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"This book provides a comprehensive look at renal cell carcinoma, exploring its biology as well as current and future molecular targets for renal cancer carcinoma."

"Karsinoma sel ginjal terhitung sekitar 3% dari kanker pada orang dewasa dan 85% dari semua keganasan primer ginjal. Tumor ini biasanya tidak memberikan gejala hingga penyakit sudah berada pada stadium lanjut. Metastasis pada kelenjar getah bening dan metastasis jauh diketahui merupakan faktor prognostik yang penting pada karsinoma sel ginjal. Parameter klinis diperlukan untuk memprediksi metastasis sebelum operasi. Penelitian ini merupakan penelitian prospektif dengan mengambil data dari rekam medis dari Januari 1995 hingga Desember 2015 di Rumah Sakit Cipto Mangunkusumo. Penelitian ini mengevaluasi faktor prediktif klinis untuk kejadian metastasis pada karsinoma sel ginjal.

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Renal cell carcinoma (RCC) accounts for about 3% of cancers in adults as well as 85% of all primary malignancies arising from the kidney. RCC is commonly large at presentation and symptoms may not occur until relatively late in the disease. Lymph node and distant metastases were known as the prognostic factor in renal cell carcinoma. Clinical parameters are needed to predict the metastases preoperatively. This is a prospective-analytic using medical record data from January 1995 - December 2015 at Cipto Mangunkusumo Hospital. This study evaluate clinical predictive factors for metastatic renal cell carcinoma incidence."

"Latar belakang: Trikloroetilen merupakan bahan kimia yang masih digunakan di industri sampai dengan saat ini. Pajanan terhadap trikloroetilen dipercaya dapat menyebabkan berbagai gangguan kesehatan. Tujuan dari laporan kasus berbasis bukti ini adalah untuk memberi bukti adanya risiko terjadinya karsinoma ginjal pada pekerja dengan pajanan trikloroetilen. Metode: Pencarian literature dilakukan melalui Pubmed dan Google Scholar dengan kriteria inklusi jenis literature adalah RCT dan ulasan sistematis, kelompok yang diteliti adalah pekerja dengan pajanan trikoloetilen dari pekerjaan. Artikel yang ditemukan kemudian dievaluasi kritis dengan menggunakan kriteria The Oxford Center for Evidence-based Medicine. Hasil: Berdasarkan kriteria pencarian ditemukan tiga artikel yaitu artikel meta-analisis yang telah diproses secara sistematik dan kuantitatif oleh Scott, et al. yang menyatakan bahwa adanya hubungan sebab-akibat yang kuat antara pajanan trikloroetilen dengan terjadinya karsinoma ginjal dengan ringaksan risiko relatif (RRm) dari 15 studi adalah 1.27 (95% CI: 1.13-1.43). Artikel yang kedua merupakan studi kohort retrospektif yang dilakukan oleh Henschler, et al. menemukan bahwa terjadi peningkatan risiko karsinoma ginjal akibat pajanan trikloroetilen dibandingkan dengan kelompok kontrol maupun pada populasi umum dengan rasio insiden terstandarisasi sebesar 7.97 (95% CI: 2.59-18.59). Artikel yang terakhir merupakan suatu studi kasus-kontrol yang dilakukan di Perancis (Arve Valley) oleh Charbotel, et al. yang menemukan bahwa merokok meningkatkan risiko terjadinya karsinoma ginjal pada pekerja yang terpajan trikloroetilen dengan OR 3.27 (95% CI:1.48-7.19). Kesimpulan dan saran: Pajanan trikloroetilen dapat menyebabkan terjadinya karsinoma ginjal yang risikonya dipengaruhi oleh dosis pajanan serta faktor risiko lainnya seperti merokok. Pengendalian risiko perlu dilakukan secara berkesinambungan untuk industri yang menggunakan trikloroetilen dalam proses produksinya. Background: Trichloroethylene is a chemical that is still used in the industry today. Exposure to trichlorethylene is believed to cause various health problems. The purpose of this evidence-based case report is to provide evidence of the risk of kidney carcinoma in workers with trichlorethylene exposure. Method: Literature searches carried out through Pubmed and Google Scholar with literature type inclusion criteria were RCTs and systematic reviews, the groups studied were workers with tricholoethylene exposure from work. Articles found are then critically evaluated using the Oxford Center for Evidence-based Medicine criteria. Results: Based on the search criteria found three articles, namely article meta-analysis that has been processed systematically and quantitatively by Scott, et al. which states that there is a strong causal relationship between exposure to trichlorethylene and the occurrence of renal carcinoma with a relative risk (RRm) of 15 studies is 1.27 (95% CI: 1.13-1.43). The second article is a retrospective cohort study conducted by Henschler, et al. found that there was an increased risk of renal carcinoma due to trichlorethylene exposure compared to the control group and in the general population with a standardized incidence ratio of 7.97 (95% CI: 2.59-18.59). The last article is a case-control study conducted in France (Arve Valley) by Charbotel, et al. who found that smoking increased the risk of kidney carcinoma in workers exposed to trichlorethylene at OR 3.27 (95% CI: 1.48-7.19). Conclusions and recommendations: Trichloroethylene exposure can cause kidney carcinoma, the risk of which is affected by exposure doses and other risk factors such as smoking. Risk control needs to be carried out continuously for industries that use trichlorethylene in their production processes."

