Anna Wegner

Oral cavity and oropharyngeal squamous cell carcinoma in young adults: a review of the literature

Abstract Background. Head and neck squamous cell carcinoma (HNSCC) is a disease of middle-aged to elderly adults. However, an increased incidence of HNSCC in young people under 45 years of age has been reported recently. In the present review, we focused on the epidemiology and aetiology of HNSCC in adults under 45 years of age. Methods. We reviewed literature related to HNSCC in adult patients less than 45 years of age and discussed current treatment options and prognosis. Results. HNSCC in young adults is associated with a higher incidence rate in nonsmokers, lower female-to-male ratio, a higher percentage of oral cavity and oropharynx tumours, and fewer second primary tumours. However, aside from traditional risk factors of tobacco and alcohol exposure, the causes of these cancers in young adults remain unclear. Agents that might contribute to risk include infection with high-risk human papillomavirus subtypes as well as genetic factors or immunodeficiency status. The expected increase in incidence and mortality of the young with HNSCC may become a major public health concern if current trends persist, particularly lifestyle habits that may contribute to this disease. Conclusions. Given the younger age and potential long-term adverse sequelae of traditional HNSCC treatments, young adults should be treated on a case-by-case basis and post-therapy quality of life must be considered in any treatment-decision making process.

Clinical value of monoclonal antibodies and tyrosine kinase inhibitors in the treatment of head and neck squamous cell carcinoma

Head and neck squamous cell carcinoma (HNSCC) is a heterogeneous group of malignant tumours that affects over 500,000 patients per year. Treatment failure is generally due to the heterogeneity of these tumours and to the serious adverse effects associated with treatment. Immunological system impairment, which is common in HNSCC, further contributes to treatment failure by mediating tumour escape mechanisms. To date, the only clinically approved targeted therapy agent is cetuximab, a monoclonal antibody (mAb) that binds to, and inhibits, epidermal growth factor receptor, which is widely overexpressed in HNSCC. Cetuximab has been proven to induce antibody-dependent cellular cytotoxicity, further magnifying its therapeutic effect. DNA sequencing of HNSCC cells has identified the presence of mutated genes, thus making their protein products potential targets for therapeutic inhibition. Immune mechanisms have been found to have a significant impact on carcinogenesis, thus providing the rationale to support efforts to identify anticancer compounds with immunomodulatory properties. In the context of the rapid development of novel targeted agents, the aim of the present paper is to review our current understanding of HNSCC and to review the novel anticancer agents (mAbs and TKIs) introduced in recent years, including an assessment of their efficacy and mechanisms of action.

Rola badań immunohistochemicznych (białka p53, cykliny D1) w prognozowaniu raka gruczołowato-torbielowatego (carcinoma adenoides cysticum) ślinianek

Summary Introduction Adenoid cystic carcinoma of the salivary glands ( carcinoma adenoides cysticum ) is malignant epithelial tumor of rare occurrence. Tumor of this kind has among salivary glands tumors uncertain prognosis and unpredictable course. The aim of the study was to characterize the patient population and the immunohistochemical analyses (p53 protein, cyclin D1). Material and methods The examined group consisted of 30 patients with adenoid cystic carcinoma of the salivary glands. The expression of p53 protein and D1 cyclin in the tumor was evaluated and the correlation between these proteins and the organ and clinical grading was defined. Results The immunohistochemical studies showed in 70% the positive staining for p53 protein and 90% for cyclin D1. There was not statistically significant difference between the advanced grading of the organic and clinical adenoid cystic carcinoma.INTRODUCTION Adenoid cystic carcinoma of the salivary glands (carcinoma adenoides cysticum) is malignant epithelial tumor of rare occurrence. Tumor of this kind has among salivary glands tumors uncertain prognosis and unpredictable course. The aim of the study was to characterize the patient population and the immunohistochemical analyses (p53 protein, cyclin D1). MATERIAL AND METHODS The examined group consisted of 30 patients with adenoid cystic carcinoma of the salivary glands. The expression of p53 protein and D1 cyclin in the tumor was evaluated and the correlation between these proteins and the organ and clinical grading was defined. RESULTS The immunohistochemical studies showed in 70% the positive staining for p53 protein and 90% for cyclin D1. There was not statistically significant difference between the advanced grading of the organic and clinical adenoid cystic carcinoma.

