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 ◦ Soft tissues of the neck & ears

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

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

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

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

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

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

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

Management Considerations Morbidity Function Cosmesis Quality of life

Voiceless

Cosmesis / QOL

Osteoradionecrosis with Orocutaneous Fistula

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

Late Presentation & Nutrition challenge

Treatment Options Curative or palliative: ◦ Surgery:  Laser  Endoscopic  open ◦ Radiotherapy:  External beam  brachytherapy ◦ Chemotherapy ◦ Combinations

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

Parotid Tumor Before surgeryAfter surgery – Deltocervical flap

Ameloblastoma Before SurgeryAfter Surgery - FFF

Oral Carcinoma Before surgeryAfter surgery - Buccinator flap

Skin Cancer Before SurgeryAfter Surgery – Pec major flap

Tongue Cancer Intra-operativeAfter surgery - FRFF

Osteoradionecrosis Pre-operativeAfter surgery – pec major flap

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

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