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Peran Th17 dalam keganasan, khususnya karsinoma sel hati, masih menjadi perdebatan. Sel Th17, sel penghasil IL-17, dilaporkan berhubungan dengan efek protumor dan antitumor sekaligus. Di lain sisi, sel Th1 yang menyekresikan IFN-γ memiliki sifat antitumor. Kemoembolisasi transarterial / transarterial chemo-embolization (TACE) diketahui dapat menyebabkan nekrosis tumor, namun peran TACE dalam memengaruhi sel Th17, Th1, IL-17, IFN-γ, dan rasio neutrofil limfosit (RNL) masih belum diketahui. Penelitian ini bertujuan untuk menentukan perubahan Th17, Th1, IL-17, IFN-γ, dan nilai RNL pada pasien KSH yang menjalani TACE.

Penelitian ini dilakukan sepanjang Juni 2015–Januari 2019 di RSCM dan beberapa rumah sakit jejaring di Jakarta. Desain potong lintang digunakan untuk membandingkan respons imun pasien KSH dengan sirosis hati. Desain kohort prospektif diterapkan untuk menilai hubungan respons imun dengan keberhasilan TACE. Pengambilan darah dilakukan sebelum dan 30 hari setelah tindakan TACE pada pasien KSH dan satu kali pada pasien sirosis. Nilai Th17 dan Th1 dianalisis menggunakan teknik flowcytometry, sedangkan nilai IL-17 dan IFN-γ diukur dengan teknik enzyme-linked immunosorbent assay (ELISA). Nilai RNL dihitung dari pembagian kadar neutrofil dengan limfosit yang diperoleh dari pemeriksaan hitung jenis. Respons terhadap TACE dievaluasi berdasarkan kriteria mRECIST.

Sebanyak 40 pasien sirosis dan 41 pasien KSH berpartisipasi dalam penelitian ini. Sebanyak 12 pasien dan 29 pasien termasuk ke dalam kelompok respons dan nonrespons, secara berurutan. Penurunan kadar AFP dan ukuran tumor secara bermakna ditemukan pada kelompok respons. Pada kelompok ini, juga ditemukan peningkatan bermakna kadar Th1, Th17, dan sel T CD4+/IFN-γ+/IL-17+ setelah TACE. Nilai IL-17, IFN-γ, dan RNL tidak berhubungan dengan respons TACE. Di samping itu, didapatkan peningkatan bermakna kadar CD4+/IFN-γ+/IL-17- pada kelompok nonrespons.

