[Malignant head-neck tumors in childhood--an interdisciplinary challenge from the viewpoint of the ENT physician].

BACKGROUND

Malignant tumors of the head and neck are very rare in children, and their symptoms are usually uncharacteristic. In most cases these tumors are of mesenchymal origin: sarcoma or lymphoma. As their growth is quick and destructive, irreversible damage of adjacent structures or even infiltration of the endocranium occurs early and rapidly, resulting in a dramatic deterioration of survival rate and life quality in advanced stages.

PATIENTS

Three cases of a malignant head-and-neck tumor in children are described, stressing typical key symptoms which might often be neglected or misinterpreted as aggravation or psychogenic if the physician is not aware of the possibility of a malignant tumor. The diagnostic and therapeutic approach is illustrated according to the tentative diagnosis and the underlying histologic results.

RESULTS

In any suspicious case, diagnostics must start immediately and often under emergency conditions. Interdisciplinary communication is mandatory from the beginning and should be directed by oncopediatricians. Since there are often fundamental differences in diagnostic procedures and therapeutic regimen compared with malignant tumors in adults, unnecessary repetitive examinations and consecutive delay in the onset of therapy can be avoided by early planning of a diagnostic strategy. Therapeutic principles differ widely from those in malignancies of adults. Following biopsy, histological examination, and staging, cytostatic chemotherapy and/or radiation is usually performed, but surgical procedures are indicated only in rare cases in the presence of a very small tumor. Mutilating surgery is always contraindicated in children. Restaging should follow conservative therapy, after which surgical removal of necrotic masses or residual tumor may be indicated.

CONCLUSIONS

An immediate onset of diagnostics and therapy is crucial for children's prognosis concerning survival and function of affected organs. An interdisciplinary approach is mandatory from the beginning. In early cases, this strategy gives a chance to restore organ function and life quality. In advanced cases, life and a residual organ function may be preserved but complete restoration is rare, especially if a rhabdomyosarcoma is the underlying histologic diagnosis.