Mutagen sensitivity: Enhanced risk assessment of squamous cell carcinoma

• Published in: European Journal of Cancer. Part B: Oral Oncology 1996-11, Vol.32 (6), p.367-372
• Main Authors: Cloos, J., Reid, C.B.A., Snow, G.B., Braakhuis, B.J.M.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Carcinoma, Squamous Cell - genetics; Carcinoma, Squamous Cell - prevention & control; Disease Susceptibility; head and neck cancer; Head and Neck Neoplasms - genetics; Head and Neck Neoplasms - prevention & control; Humans; Medical sciences; mutagen; Mutagenicity Tests; Neoplasms, Multiple Primary - genetics; Neoplasms, Multiple Primary - prevention & control; oral cancer; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Risk Assessment; Tumors
• ISSN: 0964-1955; 1878-6766
• DOI: 10.1016/S0964-1955(96)00019-X

Squamous cell carcinoma of the head and neck has an incidence of almost 5% of newly diagnosed cancers in North Western European countries and the United States. These carcinomas arise from the mucous membrane of the upper aerodigestive tract and are predominantly found in 50-70-year-old males. Head and neck squamous cell carcinoma (HNSCC) of the oral cavity, larynx and pharynx are the most common. Other sites are not included in this review as it has been suggested that they have a very distinct aetiology and comprise a very heterogeneous group of neoplasms. The treatment of HNSCC is dependent on the tumour site and stage of the disease, but commonly consists of surgery, radiotherapy or a combination of both. Especially for more advanced disease involving large tumours (usually with lymph node metastases) the patient survival has not improved significantly during the last decades, despite the development of more sophisticated surgical and radiotherapeutic treatment modalities. In addition to the risk of recurrence and metastases for HNSCC patients with more advanced disease, another important factor which influences survival of patients especially with small tumours is the occurrence of multiple primary tumours (MPT) in the epithelium of the head and neck region, oesophagus and lungs. Patients successfully treated for HNSCC are at relatively high risk (2-3% patients per year) of developing other new tumours in the respiratory and upper digestive tract (RUDT). Such development of multiple malignant epithelial tumours in this area is a major clinical concern. The occurrence of MPT can be explained in the light of "field cancerisation" a concept that postulates that the entire mucous membrane of the RUDT is abnormal and "precancerous", due to a similar exposure to carcinogens, notably tobacco and alcohol. Support for this concept has been provided by several groups using a variety or premalignancy markers. (DBO)