Cancer of the head and neck. Hypopharynx and larynx. Reasons for failure and management of recurrence

Predisposing failure in the treatment of cancer of the hypopharynx and larynx are often due to late diagnosis, which stems from the following: (1) failure to recognize the importance of symptoms such as hoarseness, dysphagia, or discomfort in the throat; (2) casual examination of the larynx and pyriform sinuses on mirror laryngoscopy, or failure to do a direct examination when the mirror examination is unsatisfactory; (3) faulty interpretation of the gross findings, and neglect of biopsy as a means of proving or disproving the diagnosis; (4) poor biopsy technique; (5) failure to perform a second biopsy in some instances when the findings from initial biopsy are reported to be normal; and (6) inadequate follow up in cases where the diagnosis is not established, and in instances in which a premalignant lesion such as leukoplakia is found.41 The important causes of failure in the treatment of proved cancer in these