Medical and Health Documents

Content provided in this 10th edition was released in June 2007. New clinical data announced since that time will be included in an updated 11th edition of “Cancer Management: A Multidisciplinary Approach,” now available.

Edited by:
Richard Pazdur, MD
Office of Oncology Drug Products
Center for Drug Evaluation and Research
US Food and Drug Administration

Lawrence R. Coia, MD
Southern Ocean County Radiation Oncology
Manahawkin, New Jersey

William J. Hoskins, MD
Curtis and Elizabeth Anderson Cancer Institute
Memorial Health University Medical Center
Savannah, Georgia

Lawrence D. Wagman, MD
Division of Surgery
City of Hope National Medical Center
Duarte, California

And the publishers of the journal ONCOLOGY

Sample

Tobacco The incidence of head and neck tumors correlates most closely with the use of tobacco.

Cigarettes Head and neck tumors occur six times more often among cigarette smokers than nonsmokers. The agestandardized risk of mortality from laryngeal cancer appears to rise linearly with increasing cigarette smoking. For the heaviest smokers, death from laryngeal cancer is 20 times more likely than for nonsmokers. Furthermore, active smoking by head and neck cancer patients is associated with significant increases in the annual rate of second primary tumor development (compared with former smokers or those who have never smoked). Use of unfiltered cigarettes or dark, aircured tobacco is associated with further increases in risk.

Cigars Total cigar smoking increased by nearly 50% in the United States in the 1990s. Often misperceived as posing a lower health risk than cigarette smoking, cigar smoking results in a change in the site distribution for aerodigestive tract cancer, according to epidemiologic data. Although the incidence of cancer at some sites traditionally associated with cigarette smoking (eg, larynx, lungs) is decreased in cigar smokers, the incidence of cancer is actually higher at other sites where pooling of saliva and associated carcinogens tends to occur (oropharynx, esophagus).

Smokeless tobacco Use of smokeless tobacco also is associated with an increased incidence of head and neck cancer, especially in the oral cavity. Smokeless tobacco users frequently develop premalignant lesions, such as oral leukoplakia, at the site where the tobacco quid rests against the mucosa. Over time, these lesions may progress to invasive carcinomas. The use of snuff has been associated with an increase in cancers of the gum and oral mucosa.

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