The objective of the study was to assess the risk of second primary cancers (SPCs) following a primary head and neck cancer (oral cavity, pharynx and larynx) and the risk of head and neck cancer as a SPC. The present investigation is a multicenter study from 13 population-based cancer registries. The study population involved 99,257 patients with a first primary head and neck cancer and contributed 489,855 person-years of follow-up. To assess the excess risk of SPCs following head and neck cancers, we calculated standardized incidence ratios (SIRs) by dividing the observed numbers of SPCs by the expected number of cancers calculated from accumulated person-years and the age-, sex- and calendar period-specific first primary cancer incidence rates in each of the cancer registries. During the observation period, there were 10,826 cases of SPCs after head and neck cancer. For all cancer sites combined, the SIR of SPCs was 1.86 (95% CI = 1.83-1.90) and the 20-year cumulative risk was 36%. Lung cancer contributed to the highest proportion of the SPCs with a 20-year cumulative risk of 13%. Excess second head and neck cancer risk was observed 10 years after diagnosis with lymphohaematopoietic cancers. The most common SPC following a first primary head and neck cancer was lung cancer. However, the highest excess of SPCs was in the head and neck region. These patterns were consistent with the notion that the pattern of cancer in survivors of head and neck cancer is dominated by the effect of tobacco smoking and alcohol drinking.

Risk of second primary cancer among patients with head and neck cancers: A pooled analysis of 13 cancer registries

ObjectiveTo review the current literature about the epidemiology, clinical presentation, diagnosis, and treatment of laryngopharyngeal reflux (LPR).Data SourcesPubMed, Cochrane Library, and Scopus....

Evaluation and Management of Laryngopharyngeal Reflux Disease: State of the Art Review:

Objectives To describe the surgical technique for transoral lateral oropharyngectomy (TLO) and its safety, postoperative management, complications, and functional outcomes. Design A 20-year retrospective case series review. Mean follow-up was 10 years. All but 10 patients were followed up until the fifth postoperative year or death. Setting Academic, tertiary referral center. Patients A total of 191 patients who underwent TLO for selected invasive squamous cell carcinoma of the tonsil and/or tonsillar fossa. Interventions Ten patients had received preoperative radiation therapy. Induction chemotherapy was used in 153 patients (80.3%). An associated neck dissection was performed in 148 patients (77.5%). Postoperative radiation therapy was administered to 52 patients (28.7%). Main Outcome Measures Overall survival rate, intraoperative mortality, and perioperative mortality were determined. The need for and length of nasogastric tube feeding and tracheotomy were calculated. The incidence of significant postoperative surgical and medical complications was recorded. Results No intraoperative mortality occurred, but 5 patients (2.6%) died in the immediate postoperative period, 3 from medical complications and 2 from unknown causes. In this series, the internal carotid artery was never injured, and no cutaneous-oropharyngeal fistulas were apparent. The incidence of significant surgical complications from the oropharynx was 6.3%. Nasopharyngeal reflux and severe rhinolalia were the most common complications, occurring in 9 patients. Increasing tobacco use was statistically correlated with an increase in postoperative pneumonia from aspiration ( P  = .05) but no surgical complications. Seven patients (3.7%) had a temporary tracheotomy for a mean of 5 days. One hundred twelve patients (58.6%) had a nasogastric tube inserted for a mean of 6 days. No patients had a permanent gastrostomy or tracheotomy tube. The mean duration of hospitalization was 9 days. The duration of hospitalization was statistically correlated with the need for nasogastric tube placement and its duration ( P P Conclusions From a functional standpoint, the TLO is a safe surgical approach for treating selected carcinoma of the tonsillar fossa. It is a reliable technique that should be considered for treatment of appropriate squamous cell carcinoma of the tonsil.

https://jamanetwork.com/journals/jamaotolaryngology/articlepdf/649252/OOA40146.pdf

Transoral Lateral Oropharyngectomy for Squamous Cell Carcinoma of the Tonsillar Region: I. Technique, Complications, and Functional Results

ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease.

Cervical lymph node metastases of squamous cell carcinoma from an unknown primary.

