Rakesh Roshan diagnosed with early stage squamous cell throat carcinoma

New Delhi, January 09, 2019:

Yet another noted film personality has been diagnosed with cancer. After Irrfan Khan, Sonali Bendre, Nafisa Ali, now actor and filmmaker Rakesh Roshan has been diagnosed with early stage squamous cell carcinoma of throat and he will have undergone surgery for the same yesterday, as reported in TOI. The diagnosis was shared by his son, Hrithik Roshan, on social media.

What is squamous cell throat carcinoma? Let’s take a quick recap here:

• Most throat cancers are squamous cell carcinomas (90-95%).
• They can be categorized as well differentiated (>75% keratinization), moderately differentiated (25-75% keratinization) and poorly differentiated (< 25% keratinization) tumors.
• Verrucous carcinoma (a variant of squamous cell carcinoma), adenocarcinoma, adenoid cystic carcinoma and mucoepidermoid carcinomas are other less common histologies.
• Tobacco (smoked and smokeless) is the most important known risk factor for the development of the cancer.
• Tobacco and alcohol consumption have a synergistic effect. The repeated exposure of the mucosa of the upper aerodigestive tract to tobacco, alcohol, or both appears to cause multiple primary and secondary tumors in this “condemned mucosa,” a phenomenon described as “field cancerization.”
• Human papillomavirus (HPV) infection, a sexually transmitted virus, is also a causative agent. HPV-associated oropharyngeal cancer typically presents in younger patients without a history of excessive exposure to alcohol and tobacco. It has a better prognosis and response to therapy than HPV-negative disease.
• Other risk factors include betel nut chewing, radiation exposure, vitamin deficiencies, periodontal disease, immunosuppression and other environmental and occupational exposures.
• Squamous cell carcinoma often develops from premalignant lesions due to carcinogen exposure. Clinical signs are leukoplakia and erythroplakia. Histopathologically, dysplasia is associated with progression to invasive cancer in 15-30% of cases.
• Leukoplakia is characterized by hyperparakeratosis and is usually associated with underlying epithelial hyperplasia. The chances of malignant transformation is <5%, if there are no underlying dysplastic changes.
•  Erythroplakia is characterized by red superficial patches adjacent to normal mucosa. It is commonly associated with epithelial dysplasia and is associated with carcinoma in situ or invasive tumor in up to 40% of cases

•  HPV tumor status should be determined for all cases of newly diagnosed oropharyngeal squamous cell carcinoma but not for the routine evaluation of nonsquamous carcinoma of the oropharynx or nonoropharyngeal squamous cell carcinoma of the head and neck. It may be useful in select cases of oropharyngeal cancer with uncertain histology.
• Symptoms include hoarseness of voice, difficulty swallowing or feeling that something is caught in the throat, persistent sore throat, cough, unexplained weight loss, ear pain.
• Diagnostic methods are biopsy of the lesion, imaging tests (CT, MRI, PET), barium swallow
• Treatment: Surgery (minimally invasive or endoscopic, transoral laser microsurgery), chemotherapy and/or radiation therapy
• Prevention: Harm Reduction and Harm Prevention: No to tobacco and alcohol or switch to non tobacco nicotine based products and limit alcohol intake

Dr KK Aggarwal

(Sources: Uptodate, MD Anderson Cancer Center)