Recent advances in endoscopic diagnosis and treatment of superficial head and neck cancer

Abstract

Head and neck cancer (HNC) frequently presents in the advanced stage, which necessitates treatments such as chemoradiotherapy and pharyngolaryngoesophagectomy. These treatments can impair functions including swallowing, speech, and saliva production, and diminish the quality of life (QOL). Key risk factors for HNC include alcohol consumption, smoking, and genetic polymorphisms in aldehyde dehydrogenase 2, which increase the susceptibility to carcinogenesis through the 'field cancerization phenomenon.' Advances in gastrointestinal endoscopy, including narrow band imaging with magnifying endoscopy, facilitate the early detection of superficial HNC. By identifying abnormal vessel patterns and mucosal changes, these diagnostic techniques improve the detectability, differential diagnosis, and identification of the invasion depth of superficial cancers. The latter is essential because tumor thickness is an important predictor of lymph node metastasis and prognosis. Minimally invasive transoral surgeries, including endoscopic mucosal resection, endoscopic submucosal dissection, endoscopic laryngopharyngeal surgery, transoral videolaryngoscopic surgery, and transoral robotic surgery, emphasize organ preservation, and are efficacious and safe for treating superficial HNC. Early detection of metachronous cancers, which are prevalent in patients with HNC and esophageal cancer, is crucial for improving long-term outcomes. Abstinence from alcohol consumption and smoking may reduce the development of cancers in the head and neck or esophagus. Future research directions include integrating artificial intelligence to improve diagnostic accuracy, refining transoral surgical techniques, and developing systematic surveillance protocols for the early detection of metachronous cancer. Continued efforts to optimize minimally invasive treatments and prevention strategies will improve the prognosis and QOL of patients with HNC.