Bonnie S. Glisson, MD

In 2009, approximately 35,720 men and women (25,240 men and 10,480 women) in the United States will be diagnosed with cancer of the oral cavity and pharynx, and 7,600 will succumb to these diseases. Further, an estimated 12,290 men and women (9,920 men and 2,370 women) in the United States will be diagnosed with laryngeal cancer, and 3,660 will die from this malignancy. Most patients with head and neck cancer have metastatic disease at the time of diagnosis (regional nodal involvement in 43% and distant metastasis in 10%).

As discussed in chapter 3, there are two major subdivisions of lung cancer: small-cell lung cancer (SCLC), for which chemotherapy is the primary treatment, and non–small-cell lung cancer (NSCLC). SCLC is decreasing in frequency in the United States, with recent data showing it represents only 14% of lung cancers. This chapter provides information on the staging and prognosis, pathology and pathophysiology, treatment, and follow-up of long-term survivors of SCLC and concludes with brief discussions on mesothelioma and thymoma.

In 2009, approximately 35,720 men and women (25,240 men and 10,480 women) in the United States will be diagnosed with cancer of the oral cavity and pharynx, and 7,600 will succumb to these diseases. Further, an estimated 12,290 men and women (9,920 men and 2,370 women) in the United States will be diagnosed with laryngeal cancer, and 3,660 will die from this malignancy. Most patients with head and neck cancer have metastatic disease at the time of diagnosis (regional nodal involvement in 43% and distant metastasis in 10%).

In 2008, it was estimated that head and neck cancers comprised ­2% to 3% of all cancers in the United States and accounted for 1% to 2% of all cancer deaths. This total includes 22,900 cases of oral cavity cancer, 12,250 cases of laryngeal cancer, and 12,410 cases of pharyngeal cancer. Most patients with head and neck cancer have metastatic disease at the time of diagnosis (regional nodal involvement in 43% and distant metastasis in 10%).

Head and neck cancers encompass a diverse group of uncommon tumors that frequently are aggressive in their biologic behavior.

Small-cell lung carcinoma (SCLC) accounts for 20% to 25% of all new cases of lung cancer in the United States. It is estimated that approximately 42,000 new cases will occur in the United States in 1995 [1,2]. Of the various histologic types of lung cancer, small-cell is the most sensitive to chemotherapy and radiotherapy, yet overall outcome is poor, with only 5% to 10% of patients surviving 5 years from diagnosis.

As discussed in chapter 6, there are two major subdivisions of lung cancer:small-cell lung cancer (SCLC), for which chemotherapy is the primary treatment,and non-small-cell lung cancer (NSCLC). SCLC is decreasing in frequencyin the United States, with recent data showing it represents only 14%of lung cancers. This chapter provides information on the staging and prognosis,pathology and pathophysiology, treatment, and follow-up of longtermsurvivors of SCLC and concludes with brief discussions on mesotheliomaand thymoma.

In 2005, it is estimated that head and neck cancers will comprise 2%-3% of allcancers in the United States and account for 1%-2% of all cancer deaths. Thistotal includes 20,780 cases of oral cavity cancer, 9,880 cases of laryngeal cancer,and 8,590 cases of pharyngeal cancer. Most patients with head and neckcancer have metastatic disease at the time of diagnosis (regional nodal involvementin 43% and distant metastasis in 10%).

The activity of docetaxel (Taxotere) as a single agent (overall response rates, 24%-45%) in the treatment of patients with recurrent squamous cell cancer of the head and neck has resulted in the investigation of docetaxel-based doublet and triplet combinations in both the recurrent and neoadjuvant settings. When combined with cisplatin, with or without fluorouracil (5-FU), in the treatment of recurrent disease, response rates of 33% to 44% have been observed for docetaxel, with median survival ranging from 9.6 to 11 months. In the neoadjuvant setting, response rates have been typically greater than 90%, with promising disease-free and overall survival results.

Dr. Sandler has written a thorough and cogent review of the literature on irinotecan (CPT-11, Camptosar) in the treatment of small-cell lung cancer. The most promising data are those from a randomized trial by Noda et al, which showed that irinotecan, compared to etoposide, in combination with cisplatin resulted in an approximately 3-month survival benefit in patients with extensive disease, good performance status, and an age < 70 years. The results of this trial were published recently in The New England Journal of Medicine and, therefore, will attract wide readership and, presumably, much enthusiasm and excitement.[1]