Published: 2019-02-23

Role of PET CT in the detection of second synchronous primary tumors and distant metastasis in head and neck cancers at initial presentation

Sowjanya Gandla, Vishal Rao


Background: The patients with the head and neck cancer are strongly at risk of developing a second primary tumor which can be related to share etiological factors such as tobacco, alcohol and smoking. The aim of the study is to evaluate the percentage of synchronous second primaries and distant metastasis that are identified on PET CT imaging in head and neck cancer patients at initial presentation.

Methods: This study is a retrospective observational study. A total of 503 patients with histological confirmation of head and neck cancer and who had undergone 18F FDG PET CT imaging from 2007 to 2013 were included in the study. The PET CT scan images of all 503 patients were reviewed. The patients with PET CT scan images indicating the presence of abnormal metabolic uptake suggestive of additional primary malignant lesion or distant metastasis were identified.  

Results: Out of the total 503 patients with histological confirmation of head and neck cancer, 34 patients were excluded due to non-availability of complete details, among the 469 patients of head and neck cancer, 7 patients (1.49%) were diagnosed with synchronous primary tumors and 33 patients (7.03%) were diagnosed with distant metastasis in PET CT imaging at the time of initial presentation.

Conclusions: PET CT imaging is a useful tool to detect distant metastasis and second primary synchronous tumors in advanced head and neck cancers. The incidence of distant metastasis is a much more valid indication for the PET CT imaging in advanced head and neck cancers.


PET CT, Synchronous second primary tumors, Distant metastasis, Head and neck cancers

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Jegu J, Foucard FB, Borel C, Velten M. Trends over three decades of the risk of second primary cancer among patients with head and neck cancer. Oral Oncol. 2013;49:9-14.

Strobel K, Haerle SK, Stoeckli SJ. Head and Neck Squamous cell carcinoma: detection of synchronous primaries with 18F-FDG-PET/CT. Eur J Nucl Med Mol Imaging. 2009;36:919-7.

Sing WC, Jie GN, Ching CY. Prevalence of synchronous second primary malignancy: Identification using whole body PET/CT imaging. Clin Imaging. 2013;38(2):179-86.

Warren S, Gates DC. Multiple primary malignant tumors: a survey of the literature. Am J Cancer. 1932;16:1358-414.

Slaughter DP, Southwick HW, Smejkal W. Field cancerization in oral stratified squamous epithelium: clinical implication of multicentric origin. Cancer. 1953;6(5):963-8.

Alok A, Singh ID, Panat SR, Singh S, Kishore M. Oral field cancerization: A Review. Int J Dent Med Res. 2014;1(3):98-104.

Ishimori T, Patel PV, Wahl RL. Detection of unexpected additional primary malignancies with PET CT. J Nucl Med. 2005;46(5):752-7.

Strobel K, Haerle SK, Stoeckli SJ, Schrank M, Jon D Soyka. Head and Neck Squamous cell carcinoma (HNSCC) -detection of synchronous primaries with 18 FDG PET CT. Eur J Nucl Med Mol Imaging. 2009;36:919-27.

Lee HS, Kim JS, Roh JL, Choi SH, Nam SY, Kim SY. Clinical values for abnormal 18F-FDG uptake in the head and neck region of patients with head and neck squamous cell carcinoma. Eur J Radiol. 2014;83(8):1455-60.

Krishnatreya M, Rahman T, Kataki AC, Das A, Das AK, Lahkar K. Synchronous primary cancers of the head and neck region and upper aero digestive tract: Defining high risk patients. Indian journal of cancer. Indian J Cancer. 2013;50(4):322-6.

Kuperman D, Auethavekiat V, Adkins DR, Nussenbaum B, Collins S, Boonchalermvichian C, et al. Squamous cell carcinoma of the head and neck with distant metastasis at presentation. Head Neck Surg. 2011;33:714-8.

Takes RP1, Rinaldo A, Silver CE, Haigentz M JR, Woolgar JA, Triantafyllou A, et al. Distant metastasis from head and neck squamous cell carcinoma. Part 1. Basic aspects. Oral Oncol. 2012;48(9):775-9.