Carcinoma de células escamosas y el rol discutido de la irritación mecánica crónica: informe de un caso / Squamous oral cell carcinoma and the discussed role of chronic mechanical irritation: report of a case

Objetivo: Describir el desarrollo de un carcinoma oral de células escamosas, en el que la irritación mecánica crónica aparenta tomar un rol protagonista en la carcinogénesis. Caso clínico: Un paciente de 41 años de edad, argen- tino, con antecedentes de fisura labio alvéolo palatina, diabe- tes mellitus, convulsiones, consumo de cocaína y marihuana, enolismo crónico y tabaquismo, acude al Servicio de Odonto- logía del Hospital Central de Mendoza para la evaluación de una úlcera dolorosa en el dorso de su lengua, de varias sema- nas de evolución, en íntima relación con un primer premolar superior derecho y una pieza supernumeraria. Se realizó una biopsia y de la anatomía patológica resultó el diagnóstico de carcinoma oral de células escamosas. Se ofreció al paciente posibles tratamientos que rechazó, por lo que se inició terapia paliativa y sintomática. Al avanzar su mal estado general, fa- lleció por complicaciones relacionadas a la deglución. Si bien no está definido el rol de la irritación mecánica crónica en la etiología de la carcinogénesis, ejerce un efecto promotor del daño causado por el tabaco y el alcohol. Si bien el paciente era fumador y bebía alcohol, se puede observar que desarrolló un carcinoma de células escamosas en evidente relación a un trauma crónico, ya que la lesión en la cara dorsal de lengua está en íntimo contacto con el factor irritante. Aun así, la evi- dencia actual disponible es limitada y discute el protagonismo del trauma crónico por lo que se necesitan más estudios para evaluar y definir la posible relación causal de la irritación me- cánica crónica en la carcinogénesis (AU)

Aim: To describe the development of an oral squamous cell carcinoma, in which chronic mechanical irritation ap- pears to play a significant role in carcinogenesis. Clinical case: A 41-year-old patient, from Argenti- na, with a history of cleft lip and palate, diabetes mellitus, seizures, cocaine and cannabis use, chronic alcoholism and smoking, comes to the Dentistry Service of the Central Hospi- tal for the evaluation of a painful ulcer on the dorsum of the tongue, which had been developing for several weeks, in close relation to an upper right first premolar and a supernumerary tooth. A biopsy was performed, and the pathological anatomy resulted in the diagnosis of oral squamous cell carcinoma. Possible treatments were offered to the patient, which he re- jected, so palliative and symptomatic therapy was initiated instead. As his poor general condition progressed, he died due to complications related to swallowing. Although the role of chronic mechanical irritation in the development of carcino- genesis is not yet fully defined, it has been shown to have a promoting effect on the damage caused by tobacco and alco- hol. Although the patient was a smoker and drank alcohol, it can be observed that he developed a squamous cell carcinoma in obvious relation to a chronic trauma, since the lesion devel- ops on the dorsal face of the tongue in close contact with the irritant factor. Still, the current evidence available is limited and discusses the role of chronic trauma, so more studies are needed to evaluate and define the possible causal relation- ship of chronic mechanical irritation in the development of carcinogenesis (AU)

Carcinoma espinocelular sobre cicatriz de fístula arteriovenosa: relato de caso / Squamous cell carcinoma on an arteriovenous fistula scar: case report

Resumo A fístula arteriovenosa (FAV) é o principal acesso para hemodiálise devido à sua patência superior e menores índices de complicação quando comparada aos demais acessos para hemodiálise. Relatamos o caso de uma paciente do sexo feminino, de 69 anos, com doença renal crônica dialítica secundária a nefroesclerose hipertensiva com FAV radio-cefálica no membro superior esquerdo realizada há 9 anos. Há 2 anos, foi submetida a transplante renal e fazia uso de imunossupressores. Evoluiu com aparecimento de lesão crostosa em antebraço esquerdo há 3 meses, foi submetida a biópsia excisional, e foi evidenciado carcinoma espinocelular bem diferenciado e superficialmente invasivo, com margens cirúrgicas laterais e profundas livres de neoplasia. No seguimento de 1 ano, a paciente não apresentava sinais de recidiva neoplásica.

Abstract The main type of access used for hemodialysis is the arteriovenous fistula (AVF) because it offers superior patency and lower complication rates when compared to other hemodialysis accesses. We report the case of a 69-year-old female patient with chronic kidney disease on dialysis secondary to hypertensive nephrosclerosis with a radiocephalic AVF in the left upper limb created 9 years previously. Two years previously, she had undergone a kidney transplant and was taking immunosuppressants. A crusted lesion developed on her left forearm with onset 3 months before presentation and she underwent an excisional biopsy that revealed a well-differentiated and superficially invasive squamous cell carcinoma, with lateral and deep surgical margins free from neoplasia. At 1-year follow-up, the patient showed no signs of neoplastic recurrence.

High serum superoxide dismutase activity improves radiation-related quality of life in patients with esophageal squamous cell carcinoma

OBJECTIVES: Esophageal squamous cell carcinoma (ESCC) is one of the most common malignant tumors in China. Intensity-modulated radiation therapy and volume-modulated arc therapy have become the main treatments for esophageal carcinoma; however, side effects caused by radiotherapy greatly impact the quality of life in these patients. This study aimed to explore the impact of serum superoxide dismutase (SOD) levels on the prognosis of patients with ESCC undergoing radiotherapy. METHODS: Patients aged between 18 and 80 years with lower-middle ESCC who underwent radiotherapy were eligible for this assessment. Adverse events, responses, treatment outcomes, and overall survival (OS) were assessed. Between 2012 and 2014, 195 patients were enrolled, of which 65 were assigned to the low- and high-SOD groups based on their serum SOD values. RESULTS: The baseline characteristics were similar between the two groups, except for the T staging. Adverse events in the low-SOD group were significantly higher than those in the high-SOD group (radiation esophagitis, p=0.007; radiation pneumonitis, p=0.032; leukopenia, p=0.023; thrombocytopenia, p=0.037; anemia, p=0.041). There were no significant differences in response, treatment outcomes, or OS. CONCLUSION: In conclusion, high serum SOD activity improved post-radiotherapy quality of life but did not impact the prognosis of patients with ESCC. To the best of our knowledge, this study is the first to report that serum SOD activity is associated with radiation-induced toxicity and moderately increased radiotherapeutic response in patients with ESCC undergoing radiotherapy.

