Cancer of the Head and Neck
Summary of Key Points
• In the United States it was estimated that in the year 2012, head and neck cancer would account for 3.2% of all new cancer cases and 2% of all cancer deaths.
• The three major risk factors for head and neck cancer are tobacco, human papillomavirus infection, and alcohol.
• Management of head and neck cancers requires a multidisciplinary approach with effective integration of multiple specialties to achieve the desired goals of cure and functional organ preservation.
• Staging of head and neck cancer should be comprehensive and include a complete physical examination, fiberoptic laryngoscopy, computed tomography and/or magnetic resonance imaging of the head and neck, and a positron emission tomography scan for advanced stage disease to assess nodal involvement and distant metastases.
• The treatment of head and neck cancer is dictated by the primary site.
• Management of paranasal sinus malignancies is primarily surgical, with adjuvant radiation and possibly chemotherapy for advanced lesions. In unresectable and nonoperative cases, definitive radiotherapy should be offered.
• Surgery is generally considered the preferred initial treatment modality for oral cavity lesions. Adjuvant radiotherapy with or without chemotherapy is indicated for patients with high-risk features on surgical pathology. Definitive radiotherapy is reserved for unresectable tumors, nonoperable tumors, and tumors in which surgical resection would result in significant functional impairment.
• Most oropharyngeal cancers in the United States are now due to human papillomavirus and as such have an improved prognosis. Early-stage oropharynx cancers can effectively be treated with surgery or radiation therapy. The standard of care for locally advanced disease is chemoradiation; however, other modes of treatment are under active investigation.
• In persons with larynx cancer, the goal of first-line therapy should be to preserve the function of the larynx, without sacrificing tumor control. Early-stage laryngeal cancer can effectively be treated with either surgery or radiotherapy. In early-stage disease, the anatomic location and extent of disease will dictate if surgery is feasible. The treatment of choice in most locally advanced larynx cancers is concurrent chemotherapy and radiation. Because the Veterans Affairs (VA) larynx study demonstrated poor outcomes for persons with T4a disease, total laryngectomy is also a consideration for these patients.
• Surgical resection is the mainstay of management in salivary gland cancer, whether it arises from the parotid, submandibular, sublingual, or minor salivary glands. Combined therapy is recommended for high-grade malignancies of the salivary gland because postoperative irradiation has been shown to improve local-regional control in patients with positive surgical margins; high-risk features such as advanced stage, high-grade, skin/nerve invasion; and adenoid cystic carcinoma.
• The management of locally recurrent head and neck cancer is technically challenging and should be performed at centers where personnel have experience in treating these patients. Surgery is typically preferred and offered for resectable lesions in the absence of unacceptable functional sequelae. The roles of adjuvant radiotherapy (or reirradiation) and chemotherapy must be determined on a case-by-case basis.
