Oral Cancer Overview: The Significance of Metastasis and Surgical Management of the Neck
Squamous cell carcinoma of the oral cavity has the propensity to metastasize to the cervical lymph nodes even in the early stages. The presence of lymph node metastasis is the most significant independent variable in determining survival of patients with cancer of the head and neck. Therefore, the diagnosis and management of cervical lymph node metastasis is one of the most important responsibilities of the head and neck oncologist.
The management of the neck in patients with cancer of the oral cavity has gone through several cycles. Initially, it was thought that the removal of the primary cancer from the oral cavity without paying attention to the neck was sufficient. However, this policy of “waiting and watching the neck” resulted in approximately one-third of the patients developing recurrence in the neck; some of these recurrences were not operable, and therefore, the majority of these patients died of their cancer.
Neck dissection has evolved from radical neck dissection for patients with clinically detectable disease in the neck to selective neck dissection for patients who have N0 or N+ neck and a “super”-selective neck dissection for patients who have persistent disease following chemoradiation. Although the use of the selective neck dissection in patients with an N0 neck has not improved the cure rate, it has had a major positive impact on regional disease-free survival and has decreased the morbidity associated with surgical management of the neck.
The evolution of the neck dissection and its current use in the management of patients with cancer of the oral cavity are the subject of this chapter.
KeywordsOral Cavity Neck Dissection Cervical Lymph Node Cervical Lymph Node Metastasis Radical Neck Dissection
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