The latest medical research on Mouth, Head and Neck Cancer

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about mouth, head and neck cancer gathered by our medical AI research bot.

The selection below is filtered by medical specialty. Registered users get access to the Plexa Intelligent Filtering System that personalises your dashboard to display only content that is relevant to you.

Want more personalised results?

Request Access

Sarcopenia and its impact in head and neck cancer treatment.

Mouth, Head and Neck

The aim of this review is to discuss recent studies on the assessment of sarcopenia and its predictive and prognostic value in head and neck cancer (HNC) patients.

There is increasing evidence that low skeletal muscle mass (SMM), often named sarcopenia, can easily be assessed on cross-sectional imaging of the head and neck and is associated with chemotherapy (dose limiting) and radiotherapy toxicity and survival.

SMM measurement at the level of the third cervical vertebra (C3) on routine computed tomography and magnetic resonance imaging is easy and robust to perform. Several studies have shown a significantly higher incidence of cisplatin dose limiting toxicity in HNC patients with a low SMM. In HNC patients pretreatment low SMM is associated with acute and late toxicity and adverse events of radiotherapy, complications of major head and neck surgery and decreased disease-specific and overall survival. This information can be used for individualized treatment planning in HNC patients with low SMM.

Parotid lymph nodes in primary malignant salivary neoplasms.

Mouth, Head and Neck

To review the literature on parotid lymph nodes and their involvement in primary malignant epithelial salivary gland neoplasms (PMESGN). The parotid gland has two identifiable lymphatic systems - extraglandular and intraglandular both topographically separate but functioning as a single unit.

The publications available have concentrated on intraparotid lymph nodal metastatic (IPLN) disease only.

The data reported was retrospective and observational. The limitations encountered was the variability of extent of the parotid surgery, unclear evaluation of IPLN limited or inconsistent follow-up periods, small subgroups limiting the explanatory power and the multivariate analysis. One multicentric publication reported on 289 patients with parotid PMESGN treated by surgery between 1995 and 2018 at four centres: three Italian and one in the United Kingdom. IPLN+ was proven in 22.1%, preoperative imaging failed to identify occult IPLN+ in 20.1%, IPLN+ and cervical nodal metastasis (cpN+) was 47.4% and cpN+ was 100% in patients bearing greater than 4 IPLN+ nodes. A multicentric prospective study is required detailing preoperative imaging, using a standardized surgical management, pathological specimen search, histopathological grading and patient outcome analysis specifically designed to resolve the role of IPLN in patients diagnosed with PMESGN.

Distant metastasis from head and neck cancer: role of surgical treatment.

Mouth, Head and Neck

The rates of distant metastases in patients with head and neck squamous cell carcinoma varies from 3 to 50%. Metastases are usually multiple, diagnosed within 24 months after treatment and sited in the lungs, bone or liver. This review highlights the importance of a personalized treatment approach in such patients.

In patients with primary tumor controlled and with oligometastatic disease, surgical options can be considered, especially for lung metastases. Overall survival for patients who are candidates for lung metastasectomy can be as high as 59%. In bone and liver metastases, resection is not frequently used but radiofrequency ablation is a promising option. Finally, mediastinal and axillary lymph node metastasis are classified as distant metastases, and lymph node dissection is the treatment of choice whenever the disease is limited to these sites.

Patients with distant metastases usually are considered incurable; however, an aggressive local treatment of solitary distant metastases should be considered in highly selected patients, with a potential increase of overall survival.

Comprehensive management of nonmelanoma skin cancer involving the skull base.

Mouth, Head and Neck

Skin cancers are the most prevalent malignant disorder affecting humans. Approximately 90% of these are nonmelanoma skin cancer (NMSC), and large tumors, especially at the 'H-zone', can invade deeply and access the skull base. The best treatment for these very advanced skin cancers is craniofacial resection followed by adjuvant treatment, but, currently, systemic therapy and neoadjuvant approaches could be considered for some patients. The current management of NMSC involving the skull base is discussed in this article.

