cases and controls showed a frequency of disease related CDKN2A mutant alleles ranging from 0.7% to 1.0%, thus expanding our knowledge about the frequency of CDKN2A mutations in different populations. In contrast to North America and Australia where a broad spectrum of mutations was observed at a similar frequency, in Iceland, functional CDKN2A mutations consist of only one or two different variants. Additional genetic and/or environmental factors are likely critical for explaining the high incidence rates for melanoma in Iceland. This study adds to the geographic regions for which population based estimates of CDKN2A mutation frequencies are available.
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Affiliation(s)
- A M Goldstein
- Genetic Epidemiology Branch, Division of Cancer Epidemiologyand Genetics/NCI/NIH/DHHS, Executive Plaza South, Room 7004, 6120 Executive Blvd MSC 7236, Bethesda, MD 20892-7236, USA.
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17
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Gillison ML. Current topics in the epidemiology of oral cavity and oropharyngeal cancers. Head Neck 2007; 29:779-92. [PMID: 17230556 DOI: 10.1002/hed.20573] [Citation(s) in RCA: 177] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Oral cancer incidence rates rose dramatically during the twentieth century in the United States and Europe, especially among individuals under the age of 60 years. Although influenced by age, sex, and country of origin, incidence trends were most strongly affected by elevated risk among individuals born after approximately 1915. This cohort effect was indicative of strong behavioral influences on oral cancer risk. In this article, associations between oral cancer risk and established behavioral risk factors including alcohol and tobacco use are reviewed. Additionally, possible associations between oral cancer risk and oral hygiene, diet, nutritional status, and sexual behavior as well as the influence of genetic factors on oral cancer risk are considered. Special emphasis is placed on evaluating possible risk differences in individuals above and below the age of 45 and in users and nonusers of alcohol and tobacco.
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Affiliation(s)
- Maura L Gillison
- Division of Viral Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA.
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18
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Suárez C, Rodrigo JP, Ferlito A, Cabanillas R, Shaha AR, Rinaldo A. Tumours of familial origin in the head and neck. Oral Oncol 2006; 42:965-78. [PMID: 16857415 DOI: 10.1016/j.oraloncology.2006.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Accepted: 03/08/2006] [Indexed: 12/15/2022]
Abstract
Individuals with inherited cancer syndromes are at significant risk of developing both benign and malignant tumours as a result of a germline mutation in a specific tumour suppressor gene. Tumours of familial origin are a rare event in the head and neck but despite this, they deserve a growing interest. Familial paragangliomas are most of the time limited to the paraganglionar system, but also may be part of different syndromic associations. Since early detection of paragangliomas reduces the incidence of morbidity and mortality, genotypic analysis in the search of SDHB, SDHC and SDHD mutations in families of affected patients plays a front-line diagnostic role, leading to more efficient patient management. Multiple endocrine neoplasias type 1 are characterized by the simultaneous occurrence of at least two of the three main related endocrine tumours: parathyroid, enteropancreatic and anterior pituitary. These tumours arise from inactivating germline mutations in the MEN-1 gene. No clear correlation of MEN-1 genotype with genotype has emerged to date, and MEN-1 mutation testing in tumours is not used clinically because it have not implications for tumour staging. Multiple endocrine neoplasia type 2 is due to a germline mutation in the RET proto-oncogene. Hallmarks of MEN-2A (the commonest phenotypic variant) include medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism. The most central clinical difference with MEN-1 is that the associated cancer can be prevented or cured by early thyroidectomy in mutation carriers. Individuals with neurofibomatosis type 1 present early in life with pigmentary abnormalities, skinfold freckling and iris hamartomas, as result of NF1 gene mutation. Neurofibromatosis 2 is caused by inactivating mutations of the NF2 gene, and is characterized by the development of nervous system tumours (mainly bilateral vestibular schwannomas), ocular abnormalities, and skin tumours. The molecular genetic basis of nasopharyngeal carcinomas remains unknown, but there is evidence for the linkage of these tumours to chromosome 3p. Finally, the high rate of p16 mutations in squamous cell carcinomas and the association of p16 with familial melanoma propose p16 as an ideal candidate gene predisposing to familial squamous cell carcinomas. The elucidation of the cellular processes affected by dysfunction in familial tumours of the head and neck may serve to identify potential targets for future therapeutic interventions.
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Affiliation(s)
- Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
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19
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Abstract
In the vast majority of cases, head and neck cancer is a preventable disease. The relationship between tobacco and alcohol and these cancers is well established. Despite efforts aimed at reduction of risk factor exposure and early detection methods, head and neck cancer remains one of the more common cancers worldwide. Recent advances in molecular techniques have provided a framework for future targets for early diagnosis and treatment of these malignancies. This review provides a summary of recent developments in primary and secondary prevention of head and neck cancer and innovative strategies aimed at a reduction in incidence and mortality from this disease. The future prevention of head and neck cancer will likely require solutions to the widespread use of tobacco products and innovative diagnostic techniques leading to improvements in overall survival.
