Academic literature on the topic 'Upper Aero-Digestive Tract (UADT)'

Introduction Foreign body in upper aero-digestive tract leads to many complications including life-threatening ones to the patients. Its management depends upon type of foreign body and site of lodgement. Materials and Methods A descriptive study was conducted from March 2013 to February 2017 to determine the different components of the epidemiological profile of the cases of Foreign body in upper Aero-digestive Tract (UADT) and its management principle. Total 192 patients were selected for this study. These patients underwent different procedures for foreign body removal and post-operative notes were taken for data analysis to note the epidemiological pattern. Results A total of 192 patients were included in the study. Epidemiological data were derived and analyzed comprehensively to present the different profiles. Conclusion Fish bone was found to be the commonest foreign body in upper aero-digestive tract, followed by coin and meat bone. Foreign bodies are commonly removed by Tilley's forceps followed by Hypopharyngoscopy.

ABSTRACT Limited data are available that summarize the relation between egg intake and the risk of upper aero-digestive tract (UADT) cancers. This systematic review and meta-analysis was conducted to investigate the association between egg intake and the risk of UADT cancers. Medline/PubMed, ISI web of knowledge, EMBASE, Scopus, and Google Scholar were searched using relevant keywords. Observational studies conducted on humans investigating the association between egg consumption and the risk of UADT cancers were included. Overall, 38 studies with a total of 164,241 subjects (27, 025 cases) were included. Based on 40 effect sizes from 32 case-control studies, we found a 42% increased risk of UADT cancers among those with the highest egg consumption (ranging from ≥1 meal/d to ≥1 time/mo among studies) compared to those with the lowest intake (ranging from 0–20 g/d to never consumed among studies) (overall OR: 1.42; 95% CI: 1.19, 1.68; P < 0.001). However, this association was only evident in hospital-based case-control (HCC) studies (OR = 1.50; 95% CI: 1.34, 1.68; P < 0.001 for ‘oropharyngeal and laryngeal cancer’ and OR: 1.27; 95% CI: 1.08, 1.50; P = 0.004 for esophageal cancer) and not in population-based case-control (PCC) studies (OR = 1.25; 95% CI: 0.59, 2.67; P = 0.56 for ‘oropharyngeal and laryngeal cancer’ and OR: 1.29; 95% CI: 0.92, 1.81; P = 0.13 for esophageal cancer). In addition, the association was not significant in prospective cohort studies (overall OR: 0.86; 95% CI: 0.71, 1.04; P = 0.11). Considering individual cancers, a positive association was observed between the highest egg consumption, compared with the lowest, and risk of oropharyngeal (OR: 1.88; 95% CI: 1.61, 2.20; P < 0.001), laryngeal (OR: 1.83; 95% CI: 1.45, 2.32; P < 0.001), oral & pharyngeal & laryngeal (OR: 1.37; 95% CI: 1.12, 1.67; P < 0.001), and esophageal cancers (OR: 1.28; 95% CI: 1.10,1.48; P = 0.001). We also found an inverse association between egg intake and the risk of oral cancer (OR: 0.78; 95% CI: 0.62, 0.99; P = 0.04). In conclusion, high egg consumption (ranging from ≥1 meal/d to ≥1 time/mo among studies) was associated with increased risk of UADT cancers only in HCC studies but not in PCC or prospective cohort studies. PROSPERO registration number: CRD42018102619.

<p class="abstract"><strong>Background:</strong> <span lang="EN-GB">The objective of the study was to describe the epidemiological and histopathological aspects of cancer of the upper aero digestive tract (UAT) in a reference service in Togo</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-GB">It was a retrospective study about UAT cancers diagnosed in the ENT and maxillofacial surgery department of Sylvanus Olympio Teaching Hospital of Lomé in Togo from 1st January 2005 to 31 December 2014, or a period of 10 years</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-GB">The UAT cancers represented 0.3% of consultations and 64.8% of head and neck cancers. The average age of patients was 51.3 years (± 16.5) with extremes of 3 months and 86 years. The sex ratio was 1.77. Chronic smoking was found in 26.4% of patients with 1.6% of women; that of chronic alcoholism among 43.8% of which 7.7% of women and the simultaneous alcoolotabagisme in 20.9% of patients. The UAT cancers were dominated by cancers of the oral cavity (36.2%) with particularly a female predominance (53.2%), followed by the oropharynx (18.5%) and the larynx (18.1%). The squamous cell carcinoma was predominant in UAT cancers (83.5%) followed by non-Hodgkin lymphoma (8.9%) and adenocarcinoma (2.7%)</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-GB">UAT cancers are the largest contingent of head and neck cancers in Togo. They occur most often in men from the fifties but there are a high proportion of women. Histology is dominated by squamous cell carcinoma</span><span lang="EN-IN">.</span></p>