Simpulan: Peningkatan kadar Th1 dan Th17 dalam darah perifer yang diiringi dengan peningkatan sel T CD4+/IFN-γ+/IL-17+ didapatkan pada pasien KSH yang berespons baik terhadap TACE.

 

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The role of Th17 cells in malignancy, especially hepatocellular carcinoma, remains controversial. Th17 cells, IL-17 producing cells, were reported to be associated with both protumor and antitumor effects. On the other hand, Th1 cells, IFN-γ producing cells, had antitumor properties. Transarterial chemoembolization (TACE) is known for its potency to cause tumor necrosis, but its impact on Th17, Th1, IL-17, IFN-γ, and neutrophil-to-lymphocyte ratio (NLR) is still unclear. This study aims to determine the changes in Th17, Th1, IL-17, IFN-γ, and NLR levels in HCC patients treated with TACE.

This study was conducted from June 2015 to January 2019 at Cipto Mangunkusumo National General Hospital dan several affiliated hospitals in Jakarta. A cross-sectional study design was used to compare the immune response between HCC and liver cirrhotic patients. A prospective cohort study design was applied to assess the relationship between immune response and tumor response to TACE. Plasma sampling was obtained from HCC and cirrhotic patients that fulfilled the inclusion and exclusion criteria. Blood samples were collected immediately before and 30 days after TACE. Th17 and Th1 levels were measured using flowcytometry technique, while IL-17 and IFN-γ levels were quantified by using enzyme-linked immunosorbent assay (ELISA). The value of NLR was calculated by dividing the neutrophil count by the lymphocyte count. Responses to TACE were evaluated based on mRECIST.

A total of 40 cirrhotic and 41 HCC patients participated in this study. As many as 12 and 29 patients were included in the response and nonresponse group, respectively. In the response group, there were significant reduction of AFP levels and tumor size, as well as significant increase of Th1, Th17 and CD4+/IFN-γ+/IL-17+ T cells levels after TACE. Furthermore, there was an increase of CD4+/IFN-γ+/IL-17- levels in the non-response group. The values of IL-17, IFN-γ, and NLR were not related to TACE response.

Conclusion: Patients with good response to TACE had increased levels of circulating Th1, Th17, and CD4+/IFN-γ+/IL-17+ T cells.

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"Praktek klinik lanjut selama praktek residensi keperawatan pada sistem Urologi bertujuan agardapat memberikan asuhan keperawatan, menerapkan Evidence Based Nursing (EBN) serta mampu berperan sebagai innovator di ruang perawatan. Peran pemberi asuhan keperawatan dilakukan dengan menggunakan model adaptasi Roy pada pasien dengan Karsinoma Ginjaldan 30 pasien lainnya dengan berbagai gangguan sistem urologi. Perilaku maladaptif paling banyak adalah mode adaptasi fisiologi, yaitu kelebihan volume cairan. Intervensi keperawatan berupa manajemen keseimbangan cairan untuk meningkatkan adaptasi pasien dalam keseimbangan cairan. Penerapan EBN dengan music intradialytic pada tiga pasien hemodialisis menunjukkan keefektifan musik intradialytic dalam menurunkan tingkat kecemasan. Program inovasi keperawatan berupa penerapan program peningkatan adekuasi hemodialisis pada pasien ESRD di Instalasi Hemodialisis.

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Advanced clinical practice during nursing residency practice in the Urology system aims to provide nursing care, implement Evidence Based Nursing (EBN) and be able to act as an

innovator in the nursing center. The role of the nursing care provider was performed using

Roy's adaptation model in patients with Renal Carcinoma and 30 other patients with various urological system disorders. The most inefektive behavior is the physiological adaptation mode, which is excess fluid volume. Nursing interventions take the form of fluid balance management to improve patient adaptation in fluid balance. The application of EBN with intradialytic music in six patients undergoing hemodialysis therapy demonstrated the effectiveness of music in reducing anxiety levels. The nursing innovation program is in the form of implementing a hemodialysis adequacy program in ESRD patients at the Hemodialysis Installation."

