Cancer of the Head and Neck

The malignant gradient increases as the origin of cancers moves posteriorly in the oral cavity and reaches the oropharynx (Fig 1, Fig 2, Table 1). Thus, cancers of the base of the tongue tend to be more extensive (60% to 70% are T3 and T4) and more aggressive than cancers in the oral portion of the tongue.2The same is true of cancers of the tonsillar region as compared to those of the buccal mucosa or alveolar ridge. The incidence of metastatic neck disease is higher (more than 50% on admission). Bilateral and contralateral presentation increases in oropharyngeal primaries because of the richer network of lymphatics. The histological features are more aggressive; cancer in the oropharynx is undifferentiated and anaplastic in contrast to the more differentiated cancers of the mouth. Cure rates are very poor when one considers the more common incidence of this disease in older age groups,