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
Associate Professor
Department of Otolaryngology, Head and
Neck Surgery
Oregon Health Sciences University
Portland, Oregon
Management of Cervical Metastasis
JAY O. BOYLE, MD
Assistant Attending Surgeon
Head and Neck Service
Memorial Sloan-Kettering Cancer Center;
Assistant Professor
Department of Otorhinolaryngology
Head and Neck Surgery
Weill Medical College of Cornell University
New York, New York
Oral Cavity Cancer
JOHN F. CAREW, MD
Assistant Attending Surgeon
Department of Otorhinolaryngology
Head and Neck Surgery
New York Presbyterian Hospital;
Assistant Professor
Department of Otorhinolaryngology
Head and Neck Surgery
The Weill Medical College of Cornell University
New York, New York
The Larynx: Advanced Stage Disease
LANCEFORD M. CHONG, M.D.
Associate Attending Radiation Oncologist
Department of Radiation Oncology
Memorial Sloan-Kettering Cancer Center
New York, New York
Head and Neck Radiation Oncology

PETER G. CORDEIRO, MD, FACS

Associate Attending Surgeon
Plastic and Reconstructive Surgery Service
Memorial Sloan-Kettering Cancer Center;
Associate Professor of Surgery
Department of Surgery
Weill Medical College of Cornell University
New York, New York
General Principles of Reconstructive Surgery
for Head and Neck Cancer
Mandible Reconstruction
BRUCE J. DAVIDSON, MD, FACS
Assistant Professor
Deartment of Otolaryngology
Head and Neck Surgery
Georgetown University Medical Center
Washington, District of Columbia
Epidemiology and Etiology
JOSEPH J. DISA, MD
Assistant Attending Surgeon
Plastic and Reconstructive Surgery Service
Memorial Sloan-Kettering Cancer Center;
Assistant Professor
Department of Surgery
Weill Medical College of Cornell University
New York, New York
General Principles of Reconstructive Surgery
for Head and Neck Cancer
Mandible Reconstruction
ANDREW G. HUVOS, MD
Attending Pathologist
Memorial Sloan-Kettering Cancer Center;
Professor of Pathology
Weill Medical College of Cornell University
New York, New York
Pathology of Head and Neck Tumors
v

vi

CONTRIBUTORS

PAUL A. KEDESHIAN, MD
Visiting Assistant Professor
Division of Head and Neck Surgery
University of California Medical Center
Los Angeles, California
Skull Base: Anterior and Middle Cranial Fossa
Neurogenic and Vascular Tumors of the Head
and Neck
DANIEL J. KELLEY, MD
Director, Head and Neck Oncology
and Skull Base Surgery
Department of Otolaryngology
Bronchoesophagology
Assistant Professor
Temple University School of Medicine
Philadelphia, Pennsylvania
Cancer of the Hypopharynx and Cervical
Esophagus
DENNIS H. KRAUS, MD, FACS
Associate Attending Surgeon
Head and Neck Service
Memorial Sloan-Kettering Cancer Center;
Associate Professor
Department of Otorhinolaryngology
Head and Neck Surgery
Weill Medical College of Cornell University
New York, New York
Cancer of the Nasal Cavity and Paranasal Sinuses
Skull Base: Anterior and Middle Cranial Fossa
DANIEL D. LYDIATT, DDS, MD, FACS
Associate Professor
Department of Otolaryngology/Head and Neck
Surgery
University of Nebraska Medical Center
Omaha, Nebraska
The Larynx: Early Stage Disease
WILLIAM M. LYDIATT, MD, FACS
Associate Professor
Department of Otolaryngology/Head and Neck
Surgery
University of Nebraska Medical Center
Omaha, Nebraska
The Larynx: Early Stage Disease

