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 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. 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