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HEAD AND NECK CANCER

HEAD AND NECK CANCER. Kenyatta National Hospital Research Symposium 13 th April 2012. What are they? . Cancers of following anatomical sites: Oral cavity Nose & paranasal sinuses Oropharynx Hypopharynx Nasopharynx Larynx Cervical oesophagus Salivary glands

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HEAD AND NECK CANCER

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  1. HEAD AND NECK CANCER Kenyatta National Hospital Research Symposium 13th April 2012

  2. What are they? • Cancers of following anatomical sites: • Oral cavity • Nose & paranasal sinuses • Oropharynx • Hypopharynx • Nasopharynx • Larynx • Cervical oesophagus • Salivary glands • Soft tissues of the neck & ears

  3. The Burden • Very common • Worldwide: • 5% of all newly diagnosed cancer cases • 640,000 cases per year • 35,000 deaths per year • Locally: • No prevalence or incidence figures • Second commonest malignancy reported after cancer of cervix in 2000-2002

  4. Risk Factors • Smoking and tobacco use • Alcohol consumption • Gastroesophageal reflux disease • Human papillomavirus • EBV • Radiation exposure • Genetic factors • Diet • Environmental pollutants • Socio-economic status

  5. Screening? • No evidence for an effective screening programme • Calls for stepping up public awareness: • Clinicians • public

  6. Age/Sex distribution • Males more than females • Incidence tends to increase with age • Majority (85%) over 50 yrs in UK

  7. Warning symptoms & signs • Persistent: • Red/white patches in oral cavity • Swelling in neck – usually painless • Ulcer/swelling in oral cavity or oropharynx • Abnormal tooth mobility • Throat discomfort • Hoarseness • Dysphagia/odynophagia

  8. Warning symptoms & signs • Serosanguinous nasal discharge • Unilateral nasal blockage • Unilateral hearing loss • Facial weakness/numbness • Unexplained ear pain • Orbital swellings • Changes in a mole

  9. Work-up • History • Physical examination • Investigations:- • Haematological • Radiological: • CT-Scans/MRI • U/S • Plain x-rays • Histological • Staging

  10. Management Considerations • Morbidity • Function • Cosmesis • Quality of life

  11. Voiceless

  12. Cosmesis / QOL

  13. Osteoradionecrosis with Orocutaneous Fistula

  14. Challenges of HNC • Late presentation/confusing symptoms • Nutritional issues • Airway issues • Availability/affordability of diagnostic facilities • Compliance • Follow-up

  15. Late Presentation & Nutrition challenge

  16. Treatment Options • Curative or palliative: • Surgery: • Laser • Endoscopic • open • Radiotherapy: • External beam • brachytherapy • Chemotherapy • Combinations

  17. Multidisciplinary Head & Neck Team • Otolaryngology • Maxillofacial • Plastic & Reconstruction • Neurosurgery • Cardiothoracic • Anaesthesia • Pathology • Nursing • Radiology • oncology • Counselling • Nutrition

  18. Before surgery After surgery – Deltocervical flap Parotid Tumor

  19. Before Surgery After Surgery - FFF Ameloblastoma

  20. Before surgery After surgery - Buccinator flap Oral Carcinoma

  21. Before Surgery After Surgery – Pec major flap Skin Cancer

  22. Intra-operative After surgery - FRFF Tongue Cancer

  23. Pre-operative After surgery – pec major flap Osteoradionecrosis

  24. Challenges of Management • Waiting time for cancer patients remains long • Post-operative care of free flaps • Pathology services:- • Frozen section • Inadequate reporting on margins, nodal status, vascular invasion, neural invasion • Delayed reports • Lack of equipment & materials • Post-operative radiation waiting time

  25. The Future • Research • Technology

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