Oral Cancer Professor Ravi Kant MS DNB FRCS
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, FRCSEd. Associate Professor in Head & Neck Oncology Tata Memorial Hospital, Mumbai
New Molecular Model HPV Normal Dysplasia 9 p, 3 p p 53 HNSCC 14 q, 8 p ? 6 p CIS 13 q, 17 p 11 q, 4 q 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
18 FDG-PET è Residual / recurrent locoregional disease è Detection è Occult of occult primaries in MUO metastatic disease in the neck è Synchronous primaries or metastasis
What is New in Staging ? T 4 lesions have been divided into T 4 a (resectable) and T 4 b (unresectable) Stage IVA Stage IVB Stage IVC T 4 a T 1 -4 a T 4 b Any T N 0 N 1 N 2 Any N N 3 Any N M 0 M 0 M 0 M 1 (AJCC 6 th Ed, 2000)
What is New in Surgery? Oral cavity: Pattern of Mandibular invasion Mandible Preservation Larynx: Endoscopic Laser Excision Conservative laryngectomy Primary voice rehabilitation PNS Tumors: Endoscopic Sinus Surgery Cranio-facial Excision
What is New in Chemotherapy ? Category Hazard ratio (p) Adjuvant 1% Neo-adjuvant CT effect Abs. benefit 5 yrs 2 yrs 0. 98 0. 74 1% MACH-NC, LANCET 2000 0. 95 0. 10 2%
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. 3 D 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-C 225 Inhibitors of EGFr-ZD 1839, Erlotinib HCl • Gene Therapy
Gene Therapy- Approaches Augmentation therapy Immunotherapy: Cytokine gene transfer- IL-2, IL-12, IFN- g Vaccination Tumor specific antigen Co-stimulator molecule Foreign antigen Chemotherapy: HSV TK Drug sensitization / Drug resistance Gene replacement Replace tumor suppressor gene- p 53 Inhibit 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- 13 c. RA, Vitamin A Retinamides a-tocopherol
Overview • • Molecular Basis of Carcinogenesis Imaging- 3 -D CT , MR Angio, FDG-PET Staging- Changes in TNM (6 th 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
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