Candida is a commensal yeast. It can be infective when the host’s defense mechanism is weakened, as in the case of squamous cell carcinoma patients. We aimed to evaluate the prevalence and clinical mycological manifestation of candidiasis in 150 cancer cases comprised of preoperative and post-operative (with or without radiotherapy) upper aerodigestive squamous cell carcinoma. A total of 150 patients suffering from squamous cell carcinoma of the Upper Aero-Digestive Tract (UADT) were divided into preoperative (n = 48), post-operative without radiotherapy (n = 29) and post-operative with radiotherapy (n = 73). Samples were collected using cotton swabs and cultured. Candida species were identified according to color pigmentation on Candida Differential Agar (CDA) plate. The clinico-mycological association of patients was evaluated by the chi-square test, and 98 out of 150 patients showed the presence of various Candida species. The major species isolated was Candida albicans (53%), followed by Candida tropicalis (16%). There was a significant statistical difference between patients who showed mycological associations and patients who did not have any such association (p = 0.0008). The prevalence of oral candidiasis was found to be 65.33% among total cases of upper aero-digestive squamous cell carcinoma. Chronic erythematous cases of candidiasis were mainly seen in preoperative squamous cell carcinoma cases, whereas the acute erythematous type of candidiasis was mainly seen in post-operative cases who received radiotherapy. The clinicomycological assessment can help to correlate the signs and symptoms with the presence of candidiasis in upper aerodigestive squamous cell carcinoma patients. Meticulous testing and examination can help in the early detection of candidiasis. Future studies are needed to develop advance scientific preventive strategies for high-risk cases.

AbstractIdiopathic fibrosis of different areas of the body such as retroperitoneal fibrosis, mediastinal fibrosis, sclerosing cholangitis, Reidel's thyroiditis and pseudo-tumour of the orbit are well recognised entities that manifest individually or in combination. A case of idiopathic fibrosis of the upper aerodigestive tract is presented, which caused dense fibrosis of the floor of mouth, tongue, pharynx and larynx leading to aphonia and severe dysphagia. A permanent tracheostomy was performed and regular bouginage is necessary. This is the first such case reported in the literature.

AbstractMultiple carcinoma of the upper aerodigestive tract is an increasingly recognized problem, and a concept of ‘field cancerization’ has been proposed to explain this phenomena. The initial assessment of a patient with an isolated aerodigestive carcinoma must be extensive so as not to miss any synchronous lesions, and may include radiography and endoscopy. Treatment cannot be standardised but must be tailored to suit individual problems and because of the high incidence of metachronous tumours, follow-up must be both thorough and ‘lifelong’.A case of three primary synchronous squamous carcinomas of the upper aerodigestive tract is presented. The relevant literature is reviewed.

Introduction Impaction of foreign bodies and obstruction in the upper aero-digestive tract is a medical emergency. Case Report A 5-month-old male infant presented with impacted large vegetable foreign body lying in the hypopharynx of an infant causing almost complete laryngeal obstruction. Cardiopulmonary resuscitation was initiated and back blows were given between the blades of the scapula to assist in its removal. Only available curved artery forceps was gently passed beyond the foreign body; blades of the forceps were opened to engage it and foreign body was swept and rolled out. Patient was revived after intensive resuscitation. Conclusion Suspect foreign body in the upper aero-digestive tract in any child presenting with severe respiratory distress or apneic spells or choking. Foreign body may be removed with only available curved artery forceps by gently passing beyond it, followed by opening and engaging blades of the forceps to sweep and roll it out of the upper aero-digestive tract.

