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| TEACHING IMAGES |
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| Year : 2019 | Volume
: 7
| Issue : 1 | Page : 128 |
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Field cancerization
Satvinder Singh Bakshi
Department of ENT and Head and Neck Surgery, AIIMS, Guntur, Andhra Pradesh, India
| Date of Web Publication | 12-Jun-2019 |
Correspondence Address:
Dr. Satvinder Singh Bakshi
House Number 1A, Selvam Apartments, 71, Krishna Nagar Main Road, Krishna Nagar, Pondicherry - 605 008
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/amhs.amhs_39_19
How to cite this article:
Bakshi SS. Field cancerization. Arch Med Health Sci 2019;7:128 |
A 63-year-old male presented with gradually progressive diffuse lesions in his mouth for 6 months. He was smoking and drinking for the past 45 years. Oral examination revealed multiple white to reddish lesions on the lips, buccal mucosa, tongue, and palate [Figure 1]a. In addition, there was a 3 cm × 3 cm proliferative growth on the left buccal mucosa [Figure 1]b. The biopsy of the lesions showed various degrees of dysplasia [Figure 2]. Surgical excision of the involved areas was done, and the patient was started on oral retinoid. No evidence of any malignancy was detected at 7-month follow-up. The term “field cancerization” was proposed by Slaughter et al. in 1953 to describe histologically abnormal tissues surrounding oral squamous cell carcinoma, particularly in the upper aerodigestive tract. There are two theories which explain the concept: the first one is the monoclonal theory in which single cell is transformed, and through the mucosal spread, gives rise to multiple genetically related tumors and the second one is the polyclonal theory in which multiple transforming events give rise to genetically unrelated multiple tumors. Tobacco and alcohol use are independent risk factors, but when combined, they have a synergistic effect. The concept has been utilized to explain cancer developing in multifocal areas of a precancerous change and the persistence of abnormal tissue even after surgery. The management includes surgical excision, radiation, and chemotherapy with agents such as retinoid. The concept is important for all physicians since not only early detection and management of oral cancer is important but also equally important is the early identification and management of a field; therefore, a close surveillance of these patients is prudent for a favorable outcome. | Figure 1: (a) Patient with multiple areas of leukoplakia (upper arrow) and erythroplakia (lower arrow). (b) Area of proliferative growth (arrow)
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 | Figure 2: Section showing squamous epithelium with loss of polarity in two-third of epithelium, hyperchromatic nucleus, and eosinophilic cytoplasm with features suggestive of moderate dysplasia (H and E, ×400)
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent form. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published, and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2]
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