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