"Kidney cancer : principles and practice is a comprehensive and interdisciplinary textbook that encompasses all clinically relevant aspects of the disease. This new edition has been extensively updated and includes brand new material covering the most recent developments in kidney cancer diagnosis and therapy. The user-friendly and clinically oriented content of the book guarantees that it will be of great interest to a wide range of medical professionals, and every effort has been made to ensure that contributions are both easy to understand and directly related to patient care. Content presentation departs from the usual dense chapter format featuring a lengthy series of paragraphs. Instead, each chapter contains several boxed sections, including one that summarizes essential "take home points" for the busy clinician and another that presents a patient-oriented case highlighting the clinical application of elements discussed in that chapter. In addition, accessible original images, illustrations, and diagrams (some in full color) are used to simplify particularly complex material. "

"Latar Belakang: Karsinoma sel sebasea adalah keganasan yang cukup sering ditemukan pada populasi Asia dan bersifat agresif dengan tingkat rekurensi lokal dan metastasis jauh yang tinggi. Peningkatan ekspresi pulasan imunohistokimia (IHK) tumor suppressor gene p53 dan Ki-67 sebagai penanda aktifitas proliferasi pada tumor kepala dan leher menunjukkan adanya korelasi antara aktivitas proliferasi dengan buruknya prognosis.Tujuan: Menilai ekspresi p53 dan Ki-67 pada karsinoma sel sebasea yang dihubungkan dengan faktor prognostik klinis dan histopatologi pada karsinoma sel sebasea yaitu ukuran tumor, keterlibatan kelenjar getah bening (KGB), metastasis jauh, diferensiasi, penyebaran pagetoid, dan invasi perineural.Metode: Pulasan IHK menggunakan antibodi p53 dan Ki-67 dilakukan pada jaringan karsinoma sel sebasea di blok parafin yang berasal dari data rekam medis sejak Juni 2017 – Juni 2022 di RSCM. Penilaian ekspresi dilakukan pada nukleus dengan metode manual dan semi-kuantitatif pada 1 lapang pandang dengan minimal jumlah sel sebanyak 500 sel dari hasil foto dan diproses ke dalam peranti lunak Qupath. Hasil penilaian selanjutnya di cek silang dengan data klinis pasien yang sudah dicatat di tabel induk dan kemudian dianalisa secara statistik untuk mengetahui hubungan keduanya.Hasil: Total 34 pasien dengan ketersediaan blok parafin dianalisa berdasarkan data klinis dan ekspresi p53 dan Ki-67. Tidak ditemukan adanya hubungan yang signifikan secara statistik antara kategori ekspresi p53 dengan faktor prognosis klinis dan histopatologi (p>0.05). Ekspresi p53 pada hasil penelitian menunjukkan proporsi faktor prognosis buruk lebih banyak ditemukan pada ekspresi tinggi yaitu adanya metastasis, invasi perineural, dan penyebaran pagetoid. Tidak ditemukan adanya hubungan yang signifikan secara statistik antara kategori ekspresi Ki-67 dengan faktor prognosis klinis dan histopatologi (p>0.05). Ekspresi Ki-67 pada penelitian ini menunjukkan proporsi faktor prognosis buruk lebih banyak ditemukan pada ekspresi tinggi yaitu ukuran tumor yang lebih besar, metastasis, diferensiasi buruk, dan invasi perineural.Kesimpulan: Tidak terdapat hubungan yang bermakna secara statistik antara ekspresi Ki-67 dan p53 dengan faktor prognosis klinis dan histopatologi buruk pada karsinoma sel sebasea. Terdapat proporsi sampel dengan ekspresi Ki-67 tinggi yang lebih banyak dan nilai tengah yang lebih tinggi pada faktor prognosis ukuran tumor, metastasis, berdiferensiasi buruk, serta invasi perineural, meskipun hasil yang didapatkan tidak jauh berbeda dan secara statistik tidak bermakna. Pada pulasan p53 terdapat perbedaan yang cukup besar dalam hal proporsi pulasan dengan ekspresi tinggi serta nilai tengah yang lebih tinggi pada faktor prognosis ukuran tumor.