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Affiliation(s)
- Terry A Day
- Head and Neck Tumor Program, Hollings Cancer Center, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA.
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20
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Abstract
From a histopathologic perspective, head and neck squamous cell carcinoma (HNSCC) is a relatively straightforward diagnosis. However, the clinically useful information presently provided by pathologists is embarrassingly limited. Similarly, our ability to accurately identify the earliest premalignant lesions as well as predict which premalignant lesions are likely to progress to HNSCC is limited. Over the last decade, an explosive growth of knowledge related to the molecular biology of this disease has occurred, which is now being used to address these issues. For example, we now appreciate that there are multiple etiologies and multiple molecular mechanisms responsible for the development of HNSCC. New techniques have improved our ability to identify molecularly premalignant, but histologically benign lesions. Similarly, recent studies have been able to predict which premalignant lesions are likely to progress to HNSCC. In addition to having utility in the realm of early diagnosis, molecular diagnostics may have a profound impact on how we diagnose and report HNSCC. While still in the developmental stage, molecular protocols are being used to evaluate surgical margins, determine the location of unknown primary tumors, identify histologically undetectable lymph node metastasis, and predict which tumors are more likely to respond to a particular postsurgical adjuvant therapy.
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Affiliation(s)
- Rifat Hasina
- Department of Pathology, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
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21
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Wiseman SM, Stoler DL, Anderson GR. The role of genomic instability in the pathogenesis of squamous cell carcinoma of the head and neck. Surg Oncol Clin N Am 2004; 13:1-11. [PMID: 15062358 DOI: 10.1016/s1055-3207(03)00118-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Measurements of genomic instability, or identification of genes responsible for instability, may potentially be used as molecular markers to predict disease course and response to therapy. Other possible applications include use of genomic instability measurements, or genes, as tools to screen for primary or recurrent disease. Methodologies for detection of genetic mutations in saliva, blood, and sputum have already been described[61,62]. Brennan et al [63] have described a molecular technique for analyzing histopathologically negative margins and lymph nodes for the presence of p53 gene mutation. This study showed that a positive molecular margin significantly predicted disease recurrence. The recognition that HNSCC is a genetically heterogeneous disease represents a major step toward developing an understanding of its underlying genetic basis. To develop an insight into this genetically heterogeneous disease, investigators must not only focus their efforts on specific head and neck disease sites. Laser-capture microdissection represents a powerful tool for isolating very specific cell populations from tumors [64]. Leethanakul et al[65] performed laser-capture microdissection on oral cavity SCC to construct stage-specific cDNA libraries. Sequencing of 96 clones from each of the six libraries constructed suggested the existence of 132 novel genes, which may play a role in the pathogenesis of HNSCC. The current literature suggests that many individuals diagnosed withHNSCC are genetically predisposed to developing malignancy because of some inherent deficiency of their capacity to maintain their genome in the presence of environmental stressors. Head and neck cancers are highly heterogeneous tumors and exhibit a wide variety of forms of genomic instability. Thus, genomic instability may be viewed as a fundamental force driving head and neck tumorigenesis and evolution. Future study of the specific genetic mechanisms that underlie genomic instability in the HNSCCpatient population is needed. It is only through study of this fundamental force that drives the development of these tumors that clinicians may gain the insight required to develop new diagnostic and therapeutic modalities to benefit the HNSCC patient population as a whole.
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Affiliation(s)
- Sam M Wiseman
- Department of Surgical Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
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22
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Wight R, Paleri V, Arullendran P. Current theories for the development of nonsmoking and nondrinking laryngeal carcinoma. Curr Opin Otolaryngol Head Neck Surg 2003; 11:73-7. [PMID: 14515082 DOI: 10.1097/00020840-200304000-00002] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The pivotal risk of smoking and alcohol in laryngeal cancer has meant that evidence for alternate cofactors has been indicative to date. A number of case series, however, contain a few patients who are life-long nondrinkers and nonsmokers and question what other cofactors may contribute. Gastroesophageal reflux disease makes a small but significant contribution to the causal development of laryngeal cancer; however, what remains to be understood is the mechanism of its action. Bile reflux appears to be an additional causative factor in achlorhydrics. After controlling for the effects of alcohol and tobacco, exposure to oncogenic types of human papilloma virus is associated with an increased risk of laryngeal carcinoma. Evidence does not support asbestos exposure itself as increasing the relative risk of laryngeal cancer. A dietary increase in vegetables and fruit may confer an advantage in reducing the laryngeal cancer incidence. Inherited differences in cell cycle control systems, DNA repair systems, and carcinogen-metabolizing enzymes can increase the risk for laryngeal cancer, but as yet, no causal mechanism has been demonstrated.
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Affiliation(s)
- Richard Wight
- North Riding Infirmary, Middlesbrough, Cleveland, UK.
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