Bartosz Szybiak

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is a disease of middle-aged to elderly adults. However, an increased incidence of HNSCC in young people under 45 years of age has been reported recently. In the present review, we focused on the epidemiology and aetiology of HNSCC in adults under 45 years of age. METHODS: We reviewed literature related to HNSCC in adult patients less than 45 years of age and discussed current treatment options and prognosis. RESULTS: HNSCC in young adults is associated with a higher incidence rate in nonsmokers, lower female-to-male ratio, a higher percentage of oral cavity and oropharynx tumours, and fewer second primary tumours. However, aside from traditional risk factors of tobacco and alcohol exposure, the causes of these cancers in young adults remain unclear. Agents that might contribute to risk include infection with high-risk human papillomavirus subtypes as well as genetic factors or immunodeficiency status. The expected increase in incidence and mortality of the young with HNSCC may become a major public health concern if current trends persist, particularly lifestyle habits that may contribute to this disease. CONCLUSIONS: Given the younger age and potential long-term adverse sequelae of traditional HNSCC treatments, young adults should be treated on a case-by-case basis and post-therapy quality of life must be considered in any treatment-decision making process.

AIM: The aim is to find out why the rate of recurrence of tongue and floor of the mouth cancer is so high despite radical surgical treatment combined with radiochemotherapy. BACKGROUND: Oropharyngeal cancer is the second most common head and neck cancer in Poland. Tongue cancers account for 40% of all oral cavity tumours. A frequent reason for a failure in treatment of tongue and floor of the mouth cancers is local recurrence. Based on that examination, cancer treatment can be precisely planned. MATERIALS AND METHODS: The study comprised a group of 56 tongue and floor of the mouth cancer patients. 9 patients who showed local recurrence were given an extended histopathological examination. The infiltration of the vessels, nerves and muscles was examined. The examination also checked the largest dimension of the tumour, the greatest depth of invasion from the mucous membrane, invasive front of the cancer, vessel embolisms, intra- and perineural infiltrations in the cancer invasive front. Tumour aggressiveness was assessed according to M. Brandwein-Gensler. RESULTS: In five patients, primary tumours were found to be histologically aggressive as indicated by the infiltration of the vessels, nerves and muscles. Tumours which penetrate these structures were characterized with peri- and intraneural infiltration and were correlated with the depth of invasion from the mucous membrane, the occurrence of embolisms, and a high risk assessment as proposed by M. Brandwein-Gensler. CONCLUSION: The progression of cancer depends strongly on histopathological traits. The incidence of penetration of the vessels, nerves and muscles correlates with aggressiveness of the tumour front.

INTRODUCTION: The anterolateral thigh flap (ALT) is one of the most commonly used grafts in head and neck reconstructive surgery. In this type of surgery, it is essential that the vascular pedicle be long enough to ensure proper vascular anastomosis. However, it is difficult to accurately estimate the pedicle length preoperatively. In this context, the current study had two aims: (1) to assess the value of colour Doppler sonography (CDS) in the preoperative assessment of the vascular pedicle and (2) to develop a mathematical model to predict the length of the vascular pedicle based on the ultrasound findings. MATERIALS AND METHODS: Retrospective review of patients who underwent primary surgery for head and neck cancer followed by ALT flap reconstruction at our institution from 2014 to 2018. All patients underwent CDS prior to surgical excision of the flap. RESULTS: Preoperative CDS was useful to identify the location of the vascular perforators, to estimate the pedicle length, and to identify the vascularization variant. Using the proposed mathematical formula, the estimated minimum pedicle length and actual length agreed in 73.9% of cases, increasing to 84.1% when a 5 mm margin of error was allowed. Moreover, preoperative ultrasound accurately distinguished the two anatomical variants of the ALT vasculature in nearly all cases (97.1%). CONCLUSION: This study confirms the value of preoperative colour Doppler sonography for ALT flap reconstruction. The proposed mathematical model provides a highly accurate method of preoperatively assessing the length of the vascular pedicle, which may be of value in head and neck surgery.

