Squamous Cell Carcinoma of the Head and Neck in the Elderly

Wayne Martin Koch, Himanshu Patel, Joseph Brennan, Jay O. Boyle, David Sidransky

Research output: Contribution to journalArticle

Abstract

Objective: While squamous cell carcinoma of the head and neck (HNSCC) most commonly affects individuals in the fifth to seventh decades of life, it occasionally arises in older patients. Biologic and epidemiologic factors of HNSCC in elderly patients have been investigated to shed light on the process of neoplastic transformation in that population. Design: The medical records of patients with new onset of HNSCC presenting between 1988 and 1993 were reviewed retrospectively. Setting: Tertiary-care hospital-based clinic. Patients: Eighty-one individuals who developed HNSCC of the upper aerodigestive tract after their 75th birthday constituted the study group. A control group consisting of 102 patients who developed HNSCC between the ages of 40 and 70 years was also analyzed. Main Outcome Measure: Information about each individual's tobacco and ethanol exposure, family history of cancer, history of second primary cancer, treatment provided, and current disease status were derived from the medical record. The presence or absence of p53 gene mutation was tabulated for a subset of individuals in both the elderly and the middle-aged groups. Results: The elderly patients had a significantly lower degree of alcohol and tobacco exposure, but a significantly higher rate of second primary cancers, especially in sites outside the upper aerodigestive tract. There was no difference in the incidence of cancer in first-degree relatives in the two groups. These findings were interpreted in light of results from our laboratory examining the incidence of p53 gene mutation in a large number of patients with HNSCC. A significantly higher percentage of tumors from the younger group contained a p53 gene mutation. Major surgery was an integral part of the treatment plan for most of the older patient group despite their advanced age. Conclusions: These findings suggest that HNSCC arising after the seventh decade of life less frequently involves a genetic change commonly found in younger patients. Heavy carcinogen exposure and p53 gene mutations are present less often in elderly individuals, whereas this group appears to be more susceptible to multiple cancers. The precise biologic factors involved in neoplastic transformation in this older population await discovery. Since aggressive therapy can be successfully tolerated by many elderly patients, an individualized approach to treatment is advocated.

Original languageEnglish (US)
Pages (from-to)262-265
Number of pages4
JournalArchives of Otolaryngology--Head and Neck Surgery
Volume121
Issue number3
DOIs
StatePublished - 1995

Fingerprint

p53 Genes
Mutation
Second Primary Neoplasms
Biological Factors
Tobacco
Medical Records
Neoplasms
Epidemiologic Factors
Carcinoma, squamous cell of head and neck
Neoplastic Processes
Incidence
Tertiary Healthcare
Therapeutics
Tertiary Care Centers
Carcinogens
Population
Ethanol
Alcohols
Outcome Assessment (Health Care)
Control Groups

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery

Cite this

Squamous Cell Carcinoma of the Head and Neck in the Elderly. / Koch, Wayne Martin; Patel, Himanshu; Brennan, Joseph; Boyle, Jay O.; Sidransky, David.

In: Archives of Otolaryngology--Head and Neck Surgery, Vol. 121, No. 3, 1995, p. 262-265.

Research output: Contribution to journalArticle

Koch, Wayne Martin ; Patel, Himanshu ; Brennan, Joseph ; Boyle, Jay O. ; Sidransky, David. / Squamous Cell Carcinoma of the Head and Neck in the Elderly. In: Archives of Otolaryngology--Head and Neck Surgery. 1995 ; Vol. 121, No. 3. pp. 262-265.
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