HEAD AND NECK CANCER
Kenyatta National Hospital Research Symposium
13th April 2012
What are they?
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Cancers of following anatomical sites:
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Oral cavity
Nose & paranasal sinuses
Oropharynx
Hypopharynx
Nasopharynx
Larynx
Cervical oesophagus
Salivary glands
Soft tissues of the neck & ears
The Burden
Very common
 Worldwide:
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◦ 5% of all newly diagnosed cancer cases
◦ 640,000 cases per year
◦ 35,000 deaths per year
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Locally:
◦ No prevalence or incidence figures
◦ Second commonest malignancy reported after
cancer of cervix in 2000-2002
Risk Factors
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Smoking and tobacco use
Alcohol consumption
Gastroesophageal reflux disease
Human papillomavirus
EBV
Radiation exposure
Genetic factors
Diet
Environmental pollutants
Socio-economic status
Screening?
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No evidence for an effective screening
programme
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Calls for stepping up public awareness:
◦ Clinicians
◦ public
Age/Sex distribution
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Males more than females
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Incidence tends to increase with age
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Majority (85%) over 50 yrs in UK
Warning symptoms & signs
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Persistent:
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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
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Work-up
History
 Physical examination
 Investigations:
◦ Haematological
◦ Radiological:
 CT-Scans/MRI
 U/S
 Plain x-rays
◦ Histological
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Staging
Management Considerations
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Morbidity
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Function
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Cosmesis
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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
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Late Presentation & Nutrition
challenge
Treatment Options
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Curative or palliative:
◦ Surgery:
 Laser
 Endoscopic
 open
◦ Radiotherapy:
 External beam
 brachytherapy
◦ Chemotherapy
◦ Combinations
Multidisciplinary Head & Neck Team
◦ Otolaryngology
◦ Maxillofacial
◦ Plastic &
Reconstruction
◦ Neurosurgery
◦ Cardiothoracic
◦ Anaesthesia
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Pathology
Nursing
Radiology
oncology
Counselling
Nutrition
Before surgery
After surgery – Deltocervical flap
Parotid Tumor
Before Surgery
After Surgery - FFF
Ameloblastoma
Before surgery
After surgery - Buccinator flap
Oral Carcinoma
Before Surgery
After Surgery – Pec major flap
Skin Cancer
Intra-operative
After surgery - FRFF
Tongue Cancer
Pre-operative
After surgery – pec major flap
Osteoradionecrosis
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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The Future
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Research
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Technology