Surgical resections with negative margins followed by adjuvant treatment are the best treatment for NMSC with skull base invasion and offer the best outcomes for those patients. This approach usually requires a free flap reconstruction, followed by external beam radiation therapy. The team must keep in mind that some factors, such as gross brain invasion and extensive dura mater extension, are associated with worse outcomes.

Although it occurs infrequently, very advanced NMSC can involve the skull base. In these very difficult clinical scenarios, the best therapeutic option is a multidisciplinary approach in a tertiary center.

Conservative management of orbital involvement in malignant tumors: is the paradigm evolving? A critical review.

Mouth, Head and Neck

Review the recent literature regarding conservative management of orbital invasion in sinonasal cancers.

Recent data seem to confirm the possibility to preserve the orbital content in a significant number of patients. MRI is the best available imaging tool for evaluating orbital invasion. Limited periorbital and extraconal fat invasion should not be considered an indication for orbital cleaning. Histology-driven neoadjuvant chemotherapy should be attempted whenever possible, and could act as a prognosticator.

Orbital preservation strategy can be attempted even in case of limited extraconal fat invasion. When extraocular muscles, massive extraconal fat, lateral wall of the lacrimal sac, eyelids or even optic nerve/globe are invaded, a conservative procedure cannot be offered. Induction chemotherapy and postoperative radiotherapy are invaluable tools for maintaining oncological outcome while preserving ocular function. Frozen section should be used for guiding surgical procedures in borderline situations.

Management of lateral neck nodes in common and aggressive variants of thyroid cancer.

Mouth, Head and Neck

Although nodal metastasis in thyroid cancer does not have a major impact on outcome, it does have some prognostic implication in adverse metastasis and aggressive histology. The purpose of this review is to discuss evaluation and management of lateral neck nodes in thyroid cancer.

There is a high incidence of central and lateral neck node metastasis in thyroid cancer. Appropriate preoperative evaluation is key prior to first surgical procedure. The distribution of nodal metastasis is well recognized and so generally a modified neck dissection is recommended from levels II through V. The risk of nodal metastasis at level IIb is rare. The complications of lateral neck dissection, though rare, are of significant importance to the quality of life.

Appropriate preoperative evaluation, including good ultrasound and CT scan with contrast, is recommended. Preoperative FNA of the lateral neck node will be helpful, along with thyroglobulin management if indicated. The neck dissection should include significant levels of neck, avoiding neural injury. Nonsurgical therapies may be recommended in selected patients.

Mandibular osteosarcoma: diagnosis and treatment.

Mouth, Head and Neck

This article presents a review of the literature on mandibular osteosarcoma, focusing on the main aspects of its management, including diagnosis, histotype, and treatment. The literature published in the last 5 years was considered but because of the rarity of mandibular osteosarcoma, major publications from the past have also been included.

Management of mandibular osteosarcoma still lacks a clear standard of care, and treatment has not changed markedly over the past several years. The mainstay of treatment is surgical resection with free margins, but chemotherapy has recently begun to play a role in both adjuvant and neoadjuvant settings.

Mandibular osteosarcoma is a rare tumor and extensive randomized trials are not available in the international literature. Therefore, the standard of care is not defined, and diagnosis and treatment protocols have been extrapolated from analysis of multiple reports that are often discordant. This makes an interdisciplinary approach mandatory for the management of these patients, to provide the best care possible based on tumor size, site, and patient characteristics.

Indications of external beams radiation for thyroid cancer.

Mouth, Head and Neck

The use of external beam radiation therapy (EBRT) for the treatment of the different histologic subtypes of thyroid cancer is a matter of debate. This article provides an up-to-date review on the current evidence concerning the benefits of EBRT in thyroid cancer in specific indications.

Based on retrospective studies, adjuvant EBRT lessens the risk of locoregional recurrence in locally advanced differentiated thyroid cancer (DTC) and medullary thyroid cancer (MTC) with high-risk features. The effect of EBRT on overall survival remains uncertain. EBRT should also be part of the multimodality treatment in anaplastic thyroid cancer (ATC), as it improves survival rates in incompletely resected ATC.

The role of EBRT in thyroid cancer remains unclear. To date, no randomized control studies are available. Retrospective data showed improved outcomes in patients with high-risk features for locoregional recurrence.

