One of the greatest challenges in the treatment of cancers in the head and neck is the occurrence of further tumours. World wide, cancer of the head and neck is the sixth most common cancer, and its prevalence is increasing. Despite therapeutic advances over the past 20 years, survival rates remain poor. Why? As treatment of local disease has improved, so the opportunity has arisen for further tumours to develop, which adversely affect survival. In 1953 Slaughter et al first proposed the concept of field cancerisation, based on finding satellites of dysplastic epithelium adjacent to the main lesion. Such a concept helps to explain why multiple primary cancers and recurrence can occur, particularly in patients who stop smoking and drinking alcohol. Although alcohol and tobacco are the most important aetiological factors, second malignant tumours can arise in those who have never drunk alcohol or smoked.
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