Head and Neck Cancers

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Head and Neck Cancers"

Transcription

1 Clinical Head and Neck Cancers Version Continue

2 Head and Neck Cancers Head and Neck Cancers Panel Members * Arlene A. Fastiere, MD/Chair The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Kian Ang, MD, PhD The University of Texas M. D. Anderson Cancer Center Timothy Aliff, MD Memial Sloan-Kettering Cancer Center Athanassios Argiris, MD Robert H. Lurie Comprehensive Cancer Center of Nthwestern University David Brizel, MD Duke Comprehensive Cancer Center Bruce E. Brockstein, MD Robert H. Lurie Comprehensive Cancer Center of Nthwestern University Frank Dunphy, MD Duke Comprehensive Cancer Center David Eisele, MD UCSF Comprehensive Cancer Center Joshua Ellenhn, MD City of Hope Cancer Center Helmuth Goepfert, MD The University of Texas M. D. Anderson Cancer Center Wesley L. Hicks, Jr., MD Roswell Park Cancer Institute Waun Ki Hong, MD The University of Texas M. D. Anderson Cancer Center Merrill S. Kies, MD The University of Texas M. D. Anderson Cancer Center William M. Lydiatt, MD UNMC Eppley Cancer Center at The Nebraska Medical Center Thomas McCaffrey, MD, PhD H. Lee Moffitt Cancer Center & Research Institute at the University of South Flida * Bharat B. Mittal, MD Robert H. Lurie Comprehensive Cancer Center of Nthwestern University David G. Pfister, MD Memial Sloan-Kettering Cancer Center Harlan A. Pinto, MD Stanfd Hospital and Clinics Marshall R. Posner, MD Dana-Farber/Partners CancerCare * John A. Ridge, MD, PhD Fox Chase Cancer Center Continue * * * * Nest R. Rigual, MD Roswell Park Cancer Institute David E. Schuller, MD Arthur G. James Cancer Hospital & Richard J. Solove Research Institute at The Ohio State University Jatin P. Shah, MD Memial Sloan-Kettering Cancer Center Ashok Shaha, MD Memial Sloan-Kettering Cancer Center Sharon Spencer, MD University of Alabama at Birmingham Comprehensive Cancer Center Andrew Trotti, III, MD H. Lee Moffitt Cancer Center & Research Institute at the University of South Flida Richard H. Wheeler, III, MD Huntsman Cancer Institute at the University of Utah Gregy T. Wolf, MD University of Michigan Comprehensive Cancer Center Frank Wden, MD University of Michigan Comprehensive Cancer Center Bevan Yueh, MD, MPH Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance * Writing Committee Member Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of.

3 Head and Neck Cancers Table of Contents Head and Neck Cancers Panel Members Multidisciplinary Team Approach (TEAM-1) Suppt Modalities (TEAM-1) Ethmoid Sinus Tums (ETHM-1) Maxillary Sinus Tums (MAXI-1) Salivary Gland Tums (SALI-1) Cancer of the Lip (LIP-1) Cancer of the Oral Cavity (OR-1) Cancer of the Oropharynx (ORPH-1) Cancer of the Hypopharynx (HYPO-1) Occult Primary (OCC-1) Cancer of the Glottic Larynx (GLOT-1) Cancer of the Supraglottic Larynx (N0) (SUPRA-1) Cancer of the Supraglottic Larynx (N+) (SUPRA-5) Cancer of the Nasopharynx (NASO-1) Unresectable Head and Neck Cancer (ADV-1) Recurrent Head and Neck Cancer (ADV-2) F help using these documents, please click here Staging Manuscript References Clinical Trials: The believes that the best management f any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. To find clinical trials online at member institutions, click here: nccn.g/clinical_trials/physician.html Categies of Consensus: All recommendations are Categy 2A unless otherwise specified. See Categies of Consensus Print the Head and Neck Cancers Guideline These guidelines are a statement of consensus of the auths regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply consult these guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient s care treatment. The National Comprehensive Cancer Netwk makes no representations warranties of any kind, regarding their content use application and disclaims any responsibility f their application use in any way. These guidelines are copyrighted by National Comprehensive Cancer Netwk. All rights reserved. These guidelines and the illustrations herein may not be reproduced in any fm without the express written permission of Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of.

4 Team Approach MULTIDISCIPLINARY TEAM The management of patients with head and neck cancers is complex. All patients need access to the full range of specialists and suppt services with expertise in the management of patients with head and neck cancer f optimal treatment and follow-up. Head and neck surgery Clinical Social wk Radiation oncology Nutrition suppt Medical oncology Pathology Plastic and reconstructive surgery Diagnostic radiology Specialized nursing care Adjunctive services Dentistry/prosthodontics Neurosurgery Physical medicine and Ophthalmology rehabilitation Psychiatry Speech and swallowing therapy Addiction Services SUPPORT AND SERVICES Follow-up should be perfmed by a physician with expertise in the management and prevention of treatment sequelae. It should include a comprehensive head and neck exam. The management of head and neck cancer patients may involve the following: Pain and symptom management Nutritional suppt Enteral feeding Oral supplements Dental care f RT effects Xerostomia management Smoking cessation Tracheotomy care Social wk and Case management Supptive Care (See Palliative Care Guideline) Back to Head and Neck Table of Contents Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. TEAM-1

5 Ethmoid Sinus Tums WORKUP Untreated H&P CT/MRI Chest x-ray Biopsy Malignant See Primary Treatment and Follow-up (ETHM-2) Ethmoid sinus: Squamous cell carcinoma Adenocarcinoma Salivary gland cancer Esthesioneuroblastomas Diagnosed with incomplete excision H&P CT/MRI Pathology review Chest x-ray See Primary Treatment and Follow-up (ETHM-2) Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. ETHM-1

6 Ethmoid Sinus Tums CLINICAL PRESENTATION PRIMARY TREATMENT ADJUVANT TREATMENT FOLLOW-UP Newly diagnosed; T1, T2 Complete surgical resection Definitive RT Adjuvant RT if adverse characteristics a Newly diagnosed; T3, T4 resectable Newly diagnosed, unresectable Diagnosed after incomplete excision (eg, polypectomy, endoscopic procedure) and gross residual disease Complete surgical resection Chemo/RT RT Clinical trial (preferred) Surgery (preferred), if feasible RT Chemo/RT Postoperative RT to primary RT Physical exam: Year 1, every 1 3 mo Year 2, every 2 4 mo Years 3 5, every 4 6 mo > 5 years, every 6 12 mo Chest imaging as clinically indicated TSH every 6-12 mo if neck irradiated CT scan/mri- baseline (categy 2B) Diagnosed after incomplete exision (eg, polypectomy, endoscopic procedure) and no disease on physical exam, imaging, and/ endoscopy RT Surgery, if feasible RT Recurrence (see ADV-2) a Adverse characteristics include positive margins and perineural invasion. Back to Head and Neck Table of Contents Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. ETHM-2

7 Maxillary Sinus Tums WORKUP PATHOLOGY Benign Complete surgical resection as indicated H&P Complete head and neck CT with contrast/mri Dental/prosthetic consultation as indicated Chest x-ray Biopsy a Lymphoma Malignant Squamous cell carcinoma Undifferentiated carcinoma Adenocarcinoma Min salivary gland tum Sarcoma See Non-Hodgkin s Lymphoma Guidelines T1-2, N0 All histologies T3-4, N0, Any T, N+ All histologies See Primary Treatment (MAXI-2) See Primary Treatment (MAXI-3) a Biopsy: Preferred route is transnasal. Needle biopsy may be acceptable. Avoid canine fossa puncture Caldwell-Luc approach. Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. MAXI-1

8 Maxillary Sinus Tums STAGING PRIMARY TREATMENT ADJUVANT TREATMENT FOLLOW-UP Margin negative T1, N0 All histologies T2, N0 Squamous cell carcinoma, undifferentiated Complete surgical resection Complete surgical resection Perineural invasion Margin positive Margin negative Perineural invasion Margin positive RT b Surgical reresection, if possible Consider RTb including upper ipsilateral neck RT b Surgical reresection, if possible RTb to primary RTb to primary + upper ipsilateral neck Physical exam: Year 1, every 1 3 mo Year 2, every 2 4 mo Years 3 5, every 4 6 mo > 5 years, every 6 12 mo Chest imaging as clinically indicated TSH every 6-12 mo, if neck irradiated CT/MRI- baseline (categy 2B) T2, N0 Adenoidcystic, other histologies Complete surgical resection Consider postoperative RTb to primary site only b See Principles of Radiation Therapy (MAXI-A). Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. MAXI-2

9 Maxillary Sinus Tums STAGING PRIMARY TREATMENT ADJUVANT TREATMENT FOLLOW-UP T3, N0 Operable T4, all histologies T4, inoperable, all histologies Any T, N+, resectable Complete surgical resection Clinical trial Definitive RTb Chemo/RTb Surgical excision + neck dissection Adverse characteristics c No adverse characteristics Adverse characteristics c No adverse characteristics Chemotherapy/RTb (categy 2B) Postoperative RT to primary and neck (f squamous cell carcinoma and undifferentiated tums) Chemotherapy/RTb (categy 2B) RT to primary + neck Physical exam: Year 1, every 1 3 mo Year 2, every 2 4 mo Years 3 5, every 4 6 mo > 5 years, every 6 12 mo Chest imaging as clinically indicated TSH every 6-12 mo, if neck irradiated CT/MRI- baseline (categy 2B) bsee Principles of Radiation Therapy (MAXI-A). c Adverse characteristics include positive margins and perineural invasion. Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. MAXI-3

