Once a squamous cell carcinoma of the head and neck is diagnosed, the treatment is based on the location of the primary and the stage at diagnosis. Oral cavity tumors and tongue cancers are most often treated with surgery alone in early stage. Nasopharynx, hypopharynx, and subglottic tumors are often treated with combined chemotherapy and radiation therapy at an early stage, and a radical neck dissection can be added to any of these treatment regimens if there is lymph node involvement. If there is extensive lymph node involvement found at neck dissection, radiation therapy is added to the neck as well. Finally, in patients with spread of their cancer to a distant site, chemotherapy is the mainstay of treatment with surgery and radiation reserved to cases in which it would be most likely to reduce local effects of the metastatic cancer (e.g., radiation to a lung tumor to slow progression near the bronchus or blood vessels).
A radical neck dissection aims to remove all the lymphatic tissue in the neck that would possibly carry tumor that has spread from the primary tumor. Usually, the sternocleidomastoid muscle is removed as is the jugular vein. In most cases, the marginal mandibular nerve is preserved in this operation. In many cases, the spinal accessory nerve, which controls the trapezius muscle and assists in shoulder strength and stability, can be preserved unless directly involved with tumor (called a modified dissection).
Head and neck squamous cell carcinoma treatment medical expert witness specialties include head and neck surgery, otolaryngology, pathology, radiation oncology, oral and maxillofacial surgery, and radiology.