American Cancer Society

Atlas of
Clinical Oncology

Published
Blumgart, Fong, Jarnagin Hepatobiliary Cancer (2001)
Cameron Pancreatic Cancer (2001)
Char Tumors of the Eye and Ocular Adnexa (2001)
Eifel, Levenback Cancer of the Female Lower Genital Tract (2001)
Shah Head and Neck Cancer (2001)
Silverman Oral Cancer (1998)
Sober, Haluska Skin Cancer (2001)
Wiernik Adult Leukemias (2001)
Willett Cancer of the Lower Gastrointestinal Tract (2001)
Winchester, Winchester Breast Cancer (2000)

Forthcoming
Carroll, Grossfeld, Reese Prostate Cancer (2001)
Clark, Duh, Jahan, Perrier Endocrine Tumors (2002)
Droller Urothelial Cancer (2002)
Fuller Uterine and Endometrial Cancer (2003)
Ginsberg Lung Cancer (2001)
Grossbard Malignant Lymphomas (2001)
Ozols Ovarian Cancer (2002)
Pollock Soft Tissue Sarcomas (2001)
Posner, Vokes, Weichselbaum Cancer of the Upper Gastrointestinal Tract (2001)
Prados Brain Cancer (2001)
Raghavan Germ Cell Tumors (2002)
Steele, Richie Kidney Tumors (2003)
Volberding Viral and Immunological Malignancies (2003)
Yasko Bone Tumors (2002)
 American Cancer Society
Atlas of
Clinical Oncology

Editors

GLENN D. STEELE JR, MD

Geisinger Health System
THEODORE L. PHILLIPS, MD
University of California
BRUCE A. CHABNER, MD
Harvard Medical School

Managing Editor

TED S. GANSLER, MD, MBA

Director of Health Content, American Cancer Society
 American Cancer Society
Atlas of
Clinical Oncology
Cancer of the
Head and Neck
Editor
Jatin P. Shah, MD, MS (Surg.), FACS,
Hon. FRCS (Edin), Hon. FDSRCS (Lond)
Chief, Head and Neck Service
E.W. Strong Chair in Head and Neck Oncology
Memorial Sloan-Kettering Cancer Center
Professor of Surgery, Weill Medical College, Cornell University
New York, New York

Assistant Editor
Snehal G. Patel, MD, MS (Surg.), FRCS
Clinical Research Associate
Head and Neck Service
Memorial Sloan-Kettering Cancer Center
New York, New York

Illustrator
Alice Y. Chen

2001
BC Decker Inc
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Contributors

PETER E. ANDERSEN, MD, FACS PETER G. CORDEIRO, MD, FACS

Associate Professor Associate Attending Surgeon
Department of Otolaryngology, Head and Plastic and Reconstructive Surgery Service
Neck Surgery Memorial Sloan-Kettering Cancer Center;
Oregon Health Sciences University Associate Professor of Surgery
Portland, Oregon Department of Surgery
Management of Cervical Metastasis Weill Medical College of Cornell University
New York, New York
JAY O. BOYLE, MD General Principles of Reconstructive Surgery
Assistant Attending Surgeon for Head and Neck Cancer
Head and Neck Service Mandible Reconstruction
Memorial Sloan-Kettering Cancer Center;
Assistant Professor BRUCE J. DAVIDSON, MD, FACS
Department of Otorhinolaryngology Assistant Professor
—Head and Neck Surgery Deartment of Otolaryngology
Weill Medical College of Cornell University —Head and Neck Surgery
New York, New York Georgetown University Medical Center
Oral Cavity Cancer Washington, District of Columbia
Epidemiology and Etiology
JOHN F. CAREW, MD
Assistant Attending Surgeon JOSEPH J. DISA, MD
Department of Otorhinolaryngology Assistant Attending Surgeon
—Head and Neck Surgery Plastic and Reconstructive Surgery Service
New York Presbyterian Hospital; Memorial Sloan-Kettering Cancer Center;
Assistant Professor Assistant Professor
Department of Otorhinolaryngology Department of Surgery
—Head and Neck Surgery Weill Medical College of Cornell University
The Weill Medical College of Cornell University New York, New York
New York, New York General Principles of Reconstructive Surgery
The Larynx: Advanced Stage Disease for Head and Neck Cancer
Mandible Reconstruction
LANCEFORD M. CHONG, M.D.
Associate Attending Radiation Oncologist ANDREW G. HUVOS, MD
Department of Radiation Oncology Attending Pathologist
Memorial Sloan-Kettering Cancer Center Memorial Sloan-Kettering Cancer Center;
New York, New York Professor of Pathology
Head and Neck Radiation Oncology Weill Medical College of Cornell University
New York, New York
Pathology of Head and Neck Tumors