10 Maxillary Sinus Tums RADIATION THERAPY GUIDELINES Definitive RT Primary and gross adenopathy: 66 Gy (2.0 Gy/day) External-beam RT 50 Gy + brachytherapy Neck Low-risk nodal stations: 50 Gy (2.0 Gy/day) Adjuvant RT Primary: 60 Gy (2.0 Gy/day) Neck High-risk nodal stations: 60 Gy (2.0 Gy/day) Low-risk nodal stations: 50 Gy (2.0 Gy/day) Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. MAXI-A

11 Salivary Gland Tums CLINICAL PRESENTATION WORKUP TREATMENT Untreated resectable See Wkup and Primary Treatment (SALI-2) Salivary gland mass Parotid Submaxillary Min salivary glanda Previously treated incompletely resected H&P CT/MRI Pathology review Chest x-ray Negative physical exam and imaging Gross residual disease on physical exam imaging Surgical resection, if possible No surgical resection possible Adjuvant RT b Adjuvant RT b Definitive RTb Chemo/RT (categy 2B) See Followup (SALI-4) Not resectable Fine-needle aspiration Open biopsy Definitive RTb Chemo/RT (categy 2B) asite and stage determine therapeutic approaches. bsee Radiation Therapy Guidelines (SALI-A). Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. SALI-1

12 Salivary Gland Tums WORKUP PRIMARY TREATMENT Benign low grade Follow-up Untreated resectable, clinically benign, c < 4 cm (T1, T2) Complete surgical excision d Adenoid cystic RT (categy 2B f T1) to tum bed and skull base Intermediate high grade RT to tum bed and entire ipsilateral neck Benign Follow-up Untreated resectable, clinically suspicious f cancer, > 4 cm deep lobe CT/MRI: base of skull to clavicle Consider fine-needle aspiration Lymphoma Surgical resection Cancer Parotid superficial lobe Parotid deep lobe See Treatment (SALI-3) See Treatment (SALI-3) See Non-Hodgkin s Lymphoma Guidelines Other salivary gland tums See Treatment (SALI-3) ccharacteristics of benign tum include mobile superficial lobe, slow growth, painless, VII intact, and no neck nodes. dsurgical excision of clinically benign tum: no enucleation of lateral lobe, intraoperative communication with pathologist if indicated. Back to Head and Neck Table of Contents Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. SALI-2

13 Salivary Gland Tums TREATMENT Parotid superficial lobe Parotid deep lobe Clinical N0 Clinical N+ Clinical N0 Clinical N+ Parotidectomy Parotidectomy + comprehensive neck dissection Total parotidectomy Total parotidectomy + comprehensive neck dissection Completely excised Incompletely excised gross residual disease No further surgical resection possible No adverse characteristics Intermediate high grade adenoid cystic Close positive margins Neural/perineural invasion Lymph node metastases Lymphatic/vascular invasion See Followup (SALI-4) Adjuvant RT b Definitive RTb Chemo/RT (categy 2B) Other salivary gland tums Clinical N0 Clinical N+ Complete excision Complete excision and lymph node dissection No adverse characteristics Intermediate high grade adenoid cystic Close positive margins Neural/perineural invasion Lymph node metastases Lymphatic/vascular invasion See Followup (SALI-4) Adjuvant RT b b See Radiation Therapy Guidelines (SALI-A). Follow-up and Recurrence (see SALI-4) Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. SALI-3

14 Salivary Gland Tums FOLLOW-UP RECURRENCE Physical exam: Year 1, every 1 3 mo Year 2, every 2 4 mo Years 3 5, every 4 6 mo > 5 yr, every 6 12 mo Chest imaging as clinically indicated TSH every 6-12 mo, if neck irradiated Locegional distant disease; Resectable Locegional disease; Not resectable Surgery + selected metastasectomy (categy 3) RTb Chemo/RT (categy 2B) Chemotherapy Best supptive care RT b See Radiation Therapy Guidelines (SALI-A). Back to Head and Neck Table of Contents Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. SALI-4

15 Salivary Gland Tums RADIATION THERAPY GUIDELINES Definitive RT Unresectable disease gross residual disease Photon/electron therapy neutron therapy Dose Primary and gross adenopathy: 70 Gy ( Gy/day) ngy (1.2 ngy/day) Low-risk nodal stations: Gy ( Gy/day) ngy (1.2 ngy/day) Adjuvant RT Photon/electron therapy neutron therapy Dose Primary: 60 Gy ( Gy/day) 1 18 ngy (1.2 ngy/day) Neck: Gy ( Gy/day) ngy (1.2 ngy/day) 1 Range based on grade/natural histy of disease (eg, 1.8 Gy fraction may be used f slower growing tums). Back to Wkup and Primary Treatment (SALI-1) Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. SALI-A

16 Cancer of the Lip WORKUP CLINICAL STAGING T1-2, N0 See Treatment of Primary and Neck (LIP-2) H&P Biopsy Chest x-ray As indicated f primary evaluation Panex CT/MRI Preanesthesia studies Dental evaluation Multidisciplinary consultation as indicated Resectable T3, T4, N0 Any T, N1-3 Surgical candidate Po surgical risk See Treatment of Primary and Neck (LIP-3) Definitive RTa to Follow-up primary and nodes Unresectable See Treatment of Head and Neck Cancer (ADV-1) a See Radiation Therapy Guidelines (LIP-A). Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. LIP-1

17 Cancer of the Lip CLINICAL STAGING TREATMENT OF PRIMARY AND NECK FOLLOW-UP Positive margins Reexcision RTa Chemo/RT (categy 3) T1 2, N0 Surgical excision Perineural/vascular/ lymphatic invasion No adverse pathologic findings RTa Chemo/RT (categy 3) Physical exam: Year 1, every 1 3 mo Year 2, every 2 4 mo Years 3 5, every 4 6 mo >5yr, every 6 12 mo External-beam RT 50 Gy + brachytherapy Brachytherapy alone External-beam RT 66 Gy Residual recurrent tum post-rt Surgery/ reconstruction Recurrence (see ADV-2) a See Radiation Therapy Guidelines (LIP-A). Back to Head and Neck Table of Contents Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. LIP-2

18 Cancer of the Lip CLINICAL STAGING: RESECTABLE T3, T4, N0; Any T, N1-3 TREATMENT OF PRIMARY AND NECK FOLLOW-UP N0 Excision of primary ± unilateral bilateral selective neck dissection (reconstruction as indicated) One positive node without adverse features Adjuvant RTa optional Surgical candidate Surgery External RT a ± brachytherapy N1, N2a b, N3 N2c (bilateral) Excision of primary, ipsilateral comprehensive neck dissection ± contralateral selective neck dissection (reconstruction as indicated) Excision of primary and bilateral comprehensive neck dissection (reconstruction as indicated) Primary site: Complete response Primary site: < complete response Residual neck mass Complete response of neck T4 Close/positive margins Perineural/ lymphatic/vascular invasion Multiple positive nodes Extracapsular spread N1 (initial stage) N2-3 (initial stage) Salvage surgery + neck dissection as indicated Neck dissection (categy 3 f selective vs comprehensive) Observe Observe Neck dissection (categy 3 f selective vs comprehensive) Chemo/RT Physical exam: Year 1, every 1 3 mo Year 2, every 2 4 mo Years 3 5, every 4 6 mo >5yr, every 6 12 mo a See Radiation Therapy Guidelines (LIP-A). Recurrence (see ADV-2) Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. LIP-3

19 Cancer of the Lip RADIATION THERAPY GUIDELINES Definitive RT Primary and gross adenopathy: 66 Gy (2.0 Gy/day) External-beam RT 50 Gy + brachytherapy brachytherapy alone Neck Low-risk nodal stations: 50 Gy (2.0 Gy/day) Adjuvant RT Primary: 60 Gy (2.0 Gy/day) Neck High-risk nodal stations: 60 Gy (2.0 Gy/day) Low-risk nodal stations: 50 Gy (2.0 Gy/day) Back to Clinical Staging (LIP-1) Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. LIP-A

20 Cancer of the Oral Cavity Buccal mucosa, flo of mouth, anteri tongue, alveolar ridge, retromolar trigone, hard palate WORKUP CLINICAL STAGING T1 2, N0 See Treatment of Primary and Neck (OR-2) H&P Biopsy Chest x-ray Chest CTa As indicated f evaluation Panex CT/MRI Examination under anesthesia, if indicated Preanesthesia studies Dental evaluation Multidisciplinary consultation as indicated Resectable T3, N0 Resectable T1 3, N1 3 Resectable T4, any N Resectable Po medical/ surgical risk See Treatment of Primary and Neck (OR-2) See Treatment of Primary and Neck (OR-3) See Treatment of Primary and Neck (OR-4) See Treatment of Primary and Neck (OR-4) Unresectable See Treatment of Head and Neck Cancer (ADV-1) a Chest CT should be considered f patients at high risk f thacic metastases. Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. OR-1

21 Cancer of the Oral Cavity Buccal mucosa, flo of mouth, anteri tongue, alveolar ridge, retromolar trigone, hard palate CLINICAL STAGING TREATMENT OF PRIMARY AND NECK FOLLOW-UP T1 2, N0 Resectable T3, N0 External-beam RT ± brachytherapy 70 Gy to primary 50 Gy to neck at risk Excision of primary (preferred) b ± unilateral bilateral selective neck dissection Excision of primary and reconstruction as indicated and unilateral bilateral selective neck dissection Residual disease One positive node without adverse features T3 4 Close/positive margins Perineural/lymphatic/ vascular invasion Multiple positive nodes Extracapsular spread Salvage surgery Adjuvant RTc optional Chemo/RTc (categy 1) Adjuvant RTc Chemo/RTc (categy 1) Physical exam: Year 1, every 1-3 mo Year 2, every 2-4 mo Years 3-5, every 4-6 mo > 5 yr, every 6-12 mo Chest imaging as clinically indicated TSH every 6-12 mo, if neck irradiated bexcluding buccal mucosa. csee Radiation Therapy Guidelines (OR-A). Recurrence (see ADV-2) Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. OR-2

