started. It is often necessary to examine the patient when he or she is anesthetized, using small scopes to see
and map the extent of the tumor .
• The risk of having a second primary cancer is as high as 15 percent, so endoscopic examinations of the
nasopharynx , hypopharynx and esophagus (triple endoscopy) are done to detect other cancers.
• A useful maneuver with large tumors is to mark the edge with an India ink tattoo. In patients who receive
radiotherapy or chemotherapy to shrink the tumor before surgery, the surgeon will be able to tell precisely
where the edge of the tumor was and remove all the tissue originally involved.
• No single treatment program offers a clear-cut survival advantage over others. Various choices are possible and
the decision will depend on a review of each case, the type and stage of the cancer, the physical and emotional
condition of the patient, as well as the experience of the physicians and the facilities available.
Treatment by Stage
Stage I
Standard Treatment The choice is determined by the anticipated functional and cosmetic results. Radiation therapy is commonly used. Surgery is equally successful. Either might be used in locations such as the tonsil, where function is expected to be normal after surgery. In areas such as the base of the tongue, radiation is preferred, since surgery would result in major functional problems. Radiation protocols using hyperfractionation (more than one treatment daily) should be considered.