v
vi CONTRIBUTORS

PAUL A. KEDESHIAN, MD FERNANDO C. MALUF, MD

Visiting Assistant Professor Associate Professor
Division of Head and Neck Surgery Division of Solid Tumor, Department of Medicine
University of California Medical Center Sirio Libanes Hospital
Los Angeles, California Sao Paolo, Brazil
Skull Base: Anterior and Middle Cranial Fossa Chemotherapy and Chemoprevention in
Neurogenic and Vascular Tumors of the Head Head and Neck Cancer
and Neck
BERNARD B. O’MALLEY, MD
DANIEL J. KELLEY, MD Attending Radiologist
Director, Head and Neck Oncology The Princeton Medical Center
and Skull Base Surgery Princeton, New Jersey
Department of Otolaryngology— Head and Neck Imaging
Bronchoesophagology
Assistant Professor SNEHAL G. PATEL, MD, MS, FRCS
Temple University School of Medicine Clinical Research Associate
Philadelphia, Pennsylvania Head and Neck Service
Cancer of the Hypopharynx and Cervical Memorial Sloan-Kettering Cancer Center
Esophagus New York, New York
Tumors of the Oropharynx
DENNIS H. KRAUS, MD, FACS Soft Tissue and Bone Tumors
Associate Attending Surgeon Thyroid and Parathyroid Tumors
Head and Neck Service
Memorial Sloan-Kettering Cancer Center; DAVID G. PFISTER, MD
Associate Professor Associate Attending Physician
Department of Otorhinolaryngology Division of Solid Tumor
—Head and Neck Surgery Memorial Sloan-Kettering Cancer Center;
Weill Medical College of Cornell University Associate Professor, Department of Medicine
New York, New York Weill Medical College of Cornell University
Cancer of the Nasal Cavity and Paranasal Sinuses New York, New York
Skull Base: Anterior and Middle Cranial Fossa Chemotherapy and Chemoprevention in
Head and Neck Cancer
DANIEL D. LYDIATT, DDS, MD, FACS
Associate Professor MANJU L. PRASAD, MD
Department of Otolaryngology/Head and Neck Assistant Professor
Surgery Department of Pathology
University of Nebraska Medical Center Ohio State University Hospital
Omaha, Nebraska Columbus, Ohio
The Larynx: Early Stage Disease Pathology of Head and Neck Tumors

WILLIAM M. LYDIATT, MD, FACS SCOTT SAFFOLD, MD

Associate Professor Resident, Department of Otolaryngology
Department of Otolaryngology/Head and Neck —Head and Neck Surgery
Surgery Oregon Health Sciences University
University of Nebraska Medical Center Portland, Oregon
Omaha, Nebraska Management of Cervical Metastasis
The Larynx: Early Stage Disease
 CONTRIBUTORS vii

