Second primary tumours

It has been recognised for a long time that patients with oral cancer are at risk of second tumours in the upper aerodiges-tive tract. This has been reported to occur in 10-35% of cases {2676}. These may be synchronous with the index tumour or, if occurring after an interval of longer than six months are described as metachro-nous. Recurrence of the index tumour after treatment can be diagnosed by the pathologist where the tumour is in deeper tissue and not associated with the epithelial surface. However, the most frequent situation of second tumours is when they arise from surface epithelium adjacent to the treated index tumour. On morphological grounds these are diagnosed as second primary tumours. The increasing use of molecular biological techniques has allowed distinction to be made between molecularly distinct second primary tumours and second field tumours derived from the same genetically altered field as the index tumour {248}.

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