Malignancies Of Upper Aerodigestive Tract Research Articles

Exploring The Potential of Human Papilloma Virus: An Overview

Human papillomavirus (HPV) infection is the most frequent viral sexually transmitted infection in the world. HPV is currently the most prevalent infection responsible for female cancers, with more than 90% of cervical cancers - the fourth deadliest malignancy in women- having been diagnosed. Additionally, genital and upper aerodigestive tract malignancies, as well as cutaneous and anogenital warts, are also linked to HPV infection. Cervical screening programs that are organized have the potential to be more effective than opportunistic screening programs. Nonetheless, screening programs have consistently been linked to lower cervical cancer incidence and mortality. Over the last 40 years, developed countries have achieved such a reduction in cervical cancer incidence and mortality. This is largely because of organized cytological screening and immunization programs. In women with no indication of previous or current HPV infection, HPV vaccinations are very efficient at preventing infection and illnesses caused by vaccine-specific genotypes. Despite the effective implementation of the HPV vaccination program in many nations around the world, challenges with HPV prevention and treatment of linked diseases will persist in developing and poor countries. This review provides an insight into various aspects of HPV infection.

Upper Aero-Digestive Tract Malignancies in Botswana: Clinicopathological Features and Human Papillomavirus Genotypes in an Hiv-Endemic Setting

Upper Aero-Digestive Tract Malignancies in Botswana: Clinicopathological Features and Human Papillomavirus Genotypes in an Hiv-Endemic Setting

A comparison of the efficacy of narrow band imaging and contact endoscopy in an early diagnosis of squamous malignancies of the upper aerodigestive tract

BackgroundThis study aims to compare the efficacy of narrow band imaging (NBI) endoscopy and contact endoscopy in early diagnosis of squamous malignancies of upper aerodigestive tract. MethodsThis study was of 18 months duration, sample size 50, and carried out at tertiary care hospital. The patients were subjected initially to NBI endoscopy followed by contact endoscopy. Thereafter, the lesion was biopsied and subjected to histopathological examination as is done routinely. The images obtained were analyzed based on criteria proposed by earlier studies and compared with histopathological examination as gold standard. ResultsThe sensitivity, specificity, and negative predictive values of NBI in early diagnosis of squamous malignancies of upper aerodigestive tract were high and better than contact endoscopy. ConclusionEndoscopic NBI is a noninvasive and promising tool used for in vivo differentiation between malignant and nonmalignant lesions of upper aerodigestive tract by using morphology of mucosal capillaries and is more efficacious than contact endoscopy. It can be employed as part of routine ENT examination in outpatient departments; however, it has got a learning curve associated with it.

Referred otalgia:evaluation of causes

Otalgia is the sensation of pain in the car, while referred otalgia Is pam felt in the ear but originating from non-otological source Lar pain is a diagnostic problem when examination of the ear shows no pathology. A prospective study was conducted in EN.T - private clinics in Kirkuk city from October 2007 to December 2008. Age , sex and causes of referred ofalgia were noted, During the study period 210 patients were evaluated , out of 210 patients 122 male "58%" and 88 females "42%", Tonsillitis,pharyngitis and post tonsillectomy were the commonest cause"S1 4%" Three patients had malignancy of upper aerodigestive tract and referred otalgia was one of its main symptoms. Referred ear pain is more commonly caused by tonsillitis , pharyngitis
 but it may be first symplom of head and neck malignancy,

Investigating factors associated to dysphagia and need for percutaneous endoscopic gastrostomy in patients with head and neck cancer receiving radiation therapy.