The incidence and mortality rates of cancers of upper aero-digestive tract (UADT) remain significantly high in India. These cancers, which occur more commonly in later adulthood, are influenced by social and lifestyle behaviours carried out during childhood, adolescence and early adult life. Thus, life-course epidemiology attempts to assess varying health effects of various risk factors, according to timing, duration and frequency of exposure, which may give important clues to the causes of cancer. These cancers have serious impacts on quality of life (QoL) as they involve anatomical structures essential for mastication, speaking, cosmetic appearance and psychological wellbeing. Moreover, these cancers frequently present late and progress rapidly. Therefore, there is a need to develop a model for cost-effective screening and detection of individuals at high-risk of these cancers in the near future as well as early detection of cancer cases. Thereby, a study was designed with the following hypotheses:  Early age at initiation, frequency and duration of use of tobacco in its all forms, exposure to second hand tobacco smoke (SHS) at home and drinking alcohol has a linear dose-response relationship with the incidence of UADT cancers.  There is an association between tobacco, alcohol drinking, diet, oral hygiene and anthropometry measures with incidence of oral cancers.  Cancer site, staging, gender and age at diagnosis have an impact on QoL.  A risk-factor based screening model for UADT cancers has strong predictive ability to detect high-risk individuals. A bi-centre hospital-based frequency matched case-control study was conducted in Pune, Maharashtra State, India, from June 2014 and May 2015. Cases were histopathologically confirmed new cases of squamous cell carcinoma of UADT. Controls were patients diagnosed with a disease other than UADT or any other cancer, selected from the same hospital during the same period as the cases were recruited. Data were collected by medical-record abstraction, face-face interviews and by visual inspection of the oral cavity. A closed-ended questionnaire with a life-course perspective was used to collect patient‟s self-reported information on sociodemographics, lifestyle habits (chewing and smoking tobacco, drinking alcohol, SHS, oral hygiene) and QoL. The interviewer recorded anthropometry measures and number of missing teeth. Unconditional logistic regression was used to estimate the odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). A reciever-operater characterstic curve was plotted against sensitivity and false-positive rate to produce a cut off point for the presence of UADT cancers. Examination of all QoL domains was done using oneway analysis of variance and the Bonferroni adjustments for post-hoc comparisons. Data were analysed by the Statistical Package for Social Sciences version 22. A total of 480 patients participated in the study. Chewing tobacco emerged as the strongest predictor for UADT cancers (OR=7.61; 95% CI 4.65-12.45) followed by smoking and drinking alcohol. Exposure to SHS during childhood (<16 years) rather than after ≥16 years increased the risk significantly (OR=4.05; 95% CI 2.06-7.95). There is a linear dose-response relationship between duration, frequency and early age at initiation for lifestyle risk factors (chewing and smoking tobacco; drinking alcohol) with incidence of UADT cancers in adulthood. Combined effects of tobacco and alcohol consumption habits elevated the risk (OR=12.05; 95% CI 4.61-31.49) in comparison to never users of these habits. Furthermore, the combination of these three lifestyle risk factors accounted for 86.82% of population attributable risk. Overall, the most affected QoL domains were anxiety and mood both among cases and controls. Oropharynx and hypopharynx cancer cases had the worst mean scores across all QoL domains. Stage IV cancer patients showed the worst QoL. Amongst UADT cancers in Pune, cancer of the oral cavity was the most common. Chewing tobacco showed higher odds (OR=8.51; 95% CI 4.90-14.77) for oral cancer risk as compared to UADT cancers. Poor oral hygiene emerged as significant predictor for oral cancer risk (OR=6.98; 95% CI 3.72-13.05). A screening model was derived for detection of individuals at high-risk for UADT cancers. This model has high sensitivity (93.5%), specificity (71.1%), false positive rate (28.8%), false negative rate (6.4%), positive predictive value (74.8%) and negative predictive value (96.6%). Our research recognises the framework of life-course influences of early exposure to behavioural risk-factors as independent and combined predictors of UADT cancers. The significantly compromised QoL in UADT cancer needs to be incorporated as an outcome measure in an individualized approach to therapeutic and palliative care planning of these cases to enable a better quality of survival. If validated in other studies, our proposed screening model can be applicable to many other high-risk UADT cancer populations with behavioural risk factors similar to our study population.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Dentistry and Oral Health and Menzies Health Institute Queensland
Griffith Health
Full Text

