Multiple primaries in the upper aerodigestive tract. Part 1: Oral cavity and oropharynx.

Background: During the last years an absolute increase of tumour incidence of squamous cell carcinoma as well as an increase in the occurrence of sync hronous and metachronous multiple primaries in the upper aerodigestive trac t can be observed. This study analyses the so-called "multi-centric canceri zation" in patients with primary carcinoma of the oral cavity and the oroph arynx. Methods: During 2 observation periods of 5 years each, from 1985 to 1994, we retrospectively analysed 235 patients with squamous cell carcinoma of the oral cavity and 232 patients with tumour localisation in the oropha rynx. Besides age, sex, tumour localisation, TNM-stage and grading, the ris k factors tobacco and alcohol were added as causes for the development of m ultiple primaries. Results: In the primary localisation of the oral cavity synchronous and metachronous double tumours increased from 7% to 17% beside s the absolute increase in tumour incidence. In the oropharynx a total incr ease of second carcinomas from 3% to 20% was found. At the same time a grow ing abuse of tobacco and alcohol could be observed. Conclusions: Panendosco py during pretherapeutical staging should be obligatory. Regular oncologica l controls are mandatory, especially for younger patients with smaller tumo urs and good prognosis, but a high risk of second primaries. In the long ru n, prevention has to play a decisive role in the fight against second prima ry tumuors of the upper aerodigestive tract. Possible improvements of early diagnosis, genetical examinations, information campaigns as well as resear ch of cancerogene environmental pollutants are of foremost interest to the clinician.