Differentiated thyroid cancer invading the hypopharynx: A case report

Most thyroid cancers (90–95%) are well differentiated. Well differentiated cancers of the thyroid are usually confined to the thyroid capsule, making them amenable to isolated thyroid resection. Invasion of the upper aerodigestive tract by these cancers is infrequent and hypopharyngeal invasion is still rare. We report a 51 year old man with thyroid cancer invading the hypopharynx, who was successfully managed with complete resection along with a partial pharyngectomy. He is asymptomatic and disease free eighteen months after surgery. We advocate aggressive surgical extirpation of thyroid carcinoma invading the upper aerodigestive tract.     

侵犯上呼吸消化道的高分化甲状腺癌的治疗

目的：探讨侵犯上呼吸消化道的高分化甲状腺癌的治疗方式。方法：回顾性分析62例侵犯上呼吸消化道的高分化甲状腺癌的治疗方法。全组均行手术治疗,术式以肿瘤削除术为主,17例患者术后行放射性碘治疗,3例行术后放疗。全部病例随访2～15年。结果：肿瘤局限性侵犯患者,手术削除干净无残留者5年局部控制率达100．0％(17／17);肿瘤广泛侵犯突入腔内而行扩大切除者为87．5％(7／8);局限性侵犯、手术削除不干净有残留者为55．6％(5／9)。姑息性切除疗效最差。17例少量肿瘤残留者术后行放射性碘治疗,其5年局部控制率与未作此治疗者,差异有显著性。结论：对于侵犯上呼吸消化道的高分化甲状腺癌,应根据具体情况选择合适的术式;对有少量肿瘤残留者术后应辅以同位素治疗,病程较晚期者宜行术后放疗。     

Temporal relationship between cancers of the lung and upper aerodigestive tract

We retrospectively reviewed the chart records at the Veterans General Hospital-Taipei for the period between January 1985 and December 1994 to examine the temporal relationship between cancers of the lung and upper aerodigestive tract. A total of 56 patients (54 males, 2 females) with histocytologically proven double primary cancers, with either lung cancer or upper aerodigestive tract cancers appearing first, were found. Squamous cell carcinoma was the most frequent histologic type of lung cancer (squamous 57%, adenocarcinoma 27%, poorly differentiated carcinoma 9%, small cell lung cancer 7%). The incidence of lung cancer patients with upper aerodigestive tract cancer was 0.9% (56/6412). There was no significant difference in the occurrence of upper aerodigestive tract cancer between non-small cell and small cell lung cancer (P > 0.05). However, the incidence of squamous cell lung cancer with upper aerodigestive tract cancer was higher than that of non-squamous cell lung cancer (P < 0.05). With regard to the location of lung cancer, the right lung was more commonly affected than the left (P < 0.001). The locations of upper aerodigestive tract cancers in these lung cancer patients were as follows: larynx 24, nasopharynx 11, esophagus 10, hypopharynx 4, pharyngeal tonsils 2, oral cavity 5. Most upper aerodigestive tract cancers were diagnosed before lung cancer (36/56, 64%), and lung cancer was diagnosed within 3 years in more than half of cases after the diagnosis of upper aerodigestive tract cancer (58.3%). Most lung cancers that preceded upper aerodigestive tract cancer were at an early stage at diagnosis (stage I 4, stage Illa 1), whereas the others, appearing either synchronously or after the diagnosis of upper aerodigestive tract cancer, were mostly at the late stage. There was no difference in survival between lung cancer patients with upper aerodigestive tract cancer and those without (P > 0.05).      

喉返神经解剖在甲状腺手术中的意义

目的探讨喉返神经解剖在甲状腺手术中的意义及在预防喉返神经损伤中的作用。方法分析125例甲状腺手术常规行喉返神经解剖;55例按传统方法仅行肿块切除而不解剖喉返神经。结果125例甲状腺手术常规行喉返神经解剖中,喉返神经损伤2例,无永久性损伤;55例按传统方法仅行肿块切除而不解剖喉返神经中,喉返神经损伤5例,永久性损伤2例。结论建议甲状腺手术应常规行喉返神经解剖,能减少喉返神经的损伤。     

Familial upper aerodigestive tract cancers: incidence trends,familial clustering and subsequent cancers

Familial risks in upper aerodigestive tract cancer have been assessed mainly through case-control studies based on reported but not medically verified cancers in family members. The nationwide Swedish Family-Cancer Database was used to describe the incidence trends for all subsites of upper aerodigestive tract cancer and to calculate standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for the cancer in 0-66-year-old offspring by cancers in family members. Additionally, SIRs for second primary cancer after upper aerodigestive tract cancers were analysed. SIRs in offspring for all upper aerodigestive tract cancer were not significant when a parent presented with concordant cancer. The population attributable fraction of familial upper aerodigestive tract cancer was 0.43%. Risk for subsequent cancers in men and women after upper aerodigestive tract cancer were increased in smoking, alcohol and other life-style related sites and in skin cancer and non-Hodgkin's lymphoma.     