Socioeconomic inequality in cancer risk and incidence burden has received limited attention compared to genetic and behavioural risk factors. Where they have been studied, the temporal relationship between socioeconomic factors and cancer risk has been under explored due to the mainly cross-sectional nature of most research. Moreover, the inter-relationships of the multiple measures of socioeconomic status and, in particular, area and individual measures and their interaction with risk behaviours have also had limited attention. The overarching aim of this thesis was to investigate socioeconomic inequalities in the risk of lung and upper aero-digestive tract cancers and the relationship between this risk and socioeconomic status, area and individual based measures of socioeconomic circumstances, and behaviours such as smoking, alcohol consumption, diet and exercise. To understand and quantify the relative contribution by age, sex and tumour subtype to the socioeconomic inequalities of all cancer risk, a descriptive epidemiological study of cancer incidence in Scotland (2000-07) was undertaken. Age standardised rates per 100,000 population were calculated by direct standardisation to the European standard. A linear regression model was used to calculate the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) which were employed to rank tumour and subtype contribution to all cancer risk socioeconomic inequalities by age for each sex for lung and upper aero-digestive tract (UADT) cancers separately. There were 216,305 cases excluding nonmelanoma skin cancer (all cancer) comprising 37,274 lung, 8,216 head and neck and 6,534 oesophageal cancers classified into anatomical or morphological subtypes. Socioeconomic circumstances were measured using the Scottish Index of Multiple Deprivation (SIMD). Analyses were partitioned by five-year age group and sex. RII was adapted to rank the contribution of each tumour type to all cancer socioeconomic inequalities and to examine subtype by age and sex simultaneously. The rank was defined as the proportion of all cancer socioeconomic inequality. All cancer socioeconomic inequality was greater for males than females (RII=0.366; female RII=0.279). The combination of lung and UADT socioeconomic inequalities contributed 91% and 81% respectively to all cancer socioeconomic inequality. For both sexes lung and UADT subtypes showed significant socioeconomic inequalities (P < 0.001) except oesophageal adenocarcinoma in males (P=0.193); for females, socioeconomic inequality was borderline significant (P=0.048). Although RII rank differed by sex, all lung and larynx subtypes contributed the most to all cancer socioeconomic inequality with RII rank for oral cavity, oesophagus–squamous cell and oropharynx following. For males 40-44 years old, socioeconomic inequalities increased abruptly peaking at 55-59 years. For females, socioeconomic inequalities gradually peaked 10 years later. In both sexes, the socioeconomic inequalities peak age preceded age of peak incidence. This study showed that socioeconomic inequalities in lung and UADT cancers vary greatly by age, tumour subtype and sex; these variations were likely to largely reflect differences between the sexes in risk behaviours which vary by birth cohort and are socioeconomically patterned. Longitudinal data enabled exploration of the temporal relationship between socioeconomic status and cancer incidence. An investigation of several individual and a single area-based measure of socioeconomic circumstances was undertaken in the second study of this thesis. The effect of country of birth, marital status, one area socioeconomic circumstances measure (Carstairs) and five individual socioeconomic variables (economic activity, education, occupational social class, car ownership, household tenure) on the risk associated with lung, UADT and all cancer combined (excluding non-melanoma skin cancer) were explored. A linked dataset using the Scottish Longitudinal Study and Scottish Cancer Registry was created to follow 203,658 cohort members aged 15+ years from 1991-2006. Relative risks (RR) were calculated using Poisson regression models by sex offset for person-years of follow-up. There were 21,832 first primary tumours (including 3,505 lung and 1,206 UADT cancers). Regardless of cancer, economic inactivity (versus activity) was associated with increased risk (male: RR 1.14 95% CI 1.10, 1.18; female: RR 1.06 95% CI 1.02, 1.11). For lung cancer, area deprivation remained significant after full adjustment suggesting that the area deprivation cannot be fully explained by individual variables. Not having a qualification (versus degree) was associated with increased lung cancer risk; likewise for UADT cancer risk (females only). Occupational social class associations were most pronounced and elevated for UADT risk. No car access (versus ownership) was associated with increased risk (excluding all cancer risk for males). Renting accommodation (versus home ownership) was associated with increased lung cancer risk, UADT cancer risk for males only and all cancer risk for females only. Regardless of cancer group, elevated risk was associated with no education and living in deprived areas. This study demonstrated that different and independent socioeconomic variables were inversely associated (greater incidence with lower socioeconomic circumstances) with different cancer risks in both sexes; no one socioeconomic variable had a dominant risk association or captured all aspects of socioeconomic circumstances or the full life-course. The association of multiple socioeconomic variables was likely to reflect the complexity and multifaceted nature of low socioeconomic circumstances as well as the various roles of these dimensions over the life-course. A final study investigated the role of behaviours (smoking, alcohol, diet and exercise) on the association of low socioeconomic circumstances with all cancer risk and lung and upper aero-digestive tract cancers combined (LUADT). The Scottish Cancer Registry and Scottish Health Survey data were linked to create a population study (1995-2011). There were 42,983 adults over 16 years old who were followed for 3,750,611 person-years. There were 2,130 first primary cancers diagnosed including 453 LUADT cancers. Poisson regression models, minimally adjusted by age and sex, were developed to estimate the risk association between five individual socioeconomic variables (economic activity, highest qualification, occupational social class, car ownership and housing tenure), one area-based socioeconomic indicator (SIMD) and all cancer and LUADT cancer. A further socioeconomic indicator was developed to reflect multiple low socioeconomic circumstances. This was defined as the count, at the individual participant level, of socioeconomic variables in the highest risk category. A similar multiple high risk behaviour derived variable, defined as the count of highest risk category for the following variables: current smoking status, units of alcohol consumed in a week, daily fruit and vegetable consumption and exercise sessions per week, was also calculated at the individual participant level. The minimally adjusted Poisson models were successively adjusted for behaviours (smoking, alcohol, diet and exercise) to establish any remaining contribution to cancer risk not explained by behaviour. Multiple low socioeconomic circumstances were very strongly associated with increased risk for both cancer groups. For all cancer risk, the elevated risk was nearly fully attenuated for all categories of multiple low socioeconomic circumstances when adjusted for smoking only. For LUADT cancer and in the minimally adjusted model, the risk increased in a dose-response manner.
The risk associated with LUADT cancer for study participants in the highest category of multiple low socioeconomic circumstances was more than three-times greater when compared to their affluent counterparts (RR 3.35 95% CI 2.26, 4.97); this elevated risk remained at 86% compared to those with no socioeconomic disadvantage, even after full adjustment for smoking, alcohol, diet and exercise behaviours. When looking at single socioeconomic status (SES) indicators, only those who rented accommodation from a local authority remained at a 50% increased risk of LUADT cancer even after adjustment for all the behaviours (RR 1.50 95% CI 1.05, 2.16). This study demonstrated that smoking is a major inequality issue and a significant cancer risk which is socially patterned. Further analytical research is required to fully understand the pathways and mechanisms between socioeconomic circumstance and lung and upper aerodigestive cancer risk.