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Sebaceous cell carcinoma is a relatively common malignancy in the Asian population, characterized by aggressive behavior with high rates of local recurrence and distant metastasis. Increased expression of immunohistochemical marker such as tumor suppressor gene p53 and Ki-67, a proliferation marker, in head and neck tumors suggests a correlation between proliferation activity and poor prognosis.

Objective: This study aims to evaluate the expression of p53 and Ki-67 in sebaceous cell carcinoma and its association with clinical and histopathological prognostic factors, including tumor size, lymph node involvement, distant metastasis, cell differentiation, pagetoid spread, and perineural invasion.

Methods: Immunohistochemical staining using p53 and Ki-67 antibodies was performed on paraffin-embedded sebaceous cell carcinoma tissues obtained from medical records between June 2017 and June 2022 at RSCM. Expression assessment was conducted on nuclei using manual and semi-quantitative methods on 500 cells per field processed with Qupath software. The results were cross-checked with patients' clinical data recorded in a master table and statistically analyzed to determine their relationship.

Results: A total of 34 patients were analyzed based on clinical data and p53 and Ki-67 expression. There was no statistically significant association between p53 expression and clinical and histopathological prognostic factors (p>0.05). However, high p53 expression was associated with a higher proportion of poor prognostic factors, such as metastasis, perineural invasion, and pagetoid spread. Similarly, there was no statistically significant association between Ki-67 expression categories and clinical and histopathological prognostic factors (p>0.05). High Ki-67 expression was more frequently observed in cases with larger tumor size, metastasis, poor differentiation, and perineural invasion.

Conclusion: This study found no significant statistical association between Ki-67 and p53 expression with poor prognostic factors in sebaceous cell carcinoma. Nonetheless, a higher proportion of samples with high Ki-67 expression and higher median values were observed in cases with bigger tumor size, metastasis, poor differentiation, and perineural invasion, although these differences were not statistically significant. For p53 expression, significant differences were found in terms of proportion and median values concerning tumor size prognostic factors.

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"Latar belakang: Peningkatan insidensi karsinoma sel skuamosa (KSS) rongga mulut dan orofaring telah memicu berbagai studi mengenai peran Human Papilloma Virus (HPV) pada patogenesis KSS rongga mulut dan orofaring. Dewasa ini, pemeriksaan imunohistokimia p16, suatu protein penanda yang dibentuk oleh sel tubuh akibat terinfeksi HPV, semakin marak digunakan sebagai alternatif dari pemeriksaan polymerase chain reaction (PCR). Pemeriksaan ini membutuhkan biaya tinggi dengan ketersediaannya yang rendah. Status p16 juga menentukan stadium KSS orofaring berdasarkan panduan diagnosis oleh American Joint Commitee on Cancer (AJCC) edisi ke-8. Panduan diagnosis tersebut dibuat berdasarkan penelitian yang menyatakan bahwa respons radiasi dan prognosis KSS orofaring lebih baik pada pasien dengan status p16 positif. Tujuan penelitian: Membandingkan respons radiasi pada pasien dengan KSS rongga mulut dan orofaring berdasarkan status p16. Metode: Penelitian ini menggunakan desain cross-sectional dan melibatkan 27 pasien KSS rongga mulut dan orofaring di RSUPN Cipto Mangunkusumo. Data karakteristik pasien diambil dari rekam medis, anamnesis pasien, serta hasil pemeriksaan CT scan dan/atau MRI. Status p16 ditentukan dengan pemeriksaan imunohistokimia dengan pulasan antibodi p16INK4a. Analisis data dilakukan menggunakan Statistical Program for Social Science (SPSS) versi 20. Hasil: Status p16 positif ditemukan pada 11 dari 27 subjek (40,7%). Berdasarkan analisis bivariat, tidak terdapat asosiasi yang bermakna antara status p16 dengan respons terapi (p>0,05). Kesimpulan: Tidak terdapat pengaruh signifikan dari status p16 terhadap respons radiasi pada KSS orofaring dan rongga mulut

