11th Biennial Congress of the European Association of Oral Medicine, Athens, Greece, 13 - 15 September 2012, vol.18, pp.43
A challenging case of field cancerization
K Bektas¸-Kayhan1 , G Karagoz*1 , CD Ozbek1 , M Altun2 , DE Peterson3 , M Unur1 1 Department of Oral Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey, 2 Department of Radiation Oncology, Institude of Oncology, Istanbul University, Istanbul, Turkey, 3 Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, University of Connecticut Health Center, Farmington, CT, USA
Introduction: The process of formation of oral cancer results from multiple sites of
premalignant change in the oral cavity (field cancerization). Field cancerization is a
proposed mechanism for the development of independent multiple premalignant
lesions and tumors in the head and neck suggesting that the upper aerodigestive tract
epithelium undergoes simultaneous genetic changes due to common carcinogenic
The probability of developing an SPT in the patients who have had head and neck
squamous cell cancer is around 20% and for each year the rate is 4–6%.
Case: A 50-year-old man with squamous cell carcinoma of tongue T3N1M0 who had
previously chemo-radiotherapy presented with diffuse oral mucositis-like lesions on
edentulous alveolar crest that had been evolving since the cession of radiotherapy.
After multiple biopsies showing a range of chronic ulceration, dysplasia, HPV
positivity after 20 month, widespread lesions covering the tongue, buccal mucosa,
vestibular sulcus and lips which developed into squamous cell carcinoma.
Conclusion: Field cancerization is a confusing contradiction to clinicians and surgeons
alike. Furthermore, it significantly affects the morbidity and mortality of oral cancer
patients. The solution to this problem seems to be remote; lifelong surveillance for
high-risk patients at regular intervals still remains the mainstay in the anticipation of
more precise targeted treatments comprising of surgery, radiotherapy, chemotherapy,
and perhaps gene therapy that can be developed in patients with evidence of field
change. There is considerable debate as to the clonality of the patch of affected mucosa/
field lesion and development of second primary tumors (SPT) or multiple primary
Relevance: Given that the survival rate of patients with multiple primary tumors is
worse than those with only one primary tumor, preventing the second primary tumor is
crucial well-being of the patient.