AAO-HNSF Primary Care Otolaryngology Handbook

HEAD AND NECK CANCER

otolaryngologist for consideration of parotidectomy with facial nerve dissection. Because many physicians, regardless of specialization, will encounter patients with head and neck symptoms or findings concerning for cancer, it is important to know when to refer a patient to an otolaryngologist for symptoms suggestive of cancer: • A mass in the neck • Persistent hoarseness in a smoker lasting more than several weeks • Pain in the ear (otalgia), pain in the throat on swallowing (odyno- phagia), or difficulty swallowing (dysphagia) • A lump below or in front of the ear • A persistent oral ulcer • Unilateral serous otitis media

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Cancer occurs most often in the fourth to seventh decade of life in people who have been exposed chronically to carcinogens and irritants found in ciga- rette smoke and alcohol (Figure 15.2). These carcinogenic agents act in a synergistic manner , that is, the combined carcinogenic effect is greater than the sum of the two. It follows that if a person develops one cancer, he or she may develop another one in a different part of the upper aerodigestive tract (esophagus and lungs). Indeed, additional cancers, also known as synchronous primary cancers , are found in 10–20 percent of the patients who present with head and neck cancer. Endoscopy

Figure 15.2. Carcinoma of the inferior alveolar ridge. Mucosal tumors of the upper aerodigestive tract are almost always squamous cell cancer and occur as a result of exposure to tobacco and alcohol. Unfortunately, tumors are often discovered late, making treatment more complex.

Once a suspicious neck mass has been identified, a full ear, nose, and throat exam should be performed, in addition to a fiberoptic or formal endoscopy in the OR. There are three main objectives for using endos- copy in this situation. First, it allows the physician to evaluate the size and extent of the primary tumor (the original mucosal tumor, the source of

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