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Head & Neck Cancer

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The tumor, node, metastases (TNM) cancer staging system is widely accepted by physicians as a predictor of prognosis and as a guide to therapy. Multiple national and international organizations, including the American Joint Committee on Cancer and the TNM Committee of the International Union Against Cancer have periodically evaluated and revised this international staging system since it was first proposed over four decades ago [1].

Drs. Ambrosch and Brinck appropriately emphasize the problems and limitations encountered when using routine pathologic procedures to examine lymph nodes from head and neck cancer specimens. Extraordinary processing techniques have repeatedly yielded a larger number of small nodes and, on occasion, have demonstrated the presence of micrometastases. The majority of these observations come from examination of breast specimens and their axillary dissections. Labor-intensive clearing techniques have varied to some extent, but generally involve progressive removal of opaque fat with alcoholic solvents of increasing percentages culminating in absolute alcohol (100%). Final visualization involves submerging the defatted specimen in cedarwood oil, followed by careful examination and dissection of the backlighted specimen.