Chromoendoscopy is a valuable tool for screening of high-risk patients with head and neck cancer for early detection of esophageal cancer.
BACKGROUND
The incidence of esophageal cancer is markedly increased in patients with head and neck cancer, and the presence of esophageal cancer is associated with reduced survival rates.


OBJECTIVE
We investigated whether the results of screening for esophageal cancer in patients with head and neck cancer using chromoendoscopy would change the treatment of such patients.


METHODS
87 patients with head and neck cancer and known alcohol or nicotine abuse were screened for esophageal cancer.


METHODS
The patients underwent esophagogastroduodenoscopy and staining of the esophagus with 2% Lugol's solution. Biopsies were taken from unstained areas for histopathological assessment.


RESULTS
Esophageal cancer was newly diagnosed in 10 patients (11.5%), including 2 with carcinoma in situ. There were dysplastic changes in 6 patients (7%) and an unknown Barrett esophagus in 4 patients (5%). In 36 patients (41%) unstained areas were associated with esophagitis. While unstained areas could not be detected in 17 patients, the histology was normal in 14 patients with unstained areas. In all the patients with newly detected invasive esophageal cancer, the treatment had to be changed from a curative neoadjuvant approach to palliative treatment. In 2 patients with carcinoma in situ mucosectomy was performed. In the cases with dysplastic areas and newly detected Barrett epithelium a careful follow-up regime was arranged.


CONCLUSIONS
The staging of patients with head and neck cancer, and the risk factors for esophageal cancer should include chromoendoscopy of the esophagus as a standard procedure. Extended staging provides critical additional information, which helps to more safely distinguish future candidates for curative and palliative treatment.
Moschler
Oliver
O
Department of General Internal Medicine and Gastroenterology, Marienhospital, Osnabruck, Germany.
Spahn
Thomas Werner
TW
Middelberg-Bisping
Christina
C
Grosse-Thie
Wolfram
W
Christoph
Bernd
B
Kloeppel
Gunter
G
Mueller
Michael Karl
MK
D001706:Biopsy; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D007454:Iodides; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000473:pathology; D012307:Risk Factors; D013194:Staining and Labeling / Q000379:methods
D007454:Iodides; C010389:Lugol's solution