[Clinical and epidemiological characteristics of squamous cell carcinoma of the oral cavity in women]. / Características clínico-epidemológicas do carcinoma epidermóide de cavidade oral no sexo feminino.

BACKGROUND: Squamous cell carcinoma (SCC) of the oral cavity occurs mainly in the male population. The objective of the study is to identify the main clinical and epidemiological differences of the oral SCC between men and women. METHODS: Retrospective analysis of the charts of 228 cases of SCC of the oral cavity in women treated at the Head & Neck Surgery Service, Heliopolis Hospital, São Paulo, Brazil from 1977 to 1996. The clinical and epidemiological characteristics of these cases were compared with those of 849 male patients. RESULTS: The mean age of women was 60.7 years (ranging 2 to 100 years) and in the male group was 55.6 years (p<0.00001). In cases where the alcohol intake and tobacco use were absent, the tumors ocurred in older patients. The isolated tobacco use didn't affect the distribuction by age but for the alcohol intake (alone or combined with tobacco) the patients were younger. On the alcohol intake, 71% of the women and 8% of the man used no alcohol. The most common sites of tumors were tongue and floor of the mouth but in the women group the incidence of tumors in these sites were 43% compared with 61% in the men. CONCLUSIONS: The highest incidence of SCC the of oral cavity occurs later in women, than in men. This could be explained by a lesser exposure to alcohol and tobacco in women. Other factors seem to be involved in this issue.

Características clínico-epidemológicas do carcinoma epidermóide de cavidade oral no sexo feminino / Clinical and epidemiological characteristics of squamous cell carcinoma of oral cavity in women

OBJETIVO: Este trabalho tem como objetivo identificar as principais diferenças clínico-epidemiológicas do carcinoma epidermóide de cavidade oral no sexo feminino quando comparado ao sexo masculino. MÉTODOS: Foram estudados retrospectivamente os prontuários de 228 pacientes do sexo feminino portadoras de carcinoma epidermóide de cavidade oral, atendidos no Serviço de Cirurgia de Cabeça e Pescoço do Hospital Heliópolis, no período entre 1977 e 1996. As características clínico-epidemiológicas destas pacientes foram comparadas com aquelas de 849 pacientes do sexo masculino. RESULTADOS: A idade das pacientes das mulheres variou de 2 a 100 anos, com uma média de 60,7 anos. Nos homens encontramos idade entre 17 e 88 anos com uma média de 55,6 (p<0,00001). Quando o etilismo e o tabagismo estavam ausentes, a incidência do carcinoma epidermóide de boca ocorreu em uma faixa etária mais tardia. A presença do tabaco isoladamente näo afetou a distribuiçäo por faixa etária, enquanto que o álcool isoladamente ou em associaçäo com o tabaco leva a uma incidência mais precoce do câncer de boca. Os dois principais sítios de incidência säo a língua e o soalho. As mulheres têm uma menor incidência de lesöes de língua e soalho (43 por cento) quando comparado aos homens (61 por cento). Aproximadamente 50 por cento das mulheres eram estadio III e IV no momento do diagnóstico. Entre os homens este índice atinge 53 por cento. CONCLUSÖES: O carcinoma epidermóide de cavidade oral nas mulheres tem características clínico-epidemiológicas peculiares que justificam o desenvolvimento de protocolos de diagnóstico e tratamento específico para ele

Perioperative frozen section examination in parotid gland tumors.

CONTEXT: The minimal recommended surgical approach to parotid tumors is partial parotidectomy with resection of the superficial lobe of the gland. Histologic diagnosis prior to surgery is not possible, as incisional biopsies are contraindicated due to the possibility of facial nerve injury or incomplete tumor resection. Thus, the biopsies tend to be perioperative. OBJECTIVE: To compare the results of frozen section examination with the definitive pathological diagnosis. DESIGN: Accuracy study by retrospective analysis. SETTING: Head and Neck Surgery Service of Heliópolis Hospital, São Paulo, Brazil. SAMPLE: 153 cases of parotid gland tumors treated between 1977 and 1994. DIAGNOSTIC TEST: Frozen section and pathological diagnosis. MAIN MEASUREMENTS: Sensibility and specificity of the frozen section examination. RESULTS: Frozen section study diagnosed 19 (12.4%) malignant and 127 (83.7%) benign tumors. Sensitivity of the frozen sections for malignancy was 61.5% (95% CI 54 to 69%) and specificity was 98% (95% CI 94 to 100%), and this result is comparable to the literature. CONCLUSIONS: We consider that frozen section examination for salivary gland tumors is not sufficient on its own for deciding on the best management. Their interpretation must be correlated with clinical and intraoperative findings, in association with the surgeon's experience.

