The natural history of some cancers affecting the head and neck

Transcranial–facial Approach for Tumours of Superior Paranasal Sinuses and Orbit

A monobloc resection of the fronto-ethmoid sphenoid area may be performed through a combined cranial and facial approach. Osmotic cerebral dehydration increases the exposure of the anterior cranial fossa. The results of treatment in 26 patients (24 with malignant disease of the ethmoid area who had disease recurrence after previous radiotherapy with or without surgery) and the complications encountered are described. The clinical details of 9 of these patients have been included in an earlier report (Clifford 1977).

Mortality after surgery for hypopharyngeal cancer

Results of 362 patients with squamous carcinoma of the hypopharynx are presented. The hospital mortality was 25 per cent for patients treated surgically. The mortality was increased by previous radiotherapy and poor general condition, and also depended on the method of pharyngeal repair: the mortality for visceral (stomach or colon) transposition was higher than that for repair by skin flaps. The chance of long term survival decreased with increasing N stage, and was also reduced for patients undergoing visceral repair compared with skin flap repair of the pharynx.

Squamous carcinoma of the head and neck: the untreated patient

One thousand, nine hundred and seventy-seven patients with squamous carcinoma of the head and neck are reviewed with particular reference to the patients not treated. The commonest reason for not treating the patients was that the tumour was too extensive (55%). A further 36% were too old or infirm to be considered fit for radical treatment, and 9% of patients refused treatment. Treated and untreated patients were compared for age, sex, site of the primary and TNM stage. The proportion of patients untreated varied according to site of the primary tumour, with 25% of pharangeal tumours being the highest proportional representation. Median survival for untreated patients was 88 days; survival time was significantly related to sex, T stage of primary tumour and patient's general condition.

Epidemiology of cancer of the nose and paranasal sinuses: current concepts

Cancer of the nose and paranasal sinuses (SNC) has been attributed to occupational exposure to nickel, chromium, radium, dichlordiethyl sulphide, isopropyl oil, and hydrocarbons. Occupational groups with an increased SNC risk include furniture, boot and show workers, and workers in U.S. countries heavily involved in both petroleum and chemical manufacturing; specific agents have not been identified with certainty. In most of the studies, the risk for developing SNC in the exposed workers was 21 to 100+ times greater than the risk for SNC in those who were not exposed. Undifferentiated and squamous histologies are associated with nickel refining; adenocarcinomas are found in woodworkers, boot and show manufacturers, and textile workers. Most occupations at risk for SNC were also at risk for cancer of other sites, particularly lung and skin cancer. Study of the epidemiology of SNC may identify unrecognized carcinogens and occupational groups at increased cancer risk.

Critical look at the classification of maxillary sinus carcinomata

All the classification systems at present adopted for use in carcinoma of the maxillary sinus suffer from both intrinsic inaccuracies and an apparent failure to relate T (extent of primary tumor) categories to clinical experience of the spread of these tumors. Three systems are critically analyzed in relation to personal experience of 86 patients with sinus carcinoma and a fourth system proposed as a compromise solution to this problem.

Oral cancer: the behaviour and response to treatment of 194 cases

During the 16 year period 1960-1975, 350 cases of Oral Cancer were seen in the Department of Oral and Maxillo-Facial Surgery at the London Hospital. Detailed records were available for 250 patients. After excluding tumours of the salivary glands, sarcomata and tumours of the reticulo-endothelial system 194 cases remained and these were subjected to a computer analysis. The overall 5 year survival figure, not corrected for age and sex was, 32.8%. The local recurrence rate for all sites was 44%, 90% of these recurred within 2 years of diagnosis. The overall uncorrected 5 year survival figure for females was 42.1% and that for males was 22.9%. Analysis of the material has not provided a satisfactory explanation for this; lesions do not present at an earlier stage in females neither do they occur in younger patients. The distribution of the lesions by site and histology was the same for both sexes. Survival rates analysed by clinical staging at presentation confirm that the prognosis for early stage lesions is very much better than for late stage lesions, the 5 year survival for Stage I being 50% whereas that for Stage IV is only 20%.

Transcranial approach for cancer of the antroethmoidal area

An improvement in the treatment results of antroethmoidal cancers may be achieved through the use of a transcranial approach, which makes an en bloc excision of the ethmoid labyrinths possible. This exposure allows dural involvement to be assessed, excised and repaired under direct vision. The technique used in the management of 9 patients is described. Eight of these patients presented with recurrent disease after previous radiotherapy and surgery. There were no deaths in the immediate postoperative period. Two patients are dead: one with disease in the frontal lobe; the other 18 months after operation, apparently free of disease. Facial deformity in patients who have undergone this operation is no greater than that associated with other operations in this area, and may be less, as a superior approach may allow the posterior ethmoidal and sphenoid area to be excised without orbital exenteration.