Diagnosis of recurrent squamous cell carcinomas with the tumor marker SCC-antigen.

Background: The follow-up of squamous cell carcinomas of the head and neck is often challenging. Due to tissue alteration and anatomic changes after p rimary treatment or submucosal tumor growth, recurrences are sometimes dete cted very late. The tumor marker SCC-Antigen (SCC-Ag) may provide additiona l information for early detection of such tumor recurrences. Patients: Seru m levels of SCC-Ag in 578 patients with primary squamous cell carcinomas of the head and neck were assayed by SCC-RIA and IMx-SCC before treatment and every 2-3 months during follow-up. During the observation period of 30-84 (mean 50) months, 179 recurrences were verified by histologic examination. Results: Seventy-seven patients (43 %) with tumor recurrence showed elevate d serum levels of SCC-Ag (< 2.0 ng/ml). Fifty-eight (32 %) of them exhibite d elevated levels of SCC-Ag up to 11 months (mean 6.1 months) prior to hist opathologic diagnosis. This mainly became evident in 48 (83%) patients whos e SCC-Ag serum levels were elevated before treatment. Conclusion: Use of SC C-Antigen in head and neck tumors follow-up can provide early evidence of a lmost one third of all recurrences of squamous cell carcinomas of the head and neck. For clinical purposes, we recommend an initial analysis of the SC C-Ag serum level in every patient with primary squamous cell carcinoma of t he head and neck. The SCC levels of all SCC positive patients should be clo sely monitored. Elevated SCC should be regarded as a potential early sign f or recurrence and therefore indicates the need for intensified follow-up. D epending on the individual situation this should include ultrasonography, C T, MRI and especially frequent endoscopy in general anesthesia with multipl e biopsies of suspicious regions.