Purpose: In this study we sought to investigate factors associated to dysphagia and subsequent need for percutaneous gastrostomy (PEG) usage, in patients with head and neck cancer receiving radiation therapy.Methods: The records of 123 patients with non-metastatic, stage I-IV head and neck cancer who were submitted to radiation therapy were retrospectively reviewed. Logistic regression models were used to investigate for associations between the outcomes of interest (grade ≥2 dysphagia and need for [PEG] usage) and potential predictive factors.Results: Mean dose to pharyngeal constrictor muscles (OR=1.08, p=.002), concurrent chemotherapy (OR=3.78, p=0.015) and upper aerodigestive tract malignancies (OR=3.27, p=0.044) were associated with dysphagia grade≥2. A threshold of constrictors mean dose for dysphagia manifestation was also identified at 43 Gy (OR=4.51, p=0.002). Need for PEG use was correlated with definitive treatment (OR=7.03, p=.022), nasopharyngeal (OR=12.62, p=0.003), upper aerodigestive tract (OR=9.12, p=0.007) or occult primary malignancies (OR=10.78, p=0.016).Conclusion: Patients suffering from upper aerodigestive tract malignancies, those with calculated constrictors mean dose >43 Gy, or planned to receive concurrent chemotherapy-radiotherapy should be closely monitored during treatment for dysphagia manifestation. Prophylactic PEG could be considered for patients receiving definitive therapy of the nasopharynx, upper aerodigestive tract or occult primary malignancies.

Prevalence of Eustachian Tube Dysfunction in the US Elderly Population.

To investigate the prevalence of eustachian tube dysfunction (ETD) in elderly adults in the United States and its association with other upper aerodigestive inflammatory processes. Cross-sectional study. Population based. In total, 147,805 patients without malignancy were compared to 13,804 demographically matched patients with malignancy of the upper aerodigestive tract (UADT) by querying the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database for patients aged 66 to 99 years between 2003 and 2011. The prevalence of ETD and inflammatory diseases among these patients was compared. Association between ETD, other upper aerodigestive inflammatory processes, and UADT malignancies was evaluated. The prevalence of ETD was 5.44% among patients without malignancy and 9.08% in those with cancer (odds ratio [OR], 1.73; 95% CI, 1.63-1.84). Patients with ETD in the control population were more likely (OR, 95% CI) to be diagnosed with chronic rhinitis (5.00, 4.70-5.33), chronic sinusitis (4.20, 3.98-4.43), allergic rhinitis (4.27, 4.08-4.47), and gastroesophageal reflux disease (GERD) (2.42, 2.31-2.53). Patients with ETD and chronic rhinitis (1.43, 1.24-1.65), chronic sinusitis (1.57, 1.38-1.78), and acute otitis media (1.33, 1.08-1.65) were associated with higher rates of UADT malignancy. Over 5% of patients older than 65 in the United States are diagnosed with ETD in the absence of UADT malignancy. Associations between ETD and chronic rhinitis, chronic sinusitis, allergic rhinitis, and GERD in the absence of UADT malignancy suggest that some patients may benefit from treatment of inflammatory disease as a cause of ETD.

Immunohistochemical expression of epidermal growth factor receptor (EGFR) in malignancies of upper aerodigestive tract

Immunohistochemical expression of epidermal growth factor receptor (EGFR) in malignancies of upper aerodigestive tract

Biliary tumorigenic effect on hypopharyngeal cells is significantly enhanced by pH reduction.

Biliary reflux has been considered a potential risk factor in upper aerodigestive tract malignancies. It is not yet clearly known how pH affects the bile‐induced activation of NF‐κB and its related oncogenic pathway previously linked to hypopharyngeal carcinogenesis. In this study, repetitive applications of conjugated primary bile acids with unconjugated secondary bile acid, deoxycholic acid (DCA), on human hypopharyngeal primary cells reveal that strongly acidic pH (4.0) optimally enhances the tumorigenic effect of bile, by inducing activation of NF‐κB, STAT3 nuclear translocation, bcl‐2 overexpression and significant overexpression of the oncogenic mRNA phenotype, compared to weakly acidic pH (5.5) or neutral pH (7.0). As the pH becomes less acidic the partially activated primary bile acids and activated DCA begin to exert their influence; however, with significantly less intensity compared to bile acids at strongly acidic pH. Our findings suggest that biliary tumorigenic effect is strongly pH dependent. Controlling pH during reflux events may be therapeutically effective in reducing the potential risk of bile‐induced hypopharyngeal cancer.