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Background: The increasing incidence of oral cavity and oropharyngeal squamous cell carcinoma (SCC) has led to the initiation of various studies on human papillomavirus (HPV), which plays a role in the pathogenesis of oral cavity and oropharyngeal SCC. Nowadays, immunohistochemistry examination of p16, a marker protein formed by HPV-infected cells, is increasingly used as an alternative to polymerase chain reaction (PCR) which requires high cost yet has low availability. According to 8th American Joint Committee of Cancer (AJCC) guideline on oropharyngeal cancer, p16 status also determines the staging of oropharyngeal SCC, indicating that the radiation response and prognosis of oropharyngeal SCC are better in p16-positive patients. Aim: To compare the radiation response in patients with oral and oropharyngeal SCC based on p16 status. Methods: This is a cross-sectional study involving 27 patients with oral and oropharyngeal SCC at Dr. Cipto Mangunkusumo National General Hospital. Patients characteristics were obtained from medical records, history taking, and CT scan and/or MRI results. p16 status was determined by p16INK4a immunohistochemistry and nasal polyp paraffin block examination (eosinophil infiltration and biofilm). Data analysis was performed using Statistical Program for Social Science (SPSS) version 20. Results: Positive p16 status was found in 11 of 27 subjects (40,7%). Based on bivariate analysis, no significant association was found between p16 status and radiation response (p>0.05)."

"Indonesian Journal of Dentistry 2006; Edisi Khusus KPPIKG XIV:239-242Oral squamous cell carcinorna ( OSCC ) is the most common malignant tumor of the oral cavity, and its account for 80-90% of all malignancies in oral cavity. The aim of this study was to detemine the presenceof p53 mutations and to associate these mutations with the histopathological type of OSCC such as well differentiated and poorly differentiated. Analitycal observational comparative study by cross sectional design was used. Forty untreated well and poorly differentiated OSCC biopsy sample and normal tissue biopsy material taken from 16 normal patients were analyzed for the presence of mutation in the conserved region of the p53 gene especially in exon 5 by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP). The results of this study showed that p53 gene mutations were detected in exon 5; 11/40 (27,5%) with heterozygous mutation 9/11 (81,8%). The incidence in exon 5 of p53 gene mutation was significantly accociated with well differentiated 2/20 (l0%) and poorly diferentiated 9/20 (45%) OSCC(P=0,013). This study concludes that 1) mutation in exon 5 of p53 gene occured frequently in OSCC; 2) exon 5 of the p53 gene could be one of the the specific targets for histopathological grade of OSCC; 3) mutation in exon 5 of p53 gene could be important prognostic factor in OSCC."