甲状腺肿瘤手术中喉返神经损伤的预防

目的 :探讨甲状腺手术中喉返神经损伤的原因及预防措施。方法 :手术治疗甲状腺疾病 12 5例 ,术中显露喉返神经 ,行甲状腺腺叶或腺叶 峡部切除术治疗原发灶。结果 :共解剖喉返神经 14 5侧 ,术后出现暂时性喉返神经损伤 1例 ,喉返神经损伤发生率为 0 8% (1/12 5 )。结论 :熟悉喉返神经的解剖及变异 ,术中显露喉返神经 ,行瘤侧腺叶或腺叶 峡部切除术 ,能避免损伤喉返神经 ,是甲状腺肿瘤手术中预防喉返神经损伤的有效方法     

Surgical Salvage of Recurrent Cancer of the Head and Neck

The therapeutic options and prognosis for recurrent squamous cell carcinoma of the upper aerodigestive tract vary greatly depending on site, extent of disease, and previous treatment. Surgical salvage represents the primary curative option when recurrent disease is resectable. Common factors associated with poor salvage surgery outcomes include positive surgical margins, lack of disease-free interval following previous definitive radiation therapy, advanced initial and recurrent tumor stage, and presence of concomitant recurrent neck disease. Surgical salvage of oropharyngeal and hypopharyngeal recurrences after primary chemoradiation therapy is associated with significant patient morbidity and poor long-term survival. Patients with laryngeal recurrences generally have the best comparative survival and functional outcomes, while patients with oral cavity recurrences have a relatively intermediate prognosis. Nasopharyngeal recurrences have often been treated with reirradiation, but surgical salvage represents the best option for small recurrences confined to the nasopharynx. Most patients with recurrent upper aerodigestive tract squamous cell carcinoma after previous aggressive therapy are not curable, and clinical judgment in determining which patients are appropriate candidates for salvage surgery is paramount.     

甲状腺癌患者术中喉返神经的显露及损伤预防

背景与目的:喉返神经(recurrent laryngeal nerve,RLN)损伤是甲状腺手术最为严重的并发症之一,尤其在甲状腺癌手术时更易发生.喉返神经损伤和防护一直是甲状腺外科关注的焦点.本文旨在探讨甲状腺癌患者术中RLN显露及损伤的预防.方法:同顾性分析2002年1月至2006年7月收治的282例行甲状腺癌手术患者临床资料.结果:282例甲状腺癌患者术前4例发现RLN损伤,9例术中发现RLN受累,在环状软骨弓外下方2～3 cm区域气管食管间沟附近稍加分离即能见到RLN 505条(505/564,89.5%).所有患者在行颈淋巴结清扫前均未全程显露RLN,分离时紧靠甲状腺进行;对行颈部淋巴结清扫的患者先行RLN的全程显露.本组无手术死亡,术后并发症包括血肿1例,乳糜漏1例.1例冈肿瘤侵犯行单侧RLN切除;2例再手术患者行RLN松解及1例RLN吻合术,术后发音有所改善;术前检查无声带麻痹者,发生暂时性声嘶9例,永久性声嘶2例,1例因肿瘤侵犯喉行全喉切除及气管造口术.结论:RLN位于环状软骨弓外下方2～3 cm区域处位置表浅,易于显露.甲状腺癌在行甲状腺切除时,不必全程显露RLN:若需行颈淋巴结清扫,可先切除甲状腺,在其局部显露部位开始显露其全程,精细无血操作,能有效预防术中RLN损伤.损伤一经诊断应尽早修复.     

After the smoke clears: environmental and occupational risks for carcinoma of the upper aerodigestive tract

Both environmental and occupational exposures are associated with the development of carcinomas of the upper aerodigestive tract, although most squamous cell carcinomas of the upper aerodigestive tract are related to smoking and drinking. This review discusses environmental and occupational risk factors, other than tobacco and alcohol, for carcinoma of the upper aerodigestive tract and the difficulties encountered when attempts are made to study these environmental and occupational exposures. However, this is not an all-inclusive review; rather, it is designed to give the reader an understanding of the topic, to allow for appropriate counseling of patients, and perhaps to advance public health initiatives.     

