Background. The concept that a patient could develop cancer twice was first put forward by Billroth. Second primary neoplasms are a particular feature of head and neck cancer. Methods. This study examines the records of 3436 patients with squamous cell carcinoma of the head and neck, of whom 274 subsequently developed a second neoplasm. Results. The actuarial second primary rate was 9.1% at 372 months, and median time to presentation for the second tumor was 36 months. Second tumors were more likely to occur in male patients younger than 60 years at the time of their index tumor, and who had laryngeal and oral cavity index tumors. Patients whose index tumor was small at diagnosis had a greater chance of developing a second tumor as did those with no cervical lymph node metastases to the neck. Radiotherapy to the index tumor was not associated with an increased risk of developing a second tumor. The commonest sites for second tumors were the head and neck (50%) and the lung (34%), and 86% were squamous cell carcinomas. The tumor‐specific mortality for those who developed a second primary tumor was 20% after 15 years compared with 44% for patients who did not develop a second primary tumor. The 5‐year survival for patients who developed a secondary tumor from the time of its diagnosis was 26%. Conclusions. Second primary tumors in the head and neck of patients with cancer are not uncommon. If the second tumor occurs in the head and neck region, the prognosis is reasonably good. Cancer 1995;75:1343‐53.

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Expression of the E-cadherin-catenin cell adhesion complex in primary squamous cell carcinomas of the head and neck and their nodal metastases NA Andrews1l23, AS Jones1, TR Helliwell3 and AR Kinsella2Departments of 1Otorhinolaryngology, 2Surgery and 3Pathology, University of Liverpool, Liverpool, UK Summary Reductions in cell-cell adhesion and stromal and vascular invasion are essential steps in the progression from localized malignancy to metastatic disease. In this study, changes in the expression of the components of the E-cadherin-catenin cell adhesion complex have been investigated using immunohistochemical techniques in primary tumours and nodal metastases from 36 patients with squamous cell carcinoma of the head and neck. For 14 patients the corresponding primary and nodal metastases samples were available. None of the 51 samples showed normal E-cadherin expression when compared with either the adjacent normal squamous epithelium or with normal colonic epithelium that was used as positive control material. In 88% of primary tumours fewer than 50% of cells exhibited normal membranous E-cadherin expression. Loss of membranous E-cadherin expression was more extensive in poorly differentiated carcinomas while, in individual carcinomas, membranous E-cadherin expression was stronger in those parts of the neoplasm that expressed the differentiation marker involucrin. Expression of P-catenin generally paralleled that of E-cadherin, but in 12 cases there was strong membranous P-catenin expression in samples that exhibited predominantly cytoplasmic E-cadherin labelling. Expression of a-catenin was generally weak and did not correlate with the expression of either P-catenin or E-cadherin. Marked intratumoral heterogeneity for protein expression was evident for all antibodies, and the abnormal expression of the catenins is a novel finding. E-cadherin is expressed more intensely in cells with greater squamous differentiation, but there was no correlation between the decreased expression of any of the adhesion molecules of the E-cadherin complex tested and local recurrence, metastasis or survival. The loss of expression of components of the E-cadherin complex is a common abnormality in squamous carcinomas and, while it may be permissive for metastasis, it does not appear to be the only determinant of this process.

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For many years nasal resistance to airflow measured by rhinomanometry has been regarded as the objective measure of nasal patency. However, recently it has become apparent that this may not be the case. The present study was designed to affirm or refute this view by using large numbers of subjects and observations. Five hundred estimations of (objective) nasal resistance to airflow and (subjective) nasal sensation of airflow where carried out. No correlation could be demonstrated between these two parameters. It is concluded nasal resistance to airflow and nasal sensation of airflow are two separate modalities which are not directly related. The possible reasons for this finding are discussed with reference to previous work on nasal sensation.