Anatomical site-wise distribution of upper aerodigestive tract malignancies in a rural population

<p class="abstract"><strong>Background:</strong> Upper aerodigestive tract malignancies constitute approximately 4% of all malignancies. These include cancers of the various sites of the upper aerodigestive tract where malignant lesions can be found such as the nasal cavity, paranasal sinuses, nasopharynx, oral cavity and it’s sub-sites, oropharynx, larynx and hypopharynx. Malignancies of these sites are found to be common in people from lower socio-economic strata. Tobacco and alcohol are considered as risk factors for it’s development.</p><p class="abstract"><strong>Methods:</strong> A cross-sectional study was conducted in the outpatient section of Department of ENT, at Chamarajanagar Institute of Medical Sciences and Hospital, Chamarajanagar, India, for a period of 1 years 10 months from October 2014 to July 2016. During the study period, 100 cases that were diagnosed as having upper aerodigestive tract malignancy by histopathology were included in the study group. The aim of this study is to determine the epidemiology, clinical features and anatomical site-wise distribution of malignancy in the study group. </p><p class="abstract"><strong>Results:</strong> Oral cavity was the commonest site where malignancy developed in the upper aerodigestive tract followed by the larynx. Malignant disease was more common in males and in the elderly. Majority of the patients who developed malignancy had history of tobacco and alcohol consumption.</p><p><strong>Conclusions:</strong> Oral cavity malignancy is common in rural population, is associated with tobacco chewing and is more common in elderly male. </p>

Abstract 567: The lysosomal transporter SLC46A3 is a potential predictive biomarker for antibody-drug conjugates bearing the non-cleavable warheads SG3376 and DM1

Abstract Antibody drug conjugates (ADCs) combine a monoclonal antibody with a potent cytotoxic drug to preferentially eliminate antigen-positive cells for the treatment of cancer. ADCs bearing non-cleavable drug-linkers such as the pyrrolobenzodiazepine (PBD) SG3376 or the maytansinoid DM1 rely upon lysosomal degradation of the antibody for release of the cytotoxic warheads, which must then escape the lysosome and bind to their intracellular targets. We sought to identify the mechanism of lysosomal transport of these membrane-insoluble warheads and have recently reported that the lysosomal transporter SLC46A3 is required for cytotoxic activity of ADCs bearing SG3376 and DM1, and that loss of SLC46A3 is a mechanism of acquired resistance to Trastuzumab-DM1 (T-DM1). Here we explore the potential translational relevance of SLC46A3. Analysis of SLC46A3 mRNA expression across several tumors showed that breast cancer cell lines and primary tumor samples have relatively high levels of SLC46A3 compared to samples derived from multiple myeloma (MM), esophageal, and upper aerodigestive tract malignancies, all of which are being targeted in clinical trials with non-cleavable DM1 ADCs. Deeper analysis indicates that levels of SLC46A3 are decreased in MM patients compared to healthy donors, and levels are further decreased in the relapsed/refractory setting compared to samples taken at diagnosis. We measured the expression of SLC46A3 in a panel of MM cell lines by RT-PCR and found that 5 of 9 (56%) had undetectable levels of SLC46A3. In vitro cytotoxicity assays demonstrate that SLC46A3-negative cells are resistant to B-cell maturation antigen (BCMA)-targeted ADCs prepared with non-cleavable DM1 and SG3376 warheads, but remain sensitive to the cleavable payload PBD SG3249 (Tesirine). Taken together, our results suggest that SLC46A3 may be a predictive response marker for ADCs bearing the non-cleavable warheads SG3376 and DM1, and this marker may be particularly useful in trials involving MM. Citation Format: Krista Kinneer, Yu-Tzu Tai, Sriram Sridhar, John Meekin, Sandrina Phipps, Ben Ruddle, Ryan Fleming, Nazzareno Dimasi, Ronald Herbst, Arnaud Tiberghien, Luke Masterson, Philip Howard, Kenneth Anderson, David Tice. The lysosomal transporter SLC46A3 is a potential predictive biomarker for antibody-drug conjugates bearing the non-cleavable warheads SG3376 and DM1 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 567.