Oral Squamous Cell Carcinoma Associated with Arsenic Exposure: A Case Series from Argentina / Carcinoma Oral de Células Escamosas Asociado con la Exposición al Arsénico: Una Serie de Casos de Argentina

ABSTRACT: Many areas of South America are directly affected by Arsenic (As) contaminated groundwater. A high percentage of the water samples taken in multiple areas of Argentina had As concentrations above the WHO level recommended guidelines. This condition was previously associated with an increased risk of chronic diseases, including different cancers. Long-term As exposure was proposed as a risk factor for Oral Squamous Cell Carcinoma (OSCC). The aim of this study is to present a series cases of Argentine patients diagnosed with OSCC who have consumed water contaminated with As for more than 10 years. Clinical data were obtained from the archive of Clinical Records Histories of the Oral Medicine Department of the Dentistry School, Universidad Nacional de Córdoba and Universidad Católica de Córdoba, Argentina. 15 cases of OSCC were included. The male: female sex ratio was 2:1. The average age was 66 years (31-89 years). Regarding location, the gum or edentulous alveolar ridge was the most prevalent site (6/15; 40 %), followed by the tongue margin. The average years of exposure to arsenical waters were 24 years (13 - 40 years of exposure). The majority of the presented cases were non drinkers non smokers. 60 % of the tumors were diagnosed at advanced stages. the epidemiological studies carried out in As-contaminated areas that address oral cancer should always incorporate the record of variables related to As exposure. Patients who live or lived at As-contaminated areas must be regularly followed up for early diagnosis of potentially malignant or malignant lesions. The high frequency of gum cancer among these cases, should raise awareness of periodontic specialists to perform a careful and thorough periodontal examination.

RESUMEN: Muchas regiones de América del Sur están directamente afectadas por aguas subterráneas contaminadas con arsénico (As). Un alto porcentaje de las muestras de agua tomadas en múltiples áreas de Argentina tenían concentraciones de As superiores al nivel aprobado por la OMS. Esta condición se asociaba previamente con un mayor riesgo de enfermedades crónicas, incluidos diferentes tipos de cáncer. La exposición a largo plazo se propuso como un factor de riesgo para el carcinoma oral de células escamosas (OSCC). El objetivo de este estudio es presentar una serie de casos de pacientes diagnosticados con OSCC que han consumido agua contaminada con As durante más de 10 años. Se obtuvieron datos clínicos del archivo de Historias de registros clínicos del Departamento de Medicina Oral de la Facultad de Odontología, Universidad Nacional de Córdoba y Universidad Católica de Córdoba, Argentina. Se incluyeron 15 casos de OSCC. La relación de género masculino: femenino fue de 2: 1. La edad promedio fue de 66 años (31-89 años). En cuanto a la ubicación, la encía o la cresta alveolar edéntula fue el sitio más frecuente (6/15; 40 %), seguido del borde de la lengua. El promedio de años de exposición a las aguas arsenicales fue de 24 años (13 - 40 años de exposición). La mayoría de los casos presentados fueron de pacientes no bebedores y no fumadores. El 60 % de los tumores fueron diagnosticados en etapas avanzadas. Los estudios epidemiológicos realizados en áreas contaminadas con As que abordan el cáncer oral siempre deben incorporar el registro de variables relacionadas con la exposición a As. Se debe hacer un seguimiento continuo de los pacientes que viven o que vivieron en áreas contaminadas con As para el diagnóstico temprano de lesiones potencialmente malignas. La alta frecuencia de cáncer de encías en estos casos, debe concienciar a los especialistas en periodoncia para que realicen un examen periodontal cuidadoso y completo.

Assessment of HPV 16, HPV 18, p16 expression in advanced stage laryngeal cancer patients and prognostic significance / Avaliação da expressão do HPV 16, HPV 18, e p16 em pacientes com câncer de laringe em estágio avançado e significado prognóstico

Abstract Introduction: Human papilloma virus is an etiological risk factor for a subset of head and neck squamous cell carcinomas. HPV has been proven to be a powerful prognostic biomarker for oropharyngeal cancer, but its role in the larynx has not been explored in depth. The developmental mechanisms of laryngeal carcinomas are quite complex and controlled by various factors. Smoking and alcohol are most important risk factors. Recent studies indicate that HPV infection also plays an important role in larynx carcinomas. HPV related laryngeal carcinomas especially occur at the supraglottic region of larynx. Objective: We aimed to determine the frequency of HPV/protein16 positivity in patients with laryngeal carcinoma and association of HPV and/or p16 positivity with variables such as age, sex, smoking habits, tumor localization, lymph node metastasis, recurrence and survival in advanced stage laryngeal carcinoma in our study. Methods: This retrospective study included 90 patients with advanced laryngeal carcinoma. The Control group was 10 normal larynx mucosa specimens. The presence of HPV was investigated polyclonally by polymerase chain reaction, and protein16 with immunohistochemical method. In HPV positive cases, the presence of HPV types 16, 18 were evaluated by polymerase chain reaction. Demographic features of patients were noted. Patient survival and association with HPV/protein16 was determined. Results: Polyclonal HPV positivity was detected in 11 (12.2%) of 90 cases. Out of these 11 cases, HPV 16 was positive in 6, HPV 18 in 4, and both HPV 16 and 18 were positive in 1. In 18 (20%) of the cases, p16 was positive. Six of the cases (6.6%) had both HPV and protein16 positivity. In cases where protein16 alone or HPV and protein16 were co-positive, alcohol use was less and the tumor was found more likely to be localized in the supraglottic area. These ratios were statistically significant. Supraglottic localization of tumor was determined to be increased in protein16 positive cases. The correlation between protein16 positivity and supraglottic area location was determined to be statistically significant (p= 0.011). 55.6% of protein16 positive cases was located in the supraglottic region, 33.3% was glottic and 11.1% was transglottic. Although life expectancy over 5 years were numerically higher in HPV and protein16 positive cases, this was not found to be statistically significant. There was no statistically significant relationship between HPV positivity and mean age, differentiation, smoking and alcohol use, tumor progression, lymph node metastasis, localization, recurrence, cause of mortality and treatment methods in our study. The mean follow-up period of our patients was 6.7 years. Conclusion: The close relationship between HPV and oropharyngeal squamous cell carcinoma could not be shown in larynx malignancy in many studies, including our study. Our findings support a limited role of HPV in laryngeal carcinogenesis. Protein16 is not a reliable surrogate for HPV status in laryngeal cancers and is not a predictor of laryngeal cancer survival. Supraglottic localization of tumor was determined to be increased in protein16 positive cases. The correlation between protein16 positivity and supraglottic area location was determined to be statistically significant. There is a need for more populated clinical trials, where neoplastic proliferation is better demonstrated and the accuracy of the results obtained is supported by different techniques.

