Second Primary Tumors and Their Risk Factors in Patients with Primary Head and Neck Tumors
Abstract Introduction and objective: The term second primary tumor (SPT) is used to designate a new primary cancer that occurs in a person previously diagnosed with cancer. SPT are considered to occur independently and not as a result of a resurgence or metastasis of the index tumor or first primary tumor (FPT). The aim of this study is to investigate the prevalence, risk factors, location and treatment of STP, as well as time elapsed between tumor occurrence. Method: A retrospective descriptive study was performed including patients diagnosed with SPT between January 2004 and December 2021 at Hospital Universitario de Fuenlabrada. The prevalence and location of SPT, related risk factors, time between the onset of FPT and SPT, treatment of FPT and SPT and their outcome were analyzed. Results: From a total of 360 cases, 73 patients were included in the study because of SPT. 75% were smokers and 46.6% were drinkers. Most of these patients were treated surgically. It was observed that the FPT with the highest development of SPT was the larynx, with supraglottis being the most frequent sublocalization. The most frequent SPT was epidermoid carcinoma of the lung. Conclusions: In our series SPT appear in 20% of head and neck tumors. They are more frequent after laryngeal cancer, the most frequent location being the lung. Both tobacco and alcohol play an important role in their development, shortening the time between the appearance of tumors, in addition to the possibility of recurrence, persistence and metastasis.
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Coca-Pelaz A, Rodrigo J, Suárez C, Nixon I, Mäkitie A, Sanabria A, et al. The risk of second primary tumors in head and neck cancer: A systematic review. Head Neck. 2020;42(3):456-66.
Sturgis E, Wei Q, Spitz M. Descriptive epidemiology and risk factors for head and neck cancer. Semin Oncol. 2004;31(6):726–33.
Mroueh R, Nevala A, Haapaniemi A, Pitkäniemi J, Salo T, Mäkitie A. Risk of second primary cancer in oral squamous cell carcinoma. Head Neck. 2020;42(8):1848-58.
Álvarez C, Fernández H, Llorente J, Franco V, Hermsen M, Cuesta M, et al. Segundos tumores primarios en el cáncer escamoso de cabeza y cuello. Acta Otorrinolaringol Esp. 2006;57(10):462–6.
Khuri F, Kim E, Lee J, Winn R, Benner S, Lippman S, et al. The impact of smoking status, disease stage, and index tumor site on second primary tumor incidence and tumor recurrence in the head and neck retinoid chemoprevention trial. Cancer Epidemiol Biomarkers Prev. 2001;10(8):823–9.
Do K, Johnson M, Doherty D, Lee J, Wu X, Dong Q, et al. Second primary tumors in patients with upper aerodigestive tract cancers: joint effects of smoking and alcohol (United States). Cancer Causes Control. 2003;14(2):131–8.
Do K, Johnson M, Doherty D, Lee J, Wu X, Dong Q, et al. Longitudinal study of smoking patterns in relation to the development of smoking-related secondary primary tumors un patients with upper aerodigestive tract malignancies. Cancer. 2004;101(12):2837–42.
Castigliano S. Influence of continued smoking on the incidence of second primary cancers involving mouth, pharynx, and larynx. J Am Dent Assoc. 1968;77(3):580–5.
Silverman S, Gorsky M, Greenspan D. Tobacco usage in patients with head and neck carcinomas: a follow-up study on habit changes and second primary oral/oropharyngeal cancers. J Am Dent Assoc. 1983;106(1):33–5.
Wang S, Chan L, Wang L, Wu C, Lin S, Huang T, et al. Secondary primary malignancy in patients with head and neck squamous cell carcinoma: 27-year experience from the perspective of diagnostic tools. PLoS One. 2022;15;17(2):e0263773.
Bagnardi V, Blangiardo M, La Vecchia C. A meta-analysis of alcohol drinking and cancer risk. Br J Cancer 2001;85(11):1700-5.
Warren S, Gates O. Multiple malignant tumors: a survey of literature and statistical study. Am J Cancer. 1932;16:1358-414.
