Is routine triple endoscopy for head and neck carcinoma patients necessary in light of a negative chest computed tomography scan?

Abstract

BACKGROUND The objective of the current study was to analyze the results obtained by triple endoscopy during the initial evaluation of a primary carcinoma of the head and neck. METHODS A total of 487 patients with a squamous cell carcinoma of the head and neck was studied. None of the patients had evidence of metastasis or a second primary tumor on the thoracic computed tomography (CT) scan or chest X‐ray. All patients underwent a triple endoscopy including nasopharyngoscopy, laryngoscopy, pharyngoscopy, bronchoscopy, and esophagoscopy. RESULTS A synchronous primary invasive carcinoma of the lung and esophagus was diagnosed in 5 patients (1%) and 10 patients (2%), respectively. In addition, nine lesions were considered to be a regional extension of the primary tumor to the esophagus, and nine in situ carcinomas were observed. It is interesting to note that a significant correlation was found between the risk of a second synchronous esophageal carcinoma and the initial location of the primary head and neck carcinoma (P = 0.002, chi‐square test). Esophageal carcinoma was observed in 1.3% of the patients with an oropharyngeal tumor, 2% of the patients with a laryngeal tumor, none of the patients with a tumor of the oral cavity, and 9.2% of the patients with a hypopharyngeal tumor. CONCLUSIONS The role of bronchoscopy and esophagoscopy in the presence of a normal thoracic CT scan has been questioned because of the relatively low incidence of a second esophageal and/or lung primary tumor. Nonetheless, based on the same incidence criterion, it appears reasonable to schedule a routine esophagoscopy for those patients with a squamous cell carcinoma of the hypopharynx. Cancer 2004. © 2004 American Cancer Society.

Prevalence and Outcomes of Head and Neck versus Non-Head and Neck Second Primary Malignancies in Head and Neck Squamous Cell Carcinoma: An Analysis of the Surveillance, Epidemiology, and End Results Database

“…In our study, we found that laryngeal and hypopharyngeal primary SCCs had a significantly higher rate of lung SPMs than other HNSCCs, and that hypopharyngeal primary SCCs had a higher rate of esophageal SPMs. This is consistent with previous studies, some of which have noted higher rates of lung SPMs after laryngeal primary diagnosis, as well as the potential benefit of esophagoscopy for SPM in hypopharyngeal cancers [11,17]. …”

Routine Endoscopy for Esophageal Cancer Is Suggestive for Patients with Oral, Oropharyngeal and Hypopharyngeal Cancer

“…However, huge diversity exists between the reported incidences for synchronous and metachronous esophageal cancers. With such inconclusive results, some researchers have questioned the efficacy and cost-benefit of the routine use of panendoscopy to detect synchronous and metachronous esophageal cancers [6]–[9].…”

Application of unsedated transnasal esophagogastroduodenoscopy in the diagnosis of hypopharyngeal cancer

“…3,18 Therefore, some diagnostic strategies regarding the evaluation of hypopharyngeal cancer are suggested in clinical practice, such as selective screening in patients with significant dysphagia and routine screening of esophageal cancer through barium esophagogram or gastroscopy. 19,20 In this study, unsedated transnasal EGD was able to detect and pathologically diagnose simultaneous invasive esophageal cancer in 6 patients (22.2%), 2 of whom had small T1 lesions that had no associated symptoms and may be missed by barium esophagogram. The treatment plans of these 6 patients were all changed for these simultaneous cancers.…”