22 Cancer of the Oral Cavity Buccal mucosa, flo of mouth, anteri tongue, alveolar ridge, retromolar trigone, hard palate CLINICAL STAGING TREATMENT OF PRIMARY AND NECK FOLLOW-UP Resectable T1 3, N1 3 Surgery (preferred) External RT c ± brachytherapy ± neck dissection Chemotherapy/RT (categy 3) N1, N2a-b, N3 N2c (bilateral) c See Radiation Therapy Guidelines (OR-A). Excision of primary, ipsilateral comprehensive neck dissection ± contralateral selective neck dissection (reconstruction as indicated) Excision of primary and bilateral comprehensive neck dissection (reconstruction as indicated) Primary site: Complete response Primary site: residual tum Residual neck mass Complete response of neck One positive node without adverse features T3 4 Close/positive margins Perineural/lymphatic/ vascular invasion Multiple positive nodes Extracapsular spread N1 (initial stage) N2-3 (initial stage) Salvage surgery + neck dissection as indicated Observe Adjuvant RTc optional Chemo/RTc (categy 1) Neck dissection (categy 3 f selective vs comprehensive) Observe Neck dissection (categy 3 f selective vs comprehensive) Physical exam: Year 1, every 1-3 mo Year 2, every 2-4 mo Years 3-5, every 4-6 mo > 5 yr, every 6-12 mo Chest imaging as clinically indicated TSH every 6-12 mo, if neck irradiated Recurrence (see ADV-2) Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. OR-3

23 Cancer of the Oral Cavity Buccal mucosa, flo of mouth, anteri tongue, alveolar ridge, retromolar trigone, hard palate CLINICAL STAGING Resectable T4, Any N Resectable Po medical/ surgical risk TREATMENT OF PRIMARY AND NECK Surgery (preferred f bone invasion) Chemotherapy/ RT (categy 3) External RT c ± brachytherapy Adverse characteristics d No adverse characteristics Primary site: Complete response Primary site: residual tum Residual neck mass Complete response of neck Chemotherapy/RTc (categy 1) RTc N1 (initial stage) N2-3 (initial stage) Salvage surgery + neck dissection as indicated Neck dissection (categy 3 f selective vs comprehensive) Observe Observe Neck dissection (categy 3 f selective vs comprehensive) FOLLOW-UP Physical exam: Year 1, every 1-3 mo Year 2, every 2-4 mo Years 3-5, every 4-6 mo > 5 yr, every 6-12 mo Chest imaging as clinically indicated TSH every 6-12 mo, if neck irradiated csee Radiation Therapy Guidelines (OR-A). d Adverse characteristics include positive margins and perineural invasion. Recurrence (see ADV-2) Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. OR-4

24 Cancer of the Oral Cavity Buccal mucosa, flo of mouth, anteri tongue, alveolar ridge, retromolar trigone, hard palate RADIATION THERAPY GUIDELINES Definitive RT Primary and gross adenopathy: 70 Gy (2.0 Gy/day) External-beam RT 50 Gy ± brachytherapy Neck Low-risk nodal stations: 50 Gy (2.0 Gy/day) Adjuvant RT Primary: 60 Gy (2.0 Gy/day) Neck High-risk nodal stations: 60 Gy (2.0 Gy/day) Low-risk nodal stations: 50 Gy (2.0 Gy/day) Back to Clinical Staging (OR-1) Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. OR-A

25 Base of tongue/tonsil/posteri pharyngeal wall/soft palate Cancer of the Oropharynx WORKUP CLINICAL STAGING H&P Biopsy Chest x-ray Chest CTa CT with contrast MRI recommended f primary and neck Panex as indicated Dental evaluation Examination under anesthesia with laryngoscopy Preanesthesia studies Multidisciplinary consultation as indicated T1-2, N0-1 T3-4, N0 Any T, N2-3 T3-4, N+ See Treatment of Primary and Neck (ORPH-2) See Treatment of Primary and Neck (ORPH-3) See Treatment of Primary and Neck (ORPH-4) a Chest CT should be considered f patients at high risk f thacic metastases. Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. ORPH-1

26 Base of tongue/tonsil/posteri pharyngeal wall/soft palate Cancer of the Oropharynx CLINICAL STAGING TREATMENT OF PRIMARY AND NECK FOLLOW-UP T1-2, N0-1 Definitive RT, b external ± brachytherapy (RT preferred f most T1-2 lesions [categy 2B]) Concurrent chemotherapy/rt (categy 2B) T2, N1 only Excision of primary ± unilateral bilateral neck dissection Primary controlled Residual disease Primary controlled Residual disease No adverse features One positive node without adverse features Adverse features Close/positive margins Perineural/lymphatic/ vascular invasion Multiple positive nodes Extracapsular spread Salvage surgery Salvage surgery Adjuvant RTb optional Adjuvant RT b Chemo/RTb (categy 1) Physical exam: Year 1, every 1-3 mo Year 2, every 2-4 mo Years 3-5, every 4-6 mo > 5 yr, every 6-12 mo Chest imaging as clinically indicated TSH every 6-12 mo, if neck irradiated Recurrence (see ADV-2) b See Radiation Therapy Guidelines (ORPH-A). Back to Head and Neck Table of Contents Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. ORPH-2

27 Base of tongue/tonsil/posteri pharyngeal wall/soft palate Cancer of the Oropharynx CLINICAL STAGING TREATMENT OF PRIMARY AND NECK FOLLOW-UP T3-4, N0 Concurrent chemotherapy/rtb (categy 1) preferred Surgery + RTb Primary controlled Residual disease Salvage surgery Physical exam: Year 1, every 1-3 mo Year 2, every 2-4 mo Years 3-5, every 4-6 mo > 5 yr, every 6-12 mo Chest imaging as clinically indicated TSH every 6-12 mo, if neck irradiated Recurrence (see ADV-2) b See Radiation Therapy Guidelines (ORPH-A). Back to Head and Neck Table of Contents Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. ORPH-3

28 Base of tongue/tonsil/posteri pharyngeal wall/soft palate Cancer of the Oropharynx CLINICAL STAGING Any T3-4, N+ Any T, N2-3 TREATMENT OF PRIMARY AND NECK Concurrent chemotherapy/rtb (categy 1) preferred Surgery: primary and neck b See Radiation Therapy Guidelines (ORPH-A). Primary site: complete response Primary site: residual tum N1 N2a b N3 N2c Residual neck mass Complete response of neck N1 (initial stage) N2-3 (initial stage) Salvage surgery + neck dissection as indicated Excision of primary, ipsilateral comprehensive neck dissection (reconstruction as indicated) Excision of primary and bilateral comprehensive neck dissection (bilateral is categy 3) (reconstruction as indicated) Neck dissection (categy 3 f selective vs comprehensive) Observe Observe Neck dissection (categy 3 f selective vs comprehensive) Adjuvant RT b Chemo/RTb (categy 1) FOLLOW-UP Physical exam: Year 1, every 1-3 mo Year 2, every 2-4 mo Years 3-5, every 4-6 mo > 5 yr, every 6-12 mo Chest imaging as clinically indicated TSH every 6-12 mo, if neck irradiated Recurrence (see ADV-2) Back to Head and Neck Table of Contents Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. ORPH-4

29 Base of tongue/tonsil/posteri pharyngeal wall/soft palate Cancer of the Oropharynx RADIATION THERAPY GUIDELINES Chemadiation Conventional fractionation: 70 Gy (2.0 Gy/day) Definitive RT (Alone) T1-2, N0 Conventional fractionation: 70 Gy (2.0 Gy/day) ± brachytherapy Selected T2, T3-4, N1-3 Altered fractionation (preferred): Concomitant boost accelerated RT: 72 Gy/6 weeks (1.8 Gy/fraction, large field; 1.5 Gy boost as second daily fraction during last 12 treatment days) Hyperfractionation: 81.6 Gy/7 weeks (1.2 Gy/fraction BID) Adjuvant RT Primary: 60 Gy (2.0 Gy/day) Neck High-risk nodal stations: 60 Gy (2.0 Gy/day) Low-risk nodal stations: 50 Gy (2.0 Gy/day) Back to Clinical Staging (ORPH-1) Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. ORPH-A

30 Cancer of the Hypopharynx WORKUP CLINICAL STAGING H&P Biopsy Chest x-ray Chest CTa CT with contrast MRI of primary and neck recommended Examination under anesthesia with laryngoscopy and esophagoscopy Preanesthesia studies Dental evaluation Early T stage not requiring total laryngectomy Most T1, N0-1 small T2, N0 Resectable advanced cancer requiring total laryngectomy T1, N2-3; T2-4, Any N (Participation in clinical trials preferred) T1, N2-3; T2-3, Any N T4, Any N See Treatment of Primary and Neck (HYPO-2) See Treatment of Primary and Neck (HYPO-3) See Treatment of Primary and Neck (HYPO-3) Multidisciplinary consultation as indicated Unresectable See Treatment of Head and Neck Cancer (ADV-1) a Chest CT should be considered f patients at high risk f thacic metastases. Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. HYPO-1

