126 - Surgical management of head and neck cancer

Summary

Head and neck cancer or cancer of the upper aerodigestive tract is an unusual malignancy comprising only 3% of all newly diagnosed cancers in the USA. However, in many parts of the world, particularly in India and France, head and neck cancer is a major cause of death. Four sites encompass the upper aerodigestive tract: the oral cavity, oropharynx, hypopharynx, and the larynx. The oral cavity includes the lips, oral tongue, floor of the mouth, alveolar ridge, and buccal mucosa; the oropharynx comprises the base of the tongue, the lateral pharyngeal wall, and the tonsil; the hypopharynx consists of the pyriform sinus, the posterior pharyngeal wall, and the postcricoid region; and the larynx includes the epiglottis, the endolarynx, and the subglottic region. The most common pathology is that of squamous cell carcinoma encompassing greater than 90% of all tumors in the upper aerodigestive tract. Five-year survival rates have changed little in the past 30 years: Stage III and IV cancer survival rates are 40%–50% and Stage I and II rates are 70%–90%. Treatment includes chemotherapy, radiotherapy, and/or surgery.

Surgery is indicated either as definitive or as salvage treatment. Definitive methods includes glossectomy, composite resection of mandible and part of the oral cavity and/or oropharynx, and laryngectomy. Neck dissections are usually included because of the primary echelon of nodal drainage for these malignancies to be in the neck. Salvage treatment is reserved for residual disease following chemotherapy and/or radiation and may include the same procedures associated with definitive treatment.