title: Multistep laryngeal carcinogenesis helps our understanding of the field cancerisation phenomenon: a review.
abstract: In this paper, we try to briefly review the most recent knowledge on head and neck cancer, and especially multistep laryngeal carcinogenesis, and to simply explain how this has modified our understanding of field cancerisation phenomenon. Experimental studies, made possible by the recent evolution of microdissection systems, have demonstrated that the "spatial progression"of the histopathological phenotype in the surroundings of malignant or premalignant head and neck lesions correlates with molecular progression. Such a "spatial progression" can be hypothesised to reflect temporal progression. The field cancerisation process has been divided into three phases, each with its own histological and molecular characteristics. Each of these phases may have clinical implications: detection and monitoring of fields may help cancer prevention (molecular epidemiology), early detection of recurrence (or, more exactly, of second field tumours (SFTs)) (molecular diagnostics) and prognostic prediction after treatment. This model appears plausible, especially in explaining the development of multiple primary tumours (MPTs) in adjacent head and neck mucosal regions, with peculiar clinical and prognostic implications: These tumours can be defined as multiple field tumours (SFTs). However, the model, in our opinion, does not convincingly explain the development of second primary tumours (SPTs) at more distant sites, such as the lung, colon and prostate.
authors.affiliation: Institute of Otolaryngology,Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy. almgio@yahoo.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Almadori
authors.forename: Francesco
authors.initials: F
authors.lastname: Bussu
authors.forename: Gabriella
authors.initials: G
authors.lastname: Cadoni
authors.forename: Jacopo
authors.initials: J
authors.lastname: Galli
authors.forename: Mario
authors.initials: M
authors.lastname: Rigante
authors.forename: Alberto
authors.initials: A
authors.lastname: Artuso
authors.forename: Maurizio
authors.initials: M
authors.lastname: Maurizi
mesh_terms: D018450:Disease Progression; D006801:Humans; D007822:Laryngeal Neoplasms / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D012307:Risk Factors