Objective: To clarify the incidence of concomitant esophageal cancers in patients with head and neck cancer (HNC), and to investigate which risk factors are responsible for this association.
Patients and methods: From 1994 to 2000, 134 patients with HNC underwent upper gastrointestinal endoscopy using the 0.8% Lugol stain method to detect esophageal cancer. A case-control study was designed to compare HNC patients with and without esophageal cancer. Logistic-regression analysis was used to obtain odds ratios of risk factors.
Results: Out of 134 patients with HNC, Lugol unstained area was detected in 42 patients. Biopsy specimens revealed squamous cell carcinoma in 17 (12.7%), dysplasia in 9 patients (6.6%), and normal in the others. Gastric carcinoma was also detected in 7 patients (5.2%). The estimated depth of cancer invasion was mucosa in 9 patients, submucosa in 5 patients, and proper muscle or deeper in 3 patients. In the results of statistical analysis, high alcohol consumption of more than 75 g per day increased the risk of esophageal cancer (odds ratio: 20.2, p<0.01). Intake of hard liquor showed a high odds ratio (whisky: 28.7, p<0.05, shochu: 12.7, p<0.05). The amount of cigarette smoking was not related to this association.
Conclusion: High incidence of esophageal cancer was found in the patients with HNC. A high alcohol consumption level, and in particular hard liquor, participated in the development of esophageal cancer in the patients with HNC. But cigarette smoking was not related to this association.