OBJECTIVE: This study was undertaken to revise the diagnostic characteristics of tuberculous otitis media (TOM), a disorder that is often diagnosed late, leading to delay in specific treatment.STUDY DESIGN AND SETTING: Retrospective study of a longitudinal series of 10 TOM patients over a 7-year period at an institutional referral center.RESULTS: Most patients showed intractable otorrhea, moderately severe hearing loss, and necrotic eardrums with granulation tissue and single perforations. Multiple perforations, facial palsy, and cervical adenopathies were rare (<10% of patients). CT generally showed soft tissue involvement of the middle ear without bone erosion. The most effective laboratory test microbiological culture of exudate (diagnostic efficacy 71%). Specific antibiotic treatment was effective in all cases.CONCLUSION: The diagnosis of TOM remains a significant challenge for otorhinolaryngologists.SIGNIFICANCE: If there are strong clinical grounds for suspicion, standard laboratory tests for tuberc...

Tuberculous Otitis Media: A Significant Diagnostic Challenge

Objective Laryngopharyngeal reflux (LPR) is a common illness of otolaryngology visits. Over the past few years, pepsin has become a promising marker of LPR. The objective of the present research is to analyze the existing literature using pepsin as a diagnostic tool of LPR through a systematic review. Data Sources PubMed (Medline), Trip Database, Cochrane Library, EMBASE, SUMsearch, and Web of Science. Review Methods The outcome assessed was the presence of pepsin in LPR patients. We included articles in which pepsin was studied in LPR patients (clinically suspected or with confirmed diagnosis). Studies with no control group, comparison group, and/or a sample size lower than 20 patients were excluded. Results Twelve studies were included. All included studies, with the exception of 2, found statistically significant differences for pepsin in cases compared with healthy controls. Conclusion Pepsin might be a reliable marker in LPR patients, although questions remain about optimal timing, location, nature, and threshold values for pepsin testing. Future investigations are necessary to clarify the best method to use pepsin in the diagnostic process of LPR.

Is Pepsin a Reliable Marker of Laryngopharyngeal Reflux? A Systematic Review.

Objective Clinical study of second primary malignancies (SPM) in patients with cancer of the head and neck (HNC). Study design and setting Retrospective study over 48 patients with SPMs culled from 636 with HNC seen in 122 months. The minimum follow-up was 18 months, and the setting for the study was the institutional referral center. Results There was association between the sites of first and second tumor. The SPMs were diagnosed with a constant rate throughout the period of study. Five year-survival rate was 29%. SPM in an advanced stage either outside of the head and neck or synchronous had poor survival. Conclusion The SPMs are a growing problem with better survival after treatment of the first malignancy. Significance Regular follow-up is necessary in HNC patients to improve their survival, giving special attention to the development of SPM.

Second primary malignancies in patients with cancer of the head and neck.

Translation and Validation of the Reflux Symptom Index to Spanish.

Cervical metastases of cancer of an unknown primary tumour (CMUPT) are infrequent but they represent botha diagnostic and therapeutic challenge for ENT physicians. We present a retrospective study over 22 patients with CMUPT diagnosed in our hospital during 13 years (3.4% of the patients with head and neck cancer). The sensitivity of the fine-needle aspiration technique was 94.7%. 54% were N2a, 36% N3 and 9% N2b. 73% were squamous cell carcinoma and 27% were undifferentiated carcinoma. We established our protocol on diagnosis and management: panendoscopy with biopsies of nasopharynx, vallecula and pyriform sinus and ipsilateral tonsillectomy. The primary source was identified in 23% of the series. All squamous cell carcinoma were treated with radical neck surgery plus radiotherapy and the undifferentiated carcinoma with chemotherapy and radiotherapy. The overall survival was 64% at 3 years. The N-stage affected the survival rate.

Pedro Vaamonde

Papers

Tuberculous Otitis Media: A Significant Diagnostic Challenge

Is Pepsin a Reliable Marker of Laryngopharyngeal Reflux? A Systematic Review.

Second primary malignancies in patients with cancer of the head and neck.

Translation and Validation of the Reflux Symptom Index to Spanish.

Estudio sobre las metástasis cervicales de primario desconocido