Resumo Introdução: O papilomavírus humano é um fator de risco etiológico para um subconjunto de carcinoma espinocelular de cabeça e pescoço. Tem sido demonstrado que o HPV é um poderoso biomarcador prognóstico para o câncer de orofaringe, mas seu papel na laringe ainda não foi explorado em profundidade. Os mecanismos de desenvolvimento dos carcinomas de laringe são bastante complexos e controlados por vários fatores. Tabagismo e álcool são os fatores de risco mais importantes. Estudos recentes indicam que a infecção pelo HPV também desempenha um papel importante nos carcinomas da laringe. Os carcinomas laríngeos relacionados ao HPV ocorrem especialmente na região supraglótica. Objetivo: Nosso objetivo foi determinar a frequência da positividade para o HPV / proteína 16 em pacientes com carcinoma da laringe e a associação da positividade para o HPV e /ou proteína 16 com variáveis como idade, sexo, tabagismo, localização do tumor, metástase linfonodal, recidiva e sobrevivência de carcinoma da laringe em estágio avançado em nosso estudo. Método: Este estudo retrospectivo incluiu 90 pacientes com carcinoma laríngeo avançado. O grupo controle incluiu 10 amostras de mucosa laríngea normal. A presença de HPV foi inves-tigada por anticorpo policlonal através de reação de polimerase em cadeia e a proteína 16 por método imunohistoquímico. Nos casos positivos para o HPV, a presença dos tipos 16 e 18 do foi avaliada por reação de polimerase em cadeia. As características demográficas dos pacientes foram observadas. A sobrevida dos pacientes e a associação com HPV / proteína 16 foram determinadas. Resultados: A positividade com anticorpo policlonal do HPV foi detectada em 11 (12,2%) dos 90 casos. Desses 11 casos, o HPV 16 foi positivo em 6, o HPV 18 em 4 e o HPV 16 e 18 foram positivos em 1. Em 18 (20%) dos casos, a proteína 16 foi positiva. Seis dos casos (6,6%) apresentaram positividade para HPV e proteína16. Nos casos positivos apenas para a proteína 16 ou quando HPV e a proteína 16 foram co-positivos, a ingestão de álcool foi menor e o tumor apresentou maior probabilidade de estar localizado na área supraglótica. Essas proporções foram estatisticamente significantes. A localização supraglótica do tumor foi maior em casos positivos para proteína 16. A correlação entre positividade para proteína 16 e localização da área supraglótica foi estatisticamente significante (p = 0,011). Dos casos positivos para proteína 16, 55,6% foram supraglóticos, 33,3% glóticos e 11,1% transglóticos. Embora a expectativa de vida acima de 5 anos tenha sido numericamente maior nos casos positivos para HPV e proteína 16, isso não foi estatisticamente significante. Não houve relação estatisticamente significante entre positividade do HPV e média de idade, diferenciação, tabagismo e uso de álcool, progressão tumoral, metástase linfonodal, localização, recidiva, causa de mortalidade e métodos de tratamento em nosso estudo. O período médio de seguimento de nossos pacientes foi de 6,7 anos. Conclusão: A estreita relação entre HPV e carcinoma espinocelular orofaríngeo não pôde ser demonstrada na laringe em muitos estudos, inclusive no nosso estudo. Nossos achados confirmam um papel limitado do HPV na carcinogênese da laringe. A proteína 16 não é um substituto confiável para o status do HPV nos cânceres de laringe e não é preditor da sobrevida do câncer de laringe. A localização supraglótica do tumor foi maior em casos positivos para proteína16. A correlação entre positividade para proteína 16 e localização na área supraglótica foi determinada como estatisticamente significante. Há necessidade de ensaios clínicos com amostras maiores, nos quais a proliferação neoplásica seja melhor demonstrada e a precisão dos resultados obtidos seja apoiada por diferentes técnicas.

Profile of Laryngeal Microsurgeries in Patients Over 60 Years Old

Abstract Introduction The increase in life expectancy is an incentive to the development of researches with the elderly population aiming at actions that may ensure healthy and active aging. Objective To analyze the profile of laryngeal microsurgery performed in patients > 60 years old. Methods A retrospective observational study, with a cross-sectional design. A retrospective analysis of the medical records of elderly patients submitted to laryngeal microsurgery was performed at a private hospital in Curitiba, state of Paraná, Brazil, between January 2004 and December 2016. Were included all of the patients > 60 years old that underwent laryngeal microsurgery during this period. Results During the studied period, 213 laryngeal microsurgeries were performed in 181 patients > 60 years old. There was a preponderance of male patients. The mean age was 67.6 years old. Squamous cell carcinoma (SCC) was the most prevalent disorder (26%), followed by Reinke edema (20%), papillomatosis (14%), polyps (11%), leukoplakia (8%), minor structural alterations (8%), associated lesions (9%), and others (4%). Men presented a higher probability of SCC diagnosis, regardless of the age group, while Reinke edema was more frequently observed in women. A directly proportional relation between the frequency of laryngeal cancer and age increase was also observed. No significant differences were observed in professional voice users. Conclusion Further researches are required to properly comprehend the factors associ- ated with laryngeal lesions and determine prevention and treatment approaches.

Estudio comparativo de los resultados del tratamiento del carcinoma anal escamoso en los pacientes HIV positivos y negativos / Comparative study of the results of the treatment of squamous anal carcinoma in HIV positive and negative patients