Head and neck squamous cell carcinoma in childhood.

BACKGROUND: Squamous cell carcinoma (SCC) of the head and neck region is rare in young patients and even less frequent in children 15 years or younger children. The patients reported in the literature are isolated cases and their management is always difficult because there is no large experience or a convincing theory to support treatment decisions for every child. PROCEDURES AND RESULTS: Four patients aged 15 years or younger were treated for SCC of head and neck between 1977 and 1995 at the Head and Neck Service of Heliópolis Hospital, São Paulo, Brazil, and with this paper we are reporting our experience with their treatment, including a genetic investigation in two cases (immunohistochemical analysis using monoclonal antibodies against p53 and c-erbB-2 oncogenes). These patients had no history of tobacco or ethanol abuse and no history of cancer in their families. Many authors attribute an unusual aggressiveness to SCC in childhood, with propensity to locoregional recurrence and high death rates and therefore, propose aggressive multidisciplinary therapy. Our cases, with the exception of one, had an early diagnosis and were treated using the same method we use for adults; the results were very good. CONCLUSIONS: We recommend for these cases the same protocol as for older patients. In these cases, however, the primary lesion is resected with a safety margin which is usually 2 to 3 mm larger than usual safety margins and selective neck dissection is routinely indicated. This management is adopted in an attempt to avoid postoperative irradiation which may prove to be dangerous in the future for young patients. On the other hand, we recognize that due to a small number de patients, definitive treatment recommendations cannot be made at this time.

The value of therapeutic planning and the degree of experience of the surgical team on the results of cancer treatment of the larynx and hypopharynx.

This is a prospective study supported by 170 cases of epidermoid carcinoma of the larynx or hypopharynx, treated during the period from January of 1981 to January of 1988, at the Head and Neck Surgery Service of the Heliópolis Hospital Complex, São Paulo. The objective of this project was to evaluate the importance of surgeon experience with regard to the rates of post-operative complications and the rates of relapse and survival. The results of the 8 surgical specialists who integrate the permanent staff at the institute and who different varying degrees of experience with regard to time spent exercising their specialties were compared. The results obtained did not show a significant difference among the various surgeons, and this uniformity is explained by the fact that all the therapeutic planning was elaborated through consensus of the whole group, and this could have minimized the effect of experience of a surgeon responsible for the operation. The authors emphasize the importance of pre-operative evaluation for good results and propose that it is in the direction of complete mastery of preliminary work in the area that programs for the formation of new specialists should be directed.

Risk factors for second cancers of the upper respiratory and digestive systems: a case-control study.

A case-control study of determinants of multiple cancers of the upper respiratory and digestive system (URDS) was conducted using a patient cohort-nested design. We analyzed demographic and risk factor information and clinical variables related to the index cancer for 85 cases of multiple cancers and 170 controls matched on sub-site of the index cancer of the case and date of hospital admission. Follow-up information for the control group was used to infer the person-years-at-risk for the cohort of 1977 patients. URDS cancer patients experienced a 10.7 times (95% confidence interval: 8.5-13.2) higher risk of additional related cancers than the general population. Although controls had cancers of the same sites as those of cases and thus, strongly tobacco and alcohol-related, there were marked residual effects for these two risks factors. In addition, characteristics related to the extension and clinical course of the index cancer were strongly associated with the patient's risk of developing additional cancers.

Reconstucao da mandibula por enxerto autogeno de crista iliaca. / Mandibular reconstruction using autogenous iliac bone graft

Os autores apresentam a experiencia do Servico de Cabeca e Pescoco do Hospital Heliopolis em reconstrucao imediata de mandibula com enxerto autogeno de crista iliaca. Sao analisados, pormenorizadamente os 10 casos tratados entre Agosto/1979 e Junho/1982. Apresentam as idversas alternativas de reconstrucao imediatas e tardias da mandibula. Discutem as vantagens e desvantagens de cada metodo, e destacam os resultados dos transplantes osseos autogenos. Discutem os detalhes tecnicos indicacoes e resultados imediatos e tardios das reparacoes com crista iliaca. Concluem que os enxertos autogenos de crista iliaca oferecem bons resultados funcionais e esteticos, e que devem ser indicados nas recosntrucoes mandibulares apos resseccao de neoplasias benignas ou malignas de baixa gravidade