{"id":1912,"date":"2022-08-25T10:48:12","date_gmt":"2022-08-25T07:48:12","guid":{"rendered":"https:\/\/www.sezaisevengil.com\/?p=1912"},"modified":"2022-08-25T11:23:06","modified_gmt":"2022-08-25T08:23:06","slug":"sekonder-primer-tumorler","status":"publish","type":"post","link":"https:\/\/www.sezaisevengil.com\/en\/secondary-primary-tumors\/","title":{"rendered":"Secondary Primary Tumors"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_72 counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Yaz\u0131n\u0131n \u0130\u00e7eri\u011fi<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #36a9e1;color:#36a9e1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewbox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #36a9e1;color:#36a9e1\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewbox=\"0 0 24 24\" version=\"1.2\" baseprofile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.sezaisevengil.com\/en\/secondary-primary-tumors\/#Sekonder_Primer_Tumorler_Nelerdir\" title=\"What are Secondary Primary Tumors?\">What are Secondary Primary Tumors?<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.sezaisevengil.com\/en\/secondary-primary-tumors\/#PATOGENEZ\" title=\"PATHOGENESIS\">PATHOGENESIS<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.sezaisevengil.com\/en\/secondary-primary-tumors\/#GORULME_SIKLIGI\" title=\"FREQUENCY\">FREQUENCY<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.sezaisevengil.com\/en\/secondary-primary-tumors\/#ILK_TUMORE_AIT_OZELLIKLER_ILE_SEKONDER_TUMOR_ILISKILERI\" title=\"RELATIONSHIPS BETWEEN THE FEATURES OF THE PRIMARY TUMOR AND SECONDARY TUMOR\">RELATIONSHIPS BETWEEN THE FEATURES OF THE PRIMARY TUMOR AND SECONDARY TUMOR<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.sezaisevengil.com\/en\/secondary-primary-tumors\/#BAS_BOYUN_MALIGNANSILI_HASTALARIN_SEKONDER_PRIMER_YONUNDEN_IZLENMESI\" title=\"MONITORING OF PATIENTS WITH HEAD AND NECK MALIGNANCE IN TERMS OF SECONDARY PRIMARY\">MONITORING OF PATIENTS WITH HEAD AND NECK MALIGNANCE IN TERMS OF SECONDARY PRIMARY<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.sezaisevengil.com\/en\/secondary-primary-tumors\/#KORUNMA\" title=\"PROTECTION\">PROTECTION<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.sezaisevengil.com\/en\/secondary-primary-tumors\/#PROGNOZ\" title=\"PROGNOSIS\">PROGNOSIS<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.sezaisevengil.com\/en\/secondary-primary-tumors\/#OZET\" title=\"SUMMARY\">SUMMARY<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n<p>Recent innovations in the fields of surgical techniques, radiotherapy and chemotherapy have significantly increased the rate of local control of head and neck malignancies, both in the primary focus and in their lymphatic spread. However, the positive developments in local control of the disease have unfortunately not been reflected equally in the life expectancy of patients. The two main reasons for this situation are distant metastasis and disease, which increase in parallel with the success of local control. <strong>secondary primary tumors<\/strong> It is one of the problems.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Sekonder_Primer_Tumorler_Nelerdir\"><\/span><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1913 alignleft\" src=\"https:\/\/www.sezaisevengil.com\/wp-content\/uploads\/2022\/08\/sekonder-primer-tumorler.jpg\" alt=\"secondary primary tumors\" width=\"245\" height=\"245\" title=\"\" srcset=\"https:\/\/www.sezaisevengil.com\/wp-content\/uploads\/2022\/08\/sekonder-primer-tumorler.jpg 600w, https:\/\/www.sezaisevengil.com\/wp-content\/uploads\/2022\/08\/sekonder-primer-tumorler-300x300.jpg 300w, https:\/\/www.sezaisevengil.com\/wp-content\/uploads\/2022\/08\/sekonder-primer-tumorler-150x150.jpg 150w, https:\/\/www.sezaisevengil.com\/wp-content\/uploads\/2022\/08\/sekonder-primer-tumorler-370x370.jpg 370w, https:\/\/www.sezaisevengil.com\/wp-content\/uploads\/2022\/08\/sekonder-primer-tumorler-196x196.jpg 196w\" sizes=\"auto, (max-width: 245px) 100vw, 245px\" \/>What are Secondary Primary Tumors?