Cigarette smoking and excessive alcohol drinking result in the rise of numbers of patients suffering from the head and neck cancer. Addiction to any of these stimulants carry a risk of developing a cancerogenesis process. Using them simultaniously lead not to a summary of each of those risks but multiplies them. Scientific research also indicates the important difference in the incidence of cancer in people who have never smoked cigarettes or drunk alcohol in comparison to those, whose exposure to these stimulatns was longterm - in such case, the former group had a lower percentage of developing the disease. Human body burdened with the ongoing cancer shows disturbances on various levels of the system. One of such disturbances is change of the concetration levels of physiological metals, such as calcium, magnesium, iron, copper, zinc or mangenese. They play key roles in maintaing the hormonal and ionic stability, they act as cofactors in many enzymes in metabolic processes. Diagnostic research of any deviations in levels of those essential elements enables a full estimation of a patient condition. The aim of this study was physiological metal levels evaluation in different kinds of biological material in patients with tumors of larynx, salivary glands and oral cavity and tongue. Hair and nail samples were used as examples of alternative material, beside the serum samples, which is a standard material and often used. Subjects were patients of Otolaryngology and Laryngological Oncology Clinic of Poznan University of Medical Sciences (Samodzielny Publiczny Szpital Kliniczny nr 2 im. Heliodora Swiecickiego Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu) and The Head and Neck Surgery Ward of The Greater Poland Cancer Centre in Poznan. Subjects were 41 men and 18 women with tumors of larynx, salivary glands and oral cavity and tongue. The control group consisted of patients from the Otolaryngology and Laryngological Oncology Clinic of Poznan University of Medical Sciences (Samodzielny Publiczny Szpital Kliniczny nr 2 im. Heliodora Swiecickiego Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu), The Head and Neck Surgery Ward of The Greater Poland Cancer Centre in Poznan and patients of Department of Endocrinology, Metabolism and Internal Medicine of Poznan University of Medical Sciences (Samodzielny Publiczny Szpital Kliniczny nr 2 im. Heliodora Swiecickiego Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu) and Department of Conservative Dentistry and Periodontology Poznań University of Medical Sciences. They gave answers to the questionnaire concerning smoking habits, alcohol consumption and dietary habits, Then the samples of their serum, hair and nails were collected. After careful preparations the biological material has underwent the process of digestion, and then calcium, magnesium, iron, copper, zinc, mangenese were determined quantitatively using the method of ICP-MS. Profile of the patients who took part in the research displayed a strong correlation between tobacco smoking with alcohol drinking and appearance of larynx, salivary gland and oral cavity and tongue cancer as well as between exclusively tobacco smoking and appearance of these types of cancer. There is a higher incidence of larynx, salivary gland and oral cavity and tongue cancer when there is a deficiency of grain products or fibre in everyday diet. A higher level of calcium, magnesium, iron and manganese was found in patients' hair and nails who suffered from salivary gland cancer. According to applied Chemometric Analysis of Principal Component 1 - concentrations of iron, copper and manganese with magnesium and zinc in patients' nail samples showed strong correlation between measured variables. In patiens' hair samples measured correlation between variables was decreased - concentrations of calcium and magnesium as well as of iron and manganese were highlighted as two groups of variables which showed some correlation in this type of biological material. Further research is required to indicate which of alternative biological materials - hair or nail samples - in relation to serum, would provide a better evaluation of physiological metal levels.

550,000 new cases of cancer of the oral cavity and pharynx and 160,000 of larynx are diagnosed each year worldwide. It is estimated that each year because of head and neck cancer 400,000 of patients will die. Head and neck neoplasms are the tumors which, because of their location, secretly develop and produce uncharacteristic symptoms identical to those that accompany the banal infections of the upper respiratory tract. Results of treatment of patients with head and neck cancer in Poland are highly unsatisfactory. This is due to significant advancement of tumor at the moment of diagnosis. Therefore, raising awareness and improving knowledge of health care workers on head and neck cancers by creating access to prevention research is a priority that will ensure improvement in treatment outcomes in this group of tumors in Poland and abroad.