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Second primary malignancies in patients with head and neck cancers

Stephen Kang, MD
Theodoros N Teknos, MD
Section Editors
Marshall R Posner, MD
Bruce E Brockstein, MD
David M Brizel, MD
Marvin P Fried, MD, FACS
Deputy Editor
Michael E Ross, MD


Patients with head and neck squamous cell carcinoma (HNSCC) are at increased risk for the development of a second primary malignancy (SPM), which is defined as a second malignancy that presents either simultaneously or after the diagnosis of an index tumor. A synchronous SPM is diagnosed simultaneously or within six months of the index tumor, while a metachronous SPM is diagnosed greater than six months after the index tumor. SPMs need to be distinguished from local recurrences or metastasis of the primary tumor.

Second primary malignancies represent the second leading cause of death in patients with HNSCC [1]. One-quarter to one-third of deaths in these patients are attributable to SPM [1-3], highlighting the importance of SPM in the successful management of HNSCC.

The classification, epidemiology, etiology, diagnosis, and management of SPMs of the upper aerodigestive tract after treatment of an initial head and neck cancer will be reviewed here. Surveillance for an SPM or locally recurrent disease and the management of head and neck cancer in patients who have already been treated once are discussed separately. (See "Posttreatment surveillance of squamous cell carcinoma of the head and neck" and "Treatment of locally recurrent squamous cell carcinoma of the head and neck".)


The concept of field cancerization has been used to explain the occurrence of SPMs, especially in the oral cavity. This concept was introduced by Slaughter et al [4], who discovered that in oral cancers, the epithelium beyond the boundaries of tumor possessed histologic changes. The classic view of the term "field cancerization" hypothesized that large areas of head and neck mucosa are affected by carcinogen exposure, resulting in a wide field of premalignant disease that gives rise to multiple independent primary tumors. (See "Head and neck squamous cell carcinogenesis: Molecular and genetic alterations", section on 'Field cancerization'.)

Some but not all studies have found that putative SPMs share a genetic pattern with the primary tumor, with both tumors originating from a common clone [5,6].


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Literature review current through: Sep 2016. | This topic last updated: Aug 3, 2016.
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