Head and Neck Cancers

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 1.2012 NCCN.g Continue Version 1.2012, 04/26/12 National Comprehensive Cancer Netwk, Inc. 2012, All rights

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

Management of Neck Metastasis from Unknown Primary

Management of Neck Metastasis from Unknown Primary Management of Neck Metastasis from Unknown Primary.. Definition Histologic evidence of malignancy in the cervical lymph node (s) with no apparent primary site of original tumour Diagnosis after a thorough

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

RADIO- AND RADIOCHEMOTHERAPY OF HEAD AND NECK TUMORS. Zoltán Takácsi-Nagy PhD Department of Radiotherapy National Institute of Oncology, Budapest 1.

RADIO- AND RADIOCHEMOTHERAPY OF HEAD AND NECK TUMORS. Zoltán Takácsi-Nagy PhD Department of Radiotherapy National Institute of Oncology, Budapest 1. RADIO- AND RADIOCHEMOTHERAPY OF HEAD AND NECK TUMORS Zoltán Takácsi-Nagy PhD Department of Radiotherapy National Institute of Oncology, Budapest 1. 550 000 NEW PATIENTS/YEAR WITH HEAD AND NECK CANCER ALL

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

QUIZZES WITH ANSWERS FOR COLLECTING CANCER DATA: PHARYNX

QUIZZES WITH ANSWERS FOR COLLECTING CANCER DATA: PHARYNX QUIZZES WITH ANSWERS FOR COLLECTING CANCER DATA: PHARYNX MP/H Quiz 1. A patient presented with a prior history of squamous cell carcinoma of the base of the tongue. The malignancy was originally diagnosed

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

EVERYTHING YOU WANTED TO KNOW ABOUT. Robin Billet, MA, CTR, Head & Neck CTAP Member May 9, 2013

EVERYTHING YOU WANTED TO KNOW ABOUT. Robin Billet, MA, CTR, Head & Neck CTAP Member May 9, 2013 EVERYTHING YOU WANTED TO KNOW ABOUT. Robin Billet, MA, CTR, Head & Neck CTAP Member May 9, 2013 Head and Neck Coding and Staging Head and Neck Coding and Staging Anatomy & Primary Site Sequencing and MPH

More information

QUIZZES WITH ANSWERS FOR COLLECTING CANCER DATA: PHARYNX

QUIZZES WITH ANSWERS FOR COLLECTING CANCER DATA: PHARYNX QUIZZES WITH ANSWERS FOR COLLECTING CANCER DATA: PHARYNX MP/H Quiz 1. A patient presented with a prior history of squamous cell carcinoma of the base of the tongue. The malignancy was originally diagnosed

More information

Protons for Head and Neck Cancer. William M Mendenhall, M.D.

Protons for Head and Neck Cancer. William M Mendenhall, M.D. Protons for Head and Neck Cancer William M Mendenhall, M.D. Protons for Head and Neck Cancer Potential Advantages: Reduce late complications via more conformal dose distributions Likely to be the major

More information

Carcinoma of Unknown Primary site (CUP) in HEAD & NECK SURGERY

Carcinoma of Unknown Primary site (CUP) in HEAD & NECK SURGERY Carcinoma of Unknown Primary site (CUP) in HEAD & NECK SURGERY SEARCHING FOR THE PRIMARY? P r o f J P P r e t o r i u s H e a d : C l i n i c a l U n i t C r i t i c a l C a r e U n i v e r s i t y O f

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

Protocol of Radiotherapy for Head and Neck Cancer

Protocol of Radiotherapy for Head and Neck Cancer 106 年 12 月修訂 Protocol of Radiotherapy for Head and Neck Cancer Indication of radiotherapy Indication of definitive radiotherapy with or without chemotherapy (1) Resectable, but medically unfit, or high

More information

North of Scotland Cancer Network Clinical Management Guideline for Oropharyngeal Cancer