Cancers of the upper aero-digestive tract (UADT) rank as the fifth most common neoplastic disease worldwide. Two identified risk contributors are consumption of tobacco and alcohol. Among all other potential etiological factors, diet has long been recognized to play an important role in the development of cancers of the UADT. Data from a multi-centre, hospital-based case-control study conducted in Brazil were used to assess the association of dietary intake with the risk of cancers of the UADT. Dietary assessment was made in terms of estimated intake of nutrients, specific foods and food groups. After adjusting for the effects of alcohol and tobacco consumption as well as empirical confounders, protective effects against cancer of the mouth (Odds Ratio (OR) = 0.61, 95% confidence interval (95% CI): 0.4--1.0) and the pharynx (OR = 0.51, 95%CI: 0.3--0.9) were found for consumption of citric fruits. (Abstract shortened by UMI.)

Malignancies of the upper aero-digestive tract are a major public health problem, especially in South Asia. The major risk factors in South Asia remain smoked/smokeless tobacco, areca nut, alcohol abuse and poor diet, with limited evidence for human papillomavirus (HPV). Although HPV-associated head and neck squamous cell carcinoma (HNSCC) is well documented in the western world, studies on South Asian populations are few and inconsistent. However, the incidence of HPV-associated head and neck cancer (HNC) has increased in recent years. Certain high-risk types of HPV infection are regarded as well-established risk factors for cervical cancer and a subset of HNSCC; however, their true role and importance in the progression of HNSCC remain unclear. Although HPV-associated HNC patients generally have a better prognosis than those with HPV-negative disease, current chemo- and radio-therapies are largely non-specific and have considerable toxicities. RNA interference (RNAi), which has shown great promise as a highly specific therapy for other diseases, has potential for treating HPV-associated HNC, especially if disease progression is dependent on the continual expression of HPV oncogenes.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Dentistry and Oral Health
Griffith Health
Full Text