Introducción: El tratamiento del carcinoma anal escamoso (CAE) en los pacientes HIV positivos resulta controvertido. Si bien las guías actuales recomiendan realizar en los pacientes con buen estado inmunológico la quimiorradioterapia (QRT) concurrente estándar, algunos autores consideran que estos pacientes presentan mayor toxicidad y peores resultados a largo plazo, por lo que requerirían un abordaje diferente. El objetivo de este trabajo es comparar los resultados del tratamiento del CAE en los pacientes VIH positivos y negativos. Diseño: Estudio retrospectivo comparativo. Pacientes y métodos: Se revisaron retrospectivamente las historias clínicas de los pacientes tratados en el Sector Coloproctología, Hospital Fernández, entre 01/2007 y 10/2018. Los del conducto anal se dividieron en: Grupo I: VIH negativos y Grupo II: VIH positivos. Se compararon variables demográficas, factores de riesgo específicos, estadificación, QRT (drogas, toxicidad y respuesta), tratamiento quirúrgico curativo/paliativo, persistencia/recurrencia y supervivencia específica y global. Resultados: Se incluyeron 28 pacientes (18 mujeres); margen: 2, conducto: 26 (Grupo I: 15. Grupo II: 11). Los VIH positivos eran en su mayoría hombres que tienen sexo con hombres vs. 100% de mujeres VIH negativas (p<0,01), más jóvenes (45,2±0,9 vs. 63,6±8; p<0,01) y tabaquistas (82% vs. 27%; p=0,005). No hubo diferencia significativa en la estadificación, aunque el Grupo II tuvo tumores con complicaciones más severas. Pudieron completar el tratamiento: Grupo I: 93%, Grupo II: 64% (p<0,05). Tuvieron respuesta completa a la QRT 13/14 (93%) pacientes del Grupo I y 3/7 (43%) del Grupo II (p<0,01). Hubo 3 recurrencias, 2 locorregionales y 1 a distancia (p=NS). Los VIH positivos requirieron más cirugías (82% vs. 27%; p<0,01). A 5 pacientes (4 del Grupo II) se les realizó una resección abdominoperineal (RAP). Tuvieron colostomía definitiva, con o sin RAP, el 46% de los pacientes, la mayoría VIH positivos (82% vs. 27%; p=0,002). En los VIH positivos el RR de mortalidad por cáncer fue 4 (IC95%: 1,01-16,5; p=0,02) y el RR de mortalidad global fue 5,45 (IC95%: 1,42-20,8; p=0,002). Tuvieron menor supervivencia, tanto global (p=0,001) como libre de enfermedad (p=0,01). Mediana de seguimiento: 27 meses (4-216).Conclusiones: Los pacientes VIH positivos con CAE se diferenciaron de los VIH negativos en una menor tasa de respuesta completa a la QRT y una mayor necesidad de tratamiento quirúrgico. Además, tuvieron una supervivencia global y libre de enfermedad significativamente menor que los VIH negativos. (AU)

INTRODUCTION: The treatment of anal squamous cell carcinoma (SCC) in HIV-positive patients is controversial. Although current guidelines recommend performing standard concurrent chemoradiotherapy (CRT) in patients with good immune status, some authors believe that these patients have greater toxicity and worse long-term results, so they would require a different approach. The purpose of this study was to compare the results of SCC treatment in HIV-positive and HIV-negative patients.DESIGN: Comparative retrospective study.PATIENTS AND METHODS: The records of patients treated in the Coloproctology Section, Hospital Fernández, between 01/2007 and 10/2018 were retrospectively reviewed. Those of the anal canal were divided into: Group I: HIV-negative and Group II: HIV-positive. Demographic variables, specific risk factors, staging, CRT (drugs, toxicity, and response), curative/palliative surgical treatment, persistence/recurrence, and cancer-specific and global survival were compared.RESULTS: 28 patients (18 women), margin: 2, conduit: 26 (Group I: 15. Group II: 11). The HIV-positive were mostly men who have sex with men (vs. 100% HIV-negative women; p<0.01), younger (45.2 ± 0.9 vs. 63.6 ± 8; p<0.01) and smokers (82% vs. 27%; p=0.005). There was no significant difference in staging, although Group II had tumors with more severe complications. Completed the treatment: Group I: 93%, Group II: 64% of patients (p<0,05). Thirteen out of 14 (93%) patients in Group I, and 3/7 (43%) patients in Group II had a complete response to CRT (p<0.01). There were 3 recurrences, 2 loco-regional and 1 distance (p=NS). HIV-positive required more surgery (82% vs. 27%; p<0.01). 5 patients (4 of Group II) underwent an abdominal-perineal resection (APR). Forty six percent of patients had permanent colostomy, with or without APR, most of them were HIV-positive (82% vs. 27%; p=0.002). In HIV-positive patients, the RR of cancer mortality was 4 (95% CI: 1.01-16.5; p=0.02) and the RR of overall mortality was 5.45 (95% CI: 1.42-20, 8; p=0.002). They also had lower overall (p=0.001) and disease-free survival (p=0.01). Median follow-up: 27 months (4 - 216).CONCLUSION: HIV-positive patients with anal SCC were different from HIV-negative patients in that they had a lower complete response rate to CRT, and a greater need for surgical treatment. They had a significantly lower overall and disease-free survival than HIV-negative patients. (AU)

Carcinoma epidermoide metastásico asociado a epidermólisis ampollosa distrófica / Metastasic squamous cell carcinoma in dystrophic epidermolysis bullosa

Caso clínico: femenino de 18 años con diagnóstico de epidermolisis ampollosa distrófica (EAD) quién desarrolló una neoformación nodular sobre una úlcera crónica. Se diagnosticó carcinoma epidermoide (CE) invasor al que se realizó resección. Sin embargo, 5 meses después del tratamiento quirúrgico presentó metástasis a ganglios, pulmón e hígado con desenlace fatal. Comentarios: el CE es la causa más importante de muerte en pacientes con EAD. Suele ser agresivo y metastásico. Se recomienda una vigilancia cada 3 a 6 meses para realizar diagnóstico y tratamiento oportunos (AU)

Case report: 18-year-old female patient with dystrophic epidermolysis bullosa (DEB) who developed a tumor over a chronic ulcer. She was diagnosed with invasive squamous cell carcinoma (SCC) and underwent surgical resection. However, 5 months later she presented metastases to the lymph nodes, lung and liver with a fatal outcome. Comments: SCC is the most important cause of death in patients with DEB. It is usually aggressive and metastatic. Surveillance every 3 to 6 months is recommended for prompt diagnosis and treatment (AU)

Transhiatal esophagectomy in squamous cell carcinoma of the esophagus: what are the best indications? / Esofagectomia transhiatal no carcinoma de células escamosas do esôfago: quais são suas melhores indicações?