ERIC SANTAMARIA, MD Department of Otorhinolaryngology

Associate Professor —Head and Neck Surgery
Department of Surgery Weill Medical College of Cornell University
Hospital General Dr. Manuel Gea Gonzalez New York, New York
Mexico City, Mexico Skin Cancers of the Head and Neck
General Principles of Reconstructive Surgery Rehabilitation and Quality of Life Assessment in
for Head and Neck Cancer Head and Neck Cancer
Mandible Reconstruction
JEFFREY D. SPIRO, MD, FACS
JATIN P. SHAH, MD, FACS Professor of Surgery
Chief and Attending Surgeon University of Connecticut Health Science Center
Elliot W. Strong Chair in Head and Neck Oncology Farmington, Connecticut
Head and Neck Service Salivary Tumors
Memorial Sloan-Kettering Cancer Center;
Professor, Department of Surgery RONALD H. SPIRO, MD, FACS
Weill Medical College of Cornell University Professor of Surgery
New York, New York Head and Neck Service
Skin Cancers of the Head and Neck Memorial Sloan-Kettering Cancer Center
Tumors of the Oropharynx New York, New York
Skull Base: Anterior and Middle Cranial Fossa Salivary Tumors
Neurogenic and Vascular Tumors of the
Head and Neck ELLIOT W. STRONG, MD, FACS
Soft Tissue and Bone Tumors Professor Emeritus
Head and Neck Service
ASHOK R. SHAHA, MD, FACS Memorial Sloan-Kettering Cancer Center
Attending Surgeon New York, New York
Head and Neck Service Oral Cavity Cancer
Memorial Sloan-Kettering Cancer Center;
Professor, Department of Surgery SUZANNE L. WOLDEN, MD
Weill Medical College of Cornell University Assistant Attending Radiation Oncologist
New York, New York Memorial Sloan-Kettering Cancer Center;
Thyroid and Parathyroid Tumors Assistant Professor of Radiation Oncology
Weill Medical College of Cornell University
ERIC J. SHERMAN, MD New York, New York
Assistant Member Cancer of the Nasopharynx
Division of Population Science
Department of Medical Oncology RICHARD J. WONG, MD
Fox Chase Cancer Center Fellow, Head and Neck Service
Philadelphia, Pennsylvania Memorial Sloan-Kettering Cancer Center
Chemotherapy and Chemoprevention in New York, New York
Head and Neck Cancer Cancer of the Nasal Cavity and Paranasal Sinuses

BHUVANESH SINGH, MD IAN M. ZLOTOLOW, DMD

Assistant Attending Surgeon Chief and Attending Dental Surgeon
Head and Neck Service Dental Service
Memorial Sloan-Kettering Cancer Center; Memorial Sloan-Kettering Cancer Center
Assistant Professor New York, New York
Dental Oncology and Maxillofacial Prosthetics
Contents

1 Epidemiology and Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Bruce J. Davidson, MD, FACS

2 Pathology of Head and Neck Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Manju L. Prasad, MD, Andrew G. Huvos, MD

3 Head and Neck Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Bernard B. O’Malley, MD

4 Skin Cancers of the Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Bhuvanesh Singh, MD, Jatin P. Shah, MD, FACS

5 Oral Cavity Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Jay O. Boyle, MD, Elliot W. Strong, MD, FACS

6 Tumors of the Oropharynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Snehal G. Patel, MD, MS, FRCS, Jatin P. Shah, MD, FACS

7 Cancer of the Nasopharynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146

Suzanne L. Wolden, MD

8 The Larynx: Advanced Stage Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156

John F. Carew, MD

9 The Larynx: Early Stage Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

William M. Lydiatt, MD, FACS, Daniel D. Lydiatt, DDS, MD, FACS

10 Cancer of the Hypopharynx and Cervical Esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

Daniel J. Kelley, MD

11 Cancer of the Nasal Cavity and Paranasal Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204

Richard J. Wong, MD, Dennis H. Kraus, MD, FACS

viii
 CONTENTS ix

12 Skull Base: Anterior and Middle Cranial Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

Paul A. Kedeshian, MD, Dennis H. Kraus, MD, FACS, Jatin P. Shah, MD, FACS

13 Salivary Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240

Jeffrey D. Spiro, MD, FACS, Ronald H. Spiro, MD, FACS

14 Thyroid and Parathyroid Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251

Ashok R. Shaha, MD, FACS, Snehal G. Patel, MD, MS, FRCS

15 Management of Cervical Metastasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274

Peter E. Andersen, MD, FACS, Scott Saffold, MD

16 Neurogenic and Vascular Tumors of the Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288

Paul A. Kedeshian, MD, Jatin P. Shah, MD, FACS

17 Soft Tissue and Bone Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309

Snehal G. Patel, MD, MS, FRCS, Jatin P. Shah, MD, FACS

18 General Principles of Reconstructive Surgery for Head and Neck Cancer . . . . . . . . . . . . . . . . . . . 330
Joseph J. Disa, MD, Eric Santamaria, MD, Peter G. Cordeiro, MD, FACS

19 Mandible Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358

Peter G. Cordeiro, MD, FACS, Eric Santamaria, MD, Joseph J. Disa, MD

20 Dental Oncology and Maxillofacial Prosthetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376

Ian M. Zlotolow, DMD

21 Head and Neck Radiation Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395

Lanceford M. Chong, MD

22 Chemotherapy and Chemoprevention in Head and Neck Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . 444

Fernando C. Maluf, MD, Eric Sherman, MD, David G. Pfister, MD

23 Rehabilitation and Quality of Life Assessment in Head and Neck Cancer . . . . . . . . . . . . . . . . . . . 467
Bhuvanesh Singh, MD

