Key Clinical Questions
What complications of cancers of the aerodigestive tract often cause hospital admission?
What consultant services should be pursued for specific clinical syndromes?
Which cancer types are the most prone to emergencies of the aerodigestive tract?
The aerodigestive tract, also called the mixed airway/gastrointestinal tract, constitutes the organs of the oral cavity, nasal cavity and pharynx, larynx and vocal cords, bronchi and small airways, and the esophagus. Cancers of the upper aerodigestive tract constitute approximately 4% of all malignancies, and chiefly include head and neck cancers, lung cancers, esophageal cancers, and lesser common cancers such as nasopharyngeal carcinomas and salivary gland cancers. Thyroid cancers, skin cancers of the head and neck, lower gastrointestinal tract cancers, and non–bronchoalveolar-mediastinal cancers are generally not included in this category. The two primary histologic varieties of aerodigestive tract cancers include squamous cell carcinoma and adenocarcinoma and common etiologies include tobacco use, alcohol use, human papilloma virus infection, and gastroesophageal reflux disease (GERD)—all of which are at least partially modifiable risk factors.
Admissions related to the treatment of aerodigestive tract cancers, rather than the cancers themselves, such as febrile neutropenia or chemotherapy-associated nausea are largely not included here with the notable exceptions of dysphagia and mucositis (see Chapter 97 [Nausea and Vomiting] and Chapter 204 [Immunocompromised Host]). Patients with aerodigestive tract neoplasia often present with complaints of the airway, breathing, or swallow function. Spinal cord compression and superior vena cava (SVC) syndrome are the two causes for admission that are considered oncologic emergencies (see Chapter 176 [Oncologic Emergencies]).
Patients should be counseled about the health risks of tobacco and excessive alcohol use. Clinicians must be proactive in referring patients who smoke and/or those who may be drinking too much for counseling or other programs. Similarly, all patients with GERD should be on an antireflux regimen, preferably a proton-pump inhibitor, or initiate diet modification.
Lung cancer is one of the most common cancers worldwide, with 225,000 new cases annually in the United States alone. Despite numerous advances in therapies, its mortality exceeds that of breast, prostate, and colon cancers combined, amounting to 160,000 deaths annually in the United States. Esophageal cancer carries an even worse fatality rate but is a much rarer disease. It represents 1% of all new cancer cases in the United States with approximately 17,000 new cases occurring annually and 15,500 deaths. Head and neck cancers constitute 3% of all malignancies in the United States and approximately 12,000 will die from the disease in a given year. In total, the combined burden of aerodigestive tract cancers is sizable and although no published data exists on admission frequency, it is likely that any given patient with such a cancer would present to the hospital numerous times during the course of their illness. See Table 181-1 for incidence and mortality rates.