ABSTRACT Background: Southern Brazil has one of the highest incidences of esophageal squamous cell carcinoma in the world. Transthoracic esophagectomy allows more complete abdominal and thoracic lymphadenectomy than transhiatal. However, this one is associated with less morbidity. Aim: To analyze the outcomes and prognostic factors of squamous esophageal cancer treated with transhiatal procedure. Methods: All patients selected for transhiatal approach were included as a potentially curative treatment and overall survival, operative time, lymph node analysis and use of neoadjuvant therapy were analyzed. Results: A total of 96 patients were evaluated. The overall 5-year survival was 41.2%. Multivariate analysis showed that operative time and presence of positive lymph nodes were both associated with a worse outcome, while neoadjuvant therapy was associated with better outcome. The negative lymph-node group had a 5-year survival rate of 50.2%. Conclusion: Transhiatal esophagectomy can be safely used in patients with malnutrition degree that allows the procedure, in those with associated respiratory disorders and in the elderly. It provides considerable long-term survival, especially in the absence of metastases to local lymph nodes. The wider use of neoadjuvant therapy has the potential to further increase long-term survival.

RESUMO Racional: O sul do Brasil tem uma das maiores incidências de carcinoma epidermoide do esôfago no mundo. A esofagectomia transtorácica permite linfadenectomia abdominal e torácica mais completa do que a transhiatal. No entanto, esta está associado à menor morbidade. Objetivo: Analisar os desfechos e fatores prognósticos do câncer epidermoide do esôfago que foram tratados com procedimento transhiatal. Métodos: Foram incluídos todos os pacientes selecionados para abordagem transhiatal como tratamento potencialmente curativo correlacionando sobrevida geral, tempo operatório, análise de linfonodos e uso de terapia neoadjuvante. Resultados: Foram avaliados 96 pacientes. A sobrevida geral em cinco anos foi de 41,2%. A análise multivariada mostrou que o tempo operatório e a presença de linfonodos positivos foram associados a pior resultado, enquanto a terapia neoadjuvante contribuiu para melhor resultado. O grupo de linfonodos negativos teve taxa de sobrevivência em cinco anos de 50,2%. Conclusão: A esofagectomia transhiatal pode ser empregada com segurança em pacientes que apresentem desnutrição com grau que permita o procedimento, nos com distúrbios respiratórios associados e nos idosos. Proporciona sobrevida em longo prazo considerável, especialmente na ausência de metástases para linfonodos locais. O uso mais amplo da terapia neoadjuvante tem o potencial de aumentar ainda mais a sobrevida em longo prazo.

Perfil clínico-demográfico de los carcinomas de células escamosas bucales en una población del nordeste de Brasil / Clinical and demographic profile of oral squamous cell carcinoma in a northeast population of Brazil

Objetivo: Describir el perfil clínico-demográfico e identificar los factores de riesgo presentes en individuos portadores de carcinoma oral de células escamosas, que asistieron a un centro de referencia del nordeste de Brasil, de 2007 a 2015. Materiales y métodos: En este estudio descriptivo y retrospectivo, los datos fueron recopilados de las historias clínicas de individuos con diagnóstico histológico de carcinoma oral de células escamosas. Resultados: De los 104 casos analizados, el 72,12% eran hombres; el 53,84%, mayores de 60 años, y el 38,9%, de tez morena. La mayoría de los individuos eran alcohólicos y/o fumadores (95%). En cuanto a las lesiones, en su mayoría eran: ulceradas (58,70%), rojas (47,42%), de superficie arrugada (92,39%), duras (78,02%), con crecimiento endofítico (56,12%) y estaban localizadas en el borde lateral de la lengua (27,62%). Conclusiones: En este estudio, el carcinoma oral de células escamosas fue diagnosticado principalmente en hombres de tez morena, mayores de 60 años. Las lesiones más frecuentes fueron úlceras en la lengua. El consumo de tabaco y alcohol fueron las características de comportamiento de mayor ocurrencia (AU)

Aim: Describe the clinical-demographic profile and identify risk factors present in individuals with oral squamous cell carcinoma, attending a reference center in Northeastern Brazil from 2007 to 2015. Materials and methods: The present descriptive and retrospective study evaluated data collected from the dental records of individuals with histological diagnosis of oral squamous cell carcinoma. Results: Of the 104 cases analyzed, 72.12% were men, 53.84% were over 60 years old and 38.9% were of brown complexion. Most of the individuals were alcoholics and/or smokers (95%). The clinical characteristics were: ulcerated (58.70%), red (47.42%), rough (92.39%), hard consistency (78.02%), endophytic growth (56.12%) and located in the lateral of the tongue (27.62%). Conclusions: In this study, the oral squamous cell carcinoma was diagnosed mainly in men, brown and over 60 years. In the majority of cases, the lesions presented as ulcers in the tongue. Tobacco and alcohol consumption were the most frequent behavioral characteristics (AU)

Hidradenitis supurativa crónica y su relación con el carcinoma epidermoide / Chronic suppurative hidradenitis and its relationship with squamous cell carcinoma

Se presenta un caso clínico con un cuadro de hidradenitis supurativa crónica que evolucionó a carcinoma epidermoide. Se realiza una revisión de la literatura de esta enfermedad. (AU)

A clinical case with a chronic suppurative hidradenitis syndrome that progressed to squamous cell carcinoma is presented. A review of the literature of this disease is made. (AU)

Fechamento de hemicorporectomia com utilização do retalho subtotal unilateral da coxa: relato de caso / Closure of hemicorporectomy using a subtotal unilateral tight flap: a case report

A hemicorporectomia ou amputação translombar foi primeiramente descrita em 1950 por Kredel como método curativo para neoplasia localmente avançada de pelve. Trata-se de um procedimento cirúrgico extenso, que quando bem indicado é capaz de prover a cura oncológica, além de possibilitar a melhora clínica e de qualidade de vida. Os autores apresentam o relato de caso de um paciente de 34 anos, com carcinoma espinocelular em úlcera de pressão crônica, acometendo períneo, glúteo e coxa posterior à direita. O paciente foi submetido à hemicorporectomia com reconstrução utilizando retalho subtotal da coxa esquerda. Observou-se boa evolução no pós-operatório e a utilização do retalho subtotal da coxa para fechamento da hemicorporectomia se mostrou como método seguro, eficiente e de técnica reprodutível.

Hemicorporectomy or translumbar amputation was first described in 1950 by Kredel to treat locally advanced pelvic neoplasia. This extensive surgical procedure can achieve oncological cure and improve clinical status and quality of life. The authors present a case report of a 34-yearold patient with squamous cell carcinoma in a chronic pressure ulcer affecting the right perineum, gluteus, and posterior thigh. The patient underwent hemicorporectomy with reconstructive surgery using a partial-thickness flap of the left thigh. The postoperative course was good, and the use of a partial-thickness flap of the thigh to close the hemicorporectomy proved to be safe, efficient, and reproducible.

