Head and Neck Cancer

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Abstract
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.

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