| PP10 |
| Title: |
Head and Neck Tumor Seeding at the PEG Site |
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| Date / Time: |
Thursday, June 21, 2012 at 11:00 AM - 02:30 PM |
| Type: |
POSTER |
| Level: |
ADVANCED |
| Sponsor(s): |
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| Speaker(s): |
June Greaves |
More than 15,000 cases of head and neck cancers are diagnosed each year, and patients often require enteral nutrition (EN) via gastrostomy tube. The percutaneous endoscopic gastrostomy (PEG) tube has become the preferred technique for EN access because placement is a minimally invasive procedure. There are three methods of PEG placement; and approximately 1% of those head and cancer patients, who have PEG placement using the Gauderer-Ponsky pull method, develop metastatic cancer at the PEG site that is consistent with head and neck cancer morphology. This method places the PEG tube through the mouth, where it is pulled into position by passing by the tumor.
A case study involving a 68-year-old male with squamous cell carcinoma of the hypopharynx, is presented. A PEG was placed in this patient; he experienced multiple problems at the PEG site, was treated for local infection twice, and was referred to a physician for biopsy. According to the patient, the physician was not overly concerned. The patient completed chemotherapy and radiation therapy and began to transition to oral intake, and the PEG was removed.
The patient suffered a recurrence of pharyngeal cancer, and underwent a total larngopharyngectomy and right radical neck dissection several months later. The previous PEG site was biopsied intraoperatively, and results confirmed metastatic carcinoma consistent with hypopharyngeal cancer. The patient required a subtotal gastrectomy, and a tracheoesophageal puncture was performed for enteral feedings.
Clinicians working with head and neck cancer patients should be aware of all potential complications of PEG placement, and should be aware of this unique complication to provide early intervention. Serious consideration should be given to tumor seeding at the PEG site if persistent or recurring redness or induration, skin breakdown, bleeding, or unusual changes are noted to the skin or stoma site. |
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