"ABSTRAK Karsinoma sel skuamosa kepala leher (KSSKL) menempati peringkat ke-6  kanker tersering di seluruh dunia.  Perkembangan  dalam  hal  terapi yang menggunakan  beragam modalitas untuk mengontrol  lokal dan  regional masih belum dapat meningkatkan angka survival lima tahun yang hanya sekitar 50% selama tiga dekade terakhir.  Metastasis jauh  menjadi penyebab utama  morbiditas dan  mortalitas pada KSSKL.  Sebagian besar pasien dengan metastasis jauh tidak terdeteksi secara klinis dan  radiologi.  Hingga saat ini sistem staging dan radiologi konvensional tidak mampu mendeteksi metastasis sejak dini . Mikrometastasis  merupakan proses awal dari suatu makrometastasis, sehingga sel tumor yang bersirkulasi dianggap sebagai silent predictor. Deteksi  CTC dianggap sebagai metode yang inovatif, sensitif, dan spesifik untuk dapat memprediksi kemungkinan terjadinya metastasis pada pasien-pasien  KSSKL. Penelitian ini menggunakan 90 sampel darah pasien penderita KSSKL stadium I-IV yang berobat di poli Bedah Onkologi dan THT RSUPNCM  pada periode Januari hingga Desember 2018.  Sampel darah  sebanyak 8 ml dikirim ke Laboratorium Patologi Klinik FKUI/RSUPNCM untuk dianalisa jumlah CTC -nya dengan  menggunakan flow cytometry, penanda epitel EpCAM dan CK19 serta penanda lekosit CD45. Analisa statistik dilakukan untuk mengetahui ada tidaknya asosiasi antara status klinikohistopatologi pasien KSSKL dengan deteksi CTC. Flow cytometry mampu  mendeteksi CTC positif sebanyak 28 dari 90 sampel darah (31.1%). Dari analisa bivariat dan multivariat, tidak didapatkan adanya asosiasi yang bermakna antara status klinikohistopatologi pasien KSSKL dengan deteksi CTC (p>0.05).    Pasien dengan stadium lanjut  memiliki kecenderungan 4.192 kali untuk mendapatkan CTC positif dibandingkan dengan stadium awal. Begitu pula pasien  yang memiliki sublokasi  tumor di daerah  faring  dan  laring   memiliki  kecenderungan 2.634 kali  untuk mendapatkan CTC positif bila dibandingkan dengan sublokasi anatomi bibir, rongga mulut, hidung dan sinus paranasal. Flow cytometry mampu mendeteksi CTC pada KSSKL dengan presentase 31.1%  bila menggunakan dua penanda epitel. Tidak terdapat asosiasi yang bermakna antara status klinikohistopatologi pasien KSSKL dengan deteksi CTC. Diperlukan studi lanjutan untuk meningkatkan sensitivitas dan spesifisitas serta mengkonfirmasi dapat tidaknya CTC dipakai sebagai prediktor dan prognostikator di bidang KSSKL.

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ABSTRACT

HNSCC is the sixth most common cancer worldwide. The therapy of choice for newly diagnosed patients consists of combined modality treatment for locoregional control. Despite of improvement in treatment, for all stages combined, the 5-year survival rate is approximately 50% and this rate has not changed significantly in the last 3 decades. As distant metastases develop, the chance for cure becomes low and survival decreases. Tumor metastasis is an important contributor to mortality in cancer patients. Mostly distant metastases are not seen by clinical examination and/ or conventional imaging. To date, TNM staging  system and  the existing image technology are not sufficient to detect tumor metastasis in early stages. The concept of the development of metastasis involves a tumor cell that dissociates from the primary tumor (micrometastasis) and circulates within lymphatic or vascular channels. The true utility of a circulating tumor cell (CTC) is that it acts as a silent predictor of metastatic disease. Detection of CTCs serves as an innovative, sensitive and specific marker and providing early and definitive evidence of metastatic disease. In this study, peripheral blood samples from 90 patients with SCCHN stage I-IV from Surgical Oncology and ENT OPD were taken. CTCs were quantified using flow cytometry of anti-EpCAM, CK19 and CD45. Their detection was correlated with clinicohistopathologic characteristics. CTCs were identified in 28 (31.1%) patients at any time point with a mean + standard deviation of  0.9 + 3.2 CTCs. In bivariate and  multivariate analysis, we observed no significant correlation between the presence of CTCs and clinicohistopathologic characteristics (p>0.05). However the odds for the patients with advanced stages to have positive CTCs  is 4.192 times higher than early stage. Moreover, patients with pharynx and larynx cancer have the odds 2.634 times higher than those with lips, oral cavity and paranasal sinuses cancer. The rate of CTCs detection in HNSCC by flow cytometry was 31.1%. Detection of CTCs does not correlate with any clinicohistopathological characteristics. Further studies is needed to increase the sensitivity and specificity  and  also to confirm the potential of CTC to serve as a predictor and prognosticator in patients with HNSCC."