Association of DNA repair genes polymorphisms and mutations with increased risk of head and neck cancer: a review

DNA repair mechanisms allow maintain genomic stability and proper functioning within the cells. Any aberrations may cause an increased risk of many diseases such as cancer. The most crucial risk factors for head and neck squamous cell carcinoma are behavioral factors, predominantly chronic exposure to tobacco, alcohol addiction, and infection with human papillomavirus or Epstein–Barr virus. These agents can induce DNA damage; therefore, cells must activate appropriate mechanisms in order to function correctly. Cancer cells are marked with genomic instability, which is associated with a greater tendency for the accumulation of a DNA damage and increased chemo- and radioresistance. Multiple studies have assessed the correlation of increased head and neck cancer (HNC) risk with polymorphism in the DNA repair genes. However, they suggest that interaction of DNA repair genes mutations with susceptibility to HNC depends on a patient’s race and risk factors, especially tobacco smoking. Further identification of these sequence variations must be performed. In this review, we discuss the current knowledge about the DNA repair genes mutations and polymorphisms associated with the high risk of head and neck treatment.

Rola zespołu interdyscyplinarnego w diagnostyce i leczeniu chorych z nowotworami krtani i gardła dolnego

INTRODUCTION In Poland the annual incidence of cancer of the larynx is about 3,000 cases which accounts 2% of all malignant tumors. Results of treatment of head and neck cancers are still unsatisfactory (five-year survival - 50%). In order to improve the outcome in Greater Poland Cancer Centre in 2010 a multidisciplinary team was created which is involved in the individual qualification of each patient to the best form of therapy. AIM The aim of the publication is to evaluate the work of the multidisciplinary team in the diagnostic, therapeutic, and post-operative follow-up of patients with larynx and hypopharynx cancer treated in Greater Poland Cancer Centre in 2007-2012. MATERIALS AND METHODS The analysis included 558 patients (84% men, 16% women) aged 38-82 years who were treated in the Department of Head and Neck Surgery Greater Poland Cancer Centre in the years 2007 to 2012 because of cancer of larynx and hypopharynx. Patients were divided into two groups - the first consisted of patients qualified without the cooperation of the multidisciplinary team - 312 patients (56%), the second - patients qualified with help of the multidisciplinary team - 246 patients (44%). In the two groups of patients evaluated were: mean time required for the implementation of additional tests and specialist consultations before treatment, the average time from the appearance of the patient to the start of treatment, the distribution of qualifications to specific forms of therapy. RESULTS Evaluating type of treatment administered after the establishment of the team noticed were an increase by 11% the number of patients treated with surgery. There has been a reduction in the time between the appearance of the patient at the clinic and the start of treatment and reduce the waiting time for diagnostic imaging and specialist consultations. It was also an increase in the number of regular check-ups and a decrease in the number of patients who stopped visits. CONCLUSION The work of the multidisciplinary team improves the effectiveness of treatment by optimizing the process of preparation and organization, and finally by contributing knowledge and experience in decision-making. His creation results in benefits for the patient, his family and the medical staff. Qualification for the most optimal treatment within the multidisciplinary team should be used in all patients with cancer of the head and neck.

