The Management of Head and Neck Cancer

Statistically speaking, head and neck cancer per se (excluding melano­ ma and basal cell carcinoma) does not outwardly seem to pose a serious threat - 27,500/870,000 total cancer cases estimated for 1984 (or 3.2% of all cancers) and 9,350/450,000 total cancer deaths in 1984 (or 2.1 %) for the United States. Yet in clinical practice, by the time that diagnosis is made, more than 60% of oral cancers have already spread to the nearby lymph node system. And while the overall five-year survival rate for localized oral cancer is 67%, this rate decreases drastically to only 25% when the original cancer has metastasized. Scientific textbooks all too often are merely a compilation of dis­ crete parts, rather than a correlated, integrated whole. Dr. Hamner and his colleagues have achieved such an integrated, succinct version in The Management of Head and Neck Cancer. The outstanding group of contributors bring to the book a wealth of accumulated knowledge and expertise in their various cancer spe­ cialty disciplines. They are associated with some of the most distin­ guished cancer centers in the United States.

I. General Remarks.- II. Anatomy.- 1. Lips (Upper and Lower).- 2. Buccal Mucosa.- 3. Lower Alveolar Ridge.- 4. Upper Alveolar Ridge.- 5. Retromolar Gingiva (Retromolar Trigone).- 6. Floor of the Mouth.- 7. Hard Palate.- 8. Anterior Two-Thirds of the Tongue.- III. Purpose.- References.- 1. Etiology and Epidemiology.- I. Overview.- II. Possible Predisposing Factors.- 1. Tobacco.- 2. Radiation.- 3. Nutritional Factors.- 4. Alcohol.- 5. Genetic Susceptibility.- 6. Viruses.- 7. Syphilis.- 8. Traumatic Irritation.- III. Oral Precancerous Conditions.- 1. Leukoplakia.- 2. Erythroplakia.- 3. Submucous Fibrosis.- IV. Epidemiology.- References.- 2. Detection.- I. Oral Examination.- 1. Facial Structure.- 2. Lymph Nodes.- 3. Temporomandibular Joint.- 4. Lips.- 5. Vestibules and Frenums.- 6. Gingivae.- 7. Buccal Mucosa and Commissures.- 8. Tongue.- 9. Floor of the Mouth.- 10. Hard and Soft Palates.- 11. Teeth.- II. Toluidine Blue as a Screening Detection Method.- III. Oral Cytology as a Screening Detection Method.- References.- 3. Diagnosis.- I. Epidermoid Carcinoma.- 1. Carcinoma of the Lip.- 2. Carcinoma of the Tongue.- 3. Carcinoma of the Floor of the Mouth.- 4. Carcinoma of the Alveolar Mucosa and Gingiva.- 5. Carcinoma of the Palate.- 6. Carcinoma of the Buccal Mucosa.- 7. Verrucous Carcinoma.- 8. Histopathology.- 9. Metastasis.- II. Carcinoma-in-situ.- III. Basal Cell Carcinoma.- IV. Malignant Melanoma.- V. Odontogenic Tumors.- 1. Ectodermal Origin.- 2. Mesodermal Origin.- 3. Mixed Origin.- VI. Fibro-Osseous Lesions.- 1. Fibro-Osseous Jaw Lesions of Periodontal Membrane Origin.- 2. Fibro-Osseous Jaw Lesions of Medullary Bone Origin.- 3. Malignant Fibro-Osseous Lesions of the Jaws.- VII. Salivary Gland Tumors.- 1. Benign Tumors.- 2. Malignant Tumors.- VIII. Biopsy.- 1. Incision Biopsy Procedure.- 2. Punch Biopsy Procedure.- 3. Excision Biopsy Procedure.- References.- 4. Pretreatment Evaluation.- I. Medical History and Symptoms.- II. Evaluation of Extent of Disease.- III. Consultations.- IV. Pretreatment Management.- V. Informed Consent.- VI. Non-Standard Treatment.- VII. Rules for Classification.- VIII. TNM Classification.- 1. Primary Tumor (T).- 2. Nodal Involvement (N).- 3. Distant Metastasis (M).- IX. Postsurgical Treatment Residual Tumor (R).- X. Summary of Stage Groupings.- XI. Common Departures from Sound Management.- 1. Open Biopsy of a Lump in the Neck Before Performing a Complete Head and Neck General Examination.- 2. Inadequate Incisional Biopsy of an Oral Cavity Lesion.- 3. Inadequate Excisional Biopsy of a Suspicious Oral Cavity Lesion.- 4. Failure to Review Previous Histopathologic Slides.- 5. Permitting a Single Histopathologic Benign Diagnosis to Override a Clinical Diagnosis of Carcinoma.- 6. Biopsies of the Larynx, Hypopharynx, Nasopharynx, Esophagus, or Trachea Prior to Radiologic Studies.- 7. Lack of Multidisciplinary Approach Where Indicated.- 8. Tailoring the Scope of Surgical Resection to the Ability of the Surgeon Rather than to the Objective Requirements Imposed by the Lesion.- 9. A Compromise of the Ablative Phase of Surgery in Order to Accommodate Limited Reconstructive Skills.- 10. Compromise of Surgical Margins Because Radiation Therapy or Chemotherapy Was or Is To Be Given.- 11. Performing the Right Operation on the Wrong Patient.- 12. Assessing the Degree of Success or Failure of Radiation Therapy on the Basis of the Response of the Lesion During or Immediately on the Completion of Treatment.- 13. Failure to Realize the Implication of the “Condemned Mucosa” or Multiple Primary Syndrome.- 14. Failure to Perform a Complete General Physical Examination As Well As a Complete Head and Neck Examination.- 15. Prolonged Watch-and-Wait Attitude in the Face of an Asymptomatic Mass.- 16. Inadequate Search for an Occult Primary.- 17. Abandonment of the Patient with Neck Metastasis from an Undetectable Primary.- 18. Enucleation of Tumors of the Major Salivary Glands and Thyroid Gland.- 19. Treating a Patient with Antibiotics for an Extended Period of Time Without a Biopsy.- References.- 5. Treatment.- I. Surgical Treatment of Head and Neck Cancer. Donald P. Shedd.- 1. Oral Cavity Cancer.- 2. Pharyngeal Cancer.- 3. Laryngeal Cancer.- 4. Paranasal Sinus Cancer.- 5. Salivary Gland Cancer.- 6. Radical Neck Dissection.- References.- II. Radiation Therapy in the Management of Head and Neck Tumors. Luther W. Brady and Lawrence W. Davis.- 1. General Considerations.- 2. The Role of Radiation Therapy in Head and Neck Sites.- 3. Treatment of Neck Nodes.- 4. Late Effects of Radiation Therapy.- 5. Future Approaches.- References.- III. Chemotherapy. James E. Hamner, III.- 1. General Remarks.- 2. Combined Treatment Modalities.- References.- 6. Follow-Up.- General Considerations.- References.- 7. Rehabilitation.- I. General Principles of Rehabilitation. James E. Hamner, III.- II. Maxillofacial Prosthetics. Joe B. Drane.- References.- 8. Series of Case Examples.- 1. Case No. 1 : Squamous Cell Carcinoma.- 2. Case No. 2: Squamous Cell Carcinoma.- 3. Case No. 3: Cemento-Ossifying Fibroma.- 4. Case No. 4: Osteosarcoma.- 5. Case No. 5: Cherubism.