Dietary risk factors for upper aerodigestive tract cancers

We examined the association between whole-grain intake and incident upper aerodigestive tract cancer in a cohort of 34,651 postmenopausal, initially cancer-free women. We also studied established risk factors for upper aerodigestive cancers, including fruit and vegetable intake, smoking and alcohol intake. A mailed questionnaire at baseline in 1986 included a food-frequency questionnaire and assessment of other cancer risk factors. During the 14-year follow-up period, 169 women developed cancer of the upper aerodigestive tract. For all upper aerodigestive cancers together, significant inverse associations were observed for the highest compared to the lowest tertile of whole grains [relative risk (RR) = 0.53, 95% confidence interval (CI) 0.34-0.81] and yellow/orange vegetables (RR = 0.58, 95% CI 0.39-0.87). In addition, those in the highest compared to lowest tertile of fiber intake from whole grain were less likely to develop upper aerodigestive tract cancer (RR = 0.56, 95% CI 0.37-0.84); fiber intake from refined grain was not significantly associated with upper aerodigestive tract cancer. Findings were generally similar for oropharyngeal (n = 53), laryngeal (n = 21), nasopharyngeal/salivary (n = 18), esophageal (n = 21) and gastric (n = 56) cancers, though numbers of cases were too small for statistical testing within individual cancers. These findings confirm previous observations that high intake of fruits and vegetables and that intake of whole grains and the fiber derived from them may reduce risk of upper aerodigestive tract cancers.     

Metabolizing enzyme genotype and risk for upper aerodigestive tract cancer

Genetic polymorphisms are associated with a number of enzymes involved in the metabolism of carcinogens important in the induction of upper aerodigestive tract cancer. It has been suggested that such polymorphisms may be linked to cancer susceptibility. Using a case-control molecular epidemiologic approach, the association between many of these genetic polymorphisms and susceptibility to upper aerodigestive tract cancer has been investigated in numerous studies. In this review, we summarize the findings of these studies, analyzing potential associations with upper aerodigestive tract cancer risk in terms of gene:environment interactions, genotype-induced functional defects in enzyme activity and/or expression, and the influence of race on these associations.     

Ganglions cervicaux : point de vue du chirurgien

Squamous cell carcinomas of the upper aerodigestive tract or head and neck cancers, are localized in a complex anatomical region with a major lymphohilic locoregional cervical extension. Cervical lymph node surgery is systematized and drainage areas are sectorized with an increasingly conservative attitude. Improving imaging techniques allow the realization of selective neck dissection; sentinel node techniques are being evaluated. The traditional dissection is reserved to the lymph in capsular rupture or cervical interstitial mass.     

A shifting paradigm for patients with head and neck cancer: transoral robotic surgery (TORS)

The evolution of surgical oncologic technology has moved toward reducing patient morbidity without compromising oncologic resection. In head and neck surgery, organ-preserving techniques have paved the way for the development of transoral techniques that remove tumors of the upper aerodigestive tract without external incisions and potentially spare the patient adjuvant treatment. The introduction of transoral robotic surgery (TORS) improves upon current transoral techniques to the oropharynx and supraglottis. This review will report on the evolution of robotic-assisted surgery: We will cover its applications in head and neck surgery by examining early oncologic and functional outcomes, training of surgeons, costs, and future directions.     

Imaging tumors of the central nervous system and extracranial head and neck

Both CT and MRI address the pertinent clinical issues in the management of patients with squamous cell carcinoma of the upper aerodigestive tract and neck, and are crucial to staging, treatment, and follow-up. By combining the clinical assessment of primary mucosal extent with the objective information provided by CT or MRI about deep tissue extension of the primary tumor and any nodal metastases, accurate assessment of the actual pretreatment primary tumor and nodal stages is possible. With this objective picture of tumor extent, decisions about surgery and radiotherapy can be made for primary and recurrent tumors, as well as for nodal metastases.     

Laryngeal reinnervation surgery — results of a selective approach in an animal study

Laryngeal reinnervation surgery is a difficult subject due to the fact that the recurrent laryngeal nerve (RLN) is responsible for both adductor and abductor laryngeal activity. Non-selective reinnervation procedures will result in laryngeal synkinesis with restoration of tonicity. Restoration of mobility requires selective reinnervation of the adductor and abductor branches with nerves with similar activity patterns as the initial abductor and adductor branches of the RLN.     

