SA3 - Case Series: Surgical Treatment of Primary Oral Cancer With Synchronous Distant Site Cancer

Oral Abstract Presenter(s)

• 

  Jiho Lim, DDS (he/him/his)

  Oral & Maxillofacial Surgery Resident
  University of Rochester Medical Center
  Rochester, New York

Co-Author(s)

• AI

  Anna Israel, MD

  Pathologist
  University of Rochester
  Rochester, New York
• MG

  Michael Giacomelli, PhD

  Associate Professor of Biomedical Engineering and Optics
  University of Rochester
  Rochester, New York
• FC

  Farshad Chowdhury, MD

  Otolaryngologist
  University of Rochester
  Rochester, New York
• WW

  Weitao Wang, MD

  Otolaryngologist
  University of Rochester
  Rochester, New York
• 

  Quyen Tran, DDS (she/her/hers)

  Oral & Maxillofacial Resident
  University of Rochester Medical Center
  Rochester, New York
• 

  Amin Dina, DDS, FACS

  Oral & Maxillofacial Program Director
  University of Rochester Medical Center
  Rochester, New York

Abstract:

Purpose: Head and neck squamous cell carcinomas (HNSCCs), including oral squamous cell carcinoma (OSCC), are a leading cause of cancer-related mortality worldwide. Patients with HNSCCs are at high risk for synchronous carcinomas, defined as two or more primary, unrelated cancers diagnosed within a short interval (2-6 months). Identifying and treating synchronous cancers is complex, as one cancer often must be prioritized for treatment. Imaging modalities such as CT and PET/CT scans are essential for detecting distant primary cancers. However, management guidelines for synchronous cancers in OSCC patients are scarce. This study aims to share our institutional experience with OSCC and synchronous cancers, proposing a treatment algorithm.
Materials and

Methods: This was a retrospective case series study. The study cohort was derived from the population of subjects presented to the Oral and Maxillofacial Surgery outpatient clinic at the University of Rochester Medical Center, Rochester, NY, between October 15, 2023, and February 15, 2025, for evaluation and/or treatment of a suspected OSCC lesion. The study inclusion criteria were subjects who were patients aged 18 years or older at the time of initial consultation, diagnosed with biopsy-proven OSCC, and had an incidental imaging findings suggestive of synchronous primary cancers in distant anatomical sites outside the oral cavity. The exclusion criteria were patients younger than 18 years old at the time of consultation, those who did not have a synchronous carcinomas, and those who were diagnosed with metachronous tumors more than 6 months after the initial diagnosis of OSCC.

Results: During the study period, 70 patients were diagnosed with OSCC, and 4 (1 male, 3 females; mean age 71, range 58-87 years) met our inclusion criteria. Most patients were white (n = 3, 75%), with 1 black patient (n = 1, 25%). Common medical histories included nicotine abuse (n = 3, 75%), depression (n = 3, 75%), marijuana use (n = 1, 25%), alcohol abuse (n = 1, 25%), hypertension (n = 2, 50%), cerebrovascular accident (n = 2, 50%), and GERD (n = 2, 50%). All patients had biopsy-proven OSCC and underwent CT and PET/CT imaging (n = 4, 100%). OSCC lesions were in the soft palate (n = 1, 25%), FOM (n = 1, 25%), anterior maxilla (n = 1, 25%), and lateral tongue (n = 1, 25%). All patients were staged as clinical stage 2 OSCC (n = 4, 100%). Incidental imaging findings suggested distant malignancies, prompting further investigation. The most common synchronous cancers were adenocarcinomas of the colon, lung, and pancreas (n = 3, 75%), and breast cancer (n = 1, 25%). Three patients (n = 3, 75%) chose palliative care, while one patient (n = 1, 25%) opted for surgical treatment for both OSCC and synchronous pancreatic cancer.

Conclusion: This study presents a case series of OSCC patients with synchronous carcinomas, emphasizing the importance of thorough diagnostic workups, including PET/CT scans, in identifying distant primary cancers. Treatment decisions should be guided by the type and stage of the synchronous cancer, and a multidisciplinary approach is essential for optimal patient care.

Pan SY, Huang CP, Chen WC. Synchronous/Metachronous Multiple Primary Malignancies: Review of Associated Risk Factors. Diagnostics (Basel). 2022 Aug 11;12(8):1940. doi: 10.3390/diagnostics12081940. PMID: 36010291; PMCID: PMC9406460.

Sanda, Nicoleta & Ristea, Roxana & Neagu, Stefan. (2019). SYNCHRONOUS AND METACHRONOUS TUMORS – A LITERATURE REVIEW. Romanian Journal of Clinical Research. 2. 49-54. 10.33695/rjcr.v2i1.16.
Figure 1. Algorithm for the selection of initial cancer to treat between the oral SCC and other primary synchronous cancer.