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„Field cancerization“ im oberen Aerodigestivtrakt

Überwachungsempfehlungen für Risikopersonen

Coincidental squamous cell cancers of the esophagus, head, and neck

Risk and screening

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Zusammenfassung

Das Phänomen der multifokalen, syn- und metachronen Karzinogenese (bei stattgehabter Tabak- und oft auch Alkoholexposition) bezeichnete Slaughter 1953 als „field cancerization“ des oberen Aerodigestivtrakts. Patienten mit Kopf-Hals-Karzinomen tragen ein Risiko von 5–14%, an einem Plattenepithelzweitkarzinom der Speiseröhre oder der Bronchien zu erkranken. Die endoskopische Überwachung ermöglicht eine Früherkennung von ösophagealen Zweitneoplasien und eine frühe kurative Therapie. Standard ist hierbei die hochauflösende Videoösophagoskopie mit Lugol-Färbung; seit kurzem stehen mit der Narrow-band-imaging- (NBI-)Endoskopie und der Endomikroskopie 2 zusätzliche neue Techniken zur Verfügung. Die Überwachung von Kopf-Hals-Tumor-Patienten im Hinblick auf Zweitkarzinome der Lunge ist ebenfalls wünschenswert, bislang aber nicht etabliert. Umgekehrt sollen Patienten mit kurativ behandeltem Plattenepithelkarzinom der Lunge oder Speiseröhre regelmäßig pharyngolaryngoskopiert werden, da auch in diesem Bereich das Risiko von Zweitneoplasien etwa 10% beträgt. Patienten mit „field cancerization“ bedürfen also generell einer interdisziplinären Betreuung und Überwachung.

Abstract

The term “field cancerization” was coined by Slaughter in1953 when describing multifocal synchronous and metachronous carcinogenesis in the upper aerodigestive system. Patients suffering from head and neck cancer (HNC) have or develop a second esophageal squamous cell cancer (ESCC) or bronchial cancer (BC) in 5–14% of cases. When a second esophageal cancer occurs in a patient with HNC, the prognosis is generally determined by the ESCC, and, unfortunately, it is poor. Screening and surveillance by Lugol chromoesophagoscopy enable early detection and curative treatment of second esophageal neoplasias. Surveillance appears to result in a survival benefit for HNC patients. Vice versa, patients with ESCC or BC have a risk of about 10% for developing HNC. Periodic pharyngolaryngoscopy is recommended for curatively treated ESCC or BC patients. Patients with field cancerization should be surveilled by a multidisciplinary approach.

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Authors and Affiliations

  1. Klinik für Innere Medizin - Gastroenterologie und Gastrointestinale Onkologie, Vivantes-Klinikum Am Urban, Dieffenbachstraße 1, 10967, Berlin, Deutschland

    H. Scherübl, J. Steinberg & C. Schwertner

  2. HNO-Klinik, Vivantes-Klinikum im Friedrichshain, Berlin, Deutschland

    P. Mir-Salim

  3. Klinik für Gastroenterologie und Infektiologie, Klinikum, Chemnitz, Deutschland

    U. Stölzel

  4. Abteilung für Tumorvirus-Charakterisierung, DKFZ, Heidelberg, Deutschland

    E.-M. de Villiers

Authors
  1. H. Scherübl
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  2. J. Steinberg
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  3. C. Schwertner
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  4. P. Mir-Salim
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  5. U. Stölzel
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  6. E.-M. de Villiers
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Correspondence to H. Scherübl.

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Die Arbeit wurde von der Kopf-Hals-Tumorstiftung und der Deutschen Krebshilfe gefördert.

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Scherübl, H., Steinberg, J., Schwertner, C. et al. „Field cancerization“ im oberen Aerodigestivtrakt. HNO 56, 603–608 (2008). https://doi.org/10.1007/s00106-007-1616-7

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  • DOI: https://doi.org/10.1007/s00106-007-1616-7

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