When should the medical oncologist call the surgeon?

Head and neck squamous cell carcinoma (HNSCC) is a pathology that necessitates collaborative care and multidisciplinary management. There is a role for timely surgical involvement which evolves at different stages of disease progression. Upfront surgery remains the standard of care for resectable disease at certain subsites to provide locoregional control and definitive pathologic information for accurate staging and guidance of adjuvant therapies. Surgery also fits into advancing treatment paradigms with neoadjuvant systemic approaches. This requires early assessment of surgical candidacy to ensure operability and sequence scheduling. While never the ideal outcome, in the setting of post-chemoradiation and persistent or recurrent disease, salvage surgery and the timely referral still can offer the best opportunity for durable control. Operative intervention can provide meaningful palliation for airway compromise, bleeding, or severe dysphagia. Surgeon team members are essential in shared surveillance, managing treatment-related sequelae, and intervening early when systemic therapy response is suboptimal.