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 478
Preface
Although oral cancer is the sixth most common cancer worldwide, cancer of the head and neck is a rare dis-
ease in the western world. A higher incidence is reported in Southeast Asia as well as certain parts of Europe
and Latin America. Tobacco and alcohol remain the most important etiologic factors; however, the primary
site incidence of head and neck cancer varies throughout the world depending on the type of substance abuse
and the extent of consumption.
Management of these patients requires a team effort with expertise in various disciplines. As our under-
standing of the biology and natural history of cancers of the head and neck increases, efforts at preservation
or restoration of form and function become increasingly important. These efforts are not only important in
the surgical treatment of these tumors but are also important in the multidisciplinary, integrated treatment
programs delivered by comprehensive treatment teams. Most major cancer centers, not only in the United
States but also worldwide, now deliver optimal care for patients with cancers of the head and neck through
the integrated efforts of multidisciplinary “disease-management” teams. Such disease-management teams
work to develop treatment algorithms and establish guidelines for a unified treatment approach in order to
maintain internal consistency, initiate investigative protocols, and push the frontiers in the battle against can-
cer. Such guidelines are also developed by the American Head and Neck Society (AHNS) and the National
Cancer Center Network (NCCN). The focus has clearly been on outcome analysis and (whenever feasible),
implementation of evidence-based medicine. These have provided excellent practice guidelines for the prac-
titioner in the community and are rapidly becoming standards of care.
The contributing authors in this book are or have been members of the head and neck disease-management
team at Memorial Sloan-Kettering Cancer Center in New York. As a result, the treatment programs practiced
at Memorial Sloan-Kettering Cancer Center tend to be reflected in the philosophies expressed in this book,
though every attempt has been made to be comprehensive and to give a balanced view of other treatment
approaches and report results. Thus, in spite of being a multi-authored book, the strength of this work is its
internal consistency of diagnostic approaches, therapeutic decisions, multidisciplinary treatment programs,
and surgical techniques. It is obviously impossible for a work of this nature to be either complete or perma-
nently up-to-date; new technology will offer newer diagnostic approaches that will impact on the development
of newer treatment strategies and therapeutic protocols. However, this book represents the art and science of
head and neck surgery and oncology as well as the current approach to the multidisciplinary management of
tumors of the head and neck. Accurate clinical staging of head and neck tumors is crucial to treatment plan-
ning and for comparison of outcomes. However, we have deliberately not included the AJCC/UICC staging
system in the book due to the anticipated revision of the AJCC/UICC staging system this year. It is expected
that the sixth edition of the AJCC/UICC staging manual will be published in the year 2002 and we recommend
that the reader refer to this manual for information on details of staging criteria. This book will not only be a
valuable resource to aspiring head and neck surgeons and oncologists but also to surgeons, medical oncolo-
gists, radiation oncologists, and physicians in other specialties as it will act as a reference volume for current
concepts in the management of cancer of the head and neck.

Jatin P. Shah, MD
August 2001

x
Dedication
This work is dedicated to our patients who have endured the ravages of head and neck cancer and who have
demonstrated extraordinary strength in their struggle to preserve life. These exceptional human beings, who
join hands with us in the dogged pursuit of a cure for their cancer and a better quality of life, have a special
place in our hearts. We salute their courage, understanding, and perseverance. We are thankful to them for
putting their trust and lives in our hands, for giving us the opportunity to understand the disease, and for
inspiring us to put this work together.
Acknowledgments
I would like to express my sincere appreciation to the American Cancer Society for asking me to edit this
volume in their series of clinical atlases. I am equally grateful for the contributions of each of the authors
who so willingly and promptly provided up-to-date, generously illustrated, comprehensive but concise chap-
ters on their assigned topics. But for their diligence and promptness, it would not have been possible to com-
pile this work on schedule.
My special thanks are owed to Ms. Alice Chen for the artwork in this book, Ms. Nancy Bennett for the
graphics and editorial responsibilities, and Ms. Arlene Cooper for transcription of the text.

Jatin P. Shah, MD