Routine Panendoscopy--Is It Necessary Every Time?

The report by Atkins and associates¹on the frequency of positive endoscopy results in patients with cancer of the head and neck is timely because it raises the issue of the costbenefit ratio and brings to our attention the problem of multiple squamous cell carcinomas in the upper aerodigestive tract, the lower tracheobronchial tree, the lungs, and the esophagus. Those of us who treat patients with tumors in these areas are acutely aware of the fact that multiple primary carcinomas occur in the common contiguous pathways of tissue shared by these organs, particularly in those who smoke tobacco or drink alcohol. This observation reflects the process of "field cancerization" in the epithelial tissues. See also p 533. Interest in multiple primary malignant neoplasms is long-standing.²Since 1932, when Warren and Gates³culled from the literature reports on 1,259 patients with multiple primary malignant neoplasms, thousands of cases