31 Cancer of the Hypopharynx CLINICAL STAGING TREATMENT OF PRIMARY AND NECK FOLLOW-UP Early T stage (not requiring total laryngectomy) Most T1, N0-1, small T2, N0 Definitive RT b Primary site: complete response Primary site: residual tum Surgery: Partial laryngopharyngectomy + ipsilateral bilateral selective neck dissection (N0); Comprehensive neck dissection levels 1-5 (N1) Residual neck mass Complete response of neck Salvage surgery + neck dissection as indicated No adverse features Adverse features: Close/positive margins Perineural/lymphatic/ vascular invasion Positive nodes Extracapsular spread Neck dissection (categy 3 f selective vs comprehensive) Observe Chemo/RTb (categy 1) Physical exam: Year 1, every 1-3 mo Year 2, every 2-4 mo Years 3-5, every 4-6 mo > 5 yr, every 6-12 mo Chest imaging as clinically indicated TSH every 6-12 mo, if neck irradiated b See Radiation Therapy Guidelines (HYPO-A). Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. HYPO-2

32 Cancer of the Hypopharynx CLINICAL STAGING TREATMENT OF PRIMARY AND NECK FOLLOW-UP Induction chemotherapyc x 2 cycles (categy 1) See Response After Induction Chemotherapy (HYPO-4) T1, N2-3; T2-3, any N (if total laryngectomy required) T4, any N Laryngopharyngectomy + selective (N0) comprehensive (N+) neck dissection Multimodality clinical trial of concurrent chemadiation that includes function evaluation Surgery + comprehensive neck dissection Multimodality clinical trial of concurrent chemadiation that includes function evaluation T3 Close/positive margins Perineural/lymphatic/ vascular invasion Positive nodes Extracapsular spread Chemo/RTb (categy 1) RT b Physical exam: Year 1, every 1-3 mo Year 2, every 2-4 mo Years 3-5, every 4-6 mo > 5 yr, every 6-12 mo Chest imaging as clinically indicated TSH every 6-12 mo, if neck irradiated bsee Radiation Therapy Guidelines (HYPO-A). csee Induction Chemotherapy (HYPO-B). Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. HYPO-3

33 Cancer of the Hypopharynx RESPONSE AFTER INDUCTION CHEMOTHERAPY FOR T1, N2-3; T2-3, ANY N TUMORS FOLLOW-UP Residual neck mass Neck dissection (categy 3 f selective vs comprehensive) Primary site: Complete response Primary site: Partial response (evaluation may require endoscopy) Chemotherapy x 1 cycle Definitive RT b Primary site: Complete response Primary site: residual tum Complete response of neck Salvage surgery N1 (initial stage) N2-3 (initial stage) No adverse features Adverse features Observe Observe Neck dissection (categy 3 f selective vs comprehensive) Adjuvant RT b Adjuvant chemo/rt (categy 1) Physical exam: Year 1, every 1-3 mo Year 2, every 2-4 mo Years 3-5, every 4-6 mo > 5 yr, every 6-12 mo Chest imaging as clinically indicated TSH every 6-12 mo, if neck irradiated Primary site: < Partial response Surgery Adjuvant RT b b See Radiation Therapy Guidelines (HYPO-A). Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. HYPO-4

34 Cancer of the Hypopharynx RADIATION THERAPY GUIDELINES Definitive RT Primary and gross adenopathy: 70 Gy (2.0 Gy/day) Neck Low-risk nodal stations: 50 Gy (2.0 Gy/day) Adjuvant RT Primary: 60 Gy (2.0 Gy/day) Neck High-risk nodal stations: 60 Gy (2.0 Gy/day) Low-risk nodal stations: 50 Gy (2.0 Gy/day) Back to Clinical Staging (HYPO-1) Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. HYPO-A

35 Cancer of the Hypopharynx INDUCTION CHEMOTHERAPY Cisplatin, 100 mg/m2 on day FU, 1,000 mg/m 2/24 hours Continuous infusion f 120 hours Back to Clinical Staging (HYPO-1) Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. HYPO-B

36 Head and Neck Cancers Occult Primary PRESENTATION WORKUP Squamous cell carcinoma, adenocarcinoma, and anaplastic epithelial tums a Complete head and neck exam, including nasopharyngoscopy Chest x-ray CT with contrast MRI with gadolinium (skull base through thacic inlet) PET scan (optional) See Wkup and Primary Treatment (OCC-2) Lymphoma See Non-Hodgkin s Lymphoma Guidelines Neck mass Fine-needle aspiration b Thyroid See Thyroid Carcinoma Guidelines Melanoma Systemic wk-up per Melanoma Guidelines skin exam, note regressing lesions See Primary Therapy f Melanoma (OCC-5) adetermined with appropriate immunohistochemical stains. bce open biopsy may be necessary f uncertain histologies. Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. OCC-1

37 Head and Neck Cancers Occult Primary PATHOLOGIC FINDINGS WORKUP PRIMARY TREATMENT Primary found Node level I, II, III, upper V Treat as appropriate (See ) Examination under anesthesia Palpation and inspection Biopsy of areas of clinical concern Tonsillectomy Direct laryngoscopy and nasopharynx survey Squamous cell carcinoma Adenocarcinoma (levels I III) Comprehensive neck dissection (levels I V) Comprehensive neck dissection + parotidectomy, if indicated RT to neck only See N1 with open biopsy (OCC-3) Extracapsular spread N2, N3 (OCC-4) Node level IV, lower V Direct laryngoscopy, bronchoscopy, esophagoscopy Chest/abdominal/pelvic CT Poly differentiated nonkeratinizing squamous cell NOS Anaplastic (Not thyroid) Surgery RT c (categy 3) Chemotherapy/RT (categy 3) c No residual disease Residual disease Comprehensive neck dissection (levels I V) Observe Comprehensive neck dissection c See Radiation Therapy Guidelines (OCC-A). Back to Head and Neck Table of Contents Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. OCC-2

38 Head and Neck Cancers Occult Primary POSTSURGICAL TREATMENT FOR SQUAMOUS CELL CARCINOMA; NOS OR ANAPLASTIC Level I only RTc to neck only (categy 3) RTc to al cavity, Waldeyer s ring, opharynx, both sides of the neck (block RT to the larynx) N1 with open biopsy Level II, III, upper level V Level IV only RTc to neck only (categy 3) RTc to nasopharynx, both sides of the neck, hypopharynx, larynx, opharynx RTc to neck only (categy 3) RTc to Waldeyer s ring, larynx, hypopharynx, both sides of the neck Lower level V RTc to neck only (categy 3) RTc to larynx, hypopharynx, both sides of the neck c See Radiation Therapy Guidelines (OCC-A). Back to Head and Neck Table of Contents Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. OCC-3

39 Head and Neck Cancers Occult Primary POSTSURGICAL TREATMENT FOR SQUAMOUS CELL CARCINOMA; NOS OR ANAPLASTIC Level I only RTc to neck only (categy 3) RTc to al cavity, Waldeyer s ring, opharynx, both sides of the neck (block RT to the larynx) Chemotherapy/RT (categy 2B) Extracapsular spread N2, N3 Level II, III, upper level V Level IV only RTc to neck only (categy 3) RTc to nasopharynx, both sides of the neck, hypopharynx, larynx, opharynx Chemotherapy/RT (categy 2B) RTc to neck only (categy 3) RTc to Waldeyer s ring, larynx, hypopharynx, both sides of the neck Chemotherapy/RT (categy 2B) Lower level V RTc to neck only (categy 3) RTc to larynx, hypopharynx, both sides of the neck Chemotherapy/RT (categy 2B) c See Radiation Therapy Guidelines (OCC-A). Back to Head and Neck Table of Contents Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. OCC-4

40 Head and Neck Cancers Occult Primary PRIMARY THERAPY FOR OCCULT PRIMARY- MELANOMA Level V, occipital node Posteri lateral node dissection ± RT to nodal bed d ± Adjuvant chemo, per Melanoma Guidelines All other nodal sites Comprehensive neck dissection dadjuvant radiotherapy: 30 Gy/5 fx over 2.5 weeks (6.0 Gy/fx). Careful attention to dosimetry is necessary. (Ang KK, Peters LJ, Weber RS, et al. Postoperative radiotherapy f cutaneous melanoma of the head and neck region. International Journal of Radiation Oncology, Biology, Physics 30: , 1994). Back to Head and Neck Table of Contents Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. OCC-5

41 Head and Neck Cancers Occult Primary RADIATION THERAPY GUIDELINES Mucosal sites: Gy (2.0 Gy/day) Neck Low-risk nodal stations: 50 Gy (2.0 Gy/day) High-risk nodal station(s): Gy * (2.0 Gy/day) * Up to 70 Gy in case of excision only f N1 neck. Back to Primary Treatment (OCC-2) Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. OCC-A

42 Cancer of the Glottic Larynx WORKUP a CLINICAL STAGING TREATMENT OF PRIMARY AND NECK Severe dysplasia/ carcinoma in situ See Treatment and Follow-up (GLOT-2) H&P Biopsy Chest x-ray Chest CTb CT with contrast and thin cuts through larynx, MRI of primary and neck recommended Examination under anesthesia with laryngoscopy Preanesthesia studies Dental evaluation Multidisciplinary consultation as indicated Total laryngectomy not required Most T1-2, any N Resectable Requiring total laryngectomy Most T3, any N T4 disease See Treatment and Follow-up (GLOT-2) See Treatment and Follow-up (GLOT-3) See Treatment and Follow-up (GLOT-4) Resectable Po medical/ surgical risk Definitive RT c acomplete wkup not indicated f Tis, T1. b Chest CT should be considered f patients at high risk f thacic metastases. csee Radiation Therapy Guidelines (GLOT-A). Note: All recommendations are categy 2A unless otherwise indicated. Clinical Trials: believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version , 07/12/ National Comprehensive Cancer Netwk, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any fm without the express written permission of. GLOT-1

Head and Neck Cancers

Head and Neck Cancers Clinical in Oncology Head and Neck Cancers V.1.2009 Continue www.nccn.g * Arlene A. Fastiere, MD/Chair The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Kie-Kian Ang, MD, PhD The University

