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The implication of tobacco use in the young adult with head and neck cancer.

To define the biologic characteristics of head and neck cancer in the young adult, the clinical course of 83 previously untreated patients less than or equal to 40 years of age with head and neck cancer was reviewed retrospectively. Their course was compared to that in a randomly chosen, concurrently treated, site-matched and stage-matched older head and neck cancer population (matched control). Patterns of recurrence as well as overall disease-free survival in each of the two populations were not significantly different. An important stratification factor, however, was related to tobacco usage. Thirty percent of the young patients denied using tobacco compared with only 9% of the controls (P less than 0.05). The 5-year disease-free survival rate of the young adults who did not use tobacco was 66% compared with 86% for their matched control group with a history of smoking. These differences were most significant in young adults with Stage II disease (P less than 0.05 by log-rank testing). The growth and progression of head and neck cancer in the young adults is characterized by tobacco use patterns; a family history of head and neck cancer in five of 17 nontobacco using young adults raises the issue of an inherent genetic determinant.

Actuarial Analysis↗

Carcinogenic effects of different nitroso-compounds in Chinese hamsters. II. N-nitrosomorpholine and N-nitrosopiperidine.

A total of 320 Chinese hamsters (Cricetulus griseus) (CH) were subcutaneously (s.c.) treated with 1/5, 1/10, or 1/20 LD50 of N-nitrosomorpholine (NM) or N-nitrosopiperidine (NP). In the CH, NM and NP both produced up to a 100% rate of papillomas of the cheek pouch, tongue, pharynx, esophagus and forestomach. Occasionally squamous cell carcinomas also developed in these organs. A high rate of hepatomas was realized by NP.

Animals↗

A method for rapid scoring of respiratory tumors in hamsters.

The larynx, trachea, and lung of Syrian golden hamsters treated with diethylnitrosamine were stained with modified Wright's stain and rendered semitransparent by a clearing technique. Areas of dense cell aggregation (tumors) were readily observable under a dissecting microscope. Tumor scoring at this subgross level correlated with subsequent microscopic evaluation, except that several tumors were found on the subgross level which would not have been observed during routine histologic procedures. The clearing method was used successfully to discern differences in tumor incidence in a dose-response study with diethylnitrosamine.

Animals↗

Cancer incidence in Hiroshima and Nagasaki, Japan, 1958-1987.

The Hiroshima and Nagasaki tumour registries, which have been in operation since 1958, are among the few population-based cancer registries in Japan. This analysis evaluated cancer incidence in Hiroshima and Nagasaki between 1958 and 1987. The overall age-adjusted (World Population Standard) cancer incidence has increased from 217 to 301 per 100,000 among males, and from 176 to 197 per 100,000 among females during the first 30 years of cancer registration. The most recent rates are intermediate to rates in other countries. Despite a gradual decrease, gastric cancer remained the most common malignancy among males and females throughout the surveillance period, accounting for 24% of all cancers by the late 1980s. The rate of liver cancer has increased dramatically among males during the past 20 years, with a 2-fold increase in incidence in the past 10 years alone. The populations of Hiroshima and Nagasaki now have among the highest rates of liver cancer in the world. Breast cancer incidence in Hiroshima and Nagasaki, in contrast, is among the lowest in the world, although incidence rates have doubled since the 1960s. Other common malignancies include cancers of the lung, colon and rectum among males and cancers of the colon, cervix and lung among females.

Adolescent↗

FHIT in human cancer.

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Acid Anhydride Hydrolases↗

Thoracoscopy in infants and children.

The recent advances in technology and technique in endoscopic surgery have dramatically altered the approach to intrathoracic lesions in the pediatric patient. Now most operations can be performed using a video-assisted approach, which has markedly decreased the associated morbidity for the patient. This has allowed for an aggressive approach in obtaining tissue for diagnostic purposes in cases of interstitial lung disease or questionable focal lesions in immunocompromised patients, without fear of the significant pulmonary complications previously associated with standard thoracotomy. In general, a lung biopsy now can be performed with little more morbidity than that of a transbronchial biopsy yet the tissue obtained is far superior. The same is true for mediastinal masses or foregut abnormalities. Patients who undergo a limited biopsy procedure can be released on the day of surgery. Lesions such as esophageal duplications can be excised thoracoscopically, with the patient ready for discharge the following day. Even closure of patent ductus arteriosus is now performed safely thoracoscopically, with a hospitalization period of less than 24 hours. Although a thoracoscopic approach may not always result in a significant decrease in the length of hospital stay, it may be associated with a significant decrease in morbidity for the patient. For example, in cases of severe scoliosis, thoracoscopic anterior spinal fusion results in earlier extubation, a stay in the intensive care unit, and earlier mobilization. It is clear that thoracoscopic surgery has significant advantages over the standard open thoracotomy in many cases. With continued improvement and miniaturization of the equipment, the procedures we can perform and the advantages to the patient should continue to grow.

Biopsy↗

Cancer incidence, mortality from cancer and survival in men of different occupational classes.

