Effect of Routine Esophageal Screening in Patients With Head and Neck Cancer

Abstract

Importance: Transnasal esophagoscopy or pandoscopy to conduct a tumor survey is routinely recommended for patients with head and neck squamous cell carcinoma (HNSCC). Despite this recommendation, the effect of routine esophageal screening remains unclear.Objective: To investigate the effect of routine esophageal screening on the detection of second primary esophageal squamous cell carcinoma (ESCC) among patients with HNSCC. Intervention: Patients were divided into 2 groups based on whether or not they had received routine esophageal screening, and the 2 groups were compared.Main Outcome Measures: Univariate logistic regression analysis was performed to investigate the odds ratios (ORs) for developing second primary ESCC at different sites. The prevalence and cancer stage of second primary ESCC among these 2 groups were compared using the 2 test.

Office-based procedures for diagnosis and treatment of esophageal pathology

“…Adequate biopsies of a suspected lesion are the key to a reliable histological diagnosis. In patients with diagnosed head and neck squamous cell carcinoma, incidence of esophageal carcinoma ranges between 0.8% and 15.9%, although the incidence may even be higher . Whether or not patients with head and neck cancer should be screened for esophagus cancer is an ongoing matter of discussion .…”

“…Furthermore, if transnasal esophagoscopy is performed instead of barium swallow examination to exclude esophageal pathology, this reduces an extra procedure, thus resulting in decreased diagnostic delay, cost savings, and avoiding the risk of radiation exposure . Standard screening can also be applied to specific types of head and neck cancer, such as hypopharyngeal carcinoma, in which patients show a higher incidence of esophageal carcinoma compared to other upper respiratory anatomic sites …”

Routine endoscopic screening for synchronous esophageal neoplasm in patients with head and neck squamous cell carcinoma: a prospective study

“…With the development of ESD for early esophageal neoplasm, it has become more important to define high‐risk groups and to perform screening endoscopy to detect early ESCN. The location of the index tumor was regarded as risk factor based on previous results, and hypopharyngeal cancer has been associated with a significantly higher frequency of ESCN than other locations of HNSCC . This finding might be a consequence of the neighboring location of the hypopharynx and esophagus, and could occur in part because of the pooling of saliva in the pyriform sinus .…”

“…The detection rate of second primary tumors varies between studies because the detection rate of metachronous cancer increases with the duration of follow‐up. In addition, the risk of developing second primary esophageal cancer was especially high during the first year of follow‐up . Therefore, screening endoscopy at the time of diagnosis or less than a year from the diagnosis of primary HNSCC may be an acceptable approach.…”

“…Therefore, it is important to define the high‐risk groups and perform screening endoscopy in selected patients to detect early ESCN. The risk of developing synchronous and metachronous esophageal cancer associated with HNSCC is high, and the incidence of synchronous ESCN ranges from 1.0% to 21.9% . Previously, we investigated the prevalence and risk factors for the development of synchronous and metachronous ESCN in patients with HNSCC .…”