Head & Neck Oncologic / Microvascular Reconstructive Surgery

Head and Neck Oncologic Surgery Overview

Over 45,000 new cases of head and neck cancers are estimated to occur each year, resulting in an estimated 11,000 deaths from this devastating disease annually. Alcohol and tobacco abuse are common etiologic factors in cancers of the oral cavity, oropharynx, hypopharynx, and larynx. Certain subtypes of human papilloma virus (HPV) are also known to be a risk factor for some squamous cell carcinoma of the oropharynx, i.e. lingual and palatine tonsils.

Head and neck cancers are classified based on the sub-sites from which they arise: oral cavity, lip, paranasal sinuses, oropharyngeal, nasopharyngeal, hypopharyngeal, salivary glands, and laryngeal cancers. Rarely, unknown primary cancers can be found in the neck. It is this diversity of the disease that renders it so complex in terms of staging and treatment.

Every type of cancer needs appropriate staging at diagnosis. Stage is the most predictive factor of survival. The TNM staging system developed by the American Joint Committee on Cancer (AJCC) is based on the tumor size and extent (T), cervical lymph node metastasis (N), and distant metastasis (M). It is used as a basis for treatment recommendations in each sub-site. In general, stage I and II are defined as early-stage disease with a relatively small primary tumor without any neck lymph node involvement. Stage III and IV cancers are advanced disease with a large primary tumor, which may invade underlying structures and/or spread to regional lymph nodes. Distant metastasis may be present as well. In general, the survival rate of patients with advanced disease is less than 50% of that of patients with early disease. 

Treating head and neck cancer patients is extremely complex. It is determined by the specific site of disease, extent of disease, and pathologic findings. In most instances, early-stage diseases (stage I and II) can be treated with either surgery or radiation alone. However, advanced diseases (stage III and IV) often require a combined treatment modality with surgery and radiation, and possibly the addition of chemotherapy as well. All patients should be encouraged to stop smoking and drinking alcohol because these habits reduce the efficacy of treatment.

A patient diagnosed with cancer is often presented at a multi-disciplinary tumor board conference where surgeons, radiation oncologists, medical oncologists, radiologists, pathologists, social workers and rehabilitation therapists discuss treatment strategies for each patient individually.