Prognosis
The 5-year survival of these cancers is approximately 50% for all sites and stages. Early cancers have a 75% survival, whereas advanced cancers have a 35% survival. Some sites have a very poor prognosis (e.g., cervical esophagus), despite our best efforts, whereas others (e.g., cancer of the glottic larynx) have good survival rates, particularly if diagnosed early enough.

WHEN TO REFER
Prevention and early diagnosis by the primary care physician are key to improved outcome in head and neck cancer. High-risk patients (significant tobacco and alcohol consumption, history of previous aerodigestive tract cancer) with one of the following symptoms of undue duration (±3 weeks) and refractory to conservative therapy should be referred to a specialist capable of visualizing the whole upper aerodigestive tract:

Sore throat Irritation (foreign body sensation) in throat
Nonhealing ulcer or mass in mouth
Chronic cough
Lump in neck
Unilateral nasal obstruction
Unilateral nasal discharge
Unilateral facial pain of unknown origin.

BIBLIOGRAPHY

Centers for Disease Control and Prevention: Reducing the health consequences of smoking: 25 years of progress—a report of the Surgeon General, U.S. Department of Health and Human Services publication no. 89-8411, Washington, DC, 1989, Public Health Service.



Gluckman JL, Crissman JD: Survival rates in 548 patients with multiple neoplasms of the upper aerodigestive tract, Laryngoscope 93:71-74, 1983.

Mashberg A, Roffetta P, Winkelman R, Garfinkel C: Tobacco smoking, alcohol drinking and cancer of the oral cavity and oropharynx among U.S. Veterans, Cancer 72:1369-1375, 1993.



Mashberg A, Samit A: Early diagnosis of asymptomatic oral and oropharyngeal squamous cancers, CA Cancer J Clin 45:328-351, 1995.



Shirinian MH, Weber RS, Lippman S: Laryngeal preservation by induction chemotherapy plus radiotherapy in locally advanced head and neck cancer: the MD Anderson Cancer Center experience, Head Neck 16:39-44, 1994.



Wingo PA, Tong T, Bolden S: Cancer statistics: 1995, CA Cancer J Clin 45:8-30, 1995.