Carcinogenesis, markers, staging, and prognosis of head and neck cancer.

The integration of basic science perspectives into clinical head and neck oncology remains a priority. During this past year, we have witnessed initial results from many laboratories regarding p53 expression. Point mutations in the p53 gene have been identified and related to carcinogen exposure. Abnormalities in p53 have been identified in not only intra-epithelia neoplasia but also normal mucosa, suggesting an early genetic event. The ability to identify early genetic abnormalities will allow for earlier therapeutic strategies. The integration of basic science advances will likewise lead to improved prognostication and ultimately to improved staging. Prototypical of this process is DNA cytometric analysis. Reports in the past year have made use of integrated image analysis technology to measure both nuclear DNA content and nuclear volume. The incorporation of these measurements provided prognostic information beyond current staging techniques. Finally, the understanding of genetic alterations is beginning to carry with it potential therapeutic implications. Chromosome alterations at 11q13 may involve expression of several genes, including glutathione S-transferase (GST). Investigators have noted that the expression of this gene, as reflected in circulating GST blood levels, may predict chemotherapeutic responsiveness. Despite these basic science advances, population studies revealed that head and neck cancer mortality is increasing in certain segments of our society, eg, black American men. New strategies are required if improved survival from head and neck cancer is to be realized.