Gil Ziv, Fliss Dan M
The Skull Base Surgery Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Isr Med Assoc J. 2009 May;11(5):296-300.
Head and neck cancer is the sixth most common cancer worldwide. HNCs can originate in the skin or soft tissue, in the upper aerodigestive tracts (oral cavity, oropharynx, hypopharynx, larynx, nasopharynx, paranasal sinuses, salivary glands), or in the thyroid. In each of these sites, tumors vary not only by the primary site but also by pathophysiology, biological behavior, and sensitivity to radiotherapy or chemotherapy. Management should be planned according to the tumor's characteristics, patient factors and expertise of the medical team. The main goals of therapy are ablation of the cancer while minimizing morbidity and preserving function and cosmesis. A multidisciplinary team is needed to achieve these goals. Early-stage HNC (stage I and II) should be managed with a single modality, and advanced tumors (stage III and IV) with multimodality therapy. Treatment should be directed to the primary tumor and the area of its lymphatic drainage--the neck lymph nodes. Evidence of metastases in the neck necessitates comprehensive clearance of regional lymphatic basins. However, even if there is no evidence of lymph nodes metastases, when the risk for positive neck lymph nodes exceeds 15-20% elective neck dissection is indicated. Advances in minimally invasive techniques now enable reliable microscopic and endoscopic procedures that mimic the open approaches. Development of contemporary surgical techniques and reconstructive means will help improve the quality of life of patients and prolong survival.
头颈癌是全球第六大常见癌症。头颈癌可起源于皮肤或软组织、上呼吸道消化道（口腔、口咽、下咽、喉、鼻咽、鼻窦、唾液腺）或甲状腺。在这些部位中的每一个，肿瘤不仅因原发部位而异，还因病理生理学、生物学行为以及对放疗或化疗的敏感性而异。治疗方案应根据肿瘤特征、患者因素以及医疗团队的专业知识来制定。治疗的主要目标是消除癌症，同时将发病率降至最低，并保留功能和美观。需要一个多学科团队来实现这些目标。早期头颈癌（I期和II期）应以单一方式进行治疗，晚期肿瘤（III期和IV期）则采用多模式治疗。治疗应针对原发肿瘤及其淋巴引流区域——颈部淋巴结。颈部有转移证据时，需要对区域淋巴引流区进行全面清扫。然而，即使没有淋巴结转移的证据，当颈部淋巴结转移阳性风险超过15%-20%时，也应进行选择性颈部清扫术。微创技术的进步现在使得可靠的显微手术和内镜手术成为可能，这些手术模仿了开放手术方法。当代外科技术和重建手段的发展将有助于提高患者的生活质量并延长生存期。
