There is a wide variety of head and neck cancers affecting areas such as the sinuses, oral cavity, pharynx and larynx (voice box). The individuals most commonly affected are males in the fifth or sixth decade of life with a long history of tobacco and alcohol use. After a diagnosis of head and neck cancer in one site up to 20% of patients can develop a second malignancy in another area of the head and neck or in the lung because of the cancerous changes in the tissues lining the upper aerodigestive tract induced by smoking.
Treatment approaches emphasize cure without major functional deficit. In younger patients with early disease surgery is usually the treatment of choice. Tolerating aggressive surgery for advanced disease can be difficult. For example treating advanced cancer of the larynx with surgery involves removing the structures that allow one to speak and can affect swallowing. The voice can be preserved in selected cases if chemotherapy is given first followed by radiation therapy, reserving surgery for treatment in the case of tumor recurrence. The choice between surgery and radiation therapy usually depends on anatomical considerations and the extent of the tumor. The lymph nodes in the neck are usually treated by the same modality as the primary tumor site. In cases of very bulky neck disease, a dissection is performed after radiation to remove residual disease. The patient diagnosed with a head and neck cancer should consult with an ENT surgeon, radiation oncologist and medical oncologist to understand the treatment options and the risks and benefits associated with each of the major treatment modalities.