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Clinical Challenges
August 1998

Screening for Simultaneous Esophageal Primary Tumors: Esophagoscopy vs Esophagography

Author Affiliations
 

KAREN H.CALHOUNMDRONALD B.KUPPERSMITHMD

Arch Otolaryngol Head Neck Surg. 1998;124(8):930-932. doi:10.1001/archotol.124.8.930

Barium swallow studies are as efficacious as either flexible or rigid esophagoscopy in the detection of a simultaneous second primary tumor in a patient with newly diagnosed upper aerodigestive tract squamous cell carcinoma.

The incidence of second esophageal primary tumors in patients diagnosed as having squamous cell carcinoma of the head and neck varies in the literature. However, in large series, an incidence of about 1% to 2% is commonly reported.1,2 This relatively low overall incidence has led some authors to question the traditional use of panendoscopy, including the use of either rigid or flexible esophagoscopy to screen for simultaneous second primary tumors of the esophagus in patients with head and neck cancer. Arguments in this regard cite the exposure of most patients to unnecessary additional risk from potential complications and prolonged operating time associated with endoscopy, as well as reduced cost-effectiveness from the routine use of such procedures in which the overall positive yield is low. In addition, an increased survival advantage in the small percentage of patients with head and neck cancer diagnosed as having a simultaneous esophageal malignancy vs those patients who are subsequently diagnosed at a later date as having an esophageal primary lesion has not been demonstrated in retrospective studies,3 and prospective studies specifically addressing this issue are currently lacking.

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