Eagles eye for exploration: Field cancerization - a surgeons dilemma


  • Ashok Mehta Medical Director & Consultant Cancer Surgeon, Brahma Kumaris’ Global Hospital and Research Centre Managing BSES Muncipal General Hospital, Mumbai, Maharashtra
  • Ritika Agrawal Department of Head and Neck Oncosurgery, Brahma Kumaris’ Global Hospital and Research Centre Managing BSES Muncipal General Hospital, Mumbai, Maharashtra


Field cancerization, Micro invasive stage, Local and distant tumors


“Field cancerization” was introduced in 1953 to describe histologically abnormal tissues surrounding oral squamous cell carcinoma, particularly in the upper aerodigestive tract, likely related to exposure to carcinogens. Concept now refers to multiple local and distant primary tumors within the upper aerodigestive tract, along with oral premalignant lesions.Tobacco and alcohol are independent risk factors, but when combined, they have a synergistic effect.Earliest lesions are often undetectable by clinical and histologic examination; careful surveillance can detect most tumors in their intraepithelial and microinvasive stage. Early detection improves long-term survival, although multiple resections are often necessary.


Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006;56(2):106-30.

Parkin DM, Pisani P, Ferlay J. Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer. 1999;80(6):827-41.

Li G, Sturgis EM, Wang LE, Chamberlain RM, Amos CI, Spitz MR, et al. Association of a p73 exon 2 G4C14-to-A4T14 polymorphism with risk of squamous cell carcinoma of the head and neck. Carcinogenesis. 2004;25(10):1911-6.

Zheng Y, Shen H, Sturgis EM, Wang LE, Eicher SA, Strom SS, et al. Cyclin D1 polymorphism and risk for squamous cell carcinoma of the head and neck: a case-control study. Carcinogenesis. 2001;22(8):1195-9.

Kuropkat C, Rudolph P, Frahm SO, Parwaresch R, Werner JA. Proliferation marker Ki-S11 – a prognostic indicator for squamous cell carcinoma of the hypopharynx. Virchows Arch. 1999;435(6):590-5.

Preisler HD, Kotelnikov VM, LaFollette S, Taylor S 4th, Mundle S, Wood N, et al. Continued malignant cell proliferation in head and neck tumors during cytotoxic therapy. Clin Cancer Res. 1996;2(9):1453-60.

Wood NB, Kotelnikov V, Caldarelli DD, Hutchinson J, Panje WR, Hegde P, et al. Mutation of p53 in squamous cell cancer of the head and neck: relationship to tumor cell proliferation. Laryngoscope. 1997;107(6):827-33.

Scholzen T, Gerdes J. The Ki-67 protein: from the known and the unknown. J Cell Physiol. 2000;182(3):311-22.

Brown JP, Pagano M. Mechanism of p53 degradation. Biochim Biophys Acta. 1997;1332(2):O1-6.

Bullock AN, Fersht AR. Rescuing the function of mutant p53. Nat Rev Cancer. 2001;1(1):68-76.

Acay RR, Felizzola CR, de Araújo N, de Sousa SO. Evaluation of proliferative potential in oral lichen planus and oral lichenoid lesions using immunohistochemical expression of p53 and Ki67. Oral Oncol. 2006;42(5):475-80.

Vousden KH, Lane DP. p53 in health and disease. Nat Rev Mol Cell Biol. 2007;8(4):275-83.

Braakhuis BJ, Tabor MP, Kummer JA, Leemans CR, Brakenhoff RH. A genetic explanation of Slaughter’s concept of field cancerization: evidence and clinical implications. Cancer Res. 2003;63(8):1727-30.

Slaughter DP, Southwick HW, Smejkal W. Field cancerization in oral stratified squamous epithelium; clinical implications of multicentric origin. Cancer. 1953;6(5):963-8.

Ha PK, Califano JA. The molecular biology of mucosal field cancerization of the head and neck. Crit Rev Oral Biol Med. 2003;14(5):363-9.