North of Scotland Cancer Network Clinical Management Guideline for Oropharyngeal Cancer Nth of Scotland Cancer Netwk Clinical Management Guideline f Oropharyngeal Cancer UNCONTROLLED WHEN PRINTED Based on NHST CMG with further extensive consultation within NOSCAN DOCUMENT CONTROL Original

More information

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

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

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

FACULTY OF MEDICINE SIRIRAJ HOSPITAL

FACULTY OF MEDICINE SIRIRAJ HOSPITAL Neck Dissection Pornchai O-charoenrat MD, PhD Division of Head, Neck and Breast Surgery Department of Surgery FACULTY OF MEDICINE SIRIRAJ HOSPITAL Introduction Status of the cervical lymph nodes is the

More information

Oral cancer: Prognosis & Treatment. Dr. Hani Al Sheikh Radhi

Oral cancer: Prognosis & Treatment. Dr. Hani Al Sheikh Radhi Oral cancer: Prognosis & Treatment Dr. Hani Al Sheikh Radhi Prognostic factors in Oral caner TNM staging T stage N stage M stage Site Histological Factors Vascular & Perineural Invasion Surgical Margins

More information

Head and Neck Cancer in FA: Risks, Prevention, Screening, & Treatment Options David I. Kutler, M.D., F.A.C.S.

Head and Neck Cancer in FA: Risks, Prevention, Screening, & Treatment Options David I. Kutler, M.D., F.A.C.S. Head and Neck Cancer in FA: Risks, Prevention, Screening, & Treatment Options David I. Kutler, M.D., F.A.C.S. Associate Professor Division of Head and Neck Surgery Department of Otolaryngology-Head and

More information

(loco-regional disease)

(loco-regional disease) (loco-regional disease) (oral cavity) (circumvillae papillae) (subsite) A (upper & lower lips) B (buccal membrane) C (mouth floor) D (upper & lower gingiva) E (hard palate) F (tongue -- anterior 2/3 rds

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

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

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 guideline for patients with differentiated thyroid cancer. Teeraporn Ratanaanekchai ENT, KKU 17 October 2007

Management guideline for patients with differentiated thyroid cancer. Teeraporn Ratanaanekchai ENT, KKU 17 October 2007 Management guideline for patients with differentiated thyroid Teeraporn Ratanaanekchai ENT, KKU 17 October 2007 Incidence (Srinagarind Hospital, 2005, both sex) Site (all) cases % 1. Liver 1178 27 2. Lung

More information

Oral Cavity. 1. Introduction. 1.1 General Information and Aetiology. 1.2 Diagnosis and Treatment

Oral Cavity. 1. Introduction. 1.1 General Information and Aetiology. 1.2 Diagnosis and Treatment Oral Cavity 1. Introduction 1.1 General Information and Aetiology The oral cavity extends from the lips to the palatoglossal folds and consists of the anterior two thirds of the tongue, floor of the mouth,

More information

Case Scenario 1. Pathology: Specimen type: Incisional biopsy of the glottis Histology: Moderately differentiated squamous cell carcinoma

Case Scenario 1. Pathology: Specimen type: Incisional biopsy of the glottis Histology: Moderately differentiated squamous cell carcinoma Case Scenario 1 History A 52 year old male with a 20 pack year smoking history presented with about a 6 month history of persistent hoarseness. The patient had a squamous cell carcinoma of the lip removed

More information

Pre- Versus Post-operative Radiotherapy

Pre- Versus Post-operative Radiotherapy Postoperative Radiation and Chemoradiation: Indications and Optimization of Practice Dislosures Clinical trial support from Genentech Inc. Sue S. Yom, MD, PhD Associate Professor UCSF Radiation Oncology

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

Clinical Discussion. Dr Pankaj Chaturvedi. Professor and Surgeon Tata Memorial Hospital

Clinical Discussion. Dr Pankaj Chaturvedi. Professor and Surgeon Tata Memorial Hospital Clinical Discussion Dr Pankaj Chaturvedi Professor and Surgeon Tata Memorial Hospital chaturvedi.pankaj@gmail.com 47/M/smoker Hopkins : Transglottic lesion No cartilage infiltration but sclerosis Left

