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Education And Debate

Current Issues in Cancer: Cancer of the head and neck

BMJ 1994; 308 doi: (Published 09 April 1994) Cite this as: BMJ 1994;308:961
  1. J S Tobias
  1. The Meyerstein Institute of Clinical Oncology, The Middlesex Hospital, London W1N 8AA.

    Cancers of the upper aerodigestive tract, collectively known as head and neck cancers, arise from a multiplicity of sites. In the West, excess tobacco and alcohol consumption are the most important of the known predisposing factors; elsewhere in the world, notably in India and China, the aetiology, pattern of primary sites, and clinical behaviour are different. Clinically these tumours pose exceptional problems in management, and skilled multidisciplinary teams are necessary in order to achieve the highest level of service and research. Historically, surgery and radiotherapy have been the most important treatment modalities; chemotherapy is now increasingly employed but not yet fully established. Successful rehabilitation of patients with head and neck cancers requires access to high quality speech therapists and other support staff with training in functional pharyngeal disorders. Current research efforts are largely directed towards defining the proper role of chemotherapy and assessing the possible advantage of unconventional radiation approaches. In recent years the roles of primary reconstructive, and salvage surgery have also become better defined. Many patients are suitable for randomisation into ongoing prospective clinical trials which have been specifically designed to address these issues.

    Despite improvements in oral and dental hygiene together with a greater understanding of the pathogenesis of head and neck cancers, these tumours remain numerically important throughout the world and are among the most difficult to treat. In the Western World they account for around 5% of all cancers,1,2 but many are either locally advanced or associated with neck lymphadenopathy at presentation, making cure less likely. In other parts of the world, notably India and southern China, cancers of the head and neck are the commonest cancers of all. As this article covers the malignancies of the upper aerodigestive tract generically referred to as “head and neck cancers” I will not discuss the presentation …

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