FERNANDO C. MALUF, MD
Associate Professor
Division of Solid Tumor, Department of Medicine
Sirio Libanes Hospital
Sao Paolo, Brazil
Chemotherapy and Chemoprevention in
Head and Neck Cancer
BERNARD B. OMALLEY, MD
Attending Radiologist
The Princeton Medical Center
Princeton, New Jersey
Head and Neck Imaging
SNEHAL G. PATEL, MD, MS, FRCS
Clinical Research Associate
Head and Neck Service
Memorial Sloan-Kettering Cancer Center
New York, New York
Tumors of the Oropharynx
Soft Tissue and Bone Tumors
Thyroid and Parathyroid Tumors
DAVID G. PFISTER, MD
Associate Attending Physician
Division of Solid Tumor
Memorial Sloan-Kettering Cancer Center;
Associate Professor, Department of Medicine
Weill Medical College of Cornell University
New York, New York
Chemotherapy and Chemoprevention in
Head and Neck Cancer
MANJU L. PRASAD, MD
Assistant Professor
Department of Pathology
Ohio State University Hospital
Columbus, Ohio
Pathology of Head and Neck Tumors
SCOTT SAFFOLD, MD
Resident, Department of Otolaryngology
Head and Neck Surgery
Oregon Health Sciences University
Portland, Oregon
Management of Cervical Metastasis

CONTRIBUTORS

ERIC SANTAMARIA, MD
Associate Professor
Department of Surgery
Hospital General Dr. Manuel Gea Gonzalez
Mexico City, Mexico
General Principles of Reconstructive Surgery
for Head and Neck Cancer
Mandible Reconstruction
JATIN P. SHAH, MD, FACS
Chief and Attending Surgeon
Elliot W. Strong Chair in Head and Neck Oncology
Head and Neck Service
Memorial Sloan-Kettering Cancer Center;
Professor, Department of Surgery
Weill Medical College of Cornell University
New York, New York
Skin Cancers of the Head and Neck
Tumors of the Oropharynx
Skull Base: Anterior and Middle Cranial Fossa
Neurogenic and Vascular Tumors of the
Head and Neck
Soft Tissue and Bone Tumors
ASHOK R. SHAHA, MD, FACS
Attending Surgeon
Head and Neck Service
Memorial Sloan-Kettering Cancer Center;
Professor, Department of Surgery
Weill Medical College of Cornell University
New York, New York
Thyroid and Parathyroid Tumors
ERIC J. SHERMAN, MD
Assistant Member
Division of Population Science
Department of Medical Oncology
Fox Chase Cancer Center
Philadelphia, Pennsylvania
Chemotherapy and Chemoprevention in
Head and Neck Cancer
BHUVANESH SINGH, MD
Assistant Attending Surgeon
Head and Neck Service
Memorial Sloan-Kettering Cancer Center;
Assistant Professor

vii

Department of Otorhinolaryngology
Head and Neck Surgery
Weill Medical College of Cornell University
New York, New York
Skin Cancers of the Head and Neck
Rehabilitation and Quality of Life Assessment in
Head and Neck Cancer
JEFFREY D. SPIRO, MD, FACS
Professor of Surgery
University of Connecticut Health Science Center
Farmington, Connecticut
Salivary Tumors
RONALD H. SPIRO, MD, FACS
Professor of Surgery
Head and Neck Service
Memorial Sloan-Kettering Cancer Center
New York, New York
Salivary Tumors
ELLIOT W. STRONG, MD, FACS
Professor Emeritus
Head and Neck Service
Memorial Sloan-Kettering Cancer Center
New York, New York
Oral Cavity Cancer
SUZANNE L. WOLDEN, MD
Assistant Attending Radiation Oncologist
Memorial Sloan-Kettering Cancer Center;
Assistant Professor of Radiation Oncology
Weill Medical College of Cornell University
New York, New York
Cancer of the Nasopharynx
RICHARD J. WONG, MD
Fellow, Head and Neck Service
Memorial Sloan-Kettering Cancer Center
New York, New York
Cancer of the Nasal Cavity and Paranasal Sinuses
IAN M. ZLOTOLOW, DMD
Chief and Attending Dental Surgeon
Dental Service
Memorial Sloan-Kettering Cancer Center
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. OMalley, 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

12

ix

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 disease 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 understanding 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 cancer. 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 practitioner 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 permanently 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 planning 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 oncologists, 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

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 chapters on their assigned topics. But for their diligence and promptness, it would not have been possible to compile 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