More information

Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over

Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over Cancer of the upper aerodigestive tract: assessment and management in people aged and over NICE guideline Draft for consultation, March 0 This guideline covers This guideline covers assessing and managing

More information

From GTV to CTV: A Critical Step Towards Cure. Kenneth Hu, MD Associate Professor New York University Langone Medical Center June 21, 2017

From GTV to CTV: A Critical Step Towards Cure. Kenneth Hu, MD Associate Professor New York University Langone Medical Center June 21, 2017 From GTV to CTV: A Critical Step Towards Cure Kenneth Hu, MD Associate Professor New York University Langone Medical Center June 21, 2017 Head and Neck Cancer Model for Understanding CTV Expansion Radiation

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

Head & Neck Clinical Sub Group. Network Agreed Imaging Guidelines for UAT and Thyroid Cancer. Measure Nos: 11-1C-105i & 11-1C-106i

Head & Neck Clinical Sub Group. Network Agreed Imaging Guidelines for UAT and Thyroid Cancer. Measure Nos: 11-1C-105i & 11-1C-106i Greater Manchester, Lancashire & South Cumbria Strategic Clinical Network & Senate Head & Neck Clinical Sub Group Network Agreed Imaging Guidelines for UAT and Thyroid Cancer Measure Nos: 11-1C-105i &

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

Case Scenario 1. Pathology report Specimen from mediastinoscopy Final Diagnosis : Metastatic small cell carcinoma with residual lymphatic tissue

Case Scenario 1. Pathology report Specimen from mediastinoscopy Final Diagnosis : Metastatic small cell carcinoma with residual lymphatic tissue Case Scenario 1 Oncology Consult: Patient is a 51-year-old male with history of T4N3 squamous cell carcinoma of tonsil status post concurrent chemoradiation finished in October two years ago. He was hospitalized

More information

Chapter 13: Mass in the Neck. Raymond P. Wood II:

Chapter 13: Mass in the Neck. Raymond P. Wood II: Chapter 13: Mass in the Neck Raymond P. Wood II: In approaching the problem of a mass in the neck, one immediately encounters the fact that there are normally palpable masses in the neck (eg, almost all

More information

Locally advanced head and neck cancer

Locally advanced head and neck cancer Locally advanced head and neck cancer Radiation Oncology Perspective Petek Erpolat, MD Gazi University, Turkey Definition and Management of LAHNC Stage III or IV cancers generally include larger primary

More information

Management of Salivary Gland Malignancies. No Disclosures or Conflicts of Interest. Anatomy 10/4/2013

Management of Salivary Gland Malignancies. No Disclosures or Conflicts of Interest. Anatomy 10/4/2013 Management of Salivary Gland Malignancies Daniel G. Deschler, MD Director: Division of Head and Neck Surgery Massachusetts Eye & Ear Infirmary Massachusetts General Hospital Professor Harvard Medical School

More information

Esophageal and Esophagogastric Junction Cancers

Esophageal and Esophagogastric Junction Cancers NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ) Esophageal and Esophagogastric Junction Cancers Version 1.2014 NCCN.g NCCN Guidelines f Patients available at www.nccn.g/patients Continue

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

Guideline for the Management of Vulval Cancer

Guideline for the Management of Vulval Cancer Version History Guideline for the Management of Vulval Cancer Version Date Brief Summary of Change Issued 2.0 20.02.08 Endorsed by the Governance Committee 2.1 19.11.10 Circulated at NSSG meeting 2.2 13.04.11

More information

Cervical Lymphadenopathy. Diagnosis and Management

Cervical Lymphadenopathy. Diagnosis and Management Cervical Lymphadenopathy Diagnosis and Management Case 1 Case 1: 6/12 hx of enlarging left level 2 neck mass no dysphonia, dysphagia, weight loss, stridor Ex smoker x 28 years 6-8 units of Ethanol weekly

