This Article Full Text Full Text (PDF) eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Braakhuis, B. J.M. Articles by Leemans, C. R. Search for Related Content PubMed PubMed Citation Articles by Braakhuis, B. J.M. Articles by Leemans, C. R.

Second Field Tumors: A New Opportunity for Cancer Prevention?

Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands

Correspondence: Boudewijn J.M. Braakhuis, Ph.D., Section Tumor Biology, Department of Otolaryngology/Head and Neck Surgery, Room 1D 116, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. Telephone: 31-20-4440905; Fax: 31-20 4440983; e-mail: bjm.braakhuis{at}vumc.nl

Recent molecular genetic studies provide evidence that the majority of, if not all, head and neck squamous cell carcinomas (HNSCCs) develop within a contiguous field of preneoplastic cells. Cells of a field show genetic alterations associated with the process of carcinogenesis. A subclone in a field gives rise to an invasive carcinoma. An important implication of this knowledge is that, after surgery of the initial carcinoma, part of the field may remain in the patient. A field with preneoplastic cells that share genetic alterations with cells of the excised tumor has been detected in the resection margins of at least 25% of patients, indicating that this frequently occurs. Fields can be much larger than the actual carcinoma, sometimes having a diameter >7 cm. When a field remains after resection of the tumor, the risk for another carcinoma, designated as a second field tumor (SFT), is considerably greater. It is important to realize that an SFT develops from preneoplastic cells clonally related to the initial tumor. In this respect, it should be discriminated from a recurrent carcinoma that has developed from minimal residual cancer that was left behind and from a second primary tumor that independently develops from the initial carcinoma. Patients at risk for SFTs belong to a unique patient group for whom intense surveillance is indicated and chemoprevention is an attractive option. The priorities are to identify the patients in whom a remaining field will progress to cancer and to find the genes involved. With this knowledge, highly efficient clinical prevention trials, including those using the local application of therapeutic agents, can be designed. It is important to note that SFTs also may occur after treatment of various other cancers, including those of the bladder, skin, esophagus, lung, cervix, breast, and colon.

Key Words. Cancer prevention • Head and neck cancer • Molecular diagnosis • Oral cancer • Squamous cell carcinoma

This article has been cited by other articles:

				C. Rhiner and E. Moreno Super competition as a possible mechanism to pioneer precancerous fields Carcinogenesis, May 1, 2009; 30(5): 723 - 728. [Abstract] [Full Text] [PDF]

				C. Rhiner, B. Diaz, M. Portela, J. F. Poyatos, I. Fernandez-Ruiz, J. M. Lopez-Gay, O. Gerlitz, and E. Moreno Persistent competition among stem cells and their daughters in the Drosophila ovary germline niche Development, March 15, 2009; 136(6): 995 - 1006. [Abstract] [Full Text] [PDF]

				C. Ferreiro-Arguelles, L. Jimenez-Juan, J. M. Martinez-Salazar, J. L. Cervera-Rodilla, M. M. Martinez-Perez, J. Cubero-Carralero, S. Gonzalez-Cabestreros, M. A. Lopez-Pino, and J. M. Fernandez-Gallardo CT Findings after Laryngectomy RadioGraphics, May 1, 2008; 28(3): 869 - 882. [Abstract] [Full Text] [PDF]

				J. S. Kim, J. W. Kim, J. Han, Y. M. Shim, J. Park, and D.-H. Kim Cohypermethylation of p16 and FHIT Promoters as a Prognostic Factor of Recurrence in Surgically Resected Stage I Non-Small Cell Lung Cancer. Cancer Res., April 15, 2006; 66(8): 4049 - 4054. [Abstract] [Full Text] [PDF]