Is there still a role for triple endoscopy as part of staging for head and neck cancer?

PURPOSE OF REVIEW

The use of tobacco and/or alcohol is linked with the occurrence of head and neck squamous cell carcinoma, esophagus cancer and lung cancer. If these carcinogenic factors can induce the development of a cancer in one of these locations, it would seem reasonable that a second cancer could appear in another of those areas, at the same time or at some point in the future.

RECENT DEVELOPMENTS

This is the reason why one can consider that triple endoscopy is required as the optimal evaluation in patients with head and neck cancer. Nevertheless, the usefulness of this systematic procedure, which includes nasopharyngoscopy, laryngoscopy, pharyngoscopy, bronchoscopy and esophagoscopy, is debatable. The low number of head and neck cancers associated with synchronous primary cancers in the esophagus and/or lungs reported by several studies does not support this procedure and its morbidity. In contrast, in other studies a higher rate was observed and the authors pointed out the impact of such findings on treatment strategy, suggesting the benefit of routine triple endoscopy. One can conclude that the relevance of routine triple endoscopy is related to the rate of second synchronous primary cancer detected. A search to identify predictive factors of synchronous cancer occurrence will therefore be required.

SUMMARY

This review summarizes the available data in the literature and highlights the need for selected patients with head and neck cancer to receive triple endoscopy.