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Oral Cancer

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.

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Oral Cancer

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  1. Oral Cancer Professor Ravi Kant MS, DNB, FRCS (Edin.) ,FRCS( Glasg.), FACS , FICS, MNAMS,

  2. 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

  3. HPV Normal Dysplasia 9p,3p p53 ? 6p 14q,8p CIS HNSCC 13q,17p 11q,4q New Molecular Model Califano et al , Cancer Research 1996

  4. 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

  5. CT Scan with 3 D views

  6. Virtual Laryngoscopy

  7. MRI and MR Angiography

  8. 18FDG-PET • Residual / recurrent locoregional disease • Detection of occult primaries in MUO • Occult metastatic disease in the neck • Synchronous primaries or metastasis

  9. What is New in Staging ? T4 lesions have been divided into T4a (resectable) and T4b (unresectable) Stage IVA T4a N0 M0 T4a N1 M0 T1-4a N2 M0 Stage IVB T4b Any N M0 Any T N3 M0 Stage IVC Any T Any N M1 (AJCC 6th Ed, 2000)

  10. 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

  11. What is New in Chemotherapy ? Category Hazard ratio CT 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

  12. 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

  13. 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)

  14. 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

  15. 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- p53 Inhibit an oncogene- Antisense c DNA Adjuvant Therapy- Post CT / RT/ Surgery

  16. 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 • a-tocopherol

  17. Thank You!

  18. 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

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