Screening Endoscopy Should Be Considered in Patients With Head and Neck Cancer to Identify a Second Primary Esophageal Tumor

Individuals diagnosed with head and neck squamous cell carcinoma (HNSCC) are known to have an increased risk of developing a second primary tumor in the esophagus. This single-center study from the Netherlands identified patients diagnosed with HNSCC to determine the incidence, risk factors, and survival of those found to have a second primary esophageal tumor. 

Of the 1708 patients (66.2% male; mean age, 64.4 [11.5] years) with pathology-confirmed HNSCC, 484 (28.3%) underwent an endoscopy after diagnosis, and 47 were found to have a second primary esophageal tumor (SCC, 43; adenocarcinoma, 4). The cumulative incidence of being diagnosed with a second primary esophageal tumor was 2.9% at 10 years. The median time from HNSCC to esophageal tumor diagnosis was 18 months, and 32% (n=15) were identified within 6 months from the original HNSCC diagnosis. The features that significantly increased the risk for a second primary esophageal tumor were HNSCC location (in the oral cavity, hypopharynx, or oropharynx) and consumption of more than 2 standard drinks of alcohol per day. The overall survival was decreased when patients were found to have a second primary esophageal tumor (hazard ratio, 3.36; 95% confidence interval, 2.16-5.22) compared with those without an esophageal tumor.