Largest case series of Latin American eyelid tumors over 13-Years from a single center in Sao Paulo, Brazil / A maior série de casos de tumores de pálpebra na América Latina ao longo de 13 anos de um único centro em São Paulo, Brasil

ABSTRACT Purpose: Malignant lesions of the eyelid are the most common eye cancers. Although rarely lethal, late diagnosis can lead to serious visual morbidity. Definitive diagnosis of neoplastic lesions is pathological. Indications and types of eyelid lesions in a single high-volume ophthalmic reference center in Sao Paulo, Brazil, were analyzed. Methods: The surgical pathological reports of patients who underwent eye removal procedures between January 2000 and December 2012 were retrieved from the electronic database of the Ophthalmology Department and retrospectively reviewed. Data regarding the final anatomopathological diagnosis, sex, and age were analyzed via the χ2 test with Yates' correction. Results: Of the 1,113 eyelid tumors resected over the 13-year study period, 324 (29%) lesions were malignant. The most prevalent lesions were basal cell, squamous cell, and sebaceous gland carcinomas. The median ages of patients (females, n=165, 51%; males, n=159, 49%) with a diagnosis of basal cell, squamous cell, and sebaceous gland carcinomas were 65, 75, and 70 years, respectively. Conclusion: This is the largest retrospective cohort analysis of eyelid tumors in a Latin American population. These findings are in agreement with those from large centers in other countries and regions.

RESUMO Objetivo: As lesões malignas de pálpebras são os cânceres oftalmológicos mais frequentes. Embora raramente letal, o diagnóstico tardio pode levar a diversas complicações severas e a uma alta taxa de morbidade visual. O diagnóstico definitivo de lesões neoplásicas é patológico. No presente estudo, revisamos casos de um único centro de referência oftalmológica de maior volume em São Paulo, Brasil. Métodos: Avaliação retrospectiva de todos os tumores palpebrais operados entre os anos de 2000 e 2012 no Departamento de Oftalmologia. Dados incluindo diagnóstico anatomopatológico final, sexo e idade - foram analisados através do método χ2 YATES. Resultados: Dentre os 1.113 tumores palpebrais ressecados no período de estudo de 13 anos, 324 (29%) dos pacientes com lesões únicas eram malignas. A lesão mais prevalente foi Carcinoma Basocelular (CBC), seguido por carcinoma espinocelular (CEC) e carcinoma de células sebáceas (CCS). A média da idade dos pacientes com diagnóstico de CBC, CCS e CEC foi 65, 75 e 70 respectivamente distribuídos entre 165 (51%) mulheres e 159 (49%) homens. Conclusão: Essa é a maior análise de coorte retrospectivo de tumores palpebrais da América Latina. Nossos achados estão de acordo com outros grandes centros de outros países e continentes.

Experience in intra-arterial chemotherapy using two protocols for the treatment of OSCC over two decades at the University Hospital Vienna

OBJECTIVES: This retrospective study performed a comprehensive analysis of the usage of intra-arterial chemotherapy (iaCh) for locally recurrent UICC stage IV oral squamous cell carcinoma (OSCC) over two decades at the Department of Cranio-Maxillofacial and Oral Surgery at the University Hospital Vienna to assess the utility of its future use. METHODS: Between 1994 and 2014, iaCh was indicated in 48 OSCC cases. In these, the two most frequent iaCh schemes, cisplatin/5-fluorouracil (Cis/5-FU) and methotrexate/bleomycin (MTX/Bleo), were chosen for further analysis. The effect on survival of two distinct intra-arterial protocols and their covariates were analyzed with the Kaplan-Meier method as well as univariate and multivariate Cox proportional hazard regression models. RESULTS: The mean follow-up period was 29.91 months. The two intra-arterial chemotherapy groups did not differ significantly in sample size, demographic data or therapeutic covariates. The Cis/5-FU iaCh regimen was associated with significantly better overall survival (median OS 2.6 years vs. 1.3 years; p=0.002) and had a beneficial effect on survival (HR=3.62, p=0.015). Side effects occurred at a frequency similar to that described in the literature for intravenous chemotherapy (ivCh). CONCLUSIONS: These results suggest a preference for administering Cis/5-FU for iaCh. Nevertheless, due to economic considerations in healthcare expenditures, there is no future for iaCh in the treatment of head and neck carcinomas because ivCh is known to be equivalent.

Surgical amniotic membrane transplantation after conjunctival and limbal tumor excision / Transplante de membrane amniótica após excisão de tumor limbar e conjuntival

ABSTRACT Purpose: To evaluate the clinical results of patients treated by amniotic membrane transplantation (AMT) following excision of conjunctival and limbal tumors. Methods: A total of 14 eyes of 14 patients who underwent AMT after total lesion-free tumor excision and perilesional cryotherapy were evaluated. Results: The excised tumors comprised 7 conjunctival intraepithelial neoplasia, 5 conjunctival nevus, 1 primary acquired melanosis, and 1 squamous cell carcinoma. Limbus was involved in 10 cases, whereas cornea was involved in 6 cases. The average measurement of the tumor base was 14.8 mm (range 6-20 mm, SD 16 mm). The mean follow-up time period was 17.5 months (range 6 -60 months, SD 20 months). Complete healing occurred in eight eyes, but limbal cell deficiency developed in two eyes. Four cases had recurrence and were treated with the same surgical and medical procedures; during follow-up after recurrence, superficial peripheral vascularization and corneal scar were noted to have developed. Conclusions: AMT was effective for reconstruction of tissue defect after excision and cryotherapy of limbal and conjunctival tumors. In most of these cases, complete healing was achieved with a smooth, stable, and translucent surface.

RESUMO Objetivo: Avaliar os resultados clínicos de pacientes tratados com transplante de membrana amniótica (TMA) após a excisão de tumores conjuntival e limbar. Métodos: Foram avaliados 14 olhos de 14 pacientes submetidos a transplante de membrana amniótica após excisão total de tumor e crioterapia perilesional. Resultados: Os tumores que foram excisados podem ser classificados como neoplasia intraepitelial conjuntival em 7, nevus conjuntival em 5, melanose adquirida primária e carcinoma espinocelular em 1 caso cada. O limbo foi envolvido em 10 casos e a córnea foi envolvida em 6 casos. A medida média da base do tumor foi de 14,8 mm (6-20, DP 16). O tempo médio de seguimento foi de 17,5 meses (6-60, DP 20). A cicatrização completa ocorreu em 8 olhos e deficiência de células limbares ocorreu em 2 olhos. A recorrência foi diagnosticada em 4 casos e tratada com o mesmo procedimento cirúrgico e médico e, após essa recorrência, a vascularização periférica superficial e a cicatriz corneana desenvolveram-se em 4 casos durante o seguimento. Conclusões: O transplante de membrana amniótica é um método eficaz para a reconstrução do defeito do tecido após a excisão de tumores limbares e conjuntivais com a combinação de crioterapia. Na maioria destes casos, a cicatrização completa pode ser conseguida com uma superfície lisa, estável e transparente.

