Screening for Head and Neck Cancer in Childhood Irradiation

Abstract

Objective: Except for thyroid disease, no guidelines exist for screening the various sites at risk after a history of childhood irradiation. We sought to develop a formal screening algorithm used to target these high risk patients.

Method: Four patients who each demonstrated 3 or more potentially radiation induced tumors of the head and neck are described. Evidence from the literature describing the relationship between these tumors and childhood irradiation provided the basis for screening recommendations.

Results: Four patients, ages 63 to 76 years, who received childhood irradiation are reported. Three patients had salivary tumors and developed hyperparathyroidism secondary to adenoma. Other tumors included papillary thyroid cancer, benign thyroid nodules, basal cell carcinoma, and ear canal osteoma. We propose an algorithm in evaluating these patients. Initially, patients receive a head and neck physical, baseline laboratories and thyroid ultrasound. Suspicious thyroid lesions or ones greater than 8 mm undergo FNA. An audiogram is recommended and potentially MRI if clinical suspicion exists for acoustic neuroma. If pathology is absent on screening, patients merit follow-up with examination and labs every 1 to 3 years.

Conclusion: Patients with a history of childhood irradiation present a risk for a multitude of head and neck neoplasms and need thorough screening and evaluation. The proposed algorithm provides a comprehensive tool for head and neck cancer screening in this population emphasizing the diversity of manifestations that may present.