Download Head and Neck Cancer - Principles D Amott

Head and Neck Cancer:
Principles
Dr Deborah Amott
[email protected]
What kinds of cancer are we talking
about?
Aerodigestive
tract SCC
Skin cancer:
BCC, SCC
Melanoma
Other:
Salivary Gland
Sarcoma
Neural
CNS
What kinds of cancer are we talking
about?
Aerodigestive
tract SCC
History: A Framework
 History of Presenting Complaint
 Risk Factors for Cancer
 Impact of Disease on Patient
 Impact of Patient on Disease
History of the Presenting
Complaint
 Local
 Local extension
 Metastases
 Systemic effects
Local
Local
 Pain: primary,
referred
 Bleeding
 Mass effect
 Loss of function
Local Extension
Local Extension
 Adjacent invasion
 Perineural invasion
(motor, sensation)
 Caeloemic spread
Metastases
Metastases
Lymphatic
Haematogenous:
typical locations?
Systemic effects
 Metabolic
 Hormonal
 Paraneoplastic
Symptoms of the Cancer Itself
 Local
 Metastases
 Pain: primary, referred
 Lymphatic
 Bleeding
 Haematogenous: typical
locations?
 Mass effect
 Loss of function
 Local extension
 Systemic effects
 Metabolic
 adjacent invasion
 Hormonal
 perineural invasion (motor,
sensation)
 Paraneoplastic
 caeloemic spread
History: A Framework
 Risk Factors for Cancer
 Genetic
 Environmental
Risk Factors
 Have you had a cancer in this area before?
 Genetic risks
 Generic: age, sex, family history
 Specific: syndromes
 Environmental
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
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Sex n’ Drugs n’ Rock and Roll
Occupational
Diet
Sun exposure
Immune dysfunction/suppression
History: A Framework
 Impact of Disease on Patient
 Impact of Patient on Disease
Impact of Disease on Patient
Organ specific
Systemic
Psychological
Impact of Patient on Disease
 Does the patient have co-morbidities that will
impact on your ability to treat the cancer?
 Does your patient have social considerations that
will impact on their ability to undergo
treatment?
Assessment of Co-morbidities
 Smoking
 Diabetes: microvascular, macrovascular, meds (insulin vs. OHGs)
 Cardiac: ischaemia, failure, arrhythmias
 Vascular disease: IHD, PVD, AAA, Stroke, renovascular disease
 Respiratory: COPD, asthma, PE/DVT, previous pneumonia
 Kidney
 Liver
 Blood thinning medications
 Infectious risk: IVDU, VRE, MRSA, immunosuppression
Social History
 Lives alone?
 Married/Partnered?
 Partner’s Health
 Employment
 Financial and Insurance status
 Travel implications
Examination
 Primary site
 Second primary?
 Regional spread
 Distant Metastases
Investigations
What information are we looking for?
Investigations
Confirm diagnosis
Confirm curability
Fitness for Treatment
Treatment
Aims of Curative Treatment
Oncology
Function
Cosmesis
Requirements for Cure
Disease
Patient
Doctor
What treatments do we use?
Surgery
Radiation
Chemotx
Biological
What if we can’t cure it?
What if we can’t cure it?
 Palliative care is specialised care and support provided for
someone living with a terminal illness.
 Importantly, palliative care also involves care and support for
family and caregivers.
 The goal of palliative care is to improve quality of life for
patients, their families and caregivers by providing care that
addresses the many needs patients, families and caregivers
have: physical (including treatment of pain and other
symptoms), emotional, social, cultural and spiritual.
 Palliative care aims to help the patient live as well as
possible.
The Bigger Picture
How do we move beyond the patient in front of us?
Future Directions
Prevention
Early Detection
Stage Specific Survival
Post-treatment rehabilitation
Palliation
Future Directions
Prevention
Early Detection
Stage Specific Survival
Post-treatment rehabilitation
Palliation
References