Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract

Article Abstract:

The status of the lymph nodes in the cervical (neck) area is the most important factor in determining the prognosis of squamous cell carcinoma of the upper airway and digestive tract. Cure rates in head and neck cancer drop to nearly half when there is involvement of the cervical lymph nodes. The common treatment for lymph node metastasis (cancer spread) is radical neck dissection; this procedure removes all the lymph nodes from the jaw to collar bone. This procedure causes reduction of shoulder function, and removal of a neck vein (internal jugular) causes facial swelling and possibly lack of proper nerve function. The reason for removal of all regional lymph nodes in the neck has not been established. A study was undertaken to determine the distribution of metastatic nodes in the neck. This information could then provide a basis for further research into the possible use of limited neck dissection in the treatment of squamous cell carcinoma of this area. Previously untreated patients (1,081) who underwent radical neck dissection for squamous cell carcinoma of the head and neck were studied. The primary tumors were located in the mouth (501 patients); the oropharynx (207); the hypopharynx, below the throat (126);and the larynx, or the voice box connecting the pharynx to the trachea (247). Metastasis was confirmed in 82 percent of the lymph node dissections performed therapeutically; micrometastases were found in 33 percent of the dissections performed electively. For each primary site of tumor, there was a predominance of metastases in certain levels or areas of the neck. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Lymphatic metastasis, Throat cancer, Pharyngeal cancer, Radical neck dissection

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The making of a head and neck surgeon

Article Abstract:

The Society of Head and Neck Surgeons was founded in 1954 to provide a medium for the exchange and advancement of knowledge pertinent to the care of patients with head and neck tumors. There were no organized training programs in this specialty at that time. Today fellowship training programs have been established with stringent standards. Only about 25 percent of surgical patients are treated in hospitals with specialty training programs, and the number of cases referred to hospitals with fellowship programs is inadequate. In addition, various other specialties (general surgery, otolaryngology, and plastic surgery) now require experience in head and neck oncology (cancer) surgery before surgeons can receive certification from their specialty boards. In some institutions, fellows and chief residents compete for surgical patients. Some action needs to be taken; the three boards should be urged to reconsider the requirement of head and neck cancer surgery training; exposure to basic head and neck surgery is all that is required for these specialties. If case loads can be equitably distributed, the fellowship training program could be improved by the development of a more specific core curriculum tailored to the needs of modern day head and neck surgeons. The training program should be balanced between research and clinical care. These specialists need to be trained to not only treat the disease, but to also treat the patient affected by the disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Training, Surgeons, Head and neck cancer, editorial, Head and neck tumors

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Subtotal laryngectomy with crico-hyoido-epiglotto-pexy for the treatment of extended glottic carcinomas

Article Abstract:

Large glottic cancers are usually treated by vertical partial laryngectomy (removal of half of the larynx), a procedure that removes true and false cords, as well as a portion of thyroid cartilage and subglottic tissue. However, there is a high incidence of cancer recurrence in these patients. In 1974, a subtotal laryngectomy technique was described that completely removes the intact thyroid cartilage, as well as the true and false vocal cords and one arytenoid; the procedure is referred to as crico-hyoido-epiglotto-pexy (CHEP). A report is presented of 104 patients with stage T2 and T3 glottic cancer who underwent the CHEP procedure. Patients remained in the hospital about three weeks after surgery. By day 23 after surgery, 91 (87.5 percent) patients were able to eat normally; by day 45, all except two patients ate normally. Normal breathing was achieved by 85 (81.5 percent) of the patients before day 28; 16 patients required a tracheostomy tube until day 45. As a result of the vibration of mucosa against the epiglottis, patients had a strong, but deep voice of about one octave range. Overall, five-year survival was 75 percent. There were five patients who developed local recurrence. The rate of local recurrence for this procedure is much lower than that associated with vertical partial laryngectomy. The CHEP procedure should be considered, instead of vertical partial laryngectomy, for patients with extensive glottic cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Laryngeal cancer

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