CT Scan of the Chest Recommended for Newly Diagnosed Head and Neck Cancer Patients

Head and neck cancer is one of the most deadly and virulent of this disease. The good news is that there have been significant advances in controlling squamous cell carcinomas (SCC) of the head and neck. This is evidenced by more patients undergoing major surgical resections and reconstructive procedures and there have been improvements in results obtained from radiotherapy.

The distressing news is that the survival rate for these patients has not improved. This has been attributed either to the spread of cancer to the chest, the incidence of which varies between 17-57 percent, or to second primary tumors in the chest, which occur in nine to 16 percent of cases. It is therefore important that simultaneous tumors (both second primaries and metastasis) be detected as early as possible and taken into consideration when a cancer management plan is undertaken.

The traditional method of screening for lung tumors is an x-ray of chest, which has a sensitivity of 33-50 percent and specificity of 95-97 percent. In recent years, the computer tomography (CT) scan of the chest, with its high resolution, offers the opportunity to detect small early lesions in the chest not revealed by a chest x-ray. However there seems to be conflicting evidence in this matter. A review of the literature shows some studies which advocate CT scan of chest, and others which do not. Some of these were retrospective studies that included only those patients who had CT scan of chest done. In some other series CT scan of the chest was done on a specific group of patients depending on clinical staging or nodal status.

A research team from the United Kingdom has conducted a prospective study, analyzing the role of routine CT scan of the chest in consecutive newly diagnosed head and neck squamous cell carcinomas in detecting synchronous tumors in the chest. The authors of "Role of CT Scan of Chest in Newly Diagnosed Head and Neck Cancers" are P.S. Arunachalam, G. Putnam, P. Jennings R. Messersmith, and A.K. Robson, all from the Cumberland Infirmary, Carlisle, United Kingdom. Their findings are to be presented at the American Academy of Otolaryngology--Head and Neck Surgery Foundation Annual Meeting and OTO EXPO, September 22-25, 2002, at the San Diego Convention Center, San Diego, CA.

Methodology: Forty-four consecutive patients who were newly diagnosed with squamous cell carcinoma SCC of the head and neck were included in the study. All these patients attended the head and neck oncology clinic at Cumberland Infirmary, Carlisle between January and December 2000. Patients with localized lesions of lip, skin and non squamous cell cancers were excluded from the study. There were 30 males and 14 females with a mean age of 67 years (47-89). All patients had a posteroanterior chest x-ray and CT scan of chest (post contrast, 7 mm helical acquisitions), at the same time as the CT scan of the primary. The CT scans and x-rays were reported by a consultant radiologist.

Results: Of 44 patients, five had positive findings in the CT scan of chest. In two cases there were multiple metastases, and these patients died within six months. One patient with a solitary lesion in the lung had biopsy-proven bronchogenic carcinoma and underwent pneumonectomy successfully. Two further patients did not show any significant lesions or enlargement of nodules on repeat CT scans and are currently being followed up. The chest x-ray was abnormal in two cases. Only one had a lung tumor as confirmed by the CT scan.

Conclusions: This study demonstrates the increased sensitivity of CT scan of the chest as compared to plain x-ray of the chest in the detection of simultaneous lung tumors in newly diagnosed squamous cell carcinomas of the head and neck. CT scan of the chest involves only a relatively small additional amount of radiologist and radiographic time with a modern scanner, when performed at the same time as the CT scan of the primary lesion. The amount of extra radiation is approximately 3-6 mSV. The additional costs involved are minimal since no additional contrast material is required.

Learn more about this deadly disease at http://www.entnet.org/healthinfo/tobacco/cancer.cfm, the Academy's patient information leaflet