Oral Cancer Professor Ravi Kant MS, DNB, FRCS (Edin.),FRCS( Glasg.), FACS, FICS, MNAMS,

WHAT IS NEW IN HEAD AND NECK CANCERS? Dr. K.A.Pathak, MS, Dip NB, FRCS, FRCSEd. Associate Professor in Head & Neck Oncology Tata Memorial Hospital, Mumbai

New Molecular Model Normal HPV 9p,3p Dysplasia CIS HNSCC p53 13q,17p ? 6p 14q,8p 11q,4q Califano et al, Cancer Research 1996

What is New in Imaging? Ultrasonography and Guided FNAC Real time Inexpensive Quicker but operator dependent Doppler can show flow characteristics CT Scan with 3 D views Virtual Laryngoscopy

CT Scan with 3 D views

Virtual Laryngoscopy

MRI and MR Angiography

 Residual / recurrent locoregional disease  Detection of occult primaries in MUO  Occult metastatic disease in the neck  Synchronous primaries or metastasis 18 FDG-PET

What is New in Staging ? T4 lesions have been divided into T4a (resectable) and T4b (unresectable) Stage IVA T4aN0M0 T4a N1 M0 T1-4a N2 M0 Stage IVB T4b Any N M0 Any T N3 M0 Stage IVC Any T Any NM1 (AJCC 6 th Ed, 2000)

What is New in Surgery? Oral cavity: Pattern of Mandibular invasion Mandible Preservation Larynx: Endoscopic Laser Excision Conservative laryngectomy Primary voice rehabilitation PNS Tumors: Endoscopic Sinus Surgery Cranio-facial Excision

What is New in Chemotherapy ? Category Hazard ratioCT effect Abs. benefit (p) 2yrs 5yrs Adjuvant % 1% Neo-adjuvant % 2% Concomitant 0.81 < % 8% Total 0.90 < % 4% MACH-NC, LANCET 2000

Laryngeal Preservation VALCSG 1991 Larynx preserved in 64% patients No change in overall survival EORTC % functioning larynx-3 yrs, 35% -5 yrs RTOG % functioning larynx at 2 years 22% loco- regional failures

What is New in Radiotherapy ? Techniques Alt. Fractionation- Accelerated & Hyperfr. 3D Conformal Radiotherapy & IMRT Stereotactic/ Fr. Stereotactic Radiothearpy Neutron Beam/Charged Particle RT Intraoperative Radiotherapy Radiation Induced Xerostomia Pharmacological Agents- Amifostin, GMCSF Submandibular Gland Transfer (Seikaly et al)

Newer Targets of Therapy Photodynamic Therapy: Palliation Curative intent- Small primary tumor Second primary/ Recurrent tumor Premalignant lesions Antibody based Therapy Monoclonal Ab against EGFr-C225 Inhibitors of EGFr-ZD1839, Erlotinib HCl Gene Therapy

Gene Therapy- Approaches Augmentation therapy Immunotherapy: Cytokine gene transfer- IL-2,IL-12, IFN-  VaccinationTumor specific antigen Co-stimulator molecule Foreign antigen Chemotherapy: HSV TK Drug sensitization / Drug resistance Gene replacement Replace tumor suppressor gene- p53 Inhibit an oncogene- Antisense c DNA Adjuvant Therapy- Post CT / RT/ Surgery

Chemoprevention  Possible Roles Reversal of oral pre-cancerous lesions Chemoprevention of SPT Primary chemoprevention in high-risk  Phamacological Agents Beta Carotene Retinoids- 13cRA,Vitamin A Retinamides   tocopherol

Overview Molecular Basis of Carcinogenesis Imaging- 3-D CT, MR Angio, FDG-PET Staging- Changes in TNM (6th Ed. AJCC) Concurrent Chemo- RT- MACH- NC, RTOG Advances in Radiotherapy Techniques Improved Quality of Life- Post Surgery/RT Newer Targets for therapy Advances in Chemoprevention