Elevated Arginine Vasopressin Levels in Squamous Cell Cancer of the Head and Neck

Abstract

The reported effectiveness of single tumor markers (TMs) associated with squamous cell cancer of the head and neck ranges from 15% to 71%, with most studies reporting sensitivity no higher than 50%. An increased incidence of the syndrome of inappropriate secretion of antidiuretic hormone or arginine vasopressin (SIADH) in patients with head and neck cancer has been reported. Serum arginine vasopressin (AVP) was studied as a possible TM in these patients. Sixty-three patients with squamous cell carcinoma of the head and neck determined as potentially curable were prospectively evaluated before treatment and compared to 17 patients with apparent cure of head and neck squamous cell cancer who served as controls. Serum AVP levels were obtained and determined by radioimmunoassay in the preoperative period and 1 week postoperatively in 15 patients. Thirty-four patients were staged as T4, 26 as T3, and 3 as T2. Twenty-one (33%) of the 63 patients had no neck involvement. Twenty-four (38%) of 63 patients had elevated serum AVP levels corrected for serum osmolarity. Of the 15 patients evaluated before and after surgery, 8 (53%) had elevated serum AVP levels preoperatively. Of these 8 patients, 3 had reduction in AVP levels and 5 had complete normalization after 1 week. The result obtained for serum AVP do not exceed results of other TMs reported. AVP may also not be as specific as other TMs for cancer of the head and neck. Our group with AVP sampled postoperatively is too small for us to draw conclusions, but reduction of its levels after treatment in all patients may be significant. These preliminary results indicate that further evaluation of AVP during the posttreatment course in a larger number of cases, and perhaps with other TMs as well, is warranted.

Syndrome of Inappropriate Antidiuretic Hormone or Arginine Vasopressin Secretion in Patients Following Neck Dissection

“…The incidence of SIADH in patients presenting with head and neck cancer before the operation was 1.15%, lower than formerly reported. 1,4,5 Although ectopic production of AVP was reported in a case of nasopharyngeal carcinoma, 9 SIADH was found before surgery in only one of our cases and this does not support the assumption that the hormone is ectopically released from the tumor cells.…”

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Secretion Caused by Squamous Cell Carcinoma of the Nasopharynx: Case Report

“…These findings led him to suggest that squamous cell carcinoma produced neuropeptide Y, which stimulated production of endogenous AVP, while small cell carcinoma produced ectopic AVP directly. In addition, there has been more compelling evidence to support Lee's theory, such as the finding of increased AVP levels in 38% of SIADH patients with squamous cell carcinoma, despite no evidence of ectopic AVP (12). In the event that neuropeptide Y is detected in SIADH patients with squamous cell carcinoma, this hypothesis can be proven clinically.…”

Gene regulation of vasopressin and vasopressin receptors in cancer

“…However, this is a property now known to be shared by many types of tumour. Vasopressin has been shown to be produced also by prostatic and testicular tumours, ovarian cancer, pancreatic cancer (North et al 1983h;Maurer et al 1983;Friedmann et al 1993), pituitary adenomas (Kimura et al 1986) (Kavanagh et al 1992), cancer of the head and neck (Talmi et al 1996;Ferlito et al 1997), phaeochromocytoma (Grazzini, 1999) and tumourh of gastrointestinal origin (A. S. Friedmann & W. G. North, unpublished data). However, only a small percentage of squamous-cell carcinomas, adenocarcinomas, and large-cell carcinomas of the lung seem to produce vasopressin (Maurer et al 1983;North et al 198%;Friedman et al 1993).…”

“…SIADH refers to a condition of hyponatraemia and comparatively high urine osmolality, consistent with excessive retention of water by individuals with tumours producing vasopressin. The condition was originally associated with small-cell lung cancer, but has now been reported for breast cancer, ovarian cancer, prostatic cancer, and head and neck cancer (Kimura et al 1986;Osterman et al 1986;Hellstrom et al 1990;Kavanagh et al 1992;Talmi et al 1996;Ferlito et al 1997;A. S. Friedmann & W. G. North, unpublished data).…”