Diagnostic accuracy of touch imprint cytology for head and neck malignancies: a useful intra-operative tool in resource limited countries

BackgroundIntraoperative consultation is an important tool for the evaluation of the upper aerodigestive tract (UAT) malignancies. Although frozen section analysis is a preferred method of intra-operative consultation, however in resource limited countries like Pakistan, this facility is not available in most institutes; therefore, we aimed to evaluate the diagnostic accuracy of touch imprint cytology for UAT malignancies using histopathology of the same tissue as gold standard.MethodsThe study involved 70 cases of UAT lesions operated during the study period. Intraoperatively, after obtaining the fresh biopsy specimen and prior to placing them in fixative, each specimen was imprinted on 4-6 glass slides, fixed immediately in 95% alcohol and stained with Hematoxylin and Eosin stain. After completion of the cytological procedure, the surgical biopsy specimen was processed. The slides of both touch Imprint cytology and histopathology were examined by two consultant histopathologists.ResultsThe result of touch imprint cytology showed that touch imprint cytology was diagnostic in 68 cases (97.1%), 55 (78.6%) being malignant, 2 cases (2.9%) were suspicious for malignancy, 11 cases (15.7%) were negative for malignancy while 2 cases (2.9%) were false negative. Amongst the 70 cases, 55 cases (78.6%) were malignant showing squamous cell carcinoma in 49 cases (70%), adenoid cystic carcinoma in 2 cases (2.9%), non-Hodgkin lymphoma 2 cases (2.9%), Mucoepidermoid carcinoma 1 case (1.4%), spindle cell sarcoma in 1 case (1.4%). Two cases (2.9%) were suspicious of malignancy showing atypical squamoid cells on touch imprint cytology, while 13 cases (18.6%) were negative for malignancy, which also included 2 false negative cases. The overall diagnostic accuracy of touch imprint cytology came out to be 96.7% with a sensitivity and specificity of 96 and 100%, respectively while PPV and NPV of touch imprint cytology was found to be 100 and 84%, respectively.ConclusionOur experience in this study has demonstrated that touch imprint cytology provides reliable specific diagnoses and can be used as an adjunct to histopathology, particularly in developing countries, where the facility of frozen section is often not available, since a rapid preliminary diagnosis may help in the surgical management planning.

Pattern of Upper Aerodigestive Tract Malignancies and Metastatic Lymph Nodes

Pattern of Upper Aerodigestive Tract Malignancies and Metastatic Lymph Nodes

Prevalence and major causative factors of upper aerodigestive tract malignancies

Background: The upper aerodigestive tract (UADT) malignancies vary with geography. Data on epidemiology of UADT are few in India, especially southern states such as Kerala. Objective: To estimate the prevalence and major causative factors of UADT malignancies. Materials and Methods: In this cross-sectional study, 60 patients (54 male and 6 female subjects) who showed proven UADT malignancies were included. Main epidemiological factors such as age, distribution, site, histopathological types, symptoms, and levels of lymph nodes were determined. The clinical and radiological stages of each site at the time of presentation were also assessed and statistically analyzed. Result: The male to female ratio was 9:1, with peak incidence in 50% cases at the 60–69 years age group. Most common symptom at presentation was change in voice with hoarseness (21/60) and neck swellings (18/60) with lymph node metastasis at the time of presentation. The most commonly involved site was glottis (19/60) with T1 presentation (15/19). Oral cavity lesions found in 11 of 60 cases with seven cases in T4 presentation. Hypopharyngeal malignancies were found in eight cases. Other sites found to be involved were oropharynx, nasopharynx, maxillary sinus, and salivary gland with lesser frequency. Fifty-three cases showed addictions such as tobacco smoking, alcoholism, or tobacco chewing. Conclusion: The distribution of UADT cancers was the highest in the 60–69 years age group with male:female ratio of 9:1. Glottic malignancy showed the highest frequency. Smoking and alcoholism were the major causative factors identified. Hence, the need for education and awareness that are aimed at reducing exposure habit forming substances are emphasized. This study showed limitations such as small sample size and short duration, which warranted further multicenter studies for a longer duration.