Ultrastructural assessment of adenoid cystic carcinoma with emphasis on tumour infiltration periphery

Summary Background There is a wide variety of morphological and clinical types of tumours of the salivary glands. Almost 30 histological types of these neoplasms are known. Adenoid cystic carcinoma is a rarely occurring malignant epithelial neoplasm. It occurs in major salivary glands, but may also originate in the salivary glands of the respiratory tract. Aim The aim of the present study was the ultrastructural assessment of the infiltration periphery of different histological types of adenoid cystic carcinoma of the salivary glands. Materials and Methods Tissue samples from patients with adenoid cystic carcinoma of the salivary glands were studied. The study group consisted of 30 pts. 21 pts with tumour of parotid, 8 with submandibular and 1 with tumour of sublingual salivary glands. All patients were surgically treated and undergone supplementary treatment using radiotherapy in the Greater Poland Cancer Centre. Assessment of tissue samples was performed using morphological diagnoses and ultrastructural evaluation. Results Ultrastructural electron microscopy assessment of adenoid cystic carcinoma revealed differentiation of the tumour cells towards ductal salivary, myoepithelial and pluripotential cells. Epithelial cells showed an increased nucleus-cytoplasm ratio, and their nucleoli were characteristic for actively proliferating cells. The analysis showed histological and structural differences between the central and peripheral parts of the tumour. Conclusions The ultrastructural assessment of adenoid cystic carcinoma revealed that the cells in the peripheral parts of the tumour show a lower degree of maturation than the ones in its centre, peripheral stroma contains fewer collagen fibres, and dominant elements at the periphery of the tumour are proteoglycans and glycosaminoglycans, no histoformative features typical of the principal (central) part of the tumour were found at its periphery.

The role of otolaryngologist - head and neck surgeon's in the treatment of thyroid cancer.

INTRODUCTION Thyroid gland is an integral part of the neck region. In the topographic anatomy of the head and neck the gland is located in the middle triangle of the neck. Therefore, it is an organ which is also subject for diagnostic and treatment by otorhinolaryngologists - head and neck surgeons. Material and methods The study group consists of 50 patients aged from 22 to 76 years (mean 48). All patients were treated for suspected thyroid tumor. The ratio of women to men was 35:15. In all patients the same panel of diagnostic tests was used including: endocrinologic consultation, ENT examination with stroboscopic examination with assessment of vocal cord mobility, neck ultrasound examination to assess the thyroid gland and lymph nodes. Results In 50 patients following surgical methods were used: total resection of the thyroid - 28 patients (56%), resection of one lobe of the thyroid - 17 (34%), open biopsy - 6 (12%) patients. In 5 cases tracheotomy was performed. In the case of malignancy (excluding unresctable lesions - 6 patients) selective lymph node dissection of the neck was performed (field III, IV, VI) - 11 patients (22%). Discussion Results of surgical treatment (relative to the percentage damage to the recurrent laryngeal nerve) achieved by head and neck surgeons are at levels comparable or higher compared to the results achieved by general surgeons - 1.3% for primary benign lesions (Enomoto et al.).

Photodynamic therapy in palliative treatment of head and neck cancer.

INTRODUCTION Head and neck cancers account for about 6% of all malignant tumors. Head and neck cancers are responsible for about 650,000 new cases and approximately 260,000 deaths in the world annually. About 50% of patients fail to achieve cure or relapse of cancer occurs despite intensive combined treatment. A small number of patients is eligible for re-treatment, and for most of them symptomatic treatment is used. Photodynamic therapy(PDT) may be an alternative these patients. PDT improves the quality of life in patients who are at the stage of the disease recognized as incurable according to present knowledge. MATERIALS AND METHODS Study group consisted of three patients treated in the Department of Head and Neck Surgery in Poznan due to recurrence of squamous cell carcinoma of the head and neck. Patients were qualified to the palliative PDT ( Photodynamic therapy)with Foscan. when other possibilities of treatment have been used up. RESULTS Two patients achieved a partial response (PR) by RECIST criteria. One patient achieved disease stabilization (SD). DISCUSSION Photodynamic therapy is a therapeutic option in the palliative treatment of patients with squamous cell carcinoma of the head and neck. The careful qualification of the patients for this type of treatment is very important. One should take into account the location of the tumor and its size. Great advantage of photodynamic therapy is that it can be used repeatedly. Treatment with photodynamic therapy should be performed in specialized centers because of the need of adequate technical facilities. PDT may improve the quality of life of selected patients with incurable cancer of the head and neck.

