SURGICAL MANAGEMENT OF HEAD AND NECK CANCER
Section snippets
Indications for Surgery
A variety of tumor types, both benign and malignant, occur in the nose and sinuses. This discussion is restricted to malignant tumors. The most common malignant tumor of the sinonasal region is squamous cell carcinoma, usually presenting in the maxillary sinus. Adenocarcinoma, esthesioneuroblastoma, melanoma, and lymphoma are, however, all seen in a much higher percentage of cases in the nose and sinuses than in other anatomical subsites of the upper aerodigestive tract.1, 64, 133 For nearly
Indications for Surgery
Oral cavity carcinoma includes lesions of the labial and buccal mucosa, alveolar ridges, retromolar trigone, hard palate, floor of mouth, and anterior two thirds of the tongue. Cancers in this location have a high propensity for early spread to cervical lymphatics, including bilateral involvement. Oral cavity cancers are often close to the mandible and involve the tongue. This relationship requires each case to be carefully considered in terms of the effect of the treatment on the mandible and
Indications
Oropharyngeal cancers are divided into several subsites, including the soft palate, tonsil, tongue base, and posterior pharyngeal wall. The decision to offer surgery for oropharyngeal tumors depends on the subsite and stage of the tumor. Surgery for T1 and T2 tumors of the palate, posterior pharyngeal wall, and tongue base is associated with significant morbidity. Wide local excision of these tumors with 2- to 3-cm margins creates a significant defect in functionally critical tissues. In
Indications
As with most head and neck tumor sites, the hypopharynx has traditionally been treated with surgery followed by radiation therapy. The exceptions are the early stage tumors of the hypopharynx. Early cancers of the hypopharynx are rare, but when they are diagnosed, treatment is generally with external beam radiation therapy.57, 88 Partial pharyngectomy may be possible if the tumor is limited to the lateral pharyngeal wall. If so, limited resection can be performed with primary closure. Even for
Indications
Perhaps the greatest innovation and continued advance in head and neck surgery has been in oncologic surgery of the larynx. Beginning in the early 1960s, a series of options has emerged that make many patients candidates for partial laryngeal surgery. Historically, as an alternative to radiation therapy, the surgeon had two options: total laryngectomy or laryngofissure with cordectomy. Because of the morbidity of the cordectomy procedure and the high degree of success with radiation therapy, it
NECK METASTASES
Cervical lymph node metastases from head and neck squamous cell carcinoma remain an ominous prognostic factor. For most patients, the presence of any neck metastasis will reduce the cure rate by about 50%. In patients with neck metastases, extracapsular spread remains the worst prognostic finding on pathologic examination, correlating with both recurrence in the neck and with distant metastasis.
The management of all but the earliest confirmed neck metastases is best achieved with surgical
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Cited by (0)
Address reprint requests to Steven C. Marks, MD, Department of Otolaryngology, Grace Hospital, 6071 West Outer Drive, Detroit, MI 48235
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Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan