Download Non-surgical Treatment of Head and Neck Cancer - G-Care

Non-surgical Treatment of
Head and Neck Cancer
Dr Audrey Cook
Consultant Clinical Oncologist
Gloucestershire Oncology Centre
What might GPs want to know about nonsurgical treatments?
•How to support and advise patient:
•At diagnosis
• Prognosis
• Treatment options
•During treatment
• Acute side effects
•After treatment
• Reduction and management of long term side
effects
• Risk of recurrence/when to refer back
Prognosis
Depends on
Stage
Histology - ?HPV +ve
Smoking history
Performance status
Treatment options
Why radiotherapy?
•Can be given alone or with surgery +/or
chemotherapy
•May be preferred treatment for:
•Cancers difficult to remove surgically
•Where surgery may impair
swallowing/speaking
•Post surgery to reduce risk of recurrence
Treatment options
Why chemotherapy?
•Concurrent chemo-radiotherapy more effective
than radiotherapy alone, especially when
lymph nodes involved
•Neo-adjuvant chemotherapy before
radiotherapy may improve results for large
tumours
•Palliative chemo for recurrence
Treatment options
Other treatments
•Cetuximab
•This is a monoclonal antibody. Targets a
receptor on cancer cells and stops them
growing
•Is used with RT in some patients
•Can be used with chemotherapy for
recurrent cancer
•Occasionally can be used alone
Main side effect is skin rash
During Treatment
Side effects from treatment
•Sometimes RT can lead to severe difficulty in
swallowing, particularly if it’s combined with
chemotherapy.
•“Usually this is temporary and settles within
a few weeks of completing treatment.”
•Is this too optimistic?
Post treatment
Main Long term Side -effects
•Swallowing difficulties
•Dry mouth
•Tooth decay
• Trismus
• Osteoradionecrosis
• Hearing problems
Post Treatment
Most common patient concerns after treatment
•Fear of Recurrence (40%)
•Dental health/teeth
•Chewing/eating
•Swallowing
•Fatigue/tiredness
•Dry mouth
How can we reduce side-effects?
•Stopping smoking
•Reducing alcohol intake
•Good diet
•Dental hygiene
•Dental assessment and treatment prior to RT
•SALT support
•Radiotherapy planning techniques
Reduction of side effects
Radiotherapy planning
Careful
shaping of
fields to
match tumour
Conventional fields for RT to tonsil
IMRT radiotherapy planning
IMRT
RT for a nasopharyngeal cancer
How we can help post treatment?
•Fear of recurrence? Follow up? Mindfulness?
•Swallowing difficulties? SALT
•Dry mouth? Water. Acupuncture?
•Tooth decay? Dental hygiene.
•Trismus? SALT
•Osteoradionecrosis? Beware dental extractions!
•Hearing problems? Grommets?