More information

Head and Neck Cancers

Head and Neck Cancers NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ) Head and Neck Cancers Version 2.2014 NCCN.g Continue Version 2.2014, 05/30/14 National Comprehensive Cancer Netwk, Inc. 2014, All rights

More information

The International Federation of Head and Neck Oncologic Societies. Current Concepts in Head and Neck Surgery and Oncology

The International Federation of Head and Neck Oncologic Societies. Current Concepts in Head and Neck Surgery and Oncology The International Federation of Head and Neck Oncologic Societies Current Concepts in Head and Neck Surgery and Oncology www.ifhnos.net The International Federation of Head and Neck Oncologic Societies

More information

MANAGEMENT OF CA HYPOPHARYNX

MANAGEMENT OF CA HYPOPHARYNX MANAGEMENT OF CA HYPOPHARYNX GENERAL TREATMENT RECOMMENDATIONS BASED ON HYPOPHARYNX TUMOR STAGE For patients presenting with early-stage definitive radiotherapy alone or voice-preserving surgery are viable

More information

Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer. American Society of Clinical Oncology Clinical Practice Guideline

Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer. American Society of Clinical Oncology Clinical Practice Guideline Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer American Society of Clinical Oncology Clinical Practice Guideline Introduction ASCO convened an Expert Panel to develop recommendations

More information

NICE guideline Published: 10 February 2016 nice.org.uk/guidance/ng36

NICE guideline Published: 10 February 2016 nice.org.uk/guidance/ng36 Cancer of the upper aerodigestive e tract: assessment and management in people aged 16 and over NICE guideline Published: 10 February 2016 nice.org.uk/guidance/ng36 NICE 2018. All rights reserved. Subject

More information

Q&A. Fabulous Prizes. Collecting Cancer Data: Pharynx 12/6/12. NAACCR Webinar Series Collecting Cancer Data Pharynx

Q&A. Fabulous Prizes. Collecting Cancer Data: Pharynx 12/6/12. NAACCR Webinar Series Collecting Cancer Data Pharynx Collecting Cancer Data Pharynx NAACCR 2012 2013 Webinar Series Q&A Please submit all questions concerning webinar content through the Q&A panel. Reminder: If you have participants watching this webinar

More information

AllinaHealthSystems 1

AllinaHealthSystems 1 Head and Neck Cancer Michelle Naylor, M.D. ENT SpecialtyCare Dimensions in Oncology October 2016 Outline H&N cancer at a glance Epidemiology Rule of 80 Locations Nasopharyngeal cancer Oropharyngeal cancer

More information

Head and Neck Cancer No relationships to disclose

Head and Neck Cancer No relationships to disclose Head and Neck Cancer No relationships to disclose Michelle Naylor, M.D. ENT SpecialtyCare Dimensions in Oncology October 2017 Outline H&N cancer at a glance Epidemiology Rule of 80 Locations Nasopharyngeal

More information

FINE NEEDLE ASPIRATION OF ENLARGED LYMPH NODE: Metastatic squamous cell carcinoma

FINE NEEDLE ASPIRATION OF ENLARGED LYMPH NODE: Metastatic squamous cell carcinoma Case Scenario 1 HNP: A 70 year old white male presents with dysphagia. The patient is a current smoker, current user of alcohol and is HPV positive. A CT of the Neck showed mass in the left pyriform sinus.

More information

Case Scenario 1. 7/13/12 Anterior floor of mouth biopsy: Infiltrating squamous cell carcinoma, not completely excised.

Case Scenario 1. 7/13/12 Anterior floor of mouth biopsy: Infiltrating squamous cell carcinoma, not completely excised. Case Scenario 1 7/5/12 History A 51 year old white female presents with a sore area on the floor of her mouth. She claims the area has been sore for several months. She is a current smoker and user of

More information

Surgery. Head and Neck Cancers III: Treatment and Survival. Lip. Surgery might be the only treatment

Surgery. Head and Neck Cancers III: Treatment and Survival. Lip. Surgery might be the only treatment Head and Neck Cancers III: Treatment and Survival 2004 A.D.A.M., Inc. Division of Cancer Prevention and Control NCCDPHP, CoCHP Centers for Disease Control and Prevention Atlanta, Georgia Surgery 2 Lip

More information

What is head and neck cancer? How is head and neck cancer diagnosed and evaluated? How is head and neck cancer treated?

What is head and neck cancer? How is head and neck cancer diagnosed and evaluated? How is head and neck cancer treated? Scan for mobile link. Head and Neck Cancer Head and neck cancer is a group of cancers that start in the oral cavity, larynx, pharynx, salivary glands, nasal cavity or paranasal sinuses. They usually begin

More information

Management of unknown primary with neck node metastasis: Current evidence

Management of unknown primary with neck node metastasis: Current evidence Management of unknown primary with neck node metastasis: Current evidence Dr. Pooja Nandwani Patel Associate Professor Dept. of Radiation Oncology GCRI, Ahmedabad Introduction- Approach to Topic What is

More information

Hypopharyngeal Cancer Chemoradiotherapy or Surgery, The Debate Continues

Hypopharyngeal Cancer Chemoradiotherapy or Surgery, The Debate Continues Hypopharyngeal Cancer Chemoradiotherapy or Surgery, The Debate Continues Wharton Head and Neck Centre The Toronto General Hospital Dr. P. Gullane Wharton Chair Head & Neck Surgery Professor Department

More information

Volumi di trattamento del cavo orale

Volumi di trattamento del cavo orale SIMPOSIO: Neoplasie del cavo orale Volumi di trattamento del cavo orale F. Miccichè ! DICHIARAZIONE Relatore: Francesco Miccichè Come da nuova regolamentazione della Commissione Nazionale per la Formazione

More information

Survey of Laryngeal Cancer at SBUH comparing 108 cases seen here from to the NCDB of 9,256 cases diagnosed nationwide in 2000

Survey of Laryngeal Cancer at SBUH comparing 108 cases seen here from to the NCDB of 9,256 cases diagnosed nationwide in 2000 Survey of Laryngeal Cancer at comparing 108 cases seen here from 1998 2002 to the of 9,256 cases diagnosed nationwide in 2000 Stony Brook University Hospital Cancer Program Annual Report 2002-2003 Gender

More information

Head and Neck Reirradiation: Perils and Practice

Head and Neck Reirradiation: Perils and Practice Head and Neck Reirradiation: Perils and Practice David J. Sher, MD, MPH Department of Radiation Oncology Dana-Farber Cancer Institute/ Brigham and Women s Hospital Conflicts of Interest No conflicts of

More information

Head and Neck Case 1 PATIENT HISTORY

Head and Neck Case 1 PATIENT HISTORY Head and Neck Case 1 PATIENT HISTORY Patient History May 7, 2007 Otolaryngology Head & Neck Subjective: Patient was recently seen by a dentist, who noted a roughness in his lower alveolus, and wanted to

More information

Goals and Objectives: Head and Neck Cancer Service Department of Radiation Oncology

Goals and Objectives: Head and Neck Cancer Service Department of Radiation Oncology Goals and Objectives: Head and Neck Cancer Service Department of Radiation Oncology The head and neck cancer service provides training in the diagnosis, management, treatment, and follow-up care of head

More information

LYMPHATIC DRAINAGE IN THE HEAD & NECK

LYMPHATIC DRAINAGE IN THE HEAD & NECK LYMPHATIC DRAINAGE IN THE HEAD & NECK Like other parts of the body, the head and neck contains lymph nodes (commonly called glands). Which form part of the overall Lymphatic Drainage system of the body.

More information

AJCC Staging of Head & Neck Cancer (7 th edition, 2010) -LIP & ORAL CAVITY-

AJCC Staging of Head & Neck Cancer (7 th edition, 2010) -LIP & ORAL CAVITY- TX: primary tumor cannot be assessed T0: no evidence of primary tumor Tis: carcinoma in situ. T1: tumor is 2 cm or smaller AJCC Staging of Head & Neck Cancer (7 th edition, 2010) -LIP & ORAL CAVITY- T2:

More information

Esophageal Cancer. What is esophageal cancer?

Esophageal Cancer. What is esophageal cancer? Scan for mobile link. Esophageal Cancer Esophageal cancer occurs when cancer cells develop in the esophagus. The two main types are squamous cell carcinoma and adenocarcinoma. Esophageal cancer may not

More information

Physician to Physician AJCC 8 th Edition. Head and Neck. Summary of Changes. AJCC Cancer Staging Manual, 7 th Ed. Head and Neck Chapters

Physician to Physician AJCC 8 th Edition. Head and Neck. Summary of Changes. AJCC Cancer Staging Manual, 7 th Ed. Head and Neck Chapters Physician to Physician Head and Neck William M. Lydiatt, MD Chair of Surgery Nebraska Methodist Hospital Clinical Professor of Surgery, Creighton University Validating science. Improving patient care.

