Source: www.docguide.com
Author: Kristina Rebelo

Patients who have been treated for head and neck cancer (HNCA) should be screened for oesophageal pathologies about 3 months out whether they are symptomatic or not, according a poster presentation here October 4 at the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting 2009.

Oesophageal pathology is extremely common in patients who have been treated for HNCA, according to the researchers.

“When we talk about HNCA, the 5-year survival rate for this cancer is 50%,” Peter C. Belafsky, MD, Head and Neck Oncological Surgery, University of California at Davis, and the Voice and Swallowing Center, Davis, California, told DocGuide.

“We took a look at the oesophagus in patients after treatment for head and neck cancer and we did oesophagoscopy and biopsy, as indicated, on all of them. We successfully performed the oesophagoscopy on all 100 patients without complication and we had only 13% of the entire cohort who had a normal examination.”

The study included 100 patients who had chemoradiation and underwent follow-up oesophagoscopy. Patient demographics, symptom surveys, treatments received, reflux medications prescribed and oesophageal findings were prospectively determined.

Findings on oesophagoscopy included stricture (22%), candidiasis (9%), peptic oesophagitis (67%), Barrett’s (8%), and new primary tumours — 1 hypopharynx, 2 oesophageal, and 1 stomach (4%); 13% had a normal oesophagoscopy. The mean age of the cohort was 64 years and 74% were male. The mean time between the cessation of treatment and endoscopy was 40 months and 77% of the HNCA population had been in advanced stage, III or IV.

The distribution of site of the primary HNCA had been oral cavity (16%), oropharynx (38%), larynx (36%), hypopharynx (2%), unknown primary cancer (7%), and nasopharynx (1%). Treatment modalities included surgery (15%), radiation (5%), radiation and chemotherapy and surgery (24%), and radiation +- chemotherapy (54%).

“Dysphagia is an extremely common condition in these patients,” said Dr. Belafsky, who also mentioned that half his practice is made up of people who have had radiation treatment who were subsequently suffering some devastating problems that can follow radiation treatment, even when appropriately given.

He said they have breathing problems, swallowing problems, formation of excessive fibrous tissue, and that eventually, as the symptoms worsen, they lose their ability to tolerate their own saliva and can choke to death if not seen.

“They have to end up using tubes and having tracheotomies in order to breathe, he said. “Many have their voice box removed and lose the ability to speak. Radiation is their hero, but it is a double-edged sword in that the patients who survive continue to have problems 20 years out that worsen over time.”

Dr. Belafsky said the largest risks for HNCA is smoking and drinking alcohol. “Together they represent a synergistic risk; HPV [human papillomavirus] is also a risk and the numbers are rising.”

The results of the study suggest that physicians cannot simply rely on patients’ symptoms, since in the study, patient symptoms were not associated with oesophageal disease. “The real big take here, is that patients who have been treated for head and neck cancer should have routine screening oesophagoscopy at least within 3 months.”

Notes:
1. Presented at American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting 2009
2. Presentation title: Esophageal Pathology After Treatment for Head & Neck Cancer. Abstract SP167