Head & Neck Cancer

Benign and malignant tumors can arise from any of the structures contained within the parapharyngeal space. Such tumors are very rare, however. Also, malignant tumors from adjacent areas (eg, the pharynx) can extend into the parapharyngeal space by direct growth, or distant tumors may metastasize to the lymphatics within the space. Although the history and physical examination can provide clues to the site of origin and nature of a parapharyngeal space tumor, imaging studies are more useful for defining the site of origin and extent of the mass, as well as its vascularity and relationship to the great vessels of the neck and other neurovascular structures. Surgery is the mainstay of treatment. The surgical approach chosen should facilitate complete tumor extirpation with minimal morbidity. Irradiation is administered as primary therapy in patients with unresectable tumors, poor surgical candidates, and selected other patients. Radiation therapy is also used after surgery for high-grade malignancies or when wide surgical margins cannot be achieved. [ONCOLOGY 11(5):633-640, 1997]

Head and neck cancer and its treatment frequently cause changes in both speech and swallowing, which affect the patient's quality of life and ability to function in society. The exact nature and severity of the post-treatment changes depend on the location of the tumor, the choice of treatment, and the availability and use of speech and swallowing therapy during the first 3 months after treatment. This paper reviews the literature on speech and swallowing problems in various types of treated head and neck cancer patients. Effective swallowing rehabilitation depends on the inclusion of a video-fluorographic assessment of the patient's oropharyngeal swallow in the post-treatment evaluation. Pilot data support the use of range of motion (ROM) exercises for the jaw, tongue, lips, and larynx in the first 3 months after oral or oropharyngeal ablative surgical procedures, as patients who perform ROM exercises on a regular basis exhibit significantly greater improvement in global measures of both speech and swallowing, as compared with patients who do not do these exercises. [ONCOLOGY 11(5):651-659, 1997]

This paper is an excellent overview of speech and swallowing rehabilitation in head and neck cancer patients. Dr. Logemann and co-workers are clearly leaders in this field and, as such, are eminently qualified to summarize the topic. This subject is of great importance, as the effects of head and neck cancer and its treatment can be economically, psychologically, and socially devastating to patients. Quality-of-life issues continue to be critical in this patient population.

Logemann and colleagues highlight an aspect of the treatment of patients with head and neck cancer that is frequently ignored; ie, the importance of rehabilitation efforts and evaluations of post-therapy quality of life. As oncologists, whether surgical, radiation, or medical, our studies and publications have traditionally focused on overall survival, disease-free survival, and, particularly in the management of head and neck cancer, local control of disease. More recently, investigators have begun to address quality of life when constructing studies for patients with all kinds of malignancies, and newer performance outcome instruments have been designed specifically for patients with head and neck cancer.[1]

The article by Moore provides an example of much needed research evaluating clinical outcomes in head and neck oncology. Measuring the quality of life (QOL) of patients with head and neck cancer presents some unique challenges. First, head and neck cancer profoundly influences some of the most fundamental functions of life, including breathing, eating, and communication. Second, treatment of head and neck cancer does not always improve these functional deficits, and in many instances, the treatment itself results in further deterioration of these functions. Finally, "traditional" outcome measures (disease-free survival, overall survival, local and regional control, response rates) do not adequately assess the global impact of this disease and/or its treatment on patients' perception of life satisfaction.

Quality-of-life (QOL) research in patients treated for head and neck cancer is in its infancy. Early research focused on psychosocial issues related to extensive surgical resection and its consequences. Many advances

Using a new molecular test, investigators at The Johns Hopkins University School of Medicine have detected genetic mutations specific to cancer in blood samples of six patients with head and neck cancer. Their findings are reported in the September issue of Nature Medicine.

At the 4th International Conference of Head and Neck Cancer held in Toronto, Canada, Robert H. Maisel, md, an otolaryngologist at the University of Minnesota Cancer Center, advocated performing tracheoesophageal puncture (TEP) at the time of surgical removal of the voice box due to cancer. While the voice-rehabilitating surgical procedure has been part of the cancer operation since 1985, it has traditionally been performed several months after removal of the larynx.

NIJMEGEN, The Netherlands--With 12,000 new cases of esophageal cancer diagnosed every year in the United States, and 5-year postoperative survival rates still hovering under 20%, the need to develop more effective multimodality treatment strategies remains crucial, said David Ilson, MD, of Memorial Sloan-Kettering Cancer Center.

We investigated the incidence of micrometastases from squamous cell carcinomas of the head and neck in neck dissection specimens originally staged as pN0. A total of 76 dissection specimens from 60 patients were

Further follow-up of a randomized trial comparing combined chemotherapy and radiotherapy with radiotherapy alone for inoperable squamous cell cancers of the head and neck confirms the trial's initial finding of greater efficacy for the combined

Docetaxel {Taxotere) demonstrated significant activity and was well tolerated in the treatment of advanced head and neck cancer, according to preliminary results of a phase II clinical trial presented at the Eighth Annual European Congress for Clinical Oncology (ECCO-8) in Paris.

The review by Mendenhall et al presents selected papers pertinent to the effect of metastatic nodes on local control in patients with head and neck cancer. These data are retrospective and, as the authors point out, do not resolve the matter.

The article by Mendenhall et al represents a comprehensive review of their own experience, as well as other large experiences in the literature, aimed at addressing the controversy of whether neck stage predicts local control after irradiation of head and neck cancer. The authors systematically explore this controversy in the setting of both definitive and postoperative therapy. Based on this review, and our own experience, we conclude that there are no significant data showing a correlation between neck stage and local control at the primary tumor site following irradiation of head and neck carcinoma.

Two hundred sixty-five patients with head and neck cancer who had previously participated in either a fixed-dose, dose-titration, or dose-ranging trial of oral pilocarpine hydrochloride tablets were enrolled in a 36-month

The impact of neck stage (N stage) on local control after treatment for head and neck cancer is controversial. This article reviews the pertinent literature. Based on this review, the authors conclude that although N stage

The paper by Mendenhall et al addresses a very debatable issue, ie, the influence of nodal stage on local control for head and neck carcinomas treated by radiotherapy. The paper is well written and appropriately referenced, and the authors fairly conclude that, based on currently available data, nodal stage has no clear impact on the probability of primary local control after radiotherapy.

The widespread use of the TNM staging system has helped standardize the classification of cancers. Despite its excellence in describing a tumor's size and extent of anatomic spread, the TNM system does not account for the clinical biology of the cancer.

Dr. Piccirillo presents an interesting concept. Although the knowledge that comorbidity and severity of symptoms have a bearing on the prognosis of a patient with cancer is not new, the attempt to measure this influence and include it into a reproducible staging system is commendable.

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.

MENLO PARK, Calif--Matrix Pharmaceutical, Inc. has begun phase III clinical testing of its IntraDose-CDDP injectable gel (see image) for treatment of recurrent head and neck cancer and other accessible tumors.

Management of the neck lymph nodes is a critical factor in the success of treatment for patients with malignant head and neck tumors. Recurrence in the neck is an important cause of treatment failure, second in frequency only to recurrence at the primary site [1,2].

Dr. Stringer has done an excellent job of reviewing the anatomic, biologic, diagnostic, and therapeutic considerations that impact on the management of nodal metastases from head and neck malignancies. This is a thorough summary of the current

This article will address modified, selective, and radical neck dissection as well as other surgical considerations, and will review the surgical techniques currently available for neck treatment.