title: Initial staging for squamous cell carcinoma of the mouth, larynx and pharynx (except nasopharynx). Part 3: general assessment. 2012 SFORL recommendations.
abstract: OBJECTIVE
  The French Society of Otorhinolaryngology (SFORL) set up a work group to draw up guidelines for initial staging of head and neck squamous cell carcinoma. Locoregional and remote extension assessment are dealt with in two separate reports. The present part 3 deals with the assessment of frequent associated symptoms and pathologies, requiring early treatment and the collection of data on a certain number of clinical and paraclinical parameters for therapeutic decision-making in the multidisciplinary team meeting.
  
  
  METHODS
  A multidisciplinary critical analysis of the literature was conducted. General assessment here covers screening, assessment and initial management of the following: usual risk factors (smoking, alcohol, HPV), the most frequent medical comorbidities, nutritional status, social and psychological status, dental status, pain and possible anemia. As oncologic management frequently associates surgery, radiation therapy and chemotherapy, the underlying examinations should be early, as part of initial staging. The levels of evidence for the examinations were estimated so as to grade guidelines, failing which expert consensuses were established.
  
  
  RESULTS
  The high rates of pain, malnutrition and anemia call for systematic screening and early management, especially as rapidly effective treatments exist. Assessing comorbidity and social and psychological status enables general health status to be assessed, along with possible contraindications to the usual treatments. Tracheal intubation problems may require intubation under flexible endoscopy or jet-ventilation by inter-cricothyroid catheterization from the diagnostic endoscopy stage. Assessment and adapted dental care should be conducted if radiation therapy is likely or certain.
  
  
  CONCLUSIONS
  Early management of symptoms and comorbidity and anticipation of subsequent treatment are intended to shorten initial staging time and to collate the data needed for therapeutic decision-making. This assessment should be performed at the same time as the locoregional and remote extension assessment, and is obviously to be adapted according to tumoral extension stage and the possible treatment options.
authors: Service d'ORL et de Chirurgie Cervico-Faciale, Centre François-Xavier-Michelet, Groupe Hospitalier Pellegrin, CHU, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France. erwan.de-mones-del-pujol@chu-bordeaux.fr
authors: E
authors: E
authors: de Monès
authors: S
authors: S
authors: Vergez
authors: B
authors: B
authors: Barry
authors: C
authors: C
authors: Righini
authors: F
authors: F
authors: Rolland
authors: G
authors: G
authors: Raoul
authors: M
authors: M
authors: Langeard
authors: J F
authors: JF
authors: Chassagne
authors: C
authors: C
authors: Badoual
authors: S
authors: S
authors: Morinière
authors: D
authors: D
authors: de Raucourt
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy; D006801:Humans; D033183:Interdisciplinary Communication; D007822:Laryngeal Neoplasms / Q000473:pathology* / Q000628:therapy; D009062:Mouth Neoplasms / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D010348:Patient Care Team; D010610:Pharyngeal Neoplasms / Q000473:pathology* / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors