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

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Presentation on theme: "HEAD AND NECK CANCER Kenyatta National Hospital Research Symposium 13 th April 2012."— Presentation transcript:

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

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 Parotid Tumor Before surgeryAfter surgery – Deltocervical flap

19 Ameloblastoma Before SurgeryAfter Surgery - FFF

20 Oral Carcinoma Before surgeryAfter surgery - Buccinator flap

21 Skin Cancer Before SurgeryAfter Surgery – Pec major flap

22 Tongue Cancer Intra-operativeAfter surgery - FRFF

23 Osteoradionecrosis Pre-operativeAfter surgery – pec major flap

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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