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Head and neck cancers comprise of a diverse set of malignancies with varying therapy and prognosis. This page is therefore the landing page for the remaining pages. I have arranged the pages according to the type of neoplasms.
Head and Neck Anatomy
Anatomy resources
This page has links and information regarding various aspects of head and neck anatomy. The main emphasis is on radiological imaging which forms the basis for much of the radiation oncology work
Target volume delineation guidelines
CTV delineation is a crucial aspect of the overall 3D planning process. This page attempts to summarize the current guidelines and elicit a healthy discussion on the various practical issues in same.
Tumor Types
Epithelial Malignancies
Given the important place of the aerodigestive tract mucosa in the head and neck region and its exposure to the environmental carcinogens it is hardly surprising that the malignancies of epithelial origin form the bulk of the head and neck cancer burden.
Non epithelial malignancies
Non epithelial malignancies while rarer do present a significant challange to the treating oncologist.
Evidence based summaries(?)
Evidence based summaries form the backbone of modern day oncology practice. This section will attempt to summarize and present the news as it happens. Writers are encouraged to post their experience from relevant CMEs and conferences here.
Upcoming and controversial issues
The diversity of malignancies encountered in this region encourages innovation which in turn breeds controversies. While Evidence based reviews and summaries are helpful they only go so far when it comes to deciding the treatment for an individual. This section is a celebration of the differences in opinion encountered while managing the different tumors of this region.
Case snippets
A collection of case discussions posted in the isocentre forum. The purpose of this section is to keep a compilation of some interesting discussions and rare cases for future use by another oncologist.
Published articles
A listing of articles with comments, which is different to evidence based summaries above which are overviews.
WHAT IS THE OPTIMAL RADIATION DOSE FOR VERUCCOUS CARCINOMA OF ORAL CAVITY WITH N0-NECK?
IS THERE ANY ROLE FOR ADJUVANT RADIOTHERAPY OR/AND CHEMOTHERAPY IN GRANULOSA CELL TUMORS OF OVARY??
Dear Colleagues,
We recently came across a patient 65 yr male with multiple primaries-scc at floor of mouth (3X3 cm), ventral aspect of tongue (1.5X1.5) and also R Buccal mucosa (2X2 cm) and R level II LN 2X2 cm. Our tumor board decided for CT+RT but we were left undecided on the staging of this patient. Any inputs?
-For breast usually the largest T is taken, is there something similar for head and neck cancers?
-Most studies are on second primaries-metachronous rather than synchronous primaries….
European Archives of Oto-Rhino-Laryngology
Volume 262, Number 1, 17-20, DOI: 10.1007/s00405-004-0743-y
Head and Neck Oncology
Panendoscopy and synchronous second primary tumors in head and neck cancer patients
Kimmo Hujala, Jukka Sipilä and Reidar Grenman
Eight patients with synchronous second primaries were found to represent a prevalence of 3.9%
J //Laryngol Otol. 2002 Oct;116(10):831-8.
Survival in second primary malignancies of patients with head and neck cancer.
Di Martino E, Sellhaus B, Hausmann R, Minkenberg R, Lohmann M, Esthofen MW.//
Patients who developed metachronous tumours had a five-year survival rate of 68.9 per cent for the index tumours, and a 26 per cent five-year survival rate with the occurrence of a second neoplasm. With synchronous tumours a mean survival time of 18 months and a five-year survival rate of 11.9 per cent was found (p < 0.0001).
The prognosis of synchronous tumours is significantly lower when compared to malignancies of a metachronous nature, despite some encouraging individual results. Only the early implementation of aggressive treatment methods for second primaries is successful in terms of survival.
Depends if the first two are on right or left. If on left then assign LN status to R buccal tumour. If not then you have a dilemma - all R sided tumours are N1? Largest is N1? The next problem comes with a nodal or distant recurrence and assigning that to a primary site.
Many Thanks AAM, and yes they are all on right side!!!!
Sounds like the floor of mouth and ventral tongue are contiguous lesions. The probability of toungue/fom lesion metastasizing to neck node is higher than buccal mucosa. I think all primaries should be staged separately. Its hard to say which one is N1. Will have to check the latest TNM book.