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>While local recurrence and metastases mostly affect the short-term survival of patients with head and neck malignancy, secondary primary tumors are now shown to be the most important factor affecting the long-term survival of these patients. The first publication drawing attention to the importance of secondary primary tumors was made by Billroth in 1889, followed by Warren and Gates&#039;s publication based on 1259 cases in 1932.&#039; The definition of secondary primary carcinoma proposed by Warren and Gates is still accepted worldwide today. Accordingly, the criteria necessary to define a tumor as secondary primary are as follows:<br \/>\n1. Malignancy of the tumor must be proven histologically.<br \/>\n2. First and secondary primary tumors should be clearly separate topographically, and there should be no submucosal or intra-epithelial spread.<\/p>\n<p>3. It should be determined that the second tumor is not metastatic. Secondary<strong> primary tumors<\/strong>, are described as simultaneous (synchronous) or at different times (metachronous) in terms of their emergence times. Synchronous are those diagnosed with the first tumor or within the first 6 months after the diagnosis of the first tumor. Differentiated tumors are tumors diagnosed at least 6 months after the diagnosis of the first tumor. There are also authors who group tumors diagnosed at the same time as the first tumor into a third group as simultaneous tumors.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"PATOGENEZ\"><\/span>PATHOGENESIS<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Various theories have been proposed to explain the multifocal development of carcinomas. The field cancerization view put forward by Slauhter et al. in 1953 is the most accepted today. According to this view, the epithelium of the upper digestive tract, along with all respiratory tract, forms a common carcinogenic area where anatomical and pathological changes occur due to external influences, especially smoking and alcohol. Precancerous tissue changes may begin in more than one focus in this area, and different foci of cancer may appear at different times depending on the degree of precancerous changes.<\/p>\n<p>There are studies showing that genetic predisposition, as well as external factors, is a very important factor in the development of multiple cancers. According to Faber, one of the pioneers of this view, cancer occurs as a result of step-like tissue changes that develop over a long period of time. Accordingly, there are three main periods in cancer development, defined as initiation, promotion and progression. In the initial period, a permanent change in the phenotype of a few target cells occurs due to carcinogenic external factors. During the growth period, these target cells proliferate and form proliferation foci similar to benignneoplasia.<\/p>\n<p>These foci then either turn into normal tissue again or progress towards cancer. In some other studies, people with genetic deficiencies in DNA repair mechanisms <strong>secondary primary tumors<\/strong>\u00a0It has been shown to develop more easily. This genetic deficiency can be revealed by investigating sensitivity to mutagens such as bleomycin. In conclusion; It is accepted that exposure to environmental carcinogenic factors and genetic predisposition play a role in the development of secondary primaries.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"GORULME_SIKLIGI\"><\/span><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1917 alignright\" src=\"https:\/\/www.sezaisevengil.com\/wp-content\/uploads\/2022\/08\/sekonder-primer-tumorler-2.jpg\" alt=\"secondary primary tumors\" width=\"215\" height=\"323\" title=\"\" srcset=\"https:\/\/www.sezaisevengil.com\/wp-content\/uploads\/2022\/08\/sekonder-primer-tumorler-2.jpg 400w, https:\/\/www.sezaisevengil.com\/wp-content\/uploads\/2022\/08\/sekonder-primer-tumorler-2-200x300.jpg 200w, https:\/\/www.sezaisevengil.com\/wp-content\/uploads\/2022\/08\/sekonder-primer-tumorler-2-370x555.jpg 370w\" sizes=\"auto, (max-width: 215px) 100vw, 215px\" \/>FREQUENCY<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Literat\u00fcrde ba\u015f boyun malignansilerindeki sekonder primer s\u0131kl\u0131\u011f\u0131 olgu say\u0131s\u0131, izleme s\u00fcresi ve co\u011frafik \u00f6zelliklere ba\u011fl\u0131 olarak %2.4 ile %35 aras\u0131nda de\u011fi\u015fmekle beraber, genel olarak %10-15 civar\u0131ndad\u0131r. Sekonder