Is panendoscopy a necessary staging procedure in patients with lacking risk factors and oral squamous cell carcinoma?

Metzger, Karl; Horn, Dominik; Pfeiffer, Timo; Moratin, Julius; Kansy, Katinka; Ristow, Oliver; Engel, Michael; Hoffmann, Jürgen; Freier, Kolja; Schaible, Anja; Freudlsperger, Christian

doi:10.1016/j.jcms.2019.11.009

Cited by 11 publications

(6 citation statements)

References 21 publications

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“…The HNC diagnosis usually includes laryngoscopy, imaging [Positron emission tomography/X-ray computed tomography (PET/CT) and magnetic resonance imaging (MRI)], and biopsy of the primary lesion [ 31 , 32 , 33 , 34 , 35 ]. As technology progresses, the development of non-invasive diagnostic tools in the field of head and neck oncology has been examined; the molecular analysis of tumor’s genetic features based on circulating malignance derivatives, such as circulating tumor DNA, intact circulating tumor cells (CTCs), and exosomes in patients’ blood, namely liquid biopsy, has become a concrete possible approach to improve diagnostics, treatment planning, and post-treatment surveillance in patients with the potentially curable disease [ 36 , 37 , 38 , 39 ].…”

Section: Head and Neck Cancer And Alcoholmentioning

confidence: 99%

Alcohol and Head and Neck Cancer: Updates on the Role of Oxidative Stress, Genetic, Epigenetics, Oral Microbiota, Antioxidants, and Alkylating Agents

et al. 2022

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Head and neck cancer (HNC) concerns more than 890,000 patients worldwide annually and is associated with the advanced stage at presentation and heavy outcomes. Alcohol drinking, together with tobacco smoking, and human papillomavirus infection are the main recognized risk factors. The tumorigenesis of HNC represents an intricate sequential process that implicates a gradual acquisition of genetic and epigenetics alterations targeting crucial pathways regulating cell growth, motility, and stromal interactions. Tumor microenvironment and growth factors also play a major role in HNC. Alcohol toxicity is caused both directly by ethanol and indirectly by its metabolic products, with the involvement of the oral microbiota and oxidative stress; alcohol might enhance the exposure of epithelial cells to carcinogens, causing epigenetic modifications, DNA damage, and inaccurate DNA repair with the formation of DNA adducts. Long-term markers of alcohol consumption, especially those detected in the hair, may provide crucial information on the real alcohol drinking of HNC patients. Strategies for prevention could include food supplements as polyphenols, and alkylating drugs as therapy that play a key role in HNC management. Indeed, polyphenols throughout their antioxidant and anti-inflammatory actions may counteract or limit the toxic effect of alcohol whereas alkylating agents inhibiting cancer cells’ growth could reduce the carcinogenic damage induced by alcohol. Despite the established association between alcohol and HNC, a concerning pattern of alcohol consumption in survivors of HNC has been shown. It is of primary importance to increase the awareness of cancer risks associated with alcohol consumption, both in oncologic patients and the general population, to provide advice for reducing HNC prevalence and complications.

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Section: Head and Neck Cancer And Alcoholmentioning

confidence: 99%

Alcohol and Head and Neck Cancer: Updates on the Role of Oxidative Stress, Genetic, Epigenetics, Oral Microbiota, Antioxidants, and Alkylating Agents

et al. 2022

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“…Therefore, in nonsmoking, nondrinking patients with early-stage tumors of the oral cavity, the low risk of second primary tumors decreases the utility of panendoscopy as these tumors can be adequately assessed in clinic. Similarly, in their cohort of 484 patients with primary oral and oropharyngeal squamous cell carcinoma, Metzger et al [22] found no synchronous malignancies in patients without risk factors such as smoking and drinking, highlighting that risk stratification of patients can avoid unnecessarily conducting panendoscopy in patients without risk factors [21]. Findings by Valentin et al [23] further reinforced that panendoscopy is not recommended in all patients, particularly in low-risk oral cancer patients like nonsmokers and nondrinkers, as they demonstrated that from a patient cohort of 194 oral squamous cell cancer patients, an SPM was found in 7 patients (3.6%), four (2.1%) of which were only found on panendoscopy.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Utility and Cost of Routine Staging Exam under Anesthesia for Oral Cavity Squamous Cell Carcinoma

