Koinzidenz von Plattenepithelkarzinomen der Speiseröhre und Kopf-Hals-Karzinomen: Risiko und Früherkennung[1]

Zusammenfassung

Patienten mit Kopf-Hals-Karzinomen tragen ein Risiko von 5 - 14 %, an einem Plattenepithelzweitkarzinom der Speiseröhre zu erkranken. Tritt bei diesen Patienten ein symptomatisches Ösophaguszweitkarzinom auf, wird die dann meist ungünstige Prognose durch das Ösophaguskarzinom bestimmt. Prospektive Studien aus Japan, Brasilien, Taiwan, Frankreich aber auch aus Deutschland zeigen, dass durch endoskopische Vorsorgeuntersuchungen mit hochauflösenden Videoendoskopen nicht nur eine Früherkennung der Ösophaguszweitneoplasien, sondern auch eine frühe kurative Therapie möglich ist. Dies unterstreicht die Bedeutung einer Screeningösophagoskopie bei Erstdiagnose des Kopf-Hals-Karzinoms als auch der Surveillance. Umgekehrt sollen Patienten mit behandelten Plattenepithelösophaguskarzinomen regelmäßig pharyngolaryngoskopiert werden, da das Risiko von Zweitneoplasien in diesem Bereich 9,3 - 11,4 % beträgt. Patienten mit einer sog. field cancerisation des Atemwegs- und oberen Verdauungsapparates bedürfen somit der interdisziplinären Betreuung und Überwachung.

Abstract

Patients suffering from head and neck cancer (HNC) have or will develop a second esophageal squamous cell cancer (ESCC) in 5 - 14 %. When a second esophageal neoplasm occurs in a HNC patient, the prognosis is generally determined by the ESCC, and unfortunately it is poor. Prospective clinical studies in Japan, Brazil, Taiwan, France and Germany have shown that screening or surveillance using Lugol chromoesophagoscopy enables early detection of second esophageal neoplasias. Such a surveillance results in a survival benefit for HNC patients. Vice versa, ESCC patients also have a risk of 9.3 - 11.4 % for a head and neck cancer. Periodic otolaryngeal examination and pharyngoscopy is recommended for curatively treated ESCC patients. Patients with a so-called field cancerisation of the airways and upper digestive tract thus require an interdisciplinary management and monitoring.

Ösophaguskarzinom - Ösophagus

oesophageal carcinoma - oesophagus

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1 Wir danken der Deutschen Krebshilfe für die Projektförderung.