More information

Neck Imaging Reporting and Data System: An Atlas of NI-RADS Categories for Head and Neck Cancer

Neck Imaging Reporting and Data System: An Atlas of NI-RADS Categories for Head and Neck Cancer Neck Imaging Reporting and Data System: An Atlas of NI-RADS Categories for Head and Neck Cancer Bethany Cavazuti Patricia Hudgins Tanya Rath Char Branstetter Kristen Baugnon Amanda Corey Ashley Aiken Disclosures

More information

NASOPHARYNX MALIGNANT NEOPLASM MOHAMMED ALESSA MBBS, FRCSC ASSISTANT PROFESSOR, CONSULTANT OTOLARYNGOLOGY, HEAD & NECK SURGRY KING SAUD UNIVERSITY

NASOPHARYNX MALIGNANT NEOPLASM MOHAMMED ALESSA MBBS, FRCSC ASSISTANT PROFESSOR, CONSULTANT OTOLARYNGOLOGY, HEAD & NECK SURGRY KING SAUD UNIVERSITY NASOPHARYNX MALIGNANT NEOPLASM MOHAMMED ALESSA MBBS, FRCSC ASSISTANT PROFESSOR, CONSULTANT OTOLARYNGOLOGY, HEAD & NECK SURGRY KING SAUD UNIVERSITY Epidemiology Anatomy Histopathology Clinical presentation

More information

State of the Art Radiotherapy for Pediatric Tumors. Suzanne L. Wolden, MD Memorial Sloan-Kettering Cancer Center

State of the Art Radiotherapy for Pediatric Tumors. Suzanne L. Wolden, MD Memorial Sloan-Kettering Cancer Center State of the Art Radiotherapy for Pediatric Tumors Suzanne L. Wolden, MD Memorial Sloan-Kettering Cancer Center Introduction Progress and success in pediatric oncology Examples of low-tech and high-tech

More information

Polymorphous Low-Grade. December 5 th, 2008

Polymorphous Low-Grade. December 5 th, 2008 Polymorphous Low-Grade Adenocarcinoma December 5 th, 2008 Epidemiology Represents 2 nd or 3 rd most common minor salivary gland malignancy (17-26%) 1 st mucoepidermoid carcinoma Rare in reported Asian

More information

Radiotherapy in feline and canine head and neck cancer

Radiotherapy in feline and canine head and neck cancer Bettina Kandel Like surgery radiotherapy is usually a localized type of treatment. Today it is more readily available for the treatment of cancer in companion animals and many clients are well informed

More information

NAACCR Hospital Registry Webinar Series

NAACCR Hospital Registry Webinar Series NAACCR Hospital Registry Webinar Series Shannon Vann, CTR Jim Hofferkamp, CTR Webinar Series 1 Abstracting Larynx Cancer Incidence & Treatment Data Estimated new cases and deaths from laryngeal cancer

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER VULVAR

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER VULVAR PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER VULVAR Last Revision Date July 2015 1 Site Group: Gynecologic Cancer Vulvar Author: Dr. Stephane Laframboise 1. INTRODUCTION

More information

Adjuvant Therapy in Locally Advanced Head and Neck Cancer. Ezra EW Cohen University of Chicago. Financial Support

Adjuvant Therapy in Locally Advanced Head and Neck Cancer. Ezra EW Cohen University of Chicago. Financial Support Adjuvant Therapy in Locally Advanced Head and Neck Cancer Ezra EW Cohen University of Chicago Financial Support This program is made possible by an educational grant from Eli Lilly Oncology, who had no

More information

Oral cavity cancer Post-operative treatment

Oral cavity cancer Post-operative treatment Oral cavity cancer Post-operative treatment Dr. Christos CHRISTOPOULOS Radiation Oncologist Centre Hospitalier Universitaire (C.H.U.) de Limoges, France Important issues RT -techniques Patient selection

More information

Locoregional recurrences are the most frequent

Locoregional recurrences are the most frequent ORIGINAL ARTICLE SECOND SALVAGE SURGERY FOR RE-RECURRENT ORAL CAVITY AND OROPHARYNX CARCINOMA Ivan Marcelo Gonçalves Agra, MD, PhD, 1 João Gonçalves Filho, MD, PhD, 2 Everton Pontes Martins, MD, PhD, 2

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER CERVIX

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER CERVIX PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER CERVIX Site Group: Gynecology Cervix Author: Dr. Stephane Laframboise 1. INTRODUCTION 3 2. PREVENTION 3 3. SCREENING AND

More information

Salivary Glands. The glands are found in and around your mouth and throat. We call the major

Salivary Glands. The glands are found in and around your mouth and throat. We call the major Salivary Glands Where Are Your Salivary Glands? The glands are found in and around your mouth and throat. We call the major salivary glands the parotid, submandibular, and sublingual glands. They all secrete

More information

See the latest estimates for new cases of salivary gland cancers in the US and what research is currently being done.

See the latest estimates for new cases of salivary gland cancers in the US and what research is currently being done. About Salivary Gland Cancer Overview and Types If you have been diagnosed with salivary gland cancer or are worried about it, you likely have a lot of questions. Learning some basics is a good place to

More information

What is ACC? (Adenoid Cystic Carcinoma)

What is ACC? (Adenoid Cystic Carcinoma) What is ACC? (Adenoid Cystic Carcinoma) 10-9-10 Where ACC Occurs ACC (Adenoid Cystic Carcinoma) is a rare and unique form of cancer that is known to be unpredictable in nature, with a typical growth pattern

More information

Nasopharyngeal Carcinoma. Rusty Stevens, MD Christopher Rassekh, MD

Nasopharyngeal Carcinoma. Rusty Stevens, MD Christopher Rassekh, MD Nasopharyngeal Carcinoma Rusty Stevens, MD Christopher Rassekh, MD Introduction Rare in the US, more common in Asia High index of suspicion required for early diagnosis Nasopharyngeal malignancies SCCA

More information

Head and Neck Cancer Treatment

Head and Neck Cancer Treatment Scan for mobile link. Head and Neck Cancer Treatment Head and neck cancer overview The way a particular head and neck cancer behaves depends on the site in which it arises (the primary site). For example,

More information

Klinikleitung: Dr. Kessler Dr. Kosfeld Dr. Tassani-Prell Dr. Bessmann. Radiotherapy in feline and canine head and neck cancer.

Klinikleitung: Dr. Kessler Dr. Kosfeld Dr. Tassani-Prell Dr. Bessmann. Radiotherapy in feline and canine head and neck cancer. Radiotherapy in feline and canine head and neck cancer Bettina Kandel Like surgery radiotherapy is usually a localized type of treatment. Today it is more readily available for the treatment of cancer

More information

NAACCR Webinar Series 1

NAACCR Webinar Series 1 Collecting Cancer Data: Lip and Oral 2013 2014 NAACCR Webinar Series October 3, 2013 Q&A Please submit all questions concerning webinar content through the Q&A panel. Reminder: If you have participants

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Intensity Modulated Radiation Therapy (IMRT) of Head and Neck File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_imrt_of_head_and_neck

More information

MANAGEMENT OF LOCALLY ADVANCED OROPHARYNGEAL CANER: HPV AND NON-HPV MEDIATED CANCERS

MANAGEMENT OF LOCALLY ADVANCED OROPHARYNGEAL CANER: HPV AND NON-HPV MEDIATED CANCERS MANAGEMENT OF LOCALLY ADVANCED OROPHARYNGEAL CANER: HPV AND NON-HPV MEDIATED CANCERS Kyle Arneson, MD PhD Avera Medical Group Radiation Oncology Avera Cancer Institute 16 th Annual Oncology Symposium September

More information

Comparative evaluation of oral cancer staging using PET-CT vs. CECT

Comparative evaluation of oral cancer staging using PET-CT vs. CECT International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 4 Number 5 (2015) pp. 1168-1175 http://www.ijcmas.com Original Research Article Comparative evaluation of oral

More information

Salivary Glands tumors

Salivary Glands tumors Salivary Glands tumors Sal.Gl. 1 Salivary Glands tumors Work-up procedure TNM staging Primary treatment Follow-up Treatment of recurrent and/or metastatic disease References Sal.Gl. 2 Standard clinical

More information

How good are we at finding nodules? Thyroid Nodules Thyroid Cancer Epidemiology Initial management Long-term follow up Disease-free status

How good are we at finding nodules? Thyroid Nodules Thyroid Cancer Epidemiology Initial management Long-term follow up Disease-free status New Perspectives in Thyroid Cancer Jennifer Sipos, MD Assistant Professor of Medicine Division of Endocrinology The Ohio State University Outline Thyroid Nodules Thyroid Cancer Epidemiology Initial management

More information

9.1 Local Address 9.2 Name & Address of Referring / Family Doctor......

9.1 Local Address 9.2 Name & Address of Referring / Family Doctor...... 8. Duration of Stay (at the permanent place of residence (in years)) 9.1 Local Address 9.2 Name & Address of Referring / Family Doctor............ Name of City/Town/District... Pin Code Name of City/Town/District...

More information

Comprehensive Cancer Cover

Comprehensive Cancer Cover Comprehensive Cancer Cover Tech Spec Comprehensive Cancer Cover provides the life insured with cover for the diagnosis and treatment of defined malignant tumours. These tumours must be characterised either

More information

Basal Cell and Squamous Cell Skin Cancers

Basal Cell and Squamous Cell Skin Cancers Clinical Basal Cell and Squamous Cell Version 2.2005 Continue Basal Cell and Squamous Cell Basal Cell and Squamous Cell Skin Cancer Panel Members * Stanley J. Miller, MD/Chair The Sidney Kimmel Comprehensive

More information

ORIGINAL ARTICLE. Salvage Surgery After Failure of Nonsurgical Therapy for Carcinoma of the Larynx and Hypopharynx

ORIGINAL ARTICLE. Salvage Surgery After Failure of Nonsurgical Therapy for Carcinoma of the Larynx and Hypopharynx ORIGINAL ARTICLE Salvage Surgery After Failure of Nonsurgical Therapy for Carcinoma of the Larynx and Hypopharynx Sandro J. Stoeckli, MD; Andreas B. Pawlik, MD; Margareta Lipp, MD; Alexander Huber, MD;

More information

Panel consensus was not to include suggested revision.