Helicobacter Pylory infection in patients with esophageal squamous cell carcinoma

OBJECTIVE: Esophageal squamous cell carcinoma is one of the most common esophageal diseases in the developing world, but the relationship between esophageal squamous cell carcinoma and Helicobacter pylori infection remains a neglected topic. The primary objective of this study was to determine the association between Helicobacter pylori infection and esophageal squamous cell carcinoma. A second purpose was to determine the incidence and factors associated with Helicobacter pylori infection following esophagectomy. METHOD: The microorganism was identified by testing the gastric biopsy materials from 95 esophageal squamous cell carcinoma patients (66 females; 39 were esophagectomized) for urease activity in a medium containing urea and a power of hydrogen detection reagent and comparing the results with those from a healthy population. Differences in patient characteristics were assessed with chi-square tests and t-tests for categorical and continuous factors, respectively. RESULTS: The patients with esophageal squamous cell carcinoma had a significantly lower prevalence of Helicobacter pylori compared with the healthy population (p<0.001). The naive and esophagectomized patients, in contrast, showed no significant differences in Helicobacter pylori infection (p>0.005). Patients with esophageal squamous cell carcinoma showed a significant association between leukocytosis and hypoglobulinemia and the presence of Helicobacter pylori infection (p=0.023 and p=0.045, respectively). CONCLUSION: These results suggest that Helicobacter pylori is not an etiological factor in patients with esophageal squamous cell carcinoma. We found a statistically significant negative correlation between esophageal squamous cell cancer and Helicobacter pylori infection. These findings may guide new strategies for esophageal squamous cell carcinoma therapy.

Quality of life impairment in patients with head and neck cancer and their caregivers: a comparative study / Comprometimento na qualidade de vida de pacientes com câncer de cabeça e pescoço e de seus cuidadores: estudo comparativo

Abstract Introduction: Head and neck cancer represents 3% of all the types of malignant neoplasms and squamous cell carcinoma (SCC) is responsible for 90% of these cases. There have been some studies evaluating the quality of life of these patients, but little is known about the physical and emotional effects on their caregivers. Objective: To evaluate the quality of life of patients with head and neck cancer and their caregivers by applying validated questionnaires. Methods: Thirty patients with advanced tumors (SCC stage III or IV) and their 30 caregivers were included. Specific questionnaires (Coop/Wonca, EORTC QLQ-C30, EORTC H&N35, Coop/Wonca, and Caregiver Strain Index - CSI) were applied during routine medical consultations. Results: Of the 30 patients, 28 were males and 25 had stage IV tumors, with mean age of 56.6 years. 36.7% had the primary tumor in the oropharynx and 70% reported pain. The functional cognitive, physical, and emotional scales were the most affected. Pain, fatigue, and sleep disorders were the most prevalent symptoms. Of the 30 caregivers, 23 were females and 70% were the primary caregivers. 36.7% of the caregivers had high levels of stress, mainly related to the feeling of incapacity. The comparison between patients and caregivers demonstrated that the two groups had similar quality of life impairment: physical fitness (p = 0.487), mental health (p = 0.615), daily activities (p = 0.793), social activities (p = 0.301), changes in health (p = 0.649), and overall health (p = 0.168). Conclusion: Quality of life impairment is similar between patients and their caregivers. This result demonstrates that not only the patients show quality of life impairment, but their caregivers also have it and at similar proportions.

Resumo Introdução: O câncer de cabeça e pescoço representa 3% de todos os tipos de neoplasias malignas e o carcinoma espinocelular corresponde a 90% dos casos. Há estudos sobre a qualidade de vida desses pacientes, mas pouco se conhece sobre os prejuízos físico e emocional dos seus cuidadores. Objetivo: Avaliar a qualidade de vida de pacientes com câncer de cabeça e pescoço e comparativamente de seus cuidadores a partir da aplicação de questionários validados. Método: A casuística foi constituída de 30 pacientes com tumores avançados (carcinomas espinocelulares de estádio III ou IV) de cabeça e pescoço e 30 cuidadores. Foram aplicados questionários específicos (Coop/Wonca, EORTC QLQ-C30, EORTC H&N35, Coop/Wonca e Caregiver Strain Index - CSI) a partir de visitas de rotina ao ambulatório. Resultados: Dos 30 pacientes, 28 eram do sexo masculino e 25 apresentavam estádio IV, com idade média de 56,6 anos. 36,7% tinham o tumor primário na orofaringe e 70% sentiam dor. As escalas funcionais cognitivas, física e emocional foram as mais afetadas. Dor, fadiga e distúrbio do sono foram os sintomas mais prevalentes. Dos 30 cuidadores, 23 eram do sexo feminino e 70% eram cuidadores primários. 36,7% dos cuidadores apresentaram alto nível de estresse, principalmente relacionado à sensação de incapacidade. A comparação entre pacientes e cuidadores demonstram que os dois grupos apresentam semelhante comprometimento da qualidade de vida: aptidão física (p = 0,487), saúde mental (p = 0,615), atividades diárias (p = 0,793), atividades sociais (p = 0,301), mudança na saúde (p = 0,649), saúde geral (p = 0,168). Conclusão: O comprometimento na qualidade de vida é semelhante entre pacientes e seus cuidadores, ou seja, não só os indivíduos de fato doentes apresentam prejuízo na sua qualidade de vida, mas os seus cuidadores também e na mesma proporção.

Carcinoma metaplásico escamoso primario de mama: un subtipo infrecuente. A propósito de tres casos en el Hospital Universitario del Caribe / Primary breast squamous metaplastic squamous cell carcinoma of the breast: a rare subtype. Presentation of three cases in the Hospital Universitario del Caribe

De todas las neoplasias malignas de mama los carcinomas ductales son los más frecuentes. Menos del 5% son denaturaleza metaplásica y 0,04%-0,1% presentan diferenciación de células escamosas, subtipo que se considera más agresivo. Debido a los pocos casos en la literatura,no hay consenso sobre su diagnósticoy tratamiento. Presentamos tres casos con ese diagnóstico vistos entre 2014 y 2015 en nuestra institución y que corresponden a mujeres de 57, 49 y 65 años sin factores de riesgo y que presentaron cuadros clínicos similares consistentes con aparición de masa de crecimiento rápido. Dos de las pacientes se habían diagnosticado previamente con carcinoma ductal infiltrante de tipo no especial en biopsias por tru-cut con diagnóstico definitivo en la mastectomía radical que reportó en todos los casos carcinoma metaplásico escamoso confirmado por inmunohistoquímica.

