oral cancer
DESCRIPTION
Oral Cancer. Professor Ravi Kant MS, DNB, FRCS (Edin.) ,FRCS( Glasg.), FACS , FICS, MNAMS,. WHAT IS NEW IN HEAD AND NECK CANCERS?. Dr. K.A.Pathak, MS, Dip NB, FRCS, FRCSEd. Associate Professor in Head & Neck Oncology Tata Memorial Hospital, Mumbai. HPV. Normal. Dysplasia. 9p,3p. p53. - PowerPoint PPT PresentationTRANSCRIPT
Oral Cancer
Professor Ravi KantMS, DNB, FRCS (Edin.) ,FRCS( Glasg.), FACS , FICS, MNAMS,
WHAT IS NEW IN HEAD AND NECK CANCERS?
Dr. K.A.Pathak, MS, Dip NB, FRCS, FRCSEd.
Associate Professor in Head & Neck Oncology
Tata Memorial Hospital, Mumbai
New Molecular Model
Normal
HPV
9p,3pDysplasia
CISHNSCC
p53
13q,17p
? 6p
14q,8p
11q,4q
Califano et al , Cancer Research 1996
What is New in Imaging?
• Ultrasonography and Guided FNAC
Real time
Inexpensive
Quicker but operator dependent
Doppler can show flow characteristics
• CT Scan with 3 D views
• Virtual Laryngoscopy
CT Scan with 3 D views
Virtual Laryngoscopy
MRI and MR Angiography
Residual / recurrent locoregional disease
Detection of occult primaries in MUO
Occult metastatic disease in the neck
Synchronous primaries or metastasis
18FDG-PET
What is New in Staging ?
T4 lesions have been divided into T4a (resectable) and T4b (unresectable)
Stage IVA T4a N0 M0T4a N1 M0T1-4a N2 M0
Stage IVB T4b Any N M0Any T N3 M0
Stage IVC Any T Any N M1
(AJCC 6th Ed, 2000)
What is New in Surgery?Oral cavity: Pattern of Mandibular invasion
Mandible Preservation
Larynx: Endoscopic Laser ExcisionConservative laryngectomyPrimary voice rehabilitation
PNS Tumors: Endoscopic Sinus SurgeryCranio-facial Excision
What is New in Chemotherapy ?
Category Hazard ratioCT effect Abs. benefit (p) 2yrs 5yrs
Adjuvant 0.98 0.74 1% 1%
Neo-adjuvant 0.95 0.10 2% 2%
Concomitant 0.81 <0.0001 7% 8%
Total 0.90 <0.0001 4% 4%
MACH-NC, LANCET 2000
Laryngeal Preservation• VALCSG 1991
Larynx preserved in 64% patients
No change in overall survival
• EORTC 1996
42% functioning larynx-3 yrs, 35% -5 yrs
• RTOG 2003
88% functioning larynx at 2 years
22% loco- regional failures
What is New in Radiotherapy ?
Techniques • Alt. Fractionation- Accelerated & Hyperfr.• 3D Conformal Radiotherapy & IMRT • Stereotactic/ Fr. Stereotactic Radiothearpy• Neutron Beam/Charged Particle RT• Intraoperative Radiotherapy
Radiation Induced Xerostomia• Pharmacological Agents- Amifostin, GMCSF• Submandibular Gland Transfer (Seikaly et al)
Newer Targets of Therapy
• Photodynamic Therapy: Palliation
Curative intent- Small primary tumor
Second primary/ Recurrent tumor
Premalignant lesions
• Antibody based Therapy
Monoclonal Ab against EGFr-C225
Inhibitors of EGFr-ZD1839, Erlotinib HCl
• Gene Therapy
Gene Therapy- ApproachesAugmentation therapy
Immunotherapy: Cytokine gene transfer- IL-2,IL-12, IFN- Vaccination Tumor specific antigen
Co-stimulator molecule
Foreign antigenChemotherapy: HSV TK
Drug sensitization / Drug resistanceGene replacement
Replace tumor suppressor gene- p53Inhibit an oncogene- Antisense c DNA
Adjuvant Therapy- Post CT / RT/ Surgery
Chemoprevention Possible Roles
• Reversal of oral pre-cancerous lesions• Chemoprevention of SPT• Primary chemoprevention in high-risk
Phamacological Agents• Beta Carotene• Retinoids- 13cRA,Vitamin A• Retinamides tocopherol
Overview
• Molecular Basis of Carcinogenesis
• Imaging- 3-D CT , MR Angio, FDG-PET
• Staging- Changes in TNM (6th Ed. AJCC)• Concurrent Chemo- RT- MACH- NC, RTOG
• Advances in Radiotherapy Techniques
• Improved Quality of Life- Post Surgery/RT
• Newer Targets for therapy
• Advances in Chemoprevention