16 Tumors of the Head and Neck

Head and neck cancer includes all carcinomas arising in squamous mucos­ al epithelium from the lip, oral and nasal cavities, pharynx to larynx, and middle ear. The head and neck is one of the most complicated regions of the body to treat. Cancers in this region occur in multiple sites and subsites (approximately 35), and each has its own natural history with varying fre­ quency and sites of nodal spread. The treatment of head and neck cancer presents a challenge in multi­ disciplinary, multimodal management. Locoregional control of tumors remains the major concern, and the incidence of distant metastases is directly related to this. In many countries, most patients present with advanced disease, and approximately 65% of patients have lymph node metastases at presentation. In addition, in many patients the entire aero­ digestive tract has been exposed to tobacco and ethanol (resulting in con­ demned mucosa and field cancerization), and patients are at high risk for second cancers. In patients with head and neck cancers there is also a high incidence of other chronic medical ailments, such as emphysema, heart disease, tuberculosis, and malnutrition, which cumulatively lead to poor patient survival rates. Although the local control rates have increased with improved locoregional treatments, overall 5-year survival rates have not changed significantly over the last decade because ofthe regular occur­ rence of often-lethal second malignancies, of distant metastases, and of ac­ companying chronic illnesses.