Ductal carcinomas are the most common of all breast malignancies, less than 5% are of metaplastic nature, and 0.04% to 0.1% have squamous cell differentiation. These special subtypes are considered more aggressive. Due to the few cases in the literature, there is no consensus about its diagnosis and treatment. Three cases are presented with this diagnosis, seen in our institution between 2014 and 2015. They were women of 57, 49, and 65 years old with no risk factors, and who presented with similar clinical features, consisting of the appearance of a rapid growing mass. Two of the patients had been previously diagnosed with infiltrating ductal carcinoma of no special type by core needle biopsy, with a definitive diagnosis in radical mastectomy, which reported squamous metaplastic carcinoma confirmed by immunohistochemistry.

Predictive factors of occult neck metastasis in patients with oral squamous cell carcinoma / Fatores preditivos de metástases cervicais ocultas em pacientes com carcinoma epidermóide de boca

ABSTRACT INTRODUCTION: It is well established that cervical lymph node metastasis is the most important prognostic factor in patients with oral squamous cell carcinoma of the upper aerodigestive tract. The definition of parameters and classifications that could separate patients in groups of low, intermediate and high-risk is being attempted for several years. OBJECTIVE: The objective of this study was to determine possible predictive factors related to the occurrence of occult cervical lymph node metastasis through the analysis of histopathological reports of surgical specimens obtained after oral squamous cell carcinoma resection and selective neck dissections of patients initially classified as N0. METHODS: This was a primary, retrospective, observational, case-control study. Histopathological reports were reviewed to determine if some findings were related to the occurrence of occult lymph node metastasis. The events analyzed were oral cavity subsites, pT-stage, muscular infiltration, desmoplasia, vascular emboli, perineural infiltration, tumor thickness and compromised margins. RESULTS: Occult cervical metastasis accounted for 19.10 percent of the cases. Desmoplasia, perineural infiltration, tumor thickness and pT4a stage are predictive factors of occult neck metastasis (p-value = 0.0488, 0.0326, 0.0395, 0.0488, respectively). CONCLUSION: The accurate definition of predictive factors of occult cervical metastasis may guide the selection of patients that should be referred to radiotherapy, avoiding the unnecessary exposure of low-risk patients to radiation and allowing a better regional control of the disease in those of moderate or high risk.

Resumo Introdução: Já é bem estabelecido que a metástase oculta em linfonodo cervical é o fator prognóstico mais importante em pacientes com Carcinoma epidermóide de boca (CEB) do trato aerodigestivo superior. Há anos pesquisadores tentam definir parâmetros e classificações que poderiam separar os pacientes em grupos de baixo, médio e alto risco. Objetivo: O objetivo deste estudo foi determinar possíveis fatores preditivos relacionados com a ocorrência de metástase oculta em linfonodo cervical, por meio da análise de laudos histopatológicos de espécimes cirúrgicos obtidos após ressecção de CEB e dissecções seletivas do pescoço em pacientes inicialmente classificados como N0. Método: Este foi um estudo primário, retrospectivo, observacional e de caso-controle. Laudos histopatológicos foram revisados para determinar se alguns resultados estavam relacionados com a ocorrência de metástases em linfonodos oculto. Os eventos analisados foram: subsítios dentro da cavidade oral, estágio-pT, infiltração muscular, desmoplasia, embolia vascular, infiltração perineural, espessura do tumor e margens comprometidas. Resultados: Metástases cervicais ocultas foram responsáveis por 19,10% dos casos. Desmoplasia, infiltração perineural, espessura do tumor e estágio pT4a foram fatores preditivos de metástase cervical oculta (p = 0,0488, 0,0326, 0,0395, 0,0488, respectivamente). Conclusão: A definição precisa dos fatores preditivos de metástase cervical oculta pode orientar a seleção de pacientes que devem ser submetidos a radioterapia, evitando a exposição desnecessária dos pacientes de baixo risco à radiação, e melhorar o controle regional da doença em pessoas de risco moderado ou alto.

Impact of delay in the diagnosis and treatment of head and neck cancer / Impacto da demora no diagnóstico e tratamento no câncer de cabeça e pescoço

ABSTRACT INTRODUCTION: Head and neck tumors can be easily recognized through clinical evaluation. However, they are often diagnosed at advanced stages. OBJECTIVE: To evaluate the delay from the patient's initial symptoms to the definitive treatment. METHODS: Retrospective study of patients enrolled in 2011 and 2012. A questionnaire was filled in about socioeconomic aspects, patient history, tumor data, professionals who evaluated the patients, and the respective time delays. RESULTS: The following time delay medians were observed: ten months between symptom onset and the first consultation; four weeks between the latter and the first consultation with a specialist; four weeks between the specialist consultation and diagnosis attainment; and 12 weeks between diagnosis and the start of treatment. CONCLUSIONS: Most head and neck tumors are diagnosed at advanced stages, due to patient and health care factors.

RESUMO INTRODUÇÃO: Apesar de poderem ser facilmente reconhecidos ao exame clínico, os tumores de cabeça e pescoço são, muitas vezes, diagnosticados em estadiamento avançado. OBJETIVO: Avaliar a demora entre o surgimento dos sintomas iniciais do paciente e seu encaminhamento para o tratamento definitivo. MÉTODO: Trata-se de um estudo retrospectivo de pacientes arrolados em 2011 e 2012. Foi preenchido questionário sobre fatores sócio-econômicos, antecedentes, dados do tumor, profissionais que avaliaram os pacientes e respectivos períodos de demora. RESULTADOS: Foram observadas as seguintes medianas de tempo de demora: 10 meses entre o início dos sintomas e o primeiro atendimento; 4 semanas entre este e a primeira consulta com o especialista; 4 semanas entre esta e o estabelecimento do diagnóstico; e 12 semanas entre este e o início do tratamento. CONCLUSÕES: A maior parte dos cânceres de cabeça e pescoço é diagnosticada em estádios avançados, por fatores relacionados aos pacientes e à atenção à saúde.