Oral Cavity, Pharynx, and Larynx Cancer

Cancers of the oral cavity, pharynx, and larynx occur with a yearly incidence of around 500,000 new cases. They are frequent in developed countries, about equally in North America and the European Community where they have a particularly high incidence in France. Most of these cancers are squamous-cell carcinomas (SCCs) occurring in rather debilitated patients after a long history of tobacco consumption and alcohol abuse. The vast majority of patients are males aged around 50 years, but there is a tendency to an increasing incidence in females and young adults. In addition, the sociocultural profile of patients suffering from head and neck SCC is often poor. In general, SCCs of the head and neck often proliferate rapidly, are locally aggressive, and carry a high tendency to metastasize to cervical lymph nodes. In presentations with very large lymph nodes, or when lymph nodes are very numerous, the possibility of distant metastasis increases significantly. This natural history explains why that these SCCs are most often diagnosed at an advanced stage, requiring combined therapies. The outcome for this patient population is poor for several reasons: the risk of failure for the index tumor; the risk of developing subsequent SCCs along the upper aerodigestive tract, esophagus, and lung; and the frequency of intercurrent diseases. The risks from comorbity and second cancers arise almost exclusively from the common etiologic association with alcohol and tobacco abuse. SCCs of the oral cavity, pharynx, and larynx are a major public health problem. Apart from large campaigns against tobacco use and alcohol abuse and information that may encourage earlier diagnosis, efforts should be made to assess prognostic factors capable of predicting both outcome and the response to various treatments. In turn, this should help select appropriate therapeutic protocols. Keywords: tumour size; nodal extension; comorbidities; tobacco and alcohol; imaging; social environment; p53 mutation; angiogenesis; mutagen sensitivity; surgical procedures