t\u00fcm\u00f6rler histolojik olarak \u00e7o\u011funlukla skuam\u00f6z h\u00fccreli kanserlerdir. Metakron sekonder kanserler, senkronlara g\u00f6re genellikle 3\/2 oran\u0131nda daha s\u0131kt\u0131r. Senkron t\u00fcm\u00f6rler daha \u00e7ok oral kavite, larenks, farenks ve \u00f6zofagusta, metakron olanlar ise daha \u00e7ok akci\u011ferde g\u00f6r\u00fclmektedir. \u0130lk t\u00fcm\u00f6r\u00fcn tan\u0131s\u0131 60 ya\u015f\u0131ndan \u00f6nce konan olgularda sekonder t\u00fcm\u00f6r \u015fans\u0131 daha \u00e7oktur. Sekonder t\u00fcm\u00f6rler en s\u0131k 60-70 ya\u015f grubunda ortaya \u00e7\u0131kmaktad\u0131r ve erkeklerde daha fazlad\u0131r.<\/p>\n<p>Annually after diagnosis of first tumor <strong>secondary primary <\/strong>t\u00fcm\u00f6rler geli\u015fme riski \u00e7e\u015fitli serilerde %1.5 ile %6 aras\u0131nda de\u011fi\u015fmektedir ve bu risk oran\u0131 seneler boyunca sabit kalmaktad\u0131r. 1920 Sekonder t\u00fcm\u00f6rler b\u00fcy\u00fck s\u0131kl\u0131kla \u00fcst solunum ve sindirim yollar\u0131 epiteli ile akci\u011ferlerde g\u00f6r\u00fclmektedir. Daha nadir olarak gastrointestinal sistem, \u00fcrogenital sistem, deri, tiroid bezi, iskelet sistemi ve di\u011fer b\u00f6lgelerde de ortaya \u00e7\u0131kabilir. Sekonder primerlerin genel olarak %40-50 kadar\u0131 \u00fcst solunum ve sindirim yollar\u0131nda yerle\u015fim g\u00f6sterir. Oral kavite, orofarenks ve hipofarenkste g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131, larenkse g\u00f6re daha fazlad\u0131r. De\u011fi\u015fik \u00e7al\u0131\u015fmalarda akci\u011ferlerdeki sekonder t\u00fcm\u00f6r oran\u0131 %10 ile 50 aras\u0131nda de\u011fi\u015fmektedir.<\/p>\n<p>Initial tumor size, stage, histology and nodal metastasis factors and lung <strong>secondary tumor<\/strong> No relationship was found between the frequency of Lung secondary tumors are most often squamous cell cancers, more rarely adenocarcinoma and small cell cancers. Difficulties in differentiating a lung lesion from metastasis or secondary tumor still persist. Histological criteria are important in differentiation. Findings supporting a secondary tumor include the lesion being hilar or endobronchial, appearing a long time after the initial tumor, and the absence of metastasis in the neck. In addition, it is reported that isolated lung nodal opacities detected radiologically are mostly secondary primary rather than metastases. In recent years, molecular level research on cancer cells has been able to distinguish metastatic and secondary tumors more clearly.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"ILK_TUMORE_AIT_OZELLIKLER_ILE_SEKONDER_TUMOR_ILISKILERI\"><\/span>RELATIONSHIPS BETWEEN THE FEATURES OF THE PRIMARY TUMOR AND SECONDARY TUMOR<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Location of the first tumor in the head and neck, <strong>secondary primary tumors<\/strong> s\u0131kl\u0131\u011f\u0131n\u0131 etkileyen \u00f6nemli bir fakt\u00f6r olarak g\u00f6r\u00fcnmektedir. Sekiz y\u00fcz elli bir olguda yap\u0131lan bir \u00e7al\u0131\u015fmada, sekonder primerler be\u015f y\u0131ll\u0131k bir izleme s\u00fcresi i\u00e7inde en s\u0131k dil k\u00f6k\u00fc kanserlerinde (%41), daha sonra s\u0131kl\u0131k s\u0131ras\u0131na g\u00f6re piriform sin\u00fcs (%34), oral kavite (%27), larenks (%23) ve tonsil kanserlerinde (%15) ortaya \u00e7\u0131km\u0131\u015ft\u0131r. \u0130lk t\u00fcm\u00f6r\u00fcn histolojisi ve diferensiyasyon derecesi, sekonder t\u00fcm\u00f6r s\u0131kl\u0131\u011f\u0131n\u0131 etkilememektedir.12 Ayr\u0131ca ba\u015f boyundaki ilk t\u00fcm\u00f6re uygulanan tedavi \u015feklinin de (cerrahi ya da radyoterapi), sekonder t\u00fcm\u00f6r s\u0131kl\u0131\u011f\u0131na etkisi yoktur.<\/p>\n<p>&quot;Larynx and oral cavity cancers are the most common head and neck malignancies in our country, as is the case around the world.&quot; Secondary primaries in laryngeal cancers frequently occur in the lung and esophagus. Although the possibility of secondary tumors in early stage (T1-T2) tumors with high local and regional control of the larynx is higher than in advanced stage tumors (T3-T4), the degree of differentiation of the tumor does not affect the frequency of secondary tumors.