[Clinical analysis of posterior hypopharyngeal wall squamous cell carcinoma: a report of 36 cases].

BACKGROUND & OBJECTIVE: Posterior hypopharyngeal wall squamous cell carcinoma is few in clinic. This study was to discuss its treatment and the simultaneous reconstruction and function of hypopharyngeal wall. METHODS: Clinical data of 36 posterior hypopharyngeal wall squamous cell carcinoma patients (24 men and 12 women; 4 in stage I, 4 in stage II, 9 in stage III, 19 in stage IV), treated in Cancer Hospital of Chinese Academy of Medical Sciences between Jun. 1967 and Jan. 2000, were retrospectively analyzed. Of the 36 patients, 20 received combined therapy (surgery plus radiotherapy), 10 received radical radiotherapy, 3 received surgery alone, 3 received salvage surgery after failure of radiotherapy (2 at neck, 1 at hypopharynx and neck). Simultaneous reconstruction of hypopharyngeal wall used gastric tissue, jejunum tissue, ileum tissue, musculi pectoralis majoris flap, forearm flap, larynx tissue, gastroepiploic tissue, platysmal flap, and musculus trapezius flap. RESULTS: The 5-year survival rates were 40% in combined therapy group, and 30% in radical radiotherapy group. In surgery alone group, 2 patients were died, and 1 was lost of follow-up. All 3 patients in salvage surgery group were died within 3 years. Of the 24 patients underwent surgery, 4 (17%) underwent local resection, 20 (83%) underwent hypopharyngeal reconstruction; of the 20 patients, 11 (55%) patients used gastric tissue or jejunum tissue, and 9 (45%) patients used other tissues; no patient died during perioperation; the occurrence of complications was 15%; the reconstruction success rate was 85%; the mean time to eating was 2-3 weeks; 3 patients suffered local recurrence. CONCLUSIONS: The combined therapy, emphasized on resume swallow function, has good effect on posterior hypopharyngeal wall squamous cell carcinoma. Simultaneous reconstruction of hypopharynx may resume swallow function without increase of prognosis hazard. Gastric and jejunum tissues are mainly used in reconstruction. Local resection could be applied to some patients to preserve swallow function.

Serial public cancer screening in China.

Screening of hollow-organ cancers has been carried out for 16 years using the occult blood test. We are currently assessing the result of serial public cancer screening in China. Human cancers can be divided into 3 types: 1) surface cancer (15%), 2) hollow-organ cancer (65%), and 3) deep-seated solid-organ cancer (20%). Through an education program, the general population was taught to self-examine the body surface and to use a self-examination kit to detect any occult blood discharged from the hollow organs. On discovering positive or doubtful results, these subjects were referred to the hospital for a complete clinical checkup. A total of 10,000 people ages 40 to 70 years chosen from the university areas in Beijing were divided in a test group (5,000) and a control group (5,000). This study, which was carried out for 4 years, showed that 79 cancers were discovered in the test group, with an annual cancer detection rate of 482.5/10,000 population and a cancer mortality rate of 36.6/10,000. The control group showed an annual cancer mortality rate of 206/10,000 population. The difference has very marked statistical significance ( p< 0.001). During the same interval, an extensive cancer screening was carried out in the high-incidence areas. The Cancer Institute in Sihui city of Guangdong province discovered, by screening 758 persons in the outpatient department during a 2-year period, 16 cancers with 15 as nasopharyngeal cancer. From 1999 to 2000, another extensive public cancer screening in the high-incidence areas in Jiangsu province discovered 480 cancers from an 80,000 population. Together with the screening test carried out by Qin's self-examination kit before the National Supported Cancer Research Project on a population of 431,000, 1,272 cancers and more than 10,000 precancerous lesions have been detected. The self-examination kit and public cancer screening are highly important in the practice of public cancer screening.