Hamdi¹,

Dougherty²,

Rasamny³

et al. 2022

ORL

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Introduction: The standard complete evaluation of patients with head and neck squamous cell carcinoma (HNSCC) has included a staging exam under anesthesia (EUA) since the 1970s. The EUA for all sites of HNSCC has historically consisted of panendoscopy for the purpose of diagnostic biopsy, accurate staging of primary disease, and identification of second primary tumors. However, due to the accessibility of the oral cavity, the sole purpose of EUA for tumors of this site is to identify second primary tumors. Since the EUA became the gold standard for evaluation of HNSCC, there have been significant advancements in less invasive technologies such as CT, PET-CT, MRI, and fiberoptic examination. In this study, we sought to determine the value to patient care and cost-effectiveness of EUA in patients with oral cavity squamous cell carcinoma (OCSCC). Methods: A retrospective chart review identified 77 patients who underwent EUA for OCSCC. Results: The most common subsites were the oral tongue and floor of mouth (59.7% and 24.7% respectively). All underwent direct laryngoscopy, 94.8% underwent esophagoscopy, and 20.8% underwent flexible transnasal examination in clinic prior to EUA. For 90.9% of patients, the EUA did not change initial T-staging based on clinical examination and imaging. The remaining 9.1% of patients were upstaged after EUA, however this change did not impact the treatment plan. Second primary tumors were identified in 3.9% of patients, all were found in either the oral cavity or oropharynx, and were also identified with clinical examination or imaging. Analysis of patient charges determined an average cost of $8,022.93 per patient under the current paradigm involving EUA, however with a new algorithm eliminating mandatory EUA average cost decreases to $1,448.44. Conclusion: Formal EUA has historically been the gold standard for all HNSCC tumors. However, when performed for cases of oral cavity carcinoma, it is safe and cost effective to limit its use to select clinical scenarios.

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“…The findings suggest that [ 18 F]FDG-PET/ CT is a reliable diagnostic alternative for secondary cancer screening in the preoperative staging of OSCC. The role of pandendoscopy relates to the increased risk for SPM of the UADT, and the convenient combination of mucous membrane inspection and immediate biopsy in cases of visible abnormalities (Chow et al, 2009;Metzger et al, 2019;Prabhu et al, 2014;Wang et al, 2011). However, an ongoing epidemiological shift from smoking-related to HPV-associated OSCC reduces the risk for SPM of the UADT in Western populations (Pytynia et al, 2014;Marur et al, 2010) and thus the benefit of routine panendoscopy, while the detrimental aspects of this invasive procedure, with general anesthesia, remain (Noor et al, 2018;Valentin et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

[18F]FDG-PET/CT improves the detection of synchronous malignancies at primary staging of oral squamous cell carcinoma – A retrospective study

Linz

Brands²,

Hackenberg³

et al. 2022

Journal of Cranio-Maxillofacial Surgery

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Is panendoscopy a necessary staging procedure in patients with lacking risk factors and oral squamous cell carcinoma?

Cited by 11 publications

References 21 publications

Alcohol and Head and Neck Cancer: Updates on the Role of Oxidative Stress, Genetic, Epigenetics, Oral Microbiota, Antioxidants, and Alkylating Agents

Alcohol and Head and Neck Cancer: Updates on the Role of Oxidative Stress, Genetic, Epigenetics, Oral Microbiota, Antioxidants, and Alkylating Agents

The Clinical Utility and Cost of Routine Staging Exam under Anesthesia for Oral Cavity Squamous Cell Carcinoma

[18F]FDG-PET/CT improves the detection of synchronous malignancies at primary staging of oral squamous cell carcinoma – A retrospective study

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