Low social class is associated with higher mortality from cancer at several sites and in patients with cancer low social class is known to be associated with a poorer chance of survival. Social differences in cancer incidence are less consistent. The present study was undertaken to assess the relation between occupational class and cancer incidence, mortality and survival from cancer in a large population of 7001 men aged 51-59, free of diagnosed cancer at baseline in 1970--1972. The main outcome measures were cancer incidence and cancer mortality until 1992 according to the Swedish national cancer and cause-specific death registries. Cancer survival was analysed in a subgroup of 904 men diagnosed with cancer before 1990. There were 1329 incident cases of cancer including 620 deaths from cancer. Overall cancer incidence during follow-up did not vary significantly by occupational class, but respiratory cancers were significantly more common among men with manual occupations; p = 0.0004. This was not be explained by differences in tobacco smoking, which were minor at the start of the study and did not increase much during follow-up. Overall mortality from cancer was significantly higher among men with manual occupations. Among professionals and higher officials 336 per 100,000 observation years died from cancer, compared to 391 among intermediate officials, 509 among lower officials, 474 among skilled and 548 among non-skilled workers; p for trend = 0.0003. This difference was mainly due to mortality from respiratory cancer, with a threefold difference between manual workers and professionals; this did not change after adjustment for smoking. Among the 904 men diagnosed before 1990 with cancer at any site (except non-melanoma skin cancer) the adjusted relative risk of dying from cancer was 1.75 (95% confidence interval 1.22-2.50) in unskilled workers compared to higher officials (p for trend 0.015).

Case-Control Studies↗

Effect of di-isopropanolnitrosamine in European hamsters.

The carcinogenic effects of di-isopropanolnitrosamine (DIPN) were tested in hibernating and non-hibernating European hamsters. The results obtained were compared with those produced by the same substance in Syrian golden hamsters and Sprague-Dawley rats. In European hamsters, tumours were produced in the nasal cavity, trachea, lung, liver and pancreas. The main target organs were the anterior part of the nasal cavity and liver. Only cholangiomas and cholangiocarcinomas were found in the liver. Early changes in the intrahepatic bile ducts and duct epithelium of the pancreas were seen 4 weeks after treatment was started. Fourteen out of 144 treated hamsters developed pancreatic-duct tumours, 2 of which were malignant. The tumorigenic response in the target organs was lower in hibernating than in non-hibernating animals.

Animals↗

Cancer survival in Sweden 1960-1998--developments across four decades.

This paper summarizes a comprehensive study of cancer survival in Sweden from 1960 to 1998. A total of 1021421 persons and 40 different cancer sites were included in the analyses. The main outcome measure is the relative survival rate (RSR) for different sites and follow-up times after diagnosis. The 10-year RSR for all sites combined has increased steadily-from 26.6% among men and 41.8% among women in the 1960s, to 44.6% (men) and 57.6% (women) in the 1990s. The expectation of life for a person diagnosed with cancer today is about 7 years longer than that of one diagnosed during the mid-1960s. About 3 years are gained due to changes in the relative distribution of various cancer types and about 4 years due to improved relative survival. During the 1990s substantial survival improvements were observed not only for uncommon types, such as testicular cancer, Hodgkin's lymphoma and some other haematologic malignancies, but also for cancer of the rectum, kidney and malignant melanoma. Survival for breast and cervical cancer also improved during the 1990s, but not that for pancreatic, liver or lung cancer.

Age Factors↗

Effects of inhaled ammonium sulfate on benzo[a]pyrene carcinogenesis.

The effect of inhaled ammonium sulfate on benzo[a]pyrene carcinogenesis in the lungs of Syrian golden hamsters was studied. Exposure to ammonium sulfate at an airborne concentration 20 times average United States ambient levels resulted in a significant depression (p less than 0.05) of benzo[a]pyrene carcinogenesis in the first 6 mo of the study. However, at 2 yr, the termination of the study, there were no differences in cancer incidence between groups receiving benzo[a]pyrene and benzo[a]pyrene plus ammonium sulfate. In addition, at the concentration studied, inhaled ammonium sulfate did not significantly increase the incidence or severity of pneumonitis or pulmonary fibrosis in the hamster. However, this inhalation did increase the incidence of emphysema but not the severity. The decreased incidence of cancer during the first 6 mo of this study in animals receiving both benzo[a]pyrene and ammonium sulfate suggests that interaction between sulfate and benzo[a]pyrene does occur, but is insufficient to afford long-term protection against the development of cancer. No enhancement of carcinogenesis by benzo[a]pyrene occurs in the presence of inhaled sulfate.

Ammonium Sulfate↗

Clinical course of thoracic cancers in Hodgkin's disease survivors.

BACKGROUND: Hodgkin's disease survivors have a high risk of subsequently developing thoracic cancers. Our goal was to evaluate the prognosis and treatment outcomes of thoracic cancers after Hodgkin's disease. PATIENTS AND METHODS: Thirty-three patients treated for Hodgkin's disease at Harvard-affiliated hospitals subsequently developed small-cell lung carcinoma, non-small-cell lung carcinoma (NSCLC) or mesothelioma. Information was obtained from medical records about the initial treatment for Hodgkin's disease, any salvage therapy, smoking history, and the stage, histology, treatment and survival for thoracic cancers. RESULTS: Of the 33 patients, 29 (88%) had a history of radiotherapy to the thorax, 17 (52%) had received alkylating chemotherapy, and 24 (73%) had a known history of smoking. The median time between diagnosis of Hodgkin's disease and diagnosis of thoracic cancer was 17.3 years (range 1.2-27.9 years). Among patients with NSCLC and a known stage, 85% presented with stage III or stage IV disease. Among patients whose treatment details were available, 40% underwent surgery, 40% received radiotherapy and 65% received chemotherapy. The median survival was 9 months (range 1-47 months). CONCLUSIONS: Most patients with thoracic cancers after Hodgkin's disease have a history of exposure to risk factors and present at an advanced stage. Patients with thoracic cancers after Hodgkin's disease have a poor survival.

Adolescent↗