Panel consensus was not to include suggested revision. DFSP-2 Footnote f should be revised to more accurately reflect current practice and the supporting literature and should read, 5,000-6,600 cgy for close-to-positive or positive margins (200 cgy fractions

More information

Local therapy for Breast Cancer Dr. Philip Lowry

Local therapy for Breast Cancer Dr. Philip Lowry Local therapy for Breast Cancer Dr. Philip Lowry The historical context of breast cancer treatment Cancer Staging With the historical predominance of local therapies, staging would guide Surgical candidacy

More information

journal of medicine The new england Concurrent Chemotherapy and Radiotherapy for Organ Preservation in Advanced Laryngeal Cancer abstract

journal of medicine The new england Concurrent Chemotherapy and Radiotherapy for Organ Preservation in Advanced Laryngeal Cancer abstract The new england journal of medicine established in 1812 november 27, 2003 vol. 349 no. 22 Concurrent Chemotherapy and Radiotherapy for Organ Preservation in Advanced Laryngeal Cancer Arlene A. Forastiere,

More information

SALIVARY GLAND TUMORS TREATED WITH ADJUVANT INTENSITY-MODULATED RADIOTHERAPY WITH OR WITHOUT CONCURRENT CHEMOTHERAPY

SALIVARY GLAND TUMORS TREATED WITH ADJUVANT INTENSITY-MODULATED RADIOTHERAPY WITH OR WITHOUT CONCURRENT CHEMOTHERAPY doi:10.1016/j.ijrobp.2010.09.042 Int. J. Radiation Oncology Biol. Phys., Vol. 82, No. 1, pp. 308 314, 2012 Copyright Ó 2012 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/$ - see front

More information

/ NCCN. ACS (www.cancer.org) NCC (www.nccn.org) NCCN NCCN ACS ACS-2345

/ NCCN. ACS (www.cancer.org) NCC (www.nccn.org) NCCN NCCN ACS ACS-2345 /2002 9 /2002 9 (NCCN) (ACS) NCCN ACS (www.cancer.org) NCC (www.nccn.org) NCCN 1-888-909-NCCN ACS 1-800-ACS-2345 NCCN ACS NCCN NCCN ACS NCCN 2002 (NCCN) (ACS) NCCN ACS ...................................

More information

SENTINEL LYMPH NODE BIOPSY FOR PATIENTS WITH EARLY-STAGE BREAST CANCER

SENTINEL LYMPH NODE BIOPSY FOR PATIENTS WITH EARLY-STAGE BREAST CANCER SENTINEL LYMPH NODE BIOPSY FOR PATIENTS WITH EARLY-STAGE BREAST CANCER Clinical Practice Guideline Update Introduction The original ASCO evidence-based clinical practice guidelines on use of sentinel node

More information

2018 SEER Solid Tumor Manual 2018 KCR SPRING TRAINING

2018 SEER Solid Tumor Manual 2018 KCR SPRING TRAINING 2018 SEER Solid Tumor Manual 2018 KCR SPRING TRAINING Eight Groups are Revised for 2018 Head & Neck Colon (includes rectosigmoid and rectum for cases diagnosed 1/1/2018 forward) Lung (2018 Draft not yet

More information

Case Scenario 1. The patient has now completed his neoadjuvant chemoradiation and has been cleared for surgery.

Case Scenario 1. The patient has now completed his neoadjuvant chemoradiation and has been cleared for surgery. Case Scenario 1 July 10, 2010 A 67-year-old male with squamous cell carcinoma of the mid thoracic esophagus presents for surgical resection. The patient has completed preoperative chemoradiation. This

More information

Treatment for early stage laryngeal cancer: surgical and non surgical approaches

Treatment for early stage laryngeal cancer: surgical and non surgical approaches David J. Mener, MD, MPH October 5 th, 2012 Treatment for early stage laryngeal cancer: surgical and non surgical approaches GBMC, The Milton J. Dance, Jr Head & Neck Center Department of Otolaryngology-Head

More information

ORIGINAL ARTICLE GAMMA KNIFE STEREOTACTIC RADIOSURGERY FOR SALIVARY GLAND NEOPLASMS WITH BASE OF SKULL INVASION FOLLOWING NEUTRON RADIOTHERAPY

ORIGINAL ARTICLE GAMMA KNIFE STEREOTACTIC RADIOSURGERY FOR SALIVARY GLAND NEOPLASMS WITH BASE OF SKULL INVASION FOLLOWING NEUTRON RADIOTHERAPY ORIGINAL ARTICLE GAMMA KNIFE STEREOTACTIC RADIOSURGERY FOR SALIVARY GLAND NEOPLASMS WITH BASE OF SKULL INVASION FOLLOWING NEUTRON RADIOTHERAPY James G. Douglas, MD, MS, 1,2 Robert Goodkin, MD, 1,2 George

More information

Head & Neck Case # 1

Head & Neck Case # 1 DISCHARGE SUMMARY Head & Neck Case # 1 Date of Admission: 10/30/2010 Date of Discharge: 11/02/2010 Present Medical History: The patient is a 33-year-old lady with a history of right superior alveolar ridge

More information

My Journey into the World of Salivary Gland Sebaceous Neoplasms

My Journey into the World of Salivary Gland Sebaceous Neoplasms My Journey into the World of Salivary Gland Sebaceous Neoplasms Douglas R. Gnepp Warren Alpert Medical School at Brown University Rhode Island Hospital Pathology Department Providence RI Asked to present

More information

L ARYNX S TAGING F ORM

L ARYNX S TAGING F ORM CLI N I CA L Extent of disease before any treatment y clinical staging completed after neoadjuvant therapy but before subsequent surgery TX T0 Tis a b L ARYNX S TAGING F ORM LATERALITY: TUMOR SIZE: left

More information

NCCN Clinical Practice Guidelines in Oncology. Melanoma V Continue.

NCCN Clinical Practice Guidelines in Oncology. Melanoma V Continue. Clinical in Oncology V.2.2007 Continue www.nccn.g Table of Contents * Alan N. Houghton, MD/Chair Þ Memial Sloan-Kettering Cancer Center Christopher K. Bichakjian, MD University of Michigan Comprehensive

More information

Oral Cavity and Oropharyngeal Cancer Early Detection, Diagnosis, and Staging

Oral Cavity and Oropharyngeal Cancer Early Detection, Diagnosis, and Staging Oral Cavity and Oropharyngeal Cancer Early Detection, Diagnosis, and Staging Detection and Diagnosis Catching cancer early often allows for more treatment options. Some early cancers may have signs and

More information

Hiroyuki Hanakawa, Nobuya Monden, Kaori Hashimoto, Aiko Oka, Isao Nozaki, Norihiro Teramoto, Susumu Kawamura

Hiroyuki Hanakawa, Nobuya Monden, Kaori Hashimoto, Aiko Oka, Isao Nozaki, Norihiro Teramoto, Susumu Kawamura Accepted Manuscript Radiation-induced laryngeal angiosarcoma: Case report Hiroyuki Hanakawa, Nobuya Monden, Kaori Hashimoto, Aiko Oka, Isao Nozaki, Norihiro Teramoto, Susumu Kawamura PII: S2468-5488(18)30005-5

More information

1. Written information to patient /GP: fax ASAP to GP & offer copy of consultation letter.

1. Written information to patient /GP: fax ASAP to GP & offer copy of consultation letter. Skin Cancer follow up guidelines If NEW serious diagnosis given: 1. Written information to patient /GP: fax ASAP to GP & offer copy of consultation letter. 2. Free prescription information details. 3.

More information

Management of Lymph Nodes in Patients with Thyroid Cancer:

Management of Lymph Nodes in Patients with Thyroid Cancer: Management of Lymph Nodes in Patients with Thyroid Cancer: What s new in the 2009 Revised ATA Guidelines Quan-Yang Duh Professor of Surgery University of California, San Francisco Thyroid Cancer Lymph

More information

Nasopharynx. 1. Introduction. 1.1 General Information and Aetiology

Nasopharynx. 1. Introduction. 1.1 General Information and Aetiology Nasopharynx 1. Introduction 1.1 General Information and Aetiology The nasopharynx is the uppermost, nasal part of the pharynx. It extends from the base of the skull to the upper surface of the soft palate.

More information

Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010

Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010 LSU HEALTH SCIENCES CENTER NSCLC Guidelines Feist-Weiller Cancer Center Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010 Initial Evaluation/Intervention: 1. Pathology Review 2. History and Physical

More information

Principles of Surgical Oncology

Principles of Surgical Oncology Principles of Surgical Oncology Dr. Ranga Perera MBBS,MS (Colombo) MRCS (Eng) Consultant Oncological Surgeon Senior Lecturer in Surgery General Sir John Kotelawala Defence University Surgical Oncologist

More information

Quiz. b. 4 High grade c. 9 Unknown

Quiz. b. 4 High grade c. 9 Unknown Quiz 1. 10/11/12 CT scan abdomen/pelvis: Metastatic liver disease with probable primary colon malignancy. 10/17/12 Colonoscopy with polypectomy: Adenocarcinoma of sigmoid colon measuring at least 6 mm

More information

Organ-Preservation Strategies in head and neck cancer. Teresa Bonfill Abella Oncologia Mèdica Parc Taulí Sabadell. Hospital Universitari

Organ-Preservation Strategies in head and neck cancer. Teresa Bonfill Abella Oncologia Mèdica Parc Taulí Sabadell. Hospital Universitari Organ-Preservation Strategies in head and neck cancer Teresa Bonfill Abella Oncologia Mèdica Parc Taulí Sabadell. Hospital Universitari Larynx Hypopharynx The goal of treatment is to achieve larynx preservation

More information

HDR Brachytherapy for Skin Cancers. Joseph Lee, M.D., Ph.D. Radiation Oncology Associates Fairfax Hospital

HDR Brachytherapy for Skin Cancers. Joseph Lee, M.D., Ph.D. Radiation Oncology Associates Fairfax Hospital HDR Brachytherapy for Skin Cancers Joseph Lee, M.D., Ph.D. Radiation Oncology Associates Fairfax Hospital No conflicts of interest Outline Case examples from Fairfax Hospital Understand radiation s mechanism

More information

Squamous Cell Carcinoma of the Oral Cavity: Radio therapeutic Considerations

Squamous Cell Carcinoma of the Oral Cavity: Radio therapeutic Considerations Squamous Cell Carcinoma of the Oral Cavity: Radio therapeutic Considerations Troy G. Scroggins Jr. MD Chairman, Department of Radiation Oncology Ochsner Health Systems 1 Association of Postoperative Radiotherapy

More information

Evaluation and Treatment of Dysphagia in the Head and Neck Cancer Patient

Evaluation and Treatment of Dysphagia in the Head and Neck Cancer Patient Evaluation and Treatment of Dysphagia in the Head and Neck Cancer Patient Linda Stachowiak MS/CCCSLP BCS-S Speech Pathology Oncology Specialist UFHealth Cancer Center at Orlando Health Orlando Florida

More information

Case Scenario year-old white male presented to personal physician with dyspepsia with reflux.