Undifferentiated Type Nasopharyngeal Carcinoma With Rare Periportal Lymph Node Metastasis

Nasopharyngeal carcinoma (NPC) is an aggressive Epstein Barr virus (EBV) associated carcinoma accounting for 3.7% of upper aerodigestive tract malignancies. At presentation, most patients (60-72%) demonstrate cervical lymphadenopathy, and 5-11% will have clinically apparent distant metastases, with 78% developing distant metastatic disease within 18 months of presentation. The most common sites for distant metastases are …

Aetiology of secondary otalgia in Mosul Medical City

Objectives: The aim of the present study is to evaluate the aetiology of secondary (referred) otalgia. Patients and methods: A case series study of 79 patients clinically diagnosed as secondary otalgia, collected from the Outpatient Department of ENT at Al-Jamhory Teaching Hospital, Mosul/IRAQ, and private clinics, for the period from Jan. 2010 to Sept. 2011. Results: The average age of the patients was 33.3 years with a range of 4-80 years. The peak age incidence was in the fourth decade of life. The study included 34 male patients (43.1%) and 45 females (56.9%) with a ratio of 1:1.3. Temporomandibular joint dysfunction was found to be the main cause of secondary otalgia (37.9%). Pharyngitis (24%), dental pain (17.7%) and cervical spine pain (7.6%) came next in that order. Conclusion: Temporomandibular joint dysfunction, pharyngitis, dental problems and cervical nerve root pain were the commonest causes of secondary otalgia. Moreover, upper aerodigestive tract malignancies should be considered in differential diagnosis. Keywords: Secondary otalgia, referred otalgia, referred ear pain.

Pediatric laryngeal cancer with 5-year follow up: Case report

Larynx cancer is the commonest malignancy of upper aerodigestive tract. However, laryngeal cancer is extremely rare in childhood since these tumors are generally not suspected in the differential diagnosis of hoarseness, dysphagia and/or progressive airway obstruction in children; diagnosis can be made relatively late. In this report we would like to present a case of advanced stage pediatric laryngeal carcinoma who was treated with chemoradiotherapy and remained well on her 5-year follow-up.

The Utility of Frozen Section Margin Analysis in Transoral Robotic Surgery

Objective: Determine the benefit of frozen section margin analysis on oncologic specimens resected via Transoral Robotic Surgery (TORS). Method: A retrospective, single institution chart review of 150 consecutive patients with upper aerodigestive tract malignancies who underwent Transoral Robotic Surgery with intraoperative frozen section margin analysis between April 2007 and November 2010. Results: A total of 105 of the 150 cases were found to have negative tumor margins on initial tumor extripation. None of these patients were found to have delayed positive margins on permanent section analysis. Forty-five patients were found to have 1 or more positive margins on frozen section analysis following initial tumor, and/or tumor margin resection. These positive margins were all re-resected until frozen section pathology was consistent with tumor free margins (no evidence of CIS or invasive carcinoma). Of the 45 patients who underwent re-resection of initial tumor involved margins, 2 were found to have positive margin disease on permanent section pathology. Conclusion: Frozen section margin analysis is a critical intraoperative tool in Transoral Robotic Surgery that accurately accesses margin free tumor resection. This technique allows for a single operative encounter consisting of initial tumor biopsy with rapid diagnosis, followed by immediate complete primary tumor resection with synchronous neck dissection when oncologically indicated.

