Abstract
Background Lung cancer is present in 1.1% of patients with oral (head and neck) SCC. Guidelines recommend that all patients with head and neck SCC receive chest computed tomography (CT) as part of their diagnostic and surgical evaluation, given that smoking is an established risk factor for cancer of both sites. The diagnosis of a synchronous lung cancer will alter the treatment of the patient. Case 1 An 85-year-old man with a 60 pack-year smoking history presented with a T1N0M0 floor of mouth SCC. His ECOG performance status was 1. CT demonstrated a 23-mm spiculated mass in the right upper lung lobe. Positron emission tomography demonstrated avidity in the lung mass (SUV 7.8), as well as multiple mildly avid associated lymph nodes. Lung biopsy demonstrated an infiltrative adenocarcinoma. Endobronchial ultrasound-guided fine-needle aspiration biopsies of the lymph nodes were unremarkable. The patient underwent stereotactic radiation therapy for lung cancer and is awaiting definitive surgery for his oral cancer. Case 2 A 53-year-old man with a 50 pack-year smoking history presented with a T3N2 floor of mouth SCC. CT and positron emission tomography demonstrated a 44-mm apical mass of the left lung, invading the mediastinum. Treatment of the oral SCC was deferred until confirmatory biopsy with a view to management of the suspected lung cancer. Conclusions These cases highlight the value of chest CT chest as part of the comprehensive evaluation of patients presenting with oral (head and neck) cancer. Lung cancer is present in 1.1% of patients with oral (head and neck) SCC. Guidelines recommend that all patients with head and neck SCC receive chest computed tomography (CT) as part of their diagnostic and surgical evaluation, given that smoking is an established risk factor for cancer of both sites. The diagnosis of a synchronous lung cancer will alter the treatment of the patient. An 85-year-old man with a 60 pack-year smoking history presented with a T1N0M0 floor of mouth SCC. His ECOG performance status was 1. CT demonstrated a 23-mm spiculated mass in the right upper lung lobe. Positron emission tomography demonstrated avidity in the lung mass (SUV 7.8), as well as multiple mildly avid associated lymph nodes. Lung biopsy demonstrated an infiltrative adenocarcinoma. Endobronchial ultrasound-guided fine-needle aspiration biopsies of the lymph nodes were unremarkable. The patient underwent stereotactic radiation therapy for lung cancer and is awaiting definitive surgery for his oral cancer. A 53-year-old man with a 50 pack-year smoking history presented with a T3N2 floor of mouth SCC. CT and positron emission tomography demonstrated a 44-mm apical mass of the left lung, invading the mediastinum. Treatment of the oral SCC was deferred until confirmatory biopsy with a view to management of the suspected lung cancer. These cases highlight the value of chest CT chest as part of the comprehensive evaluation of patients presenting with oral (head and neck) cancer.
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