The EUROSCAN Study

Abstract

Approximately 5% of all cancers develop in the mucosa of the head and neck area (Boyle et al., 1990). A substantial number of these patients present at a moment that curative treatment is possible, due to the fact that many head and neck cancers cause complaints in an early stage. The prognosis of TINO and T2NO glottic laryngeal cancer, for instance, is in the order of 90 and 70% 5 year survival respectively. It is very likely that the pathogenesis of head and neck cancer is multifactorial. Both tobacco and alcohol are important risk factors in oral, oropharyngeal, hypopharyngeal and laryngeal cancer (Wynder et al., 1956, 1976; Williams & Horn, 1977; Tuyns, 1979; Rothman et al., 1980). In addition, it is very likely that an individual genetic susceptibility (de Vries et al., 1987a, 1987b; Schantz & Hsu, 1989; Spitz et al., 1989; Schantz et al., 1990) is important if only because so many individuals have been and are being exposed to tobacco and alcohol, whereas only relatively few actually develop cancer in the upper airand food passages. Patients with head and neck cancers are prone to develop multiple primary cancers (see further), probably because the mucosa of the upper air and food passages is being exposed to the same carcinogens. The situation in lung cancer patients is different from that of head and neck cancer patients. Lung cancer is the leading cause of cancer deaths in men and the second leading cause of cancer deaths in women, after cancer of the breast. The major factor in the development of lung cancer is the inhalation of tobacco smoke, by susceptible hosts. In contrast to head and neck cancer patients, most lung cancer patients already have a poor prognosis at the time of diagnosis. The 5 year survival rate for all stages of lung cancer has been about 9% for the last 20 years. This small subpopulation of patients that will be cured from their lung cancer are unfortunately prone to develop second primary cancers as well. Multiple primary tumours occurs in 10-30% of all patients with head and neck cancer and in 10% of patients with, lung cancer (Vrabec, 1979; Gluckman & Crissman, 1983; Tepperman & Fitzpatrick, 1981; Gluckman, 1983; Wagenfeld et al., 1981; Hordijk & de Jong, 1983; de Vries & Snow, 1986; de Vries et al., 1986; De Vries, 1990, and many others). The great majority of these second primary cancers occur metachronously in the respiratory tract and upper digestive tract. These second primary tumours usually carry a bad prognosis because they often occur either at notoriously bad sites, like (again in) the lung or esophagus, or within previously