Abstract
ObjectivesThis study investigated benefits of routine panendoscopy in staging of oral squamous cell cancer patients.Materials and methodsFrom 2013 to 2017, 194 oral squamous cell cancer patients were staged. Reports of routine flexible panendoscopy including oropharyngolaryngoscopy, bronchoscopy, and esophagogastroduodenoscopy were retrospectively analyzed for diagnoses of inflammation and second primary malignancies (carcinoma in situ or cancer) and compared to results of computed tomography. The effects of alcohol and tobacco history of 142 patients were assessed.ResultsOverall, a second primary malignancy was detected in seven patients. In four patients this discovery was only found by panendoscopy. One invasive carcinoma (esophagus) was detected as well as three carcinoma in situ. The second primary malignancies were located in the lung (3), esophagus (3), and stomach (1). In one patient index tumor therapy was modified after panendoscopy. Upper gastrointestinal inflammation was present in 73.2% of patients and 61.9% required treatment. About 91.8% of bronchoscopies and 34.5% of panendoscopies were without therapeutic consequences. Patients with higher risk from smoking were more likely to benefit from panendoscopy and to have a Helicobacter pylori infection.ConclusionWe do not recommend routine panendoscopy for all oral squamous cell cancer patients. Esophagogastroduodenoscopy benefitted smoking patients primarily concerning the secondary diagnosis of inflammation of the upper digestive tract. Selective bronchoscopy, esophagogastroduodenoscopy, and oropharyngolaryngoscopy should be performed if clinical examination or medical history indicates risks for additional malignancies of the upper aerodigestive tract.Clinical relevanceRoutine panendoscopy is not recommended in all, especially not in low-risk oral cancer patients like non-smokers and non-drinkers.
Highlights
In Europe, 5–10% of new cancer cases are head and neck cancers [1]
Over 90% of head and neck cancers are squamous cell carcinoma [2, 3]. They mostly are located in the upper aerodigestive tract, with oral cavity making up 44%, larynx 31%, and pharynx 25% of squamous cell carcinoma [3]
If second primary carcinoma in situ lesions found in 1.5% (3 cases) in this study are added to synchronous primary cancer and distant metastasis, we reach a total rate of 4.1% (8 cases) of patients with synchronous second primary malignancies or distant metastasis
Summary
Over 90% of head and neck cancers are squamous cell carcinoma [2, 3]. They mostly are located in the upper aerodigestive tract, with oral cavity making up 44%, larynx 31%, and pharynx 25% of squamous cell carcinoma [3]. A definition of multiple primary cancer was presented by Warren and Gates and states that the tumors must be malignant, distinct, and without the possibility of them being metastases [5]. Slaughter proposed the concept of “field cancerization” [6] It supposed that a noxa exerts a cancerogenic effect on the entire contacted susceptible tissue. While some studies found more second primary cancers in patients with floor of mouth as index tumors [8,9,10,11], others were unable to confirm their results [12]
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