The prosthodontist′s role in head and neck cancer and Introduction - Oncologic dentistry

A comprehensive oral and dental screening should be part of the pre-treatment workup of patients with cancer, especially those who have head and neck tumors. This screening needs to be performed by a Prosthodontist who is familiar with the pathologic process of disease and the type of treatment being rendered; and who comprehends the morbidities associated with eradicating malignancy. Oftentimes, this is a specially trained prosthodontist. According to WHO statistics, individuals living in the Indian subcontinent have the highest prevalence of oral and upper aero-digestive tract malignancies. The afflicted may develop oral complications of cancer treatment, especially from systemic chemotherapy and head and neck radiation therapy. The trend toward people maintaining their teeth longer, coupled with the rising age of the population, suggest that dentists may frequently be treating patients with cancer and should be informed about the aspects of care that will affect oral health. Unfortunately however, when the cancer curricula of dental schools was investigated, it was found that deficits in oncologic dentistry education included failure to provide practical clinical oncology experience in diagnosis, the decision-making process, referral procedures, management of oral complications of cancer therapy, maxillofacial rehabilitation; and psychosocial training in oncology. This article is intended as a primer for prosthodontists, most of whom undoubtedly will need to deal with cancer patients. It is suggested that the prosthodontic curriculum in India include all aspects of oncologic dentistry.

Cervicofacial and cervicothoracic rotation flaps in head and neck reconstruction

Compound cervicofacial and cervicothoracic rotation flaps are highly versatile flaps that may be applied to a variety of defects of the cheek, orbit, periauricular region, and neck. These rotation advancement flaps should be a staple of the head and neck surgeon's reconstructive armamentarium. This is a retrospective review of medical records at a university-based head and neck cancer center. Thirty-three patients were identified, with a mean age of 66 years. Primary or recurrent skin neoplasms made up the most common indication for surgery, followed by primary parotid tumors and cervical lymphatic metastases from upper aerodigestive tract malignancies. Defects of the cheek, orbit, periauricular region, and neck were reconstructed with cervicofacial or cervicothoracic flaps, with larger wounds requiring variable extension of the incision onto the chest wall. Other reconstructive modalities were used in 18 cases to increase tissue bulk or provide internal lining. Minor wound complications occurred in 13 patients. There was no statistically significant association between wound complications and smoking or previous radiation therapy. Compound cervicofacial and cervicothoracic rotation flaps provide a straightforward, reliable, and efficient means to reconstruct complex defects of the face, lateral skull base, and neck, with the potential for excellent cosmetic results.

Longitudinal study of smoking patterns in relation to the development of smoking-related secondary primary tumors in patients with upper aerodigestive tract malignancies.

The authors set out to assess the correlation between smoking-related second primary tumor (SPT) development and cigarette smoking habits after diagnosis and definitive treatment in patients with early-stage head and neck squamous cell carcinoma who were enrolled in a placebo-controlled randomized chemoprevention trial of 13-cis-retinoic acid. Longitudinal data collected for 10 years after the index diagnosis are presented for 1190 patients. Cox proportional hazards regression models were used to examine the effects of changes in smoking behavior on smoking-related SPT development. One-third of all patients who quit smoking within 12 months before randomization experienced recurrence, compared with 6.9% and 10.4% of all never-smokers and former smokers, respectively. Approximately 16% of all current smokers stopped smoking, and nearly 22% of current smokers developed SPTs, compared with 14.5%, 13.2%, and 8.8% of all recent smokers, former smokers, and never-smokers, respectively. The probability of developing a smoking-related SPT was highest among patients who were current smokers at randomization. These patients, regardless of whether they ceased smoking during follow-up, were nearly three times more likely than patients who had never smoked to develop a smoking-related SPT. In contrast, former smokers and recent quitters who continued to abstain from smoking during follow-up were approximately 1.5 times more likely to develop an SPT compared with patients who had never smoked. Patients who continue to smoke after the successful treatment of their index head and neck malignancies have a substantially higher risk of developing smoking-related SPTs.