Herranz J, Varela P, Vázquez C. Segundos tumores primarios en cáncer de cabeza y cuello. Acta Otorrinolaringol Esp. 2016;67(3):123–9.
León X, García J, López M, Rodriguez C, Gutierrez A, Quer M. Riesgo de aparición de segundas neoplasias y neoplasias sucesivas en pacientes con un tumor índice de cabeza y cuello. Acta Otorrinolaringol Esp (Engl Ed). 2020;71(1):9-15.
Arie G, Shafat T, Belochitski O, El-Saied S, Joshua B. Treatment Modality and Second Primary Tumors of the Head and Neck. ORL J Otorhinolaryngol Relat Spec. 2021;83(6):420-7.
Bertolini F, Trudu L, Banchelli F, Schipilliti F, Napolitano M, Alberici M, et al. Second primary tumors in head and neck cancer patients: The importance of a «tailored» surveillance. Oral Dis. 2021;27(6):1412-20.
Lippman S, Hong W. Second malignant tumors in head and neck squamous cell carcinoma: the overshadowing threat for patients with early-stage disease. Int J Radiat Oncol Biol Phys. 1989;17(3):691-4.
Chuang S, Scelo G, Tonita J, et al. Risk of second primary cancer among patients with head and neck cancers: A pooled analysis of 13 cancer registries. Int J Cancer. 2008;123(10):2390-6.
Ha PK, Califano JA. The molecular biology of mucosal field cancerization of the head and neck. Crit Rev Oral Biol Med. 2003;14:363-9.
Slaughter D, Southwick H, Smejkal W. Field cancerization in oral stratified squa- mous epithelium; clinical implications of multicentric origin. Cancer. 1953;6(5):963–8.
Simple M, Suresh A, Das D, Kuriakose M. Cancer stem cells and field cancerization of oral squamous cell carcinoma. Oral Oncol. 2015;51(7):643-51.
Wynder E, Mushinski M, Spivak J. Tobacco and alcohol consumption in relation to the development of multiple primary cancers. Cancer. 1977;40(S4):1872–8.
Martel M, Alemany L, Taberna M, Mena M, Tous S, Bagué S, et al. The role of HPV on the risk of second primary neoplasia in patients with oropharyngeal carcinoma. Oral Oncol. 2017;64:37-43.
Ballesteros A. Cáncer de cabeza y cuello.Sistema. En: Tumores cabeza y cuello - O.R.L. - SEOM: Sociedad Española de Oncología Médica. Publicado el 4 de febrero de 2020. Disponible en: https://seom.org/123-Informaci%C3%B3n%20al%20P%C3%BAblico%20%20Patolog%C3%ADas/tumores-cabeza-y-cuello-orl. [Consultado el 13/12/2022].
International Agency for Research on Cancer (IARC). The Global Cancer Observatory. Larynx (Globocan 2020). Disponible en: https://gco.iarc.fr/today/data/factsheets/cancers/14-Larynx-fact-sheet.pdf. [Consultado el 13/12/2022].
Coca-Pelaz A, Rodrigo J, Suárez C, Nixon I, Mäkitie A, Sanabria A, et al. The risk of second primary tumors in head and neck cancer: A systematic review. Head Neck. 2020;42(3):456-66.
Sturgis E, Wei Q, Spitz M. Descriptive epidemiology and risk factors for head and neck cancer. Semin Oncol. 2004;31(6):726–33.
Mroueh R, Nevala A, Haapaniemi A, Pitkäniemi J, Salo T, Mäkitie A. Risk of second primary cancer in oral squamous cell carcinoma. Head Neck. 2020;42(8):1848-58.
Álvarez C, Fernández H, Llorente J, Franco V, Hermsen M, Cuesta M, et al. Segundos tumores primarios en el cáncer escamoso de cabeza y cuello. Acta Otorrinolaringol Esp. 2006;57(10):462–6.
Khuri F, Kim E, Lee J, Winn R, Benner S, Lippman S, et al. The impact of smoking status, disease stage, and index tumor site on second primary tumor incidence and tumor recurrence in the head and neck retinoid chemoprevention trial. Cancer Epidemiol Biomarkers Prev. 2001;10(8):823–9.
