Four synchronous malignancies of the upper aerodigestive tract—Management of an unusual case

Abstract

The chronic irritation of the upper aerodigestive tract by carcinogen, usually resulting from the heavy usage of betel nuts, tobacco, and alcohol, leads to dysplastic mucosal changes and eventually, multiple primary carcinomas. Patients with squamous cell carcinoma of the upper aerodigestive tract are at higher risk of developing a second tumor in this area. The prevalence of synchronous second primaries ranges from 10% to 19% in the patients with squamous cell carcinoma in this region. The incidence of multiple primary carcinomas is increasing as better control of the index tumor is achieved. Greater awareness of the concept of field cancerization has resulted in more aggressive screening procedures. Today’s head and neck surgeons should be well prepared to manage multiple primary malignancies. This case reports on a patient who developed 4 primary malignancies within 6 months, all located in the head and neck region. Some strategies in management will also be discussed.