Correspondence

Head and Neck Cancer

N Engl J Med 2002; 346:1416-1417May 2, 2002

Article

To the Editor:

Both synchronous and metachronous second cancers in the upper aerodigestive tract are an important problem in patients with head and neck cancer, but this major problem was not discussed in the review by Forastiere et al. (Dec. 27 issue).1 Among patients who survive head and neck cancer, the risk of a second neoplasm is 3 to 7 percent per year.2 The risk of a second squamous-cell neoplasm of the esophagus is as high as 11.8 percent.3-5 When a symptomatic esophageal cancer develops in a patient with a history of head and neck cancer, the prognosis is very poor.2 Screening for esophageal squamous-cell cancer by high-resolution videoendoscopy combined with either Lugol's staining or systematic biopsies (or possibly fluorescence spectroscopy) has therefore been recommended for patients who have had head and neck cancer.3,4 The introduction of endoscopic esophageal mucosal resection has revolutionized the treatment of intraepithelial esophageal neoplasia,3 offering an effective and minimally invasive treatment option if esophageal squamous-cell neoplasia is diagnosed early. The survival benefit of both screening for and treating early esophageal cancer5 underscores the need for general surveillance in patients with newly diagnosed or already curatively treated head and neck cancer.

Hans Scherübl, M.D.
Hans Scherer, M.D.
Bodo Hoffmeister, M.D.
Free University Berlin, 12200 Berlin, Germany
hscher@zedat.fu-berlin.de

5 References

1. 1

   Forastiere A, Koch W, Trotti A, Sidransky D. Head and neck cancer. N Engl J Med 2001;345:1890-1900[Erratum, N Engl J Med 2002;346:788.]
   Full Text | Web of Science | Medline

2. 2

   Leon X, Quer M, Diez S, Orus C, Lopez-Pousa A, Burgues J. Second neoplasm in patients with head and neck cancer. Head Neck 1999;21:204-210
   CrossRef | Web of Science | Medline

3. 3

   Makuuchi H, Machimura T, Shimada H, et al. Endoscopic screening for esophageal cancer in 788 patients with head and neck cancers. Tokai J Exp Clin Med 1996;21:139-145
   Medline

4. 4

   Scherubl H, von Lampe B, Faiss S, et al. Screening for oesophageal neoplasia in patients with head and neck cancer. Br J Cancer 2002;86:239-243
   CrossRef | Web of Science | Medline

5. 5

   Horiuchi M, Makuuchi H, Machimura T, Tamura Y, Sakai M. Survival benefit of screening for early oesophageal carcinoma in head and neck cancer patients. Dig Endosc 1998;10:110-115
   CrossRef

To the Editor:

Forastiere et al. do not mention the habit of paan chewing, which is widespread in Asia, as a risk factor for oral cancer.1 The practice of chewing pieces of areca nut with lime folded into a betel leaf (a preparation known in South Asia as paan) is widespread in South Asia, Southeast Asia, and the South Pacific. Although other ingredients, such as tobacco and various spices, are commonly added, paan almost always includes calcium hydroxide, areca nut (from the Areca catechu tree), and betel leaf (from the Piper betle vine). The link between the use of paan and oral cancer has been recognized for more than a century,2 and heavy users of paan have a significantly increased mortality rate.3 Unfortunately, efforts to control the habit have been less ambitious and generally less successful than efforts to control cigarette smoking.4

Ajit Singh Kashyap, M.D.
Surekha Kashyap, M.D.
Armed Forces Medical College, Pune 411 040, India
skashyap@pn2.vsnl.net.in

4 References

1. 1

   Mack TM. The new pan-Asian paan problem. Lancet 2001;357:1638-1639
   CrossRef | Web of Science | Medline

2. 2

   Betel-quid and areca-nut chewing. In: IARC monographs on the evaluation of the carcinogenic risk of chemicals to humans. Vol. 37. Lyons, France: International Agency for Research on Cancer, September 1985:141-200.
   

3. 3

   Gupta PC, Mehta HC. Cohort study of all-cause mortality among tobacco users in Mumbai, India. Bull World Health Organ 2000;78:877-883
   Web of Science | Medline

4. 4

   Gupta P. Chewing and smoking: the underestimated epidemic. In: Proceedings of the Seventh World Congress on Tobacco and Health, Perth, Western Australia, April 1–5, 1990. abstract.
   

Citing Articles (6)

Citing Articles

1. 1

   Lewis Roy Eversole. (2009) Dysplasia of the Upper Aerodigestive Tract Squamous Epithelium. Head and Neck Pathology 3:1, 63-68
   CrossRef

2. 2

   H. Scherübl, J. Steinberg, C. Schwertner, P. Mir-Salim, U. Stölzel, E.-M. Villiers. (2008) „Field cancerization“ im oberen Aerodigestivtrakt. HNO 56:6, 603-608
   CrossRef

3. 3

   Suvi-Tuuli Vilen, Pia Nyberg, Mika Hukkanen, Meeri Sutinen, Merja Ylipalosaari, Anders Bjartell, Annukka Paju, Virpi Haaparanta, Ulf-Håkan Stenman, Timo Sorsa, Tuula Salo. (2008) Intracellular co-localization of trypsin-2 and matrix metalloprotease-9: Possible proteolytic cascade of trypsin-2, MMP-9 and enterokinase in carcinoma. Experimental Cell Research 314:4, 914-926
   CrossRef

4. 4

   Jonathan J. Beitler, Richard V. Smith, Randall P. Owen, Carl E. Silver, Madhu Mazumdar, Scott Wadler. (2007) Phase II clinical trial of parenteral hydroxyurea and hyperfractionated, accelerated external beam radiation therapy in patients with advanced squamous cell carcinoma of the head and neck: Toxicity and efficacy with continuous ribonucleoside reductase inhibition. Head & Neck 29:1, 18-25
   CrossRef

5. 5

   G. N. J. Tytgat, H. Bartelink, R. Bernards, G. Giaccone, J. J. B. van Lanschot, G. J. A. Offerhaus, G. J. Peters. (2004) Cancer of the esophagus and gastric cardia: recent advances*. Diseases of the Esophagus 17:1, 10-26
   CrossRef

6. 6

   Ethel-Michele de Villiers, Karin Gunst, Harald Stein, Hans Scherbl. (2004) Esophageal squamous cell cancer in patients with head and neck cancer: Prevalence of human papillomavirus DNA sequences. International Journal of Cancer 109:2, 253-258
   CrossRef