Do K, Johnson M, Doherty D, Lee J, Wu X, Dong Q, et al. Second primary tumors in patients with upper aerodigestive tract cancers: joint effects of smoking and alcohol (United States). Cancer Causes Control. 2003;14(2):131–8.
Do K, Johnson M, Doherty D, Lee J, Wu X, Dong Q, et al. Longitudinal study of smoking patterns in relation to the development of smoking-related secondary primary tumors un patients with upper aerodigestive tract malignancies. Cancer. 2004;101(12):2837–42.
Castigliano S. Influence of continued smoking on the incidence of second primary cancers involving mouth, pharynx, and larynx. J Am Dent Assoc. 1968;77(3):580–5.
Silverman S, Gorsky M, Greenspan D. Tobacco usage in patients with head and neck carcinomas: a follow-up study on habit changes and second primary oral/oropharyngeal cancers. J Am Dent Assoc. 1983;106(1):33–5.
Wang S, Chan L, Wang L, Wu C, Lin S, Huang T, et al. Secondary primary malignancy in patients with head and neck squamous cell carcinoma: 27-year experience from the perspective of diagnostic tools. PLoS One. 2022;15;17(2):e0263773.
Bagnardi V, Blangiardo M, La Vecchia C. A meta-analysis of alcohol drinking and cancer risk. Br J Cancer 2001;85(11):1700-5.
Warren S, Gates O. Multiple malignant tumors: a survey of literature and statistical study. Am J Cancer. 1932;16:1358-414.
Herranz J, Varela P, Vázquez C. Segundos tumores primarios en cáncer de cabeza y cuello. Acta Otorrinolaringol Esp. 2016;67(3):123–9.
León X, García J, López M, Rodriguez C, Gutierrez A, Quer M. Riesgo de aparición de segundas neoplasias y neoplasias sucesivas en pacientes con un tumor índice de cabeza y cuello. Acta Otorrinolaringol Esp (Engl Ed). 2020;71(1):9-15.
Arie G, Shafat T, Belochitski O, El-Saied S, Joshua B. Treatment Modality and Second Primary Tumors of the Head and Neck. ORL J Otorhinolaryngol Relat Spec. 2021;83(6):420-7.
Bertolini F, Trudu L, Banchelli F, Schipilliti F, Napolitano M, Alberici M, et al. Second primary tumors in head and neck cancer patients: The importance of a «tailored» surveillance. Oral Dis. 2021;27(6):1412-20.
Lippman S, Hong W. Second malignant tumors in head and neck squamous cell carcinoma: the overshadowing threat for patients with early-stage disease. Int J Radiat Oncol Biol Phys. 1989;17(3):691-4.
Chuang S, Scelo G, Tonita J, et al. Risk of second primary cancer among patients with head and neck cancers: A pooled analysis of 13 cancer registries. Int J Cancer. 2008;123(10):2390-6.
Ha PK, Califano JA. The molecular biology of mucosal field cancerization of the head and neck. Crit Rev Oral Biol Med. 2003;14:363-9.
Slaughter D, Southwick H, Smejkal W. Field cancerization in oral stratified squa- mous epithelium; clinical implications of multicentric origin. Cancer. 1953;6(5):963–8.
Simple M, Suresh A, Das D, Kuriakose M. Cancer stem cells and field cancerization of oral squamous cell carcinoma. Oral Oncol. 2015;51(7):643-51.
Wynder E, Mushinski M, Spivak J. Tobacco and alcohol consumption in relation to the development of multiple primary cancers. Cancer. 1977;40(S4):1872–8.
Martel M, Alemany L, Taberna M, Mena M, Tous S, Bagué S, et al. The role of HPV on the risk of second primary neoplasia in patients with oropharyngeal carcinoma. Oral Oncol. 2017;64:37-43.
Gómez-Cabeza, A., Miranda-Sánchez, E., Martínez Ruiz-Coello, M., García-García, C., Hernandez-García, E., & Plaza-Mayor, G. (2023). Second Primary Tumors and Their Risk Factors in Patients with Primary Head and Neck Tumors. Revista ORL, 14(2), e29827. https://doi.org/10.14201/orl.29827
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