It's not only swallowing: a clinician primer to adult food refusal beyond dysphagia.

Mouth, Head and Neck

Medical teams are frequently faced with challenging clinical scenarios when their patients exhibit reduced intake of food and drink. Speech-language pathologists, who serve as oropharyngeal swallowing specialists in medical settings, are frequently the first to be summoned with the referral, 'Poor PO intake. Please evaluate and treat.' As our practices have illuminated, many differentials other than oropharyngeal dysphagia are often at play.

Changes to taste, salivary supply/dry mouth, hunger drive, and psychosocial circumstances will significantly impact intake per os - each scenario to be explored further in this paper. Consequences to diminished nutrition and hydration include medical complications, lengthier hospital stays, and diminished quality of life.

In this review, two medical speech-language pathologists detail more common alternative diagnoses that explain reduced intake by mouth amongst adults with acute and chronic diseases. Ultimately, a multidisciplinary approach should be considered when evaluating such patients to ensure a comprehensive and effective care plan.

Is the exoscope ready to replace the operative microscope in transoral surgery?

Mouth, Head and Neck

Exoscopes are external digital devices that provide enhanced and magnified visualization of the surgical field. They usually have dedicated digital controls and a more compact mechanical structure than operative microscopes and current robotic surgical systems. This technology has significant potential in otolaryngology - head and neck surgery, especially concerning the field of transoral approaches. We herein analysed the overall technical characteristics of currently available exoscopic systems and contextualized their advantages and drawbacks in the setting of transoral surgery.

The actual advantages of exoscopy are still indeterminate, as it has only been applied to limited surgical series. However, its specific properties are herein compared with conventional transoral microsurgery and transoral robotic surgery, discussing the available literature on such a topic, filtered on the basis of the authors' experience and its possible future evolutions. Finally, a summary of current experiences in the field of three-dimensional (3D) transoral exoscopic surgery is presented, highlighting differences compared with standard approaches.

3D-exoscopic transoral surgery will possibly play an essential role in future management of early laryngeal and oropharyngeal lesions, significantly shifting the paradigms of this type of procedures.

Limits and potential implementation of the present pN classification for oral squamous cell carcinoma.

Mouth, Head and Neck

The purpose of this review is to highlight the most important changes in the eighth TNM classification system for oral squamous cell carcinomas compared with the seventh edition with focus on lymph node staging (pN). Nodal involvement is crucial when addressing prediction of survival, and staging must mirror the disease extension. pN classification will be evaluated with respect to lymph node yield (LNY), lymph node density (LND), and a recently proposed classification: pN-N+ reflecting positive regional lymph nodes (metastatic burden) and extra nodal extension.

TNM8 was introduced in 2018, and the most noteworthy changes were depth of invasion (DOI) and extranodal extension (ENE). Recent studies indicate, that TNM8-related pN is not superior to TNM7 with respect to predicting survival. LNY and LND are biased with ecological interference fallacy, and currently not recommended in future iterations of TNM. In contrast, the pN-N+ classification has demonstrated improved survival prediction compared with TNM8.

The recent findings support the inclusion of pN-N+, that is, metastatic burden and extranodal extension in future iterations of TNM.

The role of nasopharyngectomy in the management of nasopharyngeal carcinoma.

Mouth, Head and Neck

Recently, endoscopic nasopharyngectomy (ENPG) has become an effective treatment for locally recurrent nasopharyngeal carcinoma (NPC). This article reviews recent publications on ENPG and specifically addresses the surgical anatomy of the nasopharynx and discusses several important issues regarding ENPG.

The surgical techniques for ENPG have been previously described in several studies. The latest published data revealed good outcomes of ENPG compared with intensity-modulated radiation therapy (IMRT) in recurrent NPC. In addition, ENPG avoids severe reirradiation side effects. This review highlights the surgical anatomy of ENPG, which is important in preventing possible serious complications.

ENPG is a good option for managing recurrent NPC. Careful preoperative evaluation and a full understanding of the surgical anatomy help in preventing damage to nearby critical neurovascular structure. Long-term follow-up is still needed to evaluate its eventual morbidity and efficacy.