Correlations between Urologic and Head and Neck Cancers John R Jacobs MD Edson J Pontes MD Karmanos Cancer Center Wayne State University

Case Report 57 y/o male smoker (2PPD x42yr) construction worker 4/2004 Rt neck swelling dx metastatic squamous cell cancer UNK Primary Treated with MND post op RT/CT 5/2006 Renal mass ID on routine CT of thorax for HN Ca Laparoscopic Assisted Left Radical Nephrectomy Clear cell (Furman Grade 3) 6.2 cm T1NxMo organ confined

Case Report (con) 12/2008 elevation PSA Prostate Biopsy negative 8/2009 Gross painless hematuria 8cm left lateral wall urinary bladder Low grade non invasive papillary urothelial ca

Case Report (con) 3/2010 Surveillance cysto small recurrence bladder neck 10/2010 recurrence two areas 5/2011 Surveillance cysto pending

Question Is it reasonable to prospectively screen head and neck cancer patients for urologic malignancies?

Hypothesis There exists a significant number of patients with both head and neck and urologic malignancies because of similar risk factors

Background

Known Etiologic Factors for Head and Neck Cancer Tobacco products Alcohol Betel nut usage Aniline dyes Woodworkers Nickel refiners Paint fumes Petroleum industry chemicals Human papillomavirus Epstein barr virus (nasopharyngeal)

Known Etiologic Factors for Urologic Cancer Tobacco Aniline dyes Rubber manufacturing Textile printing Cyclophosphamide or ifosfamide Pelvic irradiation Schistosomiasis Chronic irritation (Foley) Phenacetin

Common Etiologic Factors Tobacco Aniline dyes Petroleum industry products

Methodology SEER data base Surveillance Epidemiology and End Results

Methodology Established in 1973 Covers roughly 26% of the USA population Cancer incidence and survival from population based data bases Both academic and community hospitals participate

Results

Participating Sites

Total Cases

Frequency by Years

Sex by Site

Site and Stage

Sequence

Conclusions

Majority of patients are male Conclusions Majority of patients are male

Conclusions Majority of patients are male Distant disease at presentation is unusual

Conclusions Majority of patients are male Distant disease at presentation is unusual More undifferentiated cancers in urology

Conclusions Majority of patients are male Distant disease at presentation is unusual More undifferentiated cancers in urology More regional disease in head and neck

128,650 Head and Neck 237,509 Urologic ONLY 2462 with both Total Cases 128,650 Head and Neck 237,509 Urologic ONLY 2462 with both

Conclusion Less than 1% of patients will have both head and neck and urologic cancers

Hypothesis There exists a significant number of patients with both head and neck and urologic problems because 60 year males with a past history of tobacco usage are common in both groups

Unique patients seen at KCI

Conclusion Less than 2% patients are see jointly between Head and Neck and Urology

Conclusion Two busy surgeons who refer to each other see a number of patients in common

Conclusion The incidence of joint problems in the head and neck and the urologic cancer population is too low to justify screening

Patient Characteristics H&N URO

Patient Characteristics H&N URO

Patient Characteristics H&N URO

Patient Characteristics

Patient Characteristics H&N URO