Multiple squamous cell carcinomas within the head and neck region

Abstract

100 Years Memorial Hospital A total of 827 head and neck squamous cell carcinoma(HNSCC)cases were treated at the Hyogo College of Medicine between 1986 and 2003. They consisted of 126 cases of the tongue, 59 cases of the oral cavity, 122 cases of the oropharynx, 174 cases of the hypopharynx, and 346 cases of the larynx. Of these, 38 cases(4.6％) were found to have other primary HNSCC, in which double cancers were 63.2％, and triple or more cancers were 36.8％.The primary site of the first HNSCC was the hypopharynx 16/38(42.1％) , and it was the highest region of secondary or more HNSCC(9.2％) . Heavy smokers with a Brinkman index of more than 601 were 62.2％, and heavy drinkers with alcohol intake of more than 31 g/day was 86.5％. Eighteen of 38(47.4％)cases had multiple cancers in other areas, and 14 of 18 cases(77.8％)had esophageal cancer. In seven cases the treatment for second HNSCC was restricted as a consequence of the treatment of first HNSCC. The prognosis of allochronic multiple HNSCC was comparatively good, i.e., cases with no evidence due to disease were 62.5％ and cases with death of disease were 20.8％. About 40％ of the allochronic multiple HNSCC were found more than 5 years after the first HNSCC was treated, and most of them were found with the appearance of subjective symptoms rather than by followup examination. In order to detect double or more cancers in the early stage after the treatment for the first HNSCC, it is important to inform patients about multiple HNSCC and to examine more frequently high-risk patients subject to heavy smoking and high alcohol intake.