The diagnosis, classification and treatment of cancers of the head and neck features in one-third of all the Semon Lectures given since its inception in 1913.
The first to address the issue, in 1924, was Dr Jean Guisez of Paris, who focused on malignant tumours of the oesophagus. He notes that whilst it is not the most serious form of cancer, it is ‘one of the most grave’, with the patient often dying not of the cancel, but of hunger. He acknowledged that surgical removal of the malignancy was ideal, but rarely prolonged life. The poor results did not, he argued, compensate for the difficulties that accompanied surgical endeavour. He concluded with outlining palliative care for the patient.
During the decades that followed, several explorations were made of the treatment of head and neck cancers; the introduction of conservation surgery (1969), the use of histology in diagnosis and classification (1959, 1970), and the refinement of radiotherapy in treating cancers (1931, 1968). Throughout most of the century, surgical removal (complete, or conservative) and radiotherapy remained the only real treatment options for cases of malignancy. In 1978, Clifford introduced the use of cytotoxic drugs in head and neck cancers, offering the first really novel treatment. In the 90’s and 00’s, the Semon Lectures captured several innovations in head and neck cancer, namely the potential of investigation into the role of oncogenes and the reclassification of carcinomas.
Despite these advances, and new technologies, the general outcomes have not improved. In 1984, Shaw pointed out that only about 40% of head and neck cancers were ‘cured’, and his lecture identified the need to shift focus from improving prognosis to improving patient care. Stell’s 1986 lecture “Head and Neck Cancer: Can we do any better?” reaffirmed this, pointing out that there had been no real increase in cured for head and neck cancer, but that through reconstruction and rehabilitation, the quality of life of the patient was improving.
In 1990, Maran pointed to disciplinary boundaries and specialist expertise as a possible explanation for poor outcomes. He argued that lack of clarity over whose responsibility the treatment of head and neck cancers was led to ‘occasional head and neck surgeons’ with poor outcomes, and that by limiting surgical treatment to within the discipline, improvement could be seen by fewer, but more expert head and neck surgeons. This was readdressed in 2001 by Gluckman, who discussed the implementation and maintenance of certification of head and neck surgeons in order to keep skills up to date and learn new techniques. Most recently, the focus has indeed been on patient care, rather than radical cure. The real innovations in surgical techniques seen recently, including laser microsurgery (2005) and robotics (2014), emphasise the retention of function, less risk and rapid recovery.