<\/p>\n<p>The possibility of secondary tumors is slightly higher in supraglottic tumors than in glottic tumors. On the other hand, secondary primary tumors are twice as common in patients who underwent conservative surgery for laryngeal cancer compared to those who underwent total laryngectomy. In oral cavity cancers, secondary tumors are usually seen in the oral cavity and oropharynx. In oral cavity cancer, it is reported that the probability of secondary primary in the oral cavity is 75 times higher in men and 190 times more in women than in the normal population, and the chance of secondary primary in the esophagus is 25 times higher in men and 45 times higher in women. In cancers of the lower region of the oral cavity (floor of the mouth, lower alveolar ridge and retromolar trigone) that are more exposed to external factors such as smoking and alcohol, the possibility of secondary primary is higher than in other regions of the oral cavity.<\/p>\n<p>In oropharynx and hypopharynx cancers <strong>secondary primers<\/strong>\u00a0It most commonly develops in the oral cavity and hypopharynx, and in esophageal cancers, it often develops in the upper digestive tract, especially in the hypopharynx, oropharynx and buccal mucosa. On the other hand, secondary cancers located in the head and neck, especially the larynx, are common in lung cancers.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"BAS_BOYUN_MALIGNANSILI_HASTALARIN_SEKONDER_PRIMER_YONUNDEN_IZLENMESI\"><\/span>MONITORING OF PATIENTS WITH HEAD AND NECK MALIGNANCE IN TERMS OF SECONDARY PRIMARY<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Since the risk of secondary tumors in head and neck malignancies continues at a constant rate over the years, patients need to be monitored periodically throughout their lives after the diagnosis and treatment of the first tumor. The recommendation of the American Cancer Society (ACS) on this subject is that patients should be checked monthly for the first year, every 2 months for the second year, every 3 months for the third year, and every 6 months for the remainder of their lives. In the follow-up of patients, it is important to examine the head and neck region, where secondary primary tumors are most common.<\/p>\n<p>For this purpose, in addition to routine mouth and throat examination, indirect and direct laryngoscopy, rigid and flexible endoscopic examinations of the nasal cavities, nasopharynx, oropharynx and larynx should be performed. There are also authors who recommend esophageal abrasive cytological examinations in addition to routine panendoscopic examination, including esophagoscopy and bronchoscopy, at periodic check-ups. However, in our department and many other centers, esophagography and selective endoscopy are preferred instead of panendoscopy, considering the symptoms of the patients. <strong>Secondary primary tumors<\/strong> To evaluate the lungs where it is most common, radiological examination is recommended every 6 months.<\/p>\n<p>This monitoring is especially important in laryngeal cancers, where lung secondary tumors are more common. Depending on the available resources, radiological examination can be performed as conventional radiography or computed tomography, but it is reported that computed tomography is much more sensitive in the early detection of lung secondary tumors. Nearly half of the secondary primaries other than the head, neck and lungs occur in the urogenital system.<br \/>\nTherefore, patients&#039; complaints in this regard should be carefully evaluated during follow-up. There are many studies investigating the value of biological tumor markers (tumor markers) in monitoring patients with head and neck malignancy in terms of secondary primary, but today, a marker that has proven its value has not yet been found.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"KORUNMA\"><\/span>PROTECTION<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Secondary in patients with head and neck malignancy<strong> primary tumor<\/strong>\u00a0In order to reduce the possibility, emphasis is placed on the elimination of carcinogenic external factors such as smoking, alcohol, occupational and environmental irritants, as well as the benefit of chemoprevention with retinoid derivatives. It has been shown that high doses and long-term use of retinoid derivatives cause regression of precancerous lesions. However, it has side effects such as dry mouth, dysphagia, weight loss, and cachexia, and the lesions often recur after discontinuation of treatment.