Treatment of Very Advanced Stage Head and Neck Cancer

Abstract

Approximately 50–60 % cases of head and neck cancer present in advanced stage in developing world. The conventional TNM staging considers only limited factors, and it is not feasible to group every advanced cancer in the same group. There are various factors that predict biological behavior that can be of great help in treating these tumors. The treatment of such cases needs clear philosophy, and choices need to be rational to avoid catastrophic outcome. These patients are often miserable due to constant pain, fungation, and bleeding and deserve good care. Majority of these patients are treated with palliative intent considering them either inoperable or borderline operable without actually considering possibility of cure. It is also essential to realize that these patients are actually at very advanced stage and surgery remains the only realistic chance of cure. Any other treatment including chemoradiotherapy essentially remains a palliative option. We have developed a rational approach to treat these patients that is discussed in this chapter.