Lip cancer: a 5-year review in a tertiary referral centre.

INTRODUCTION: Lip cancer is second only to skin cancer in terms of frequency in the head and neck region. Surgery is the treatment of choice for most of these cancers. Although there are several strategies to reconstruct lip tumours after tumour ablation, scarce attention has been paid to the impact of the specific reconstructive modality on recurrence and survival. PATIENTS AND METHODS: A retrospective review of 228 patients treated for lip cancer in the Head and Neck Surgery Department of the Portuguese Institute of Oncology Francisco Gentil, Lisbon, Portugal, from 1993 to 2000 with at least 2 years of follow-up was conducted. All the cases were evaluated for demographic features, tumour characteristics, lip reconstructive surgery used and recurrence and survival. RESULTS: There were 184 male and 44 female patients (4:1 ratio), with an average age of 67.6±13.3 years. Most tumours were squamous cell carcinomas (94.7%), and were located in the lower lip (99.5%). Squamous cell carcinomas were well differentiated in 70.8% of cases. Tumour size and neck staging were strongly correlated (Pearson's coefficient of 0.805; p<0.001). Microscopical signs of neuroinvasion or lymphatic invasion were associated an increased risk of death due to cancer (chi-square=18.5; df=3; p=0.016). The different strategies used for lip reconstruction after tumour ablation did not differ significantly in the probability of later recurrence or death. CONCLUSIONS: Our data seem to lend support to the classical view that the most significant aspect of lip cancer surgery is tumour ablation, and that this is not affected by the subsequent reconstructive strategy. Hence, this seems to indicate that experienced surgeons are rightly not willing to compromise complete excision of the tumour for the sake of an easier or better reconstruction.

Chromosomal imbalances associated with anaplastic transformation of follicular thyroid carcinomas.

The genetic alterations that underlie the progression of follicular thyroid carcinoma towards anaplasia are still largely uncharacterised. We compared the Comparative Genomic Hybridization (CGH) profiles of 20 follicular (FTCs), 12 poorly differentiated (PDTCs) and seven anaplastic thyroid carcinomas (ATCs), in order to identify the chromosomal imbalances potentially associated with cancer progression. We found: (i) when considering that a 'direct' transformation of FTC towards anaplasia occurs, the defined significantly important alterations were the increase of gains at 3q (P<0.05) and 20q (P<0.01), and the increase of losses at 7q (P<0.05) and Xp (P<0.01); (ii) regarding poorly differentiated carcinomas as an intermediate independent entity in the anaplastic transformation of follicular cancers, evidenced as important alterations towards anaplasia, were the proportional decrease in copy sequences at 7p, 7q, 12q and 13q resulting from the significant decrease of DNA gains at 7p and 12q (P<0.05), and the significant increase of losses at 7q and 13q (P<0.05). These results unveil the chromosomal regions where genes of interest in thyroid anaplastic transformation are to be located, and demonstrate that different gene dosage copy sequence imbalances are associated to the 'direct' pathway of transformation of follicular into anaplastic cancers and to the progressive FTC --> PDTC --> ATC pathway.