[The expression assessment of the estrogen, progesterone and HER2 receptors in selected malignant tumors of the salivary glands].

INTRODUCTION The incidence of the malignant tumors of the salivary glands is relatelively low. However, rapid locoregional progression, distant metastases occurrence and high local recurrence rate occurring despite radical surgical treatment, significantly affect the outcome. Malignant tumors of the salivary glands are characterized by low radiosensitivity and poor response to systemic therapy. Therefore there is a need for new targeted therapies which may improve the prognosis. In some aspects, malignant tumors of the salivary glands are similar to breast cancers. Efficacy of hormonal replacement therapy and the treatment with the monoclonal antibody (trastuzumab) in the treatment of breast cancer is well known and confirmed. Criterion determining the qualification for treatment is the presence of hormone receptors and HER2 receptors in the tumor. AIM The aim of this study was to evaluate the expression of estrogen receptor, progesterone receptor and HER2 in selected salivary gland malignancies. MATERIALS AND METHODS Study group consisted of 51 patients with the salivary glands cancer. In the study group there were 42 tumors in the parotid gland, 7 tumors of the submandibular gland, 1 in the mucosa of the cheek and 1 tumor in the tongue. Histologically material comprised of muco-epidermoid carcinoma (10), adenoid-cystic carcinoma (8), salivary duct (7), adenocarcinoma (6), squamous cell carcinoma (6), mioepithelial carcinoma (5) and other (9). In all cases immunohistochemical analysis of the estrogen receptor, progesterone receptor and HER2 receptor was performed. RESULTS The expression of the estrogen receptor was found in 18% of tumors (9 patients). The expression of the progesterone receptor was found in 20% (10 patients). HER2 expression was found in 10% of tumors and was related to only one histological type of tumor - salivary duct carcinoma. CONCLUSION HER2 expression in malignant tumors of the salivary glands, especially in salivary duct carcinoma may be of use in future implementation of new targeted therapies based on monoclonal antibodies.

Ocena ekspresji receptora estrogenowego, progesteronowego i receptora HER2 w wybranych nowotworach złośliwych ślinianek

INTRODUCTION The incidence of the malignant tumors of the salivary glands is relatelively low. However, rapid locoregional progression, distant metastases occurrence and high local recurrence rate occurring despite radical surgical treatment, significantly affect the outcome. Malignant tumors of the salivary glands are characterized by low radiosensitivity and poor response to systemic therapy. Therefore there is a need for new targeted therapies which may improve the prognosis. In some aspects, malignant tumors of the salivary glands are similar to breast cancers. Efficacy of hormonal replacement therapy and the treatment with the monoclonal antibody (trastuzumab) in the treatment of breast cancer is well known and confirmed. Criterion determining the qualification for treatment is the presence of hormone receptors and HER2 receptors in the tumor. AIM The aim of this study was to evaluate the expression of estrogen receptor, progesterone receptor and HER2 in selected salivary gland malignancies. MATERIALS AND METHODS Study group consisted of 51 patients with the salivary glands cancer. In the study group there were 42 tumors in the parotid gland, 7 tumors of the submandibular gland, 1 in the mucosa of the cheek and 1 tumor in the tongue. Histologically material comprised of muco-epidermoid carcinoma (10), adenoid-cystic carcinoma (8), salivary duct (7), adenocarcinoma (6), squamous cell carcinoma (6), mioepithelial carcinoma (5) and other (9). In all cases immunohistochemical analysis of the estrogen receptor, progesterone receptor and HER2 receptor was performed. RESULTS The expression of the estrogen receptor was found in 18% of tumors (9 patients). The expression of the progesterone receptor was found in 20% (10 patients). HER2 expression was found in 10% of tumors and was related to only one histological type of tumor - salivary duct carcinoma. CONCLUSION HER2 expression in malignant tumors of the salivary glands, especially in salivary duct carcinoma may be of use in future implementation of new targeted therapies based on monoclonal antibodies.