Head and neck cancer arising after endoscopic mucosal resection for squamous cell carcinoma of the esophagus.
OBJECTIVE
It is well known that patients with head and neck cancer often have synchronous or metachronous squamous cell carcinoma of the esophagus. However, the prevalence of subsequent head and neck cancer in patients with early-stage esophageal cancer is still unknown. The aims of this study were to analyze the frequency of metachronous head and neck cancer after endoscopic mucosal resection (EMR) for esophageal cancer and to investigate whether minute iodine-unstained areas, often associated with squamous cell carcinomas, would be an index for metachronous head and neck cancer.


METHODS
99 patients with esophageal squamous cell carcinoma who underwent EMR were studied. Based on the iodine-staining pattern at initial EMR, they were categorized into those with uniform (group U) and scattered (group S) types of background mucosa. Patients were monitored endoscopically and otolaryngologically (group U, median 46 months, range 12-83 months; group S, median 44 months, range 13-80 months).


RESULTS
In total, 5/99 patients (5.1 %) were found to have metachronous head and neck cancer during the follow-up, including 4/20 patients (20 %) in group S. In three cases laryngeal or hypopharyngeal cancer was found by endoscopic examination. The cumulative proportion of metachronous head and neck cancer-free subjects was significantly lower in group S than group U (P = 0.0007).


CONCLUSIONS
Among patients who undergo EMR for esophageal carcinoma, those with scattered-type iodine staining of the background mucosa have an increased risk of metachronous head and neck cancer, and should therefore be closely observed. Careful endoscopic observation led to early detection of laryngeal and hypopharyngeal cancer.
Shimizu
Y
Y
Division of Endoscopy, Hokkido University Medical Hospital, Sapporo, Japan. yshimizu@med.hokudai.ac.jp
Tsukagoshi
H
H
Fujita
M
M
Hosokawa
M
M
Watanabe
A
A
Kawabori
S
S
Kato
M
M
Sugiyama
T
T
Asaka
M
M
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D004724:Endoscopy; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000453:epidemiology / Q000473:pathology; D007822:Laryngeal Neoplasms / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000473:pathology