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"PROGNOZ\"><\/span><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1918 alignleft\" src=\"https:\/\/www.sezaisevengil.com\/wp-content\/uploads\/2022\/08\/sekonder-primer-tumorler-3.jpg\" alt=\"secondary primary tumors\" width=\"262\" height=\"209\" title=\"\" srcset=\"https:\/\/www.sezaisevengil.com\/wp-content\/uploads\/2022\/08\/sekonder-primer-tumorler-3.jpg 500w, https:\/\/www.sezaisevengil.com\/wp-content\/uploads\/2022\/08\/sekonder-primer-tumorler-3-300x240.jpg 300w, https:\/\/www.sezaisevengil.com\/wp-content\/uploads\/2022\/08\/sekonder-primer-tumorler-3-370x296.jpg 370w\" sizes=\"auto, (max-width: 262px) 100vw, 262px\" \/>PROGNOSIS<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Ba\u015f boyun malignansilerinde sekonder primer varl\u0131\u011f\u0131, prognozu dramatik bir \u015fekilde k\u00f6t\u00fcle\u015ftirmektedir. Metakron t\u00fcm\u00f6rlerde prognoz senkronlara g\u00f6re biraz daha iyidir.&#8221; Ba\u015f boyun yerle\u015fimli sekonder t\u00fcm\u00f6rlerde 5 y\u0131ll\u0131k sa\u011fkal\u0131m \u015fans\u0131n\u0131n %20 civar\u0131nda, \u00f6zofagus ve akci\u011fer yerle\u015fiminde ise %5&#8217;in alt\u0131nda oldu\u011fu bildirilmektedir.10122 \u0130lk t\u00fcm\u00f6r\u00fcn tan\u0131 ve tedavisinden sonra periyodik olarak izlenen hastalar\u0131n ortalama sa\u011fkal\u0131m \u015fans\u0131, ortaya \u00e7\u0131kan semptomlarla kendili\u011finden ba\u015fvuranlara g\u00f6re yakla\u015f\u0131k 2 kez daha fazlad\u0131r.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"OZET\"><\/span>SUMMARY<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><strong>Secondary primary tumors<\/strong> g\u00fcn\u00fcm\u00fczde ba\u015f boyun malignansili hastalarda prognozu olumsuz y\u00f6nde etkileyen \u00f6nemli bir sorundur. Ba\u015f boyun malignansilerinde senkron ya da metakron olarak olgular\u0131n %10-15&#8217;inde g\u00f6r\u00fclen sekonder primerler, en s\u0131k olarak yine ba\u015f boyun b\u00f6lgesinde ve ikinci s\u0131kl\u0131kla akcigerlerde ortaya \u00e7\u0131kmaktad\u0131r. \u0130lk t\u00fcm\u00f6r\u00fcn tan\u0131s\u0131ndan sonra sekonder t\u00fcm\u00f6r olas\u0131l\u0131\u011f\u0131n\u0131n y\u0131llarca sabit bir oranda s\u00fcrmesi, ba\u015f boyun malignansili olgular\u0131n \u00f6m\u00fcr boyu periyodik izlenmelerini gerektirmektedir.<\/p>","protected":false},"excerpt":{"rendered":"<p>Recent innovations in the fields of surgical techniques, radiotherapy and chemotherapy have significantly increased the rate of local control of head and neck malignancies, both in the primary focus and in their lymphatic spread. However, the positive developments in local control of the disease have unfortunately not been reflected equally in the life expectancy of patients. The two main reasons for this situation are the problems of distant metastasis and secondary primary tumors, which increase in parallel with the success of local control. Secondary Primary Tumors\u2026<\/p>","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[83],"tags":[],"class_list":["post-1912","post","type-post","status-publish","format-standard","hentry","category-bogaz"],"_links":{"self":[{"href":"https:\/\/www.sezaisevengil.com\/en\/wp-json\/wp\/v2\/posts\/1912","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.sezaisevengil.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.sezaisevengil.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.sezaisevengil.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.sezaisevengil.com\/en\/wp-json\/wp\/v2\/comments?post=1912"}],"version-history":[{"count":0,"href":"https:\/\/www.sezaisevengil.com\/en\/wp-json\/wp\/v2\/posts\/1912\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.sezaisevengil.com\/en\/wp-json\/wp\/v2\/media?parent=1912"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.sezaisevengil.com\/en\/wp-json\/wp\/v2\/categories?post=1912"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.sezaisevengil.com\/en\/wp-json\/wp\/v2\/tags?post=1912"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}