Case Scenario year-old white male presented to personal physician with dyspepsia with reflux. Case Scenario 1 57-year-old white male presented to personal physician with dyspepsia with reflux. 7/12 EGD: In the gastroesophageal junction we found an exophytic tumor. The tumor occupies approximately

More information

Mediastinal Staging. Samer Kanaan, M.D.

Mediastinal Staging. Samer Kanaan, M.D. Mediastinal Staging Samer Kanaan, M.D. Overview Importance of accurate nodal staging Accuracy of radiographic staging Mediastinoscopy EUS EBUS Staging TNM Definitions T Stage Size of the Primary Tumor

More information

Case Scenario #1 Larynx

Case Scenario #1 Larynx Case Scenario #1 Larynx 56 year old white female who presented with a 2 month history of hoarseness treated with antibiotics, but with no improvement. In the last 3 weeks, she has had a 15 lb weight loss,

More information

External Beam Radiation Therapy for Thyroid Cancer

External Beam Radiation Therapy for Thyroid Cancer External Beam Radiation Therapy for Thyroid Cancer C. Jillian Tsai, M.D, PH.D. Assistant Attending Director of Head and Neck Cancer Research Department of Radiation Oncology Memorial Sloan Kettering Cancer

More information

ACR Appropriateness Criteria Adjuvant Therapy for Resected Squamous Cell Carcinoma of the Head and Neck EVIDENCE TABLE

ACR Appropriateness Criteria Adjuvant Therapy for Resected Squamous Cell Carcinoma of the Head and Neck EVIDENCE TABLE 1. Johnson JT, Barnes EL, Myers EN, Schramm VL, Jr., Borochovitz D, Sigler BA. The extracapsular spread of tumors in cervical node metastasis. Arch Otolaryngol 1981; 107(1):75-79.. Snow GB, Annyas AA,

More information

Case Scenario 1 Worksheet. Primary Site C44.4 Morphology 8743/3 Laterality 0 Stage/ Prognostic Factors

Case Scenario 1 Worksheet. Primary Site C44.4 Morphology 8743/3 Laterality 0 Stage/ Prognostic Factors CASE SCENARIO 1 9/10/13 HISTORY: Patient is a 67-year-old white male and presents with lesion located 4-5cm above his right ear. The lesion has been present for years. No lymphadenopathy. 9/10/13 anterior

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM MENINGIOMA CNS Site Group Meningioma Author: Dr. Norm Laperriere Date: February 20, 2018 1. INTRODUCTION 3 2. PREVENTION

More information

ORIGINAL ARTICLE. Masses of the Salivary Gland Region in Children

ORIGINAL ARTICLE. Masses of the Salivary Gland Region in Children ORIGINAL ARTICLE Masses of the Salivary Gland Region in Children Brandon G. Bentz, MD; C. Anthony Hughes, MD; Jeffrey P. Lüdemann, MD; John Maddalozzo, MD Background: Noninflammatory masses of the salivary

More information

Prostate Case Scenario 1

Prostate Case Scenario 1 Prostate Case Scenario 1 H&P 5/12/16: A 57-year-old Hispanic male presents with frequency of micturition, urinary urgency, and hesitancy associated with a weak stream. Over the past several weeks, he has

More information

THE IMPACT OF THE TIME FACTOR ON THE OUTCOME OF A COMBINED TREATMENT OF PATIENTS WITH LARYN- GEAL CANCER

THE IMPACT OF THE TIME FACTOR ON THE OUTCOME OF A COMBINED TREATMENT OF PATIENTS WITH LARYN- GEAL CANCER THE IMPACT OF THE TIME FACTOR ON THE OUTCOME OF A COMBINED TREATMENT OF PATIENTS WITH LARYN- GEAL CANCER Piotr Milecki 1, Grażyna Stryczyńska 1, Aleksandra Kruk-Zagajewska 2 Department of Radiotherapy,

More information

Intensity Modulated Radiation Therapy (IMRT)

Intensity Modulated Radiation Therapy (IMRT) Intensity Modulated Radiation Therapy (IMRT) Policy Number: Original Effective Date: MM.05.006 03/09/2004 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 05/01/2017 Section: Radiology

More information

Survival impact of cervical metastasis in squamous cell carcinoma of hard palate

Survival impact of cervical metastasis in squamous cell carcinoma of hard palate Vol. 116 No. 1 July 2013 Survival impact of cervical metastasis in squamous cell carcinoma of hard palate Quan Li, MD, a Di Wu, MD, b,c Wei-Wei Liu, MD, PhD, b,c Hao Li, MD, PhD, b,c Wei-Guo Liao, MD,

More information

ADJUVANT CHEMOTHERAPY...

ADJUVANT CHEMOTHERAPY... Colorectal Pathway Board: Non-Surgical Oncology Guidelines October 2015 Organization» Table of Contents ADJUVANT CHEMOTHERAPY... 2 DUKES C/ TNM STAGE 3... 2 DUKES B/ TNM STAGE 2... 3 LOCALLY ADVANCED

More information

Prognostic factors affecting the clinical outcome of carcinoma ex pleomorphic adenoma in the major salivary gland

Prognostic factors affecting the clinical outcome of carcinoma ex pleomorphic adenoma in the major salivary gland Zhao et al. World Journal of Surgical Oncology 2013, 11:180 WORLD JOURNAL OF SURGICAL ONCOLOGY RESEARCH Open Access Prognostic factors affecting the clinical outcome of carcinoma ex pleomorphic adenoma

More information

Lip. 1. Introduction. 1.1 General Information and Aetiology

Lip. 1. Introduction. 1.1 General Information and Aetiology Lip 1. Introduction 1.1 General Information and Aetiology Lips are the external part of the mouth. They are bounded externally by facial skin. On the oral cavity side, they are continuous with buccal mucosa

More information

4/10/2018. SEER EOD and Summary Stage. Overview KCR 2018 SPRING TRAINING. What is SEER EOD? Ambiguous Terminology General Guidelines

4/10/2018. SEER EOD and Summary Stage. Overview KCR 2018 SPRING TRAINING. What is SEER EOD? Ambiguous Terminology General Guidelines SEER EOD and Summary Stage KCR 2018 SPRING TRAINING Overview What is SEER EOD Ambiguous Terminology General Guidelines EOD Primary Tumor EOD Regional Nodes EOD Mets SEER Summary Stage 2018 Site Specific

More information

Cystic carcinoma of the neck

Cystic carcinoma of the neck Case Report Brunei Int Med J. 2010; 6 (1): 56-60 Cystic carcinoma of the neck Prathibha Parampalli SUBRHAMANYA, Ghazala KAFEEL, Hla OO, Pemasiri Upali TELISINGHE, Department of Pathology, RIPAS Hospital,

More information

Lung Cancer. Current Therapy JEREMIAH MARTIN MBBCh FRCSI MSCRD

Lung Cancer. Current Therapy JEREMIAH MARTIN MBBCh FRCSI MSCRD Lung Cancer Current Therapy JEREMIAH MARTIN MBBCh FRCSI MSCRD Objectives Describe risk factors, early detection & work-up of lung cancer. Define the role of modern treatment options, minimally invasive

More information

A Pathologist s Guide to Neck Dissection. Neck Dissections. Lymphatics of head and neck. Neck Dissections

A Pathologist s Guide to Neck Dissection. Neck Dissections. Lymphatics of head and neck. Neck Dissections A Pathologist s Guide to Neck Dissection North American Society for Head and Neck Pathology Companion Meeting 2006 Sigrid Wayne, M.D. Department of Pathology University of Iowa The presence of cervical

More information

6 th Reprint Handbook Pages AJCC 7 th Edition

6 th Reprint Handbook Pages AJCC 7 th Edition 6 th Reprint Handbook Pages AJCC 7 th Edition AJCC 7 th Edition Errata for 6 th Reprint Table 1 Handbook No Significant Staging Clarifications for 6 th Reprint AJCC 7 th Edition Errata for 6 th Reprint

More information

Rare Presentation Of Adenoidcystic Carcinoma Of External Auditory Canal With Subcutaneous Metastasis In Temporal Region

Rare Presentation Of Adenoidcystic Carcinoma Of External Auditory Canal With Subcutaneous Metastasis In Temporal Region ISPUB.COM The Internet Journal of Otorhinolaryngology Volume 13 Number 2 Rare Presentation Of Adenoidcystic Carcinoma Of External Auditory Canal With Subcutaneous Metastasis In Temporal Region S Kaushik,

More information