Melanosis and squamous cell neoplasms of the upper aerodigestive tract in Japanese alcoholic men

Melanosis is frequently observed in the upper aerodigestive tract of Japanese alcoholic men, and the prevalences of squamous cell dysplasia and SCC in the upper aerodigestive tract of Japanese alcoholic men are high. This study evaluated associations between melanosis and both neoplasms of the upper aerodigestive tract and factors contributing to the development of melanosis in Japanese alcoholic men. Endoscopic screening of 643 Japanese alcoholic men (aged 50-79 years) was combined with oropharyngolaryngeal inspection and esophageal iodine staining, and ALDH2 genotyping was carried out in 425 of them. Melanosis was frequently (20.8%) observed in the upper aerodigestive tract. The palate was the most common site of melanosis (11.2%), followed by the pharynx (9.5%), and by the esophagus (7.0%). The incidence of melanosis was higher in those with esophageal dysplasia (31/126, 24.6%), esophageal SCC (19/42, 45.2%), and oropharyngolaryngeal SCC (8/14, 54.1%) than in cancer- and dysplasia-free controls (69/437, 15.8%). The presence of melanosis was associated with a higher risk of esophageal dysplasia, esophageal SCC, and oropharyngolaryngeal SCC (OR 1.69, 4.03, and 6.61, respectively). Multivariate analysis showed that older age, heavier smoking, and heterozygosity for inactive ALDH2 were positively associated with the presence of melanosis. The presence of melanosis indicates a high risk for neoplasms in the upper aerodigestive tract of Japanese alcoholic men. Melanosis and neoplasms have the same causes, including older age, heavy smoking, and high acetaldehyde exposure.     

Treatment of radiation side effects with oral pilocarpine

Radiation therapy is commonly utilized either alone or in combination with surgery in the treatment of malignancies arising in the upper aerodigestive tract. Frequent post-treatment sequelae include xerostomia, dysgeusia, and dysphagia. Numerous commercial products designed to decrease these symptoms have not been uniformly successful. This pilot study was designed to evaluate prospectively oral pilocarpine as a means of stimulating minor and major salivary gland flow to eradicate these radiation-induced symptoms. The results of this pilot study support the hypothesis that the salivary glands are capable of responding to oral pilocarpine, and this therapeutic approach warrants further study.     

Descriptive epidemiology of upper aerodigestive tract cancers in the department of Somme

The aim of this study is to show the epidemiologic features of upper aerodigestive tract cancers in the department of Somme. This study focused on the 1984-1995 period. For men, the upper aerodigestive tract cancers are the most frequent cancers in the Somme area. The incidence rate of pharynx cancers has shown slightly a decline over the past 10 years. The mortality rate of larynx cancers for males fell from 18.2 in 1984-1987 to 13.8 in 1992-1995 per 100,000. 5-year survival rates are between 20 and 39% for men, and from 23 to 42% for women. France has the highest incidence of these cancers in Europe. Within the country, the Somme area has a high risk for incidences and mortality as well. The results of this study indicate that upper aerodigestive tract cancers represent a serious problem for public health. Further areas need to be researched before such factors can be causally implicated in the aetiology of the disease in order to make up the prevention.     

Detection of squamous cell cancer and pre-cancerous lesions by imaging of tissue autofluorescence in the hamster cheek pouch model.

Early detection of invasive and pre-invasive neoplasms of the aerodigestive tract will ultimately improve the management of patients with these lesions. This paper describes the use of quantitative fluorescence imaging of early squamous cell carcinomas in an animal model. Dysplasia, carcinoma in situ and invasive cancers were imaged exploiting tumour autofluorescence. Mapped biopsies were obtained from areas imaged determining a sensitivity of 100% and specificity of 80%. Autofluorescence imaging is an excellent method of detecting neoplasms of the aerodigestive tract.     

Cervical metastases from an occult primary site

Less than 5% of patients with metastatic cervical carcinoma will not have a detectable primary site despite a proper work-up. Recent aids for these diagnostic problems include fine needle aspiration and immunohistochemical panels to differentiate undifferentiated carcinoma from melanoma and/or lymphoma. CT scanning can suggest areas in the upper aerodigestive tract for biopsy and can be helpful in suggesting the pathology of the enlarged lymph nodes. EBV titers are often elevated when a nasopharyngeal carcinoma is small. Aggressive treatment of the occult primary patient with metastatic melanoma, thyroid cancer, and metastatic cancer presumed to arise from the skin of the head and neck or the mucous membranes of the upper aerodigestive tract is indicated as long-term survival is often achieved.