9 General introduction 1 General Introduction Head and Neck Cancer Head and neck cancer (HNC) includes malignancies of the upper aerodigestive tract above the level of the clavicles [1]. It encompasses the lip and oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, nasal cavity and paranasal sinuses, salivary glands, lymph node metastases from unknown primary tumors, ear canal/middle ear carcinomas (lateral skull base), and various skin tumors in the head and neck region. To this are added: thyroid carcinomas with involvement of the larynx, cervical esophagus and tracheal tumors, malignant orbital, non-ocular tumors and HNC in children [2]. The vast majority of HNCs are squamous cell carcinomas [1]. The complex head and neck region is responsible for many different functions such as eating, speaking and swallowing. At the same time, the appearance of the face plays a very important role in social interaction. HNC and its treatment affects these important functions in most patients and regularly also the appearance. Epidemiology and etiology Head and neck cancer is the seventh most common cancer worldwide. In 2020, there were 930,000 new patients with HNC and 470,000 related deaths [3, 4]. In the Netherlands, HNC accounts for about three percent of the total number of malignant neoplasms, making it one of the ten most common forms of cancer. The incidence of HNC in the Netherlands has ranged from 3000 to 3250 new cases per year over the past 10 years, with an increase in the incidence of oral cavity and oropharyngeal tumors and a decrease in laryngeal cancer [5]. This increase in the incidence of oropharyngeal cancer is consistent with global figures, in which the increased incidence of human papilloma virus (HPV) related oropharyngeal squamous cell carcinoma accounts for most of this growth [6]. While tobacco and alcohol use remain the leading causes of HNC, the incidence of laryngeal cancer is slowly declining, in part due to decreased tobacco use [3]. Treatment of head and neck cancer Due to the complexity of diagnostic procedures and therapeutic modalities, HNC treatment is centralized in dedicated multidisciplinary HNC centers [7]. According to the Dutch Cooperative Head & Neck Group, treatment should start within 30 calendar days after the first consultation in 80% of the patients [2]. To minimize the time between the first consultation and the start of treatment, a multidisciplinary consultation on the first day has been introduced in several
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