More information

Appendix 1: QIICR Iowa Head and Neck Clinical Data DICOM SR Template

Appendix 1: QIICR Iowa Head and Neck Clinical Data DICOM SR Template Appendix 1: QIICR Iowa Head and Neck Clinical Data DICOM SR Template Table of Content s Document Histor y TID QIICR_2000. Clinical Data Repor t TID QIICR_2002. Biops y TID QIICR_2003. Surgical Procedure

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

C. Douglas Phillips, MD FACR Director of Head and Neck Imaging Weill Cornell Medical Center NewYork Presbyterian Hospital

C. Douglas Phillips, MD FACR Director of Head and Neck Imaging Weill Cornell Medical Center NewYork Presbyterian Hospital C. Douglas Phillips, MD FACR Director of Head and Neck Imaging Weill Cornell Medical Center NewYork Presbyterian Hospital Objectives Review basics of head and neck imaging Discuss our spatial approach

More information

Head and Neck Cancer. What is head and neck cancer?

Head and Neck Cancer. What is head and neck cancer? Scan for mobile link. Head and Neck Cancer Head and neck cancer is a group of cancers that usually originate in the squamous cells that line the mouth, nose and throat. Typical symptoms include a persistent

More information

Clinical Trials in Transoral Endoscopic Head &Neck Surgery ECOG3311 and RTOG1221. Chris Holsinger, MD, FACS Bob Ferris, MD, PhD, FACS

Clinical Trials in Transoral Endoscopic Head &Neck Surgery ECOG3311 and RTOG1221. Chris Holsinger, MD, FACS Bob Ferris, MD, PhD, FACS Clinical Trials in Transoral Endoscopic Head &Neck Surgery ECOG3311 and RTOG1221 Chris Holsinger, MD, FACS Bob Ferris, MD, PhD, FACS 1 Disclosure I have no conflicts of interest to disclose 2 Robotic H&N

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

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES HEAD AND NECK CARCINOMA UNKNOWN PRIMARY

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES HEAD AND NECK CARCINOMA UNKNOWN PRIMARY PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES HEAD AND NECK CARCINOMA UNKNOWN PRIMARY Head & Neck Site Group Carcinoma Unknown Primary 1. INTRODUCTION 3 2. PREVENTION 3 3. SCREENING AND

More information

THORACIC MALIGNANCIES

THORACIC MALIGNANCIES THORACIC MALIGNANCIES Summary for Malignant Malignancies. Lung Ca 1 Lung Cancer Non-Small Cell Lung Cancer Diagnostic Evaluation for Non-Small Lung Cancer 1. History and Physical examination. 2. CBCDE,

More information

Laryngeal Preservation Using Radiation Therapy. Chemotherapy and Organ Preservation

Laryngeal Preservation Using Radiation Therapy. Chemotherapy and Organ Preservation 1 Laryngeal Preservation Using Radiation Therapy 1903: Schepegrell was the first to perform radiation therapy for the treatment of laryngeal cancer Conventional external beam radiation produced disappointing

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

Head & Neck Contouring

Head & Neck Contouring Head & Neck Contouring Presented by James Wheeler, MD Center for Cancer Care Goshen, IN 46526 September 12, 2014 Special Thanks to: Spencer Boulter, Director of Operations (AAMD) Adam Moore, RT(T), CMD

More information

3/12/2018. Head & Neck Cancer Review INTRODUCTION

3/12/2018. Head & Neck Cancer Review INTRODUCTION Head & Neck Cancer Review Joseph Rosales, MD March 12, 2018 INTRODUCTION Epidemiology/Risk Factors Anatomy Presentation/Workup Treatment Surgery vs Radiation Chemotherapy Side effects Special circumstances

More information

Neck Dissection. Asst Professor Jeeve Kanagalingam MA (Cambridge), BM BCh (Oxford), MRCS (Eng), DLO, DOHNS, FRCS ORL-HNS (Eng), FAMS (ORL)

Neck Dissection. Asst Professor Jeeve Kanagalingam MA (Cambridge), BM BCh (Oxford), MRCS (Eng), DLO, DOHNS, FRCS ORL-HNS (Eng), FAMS (ORL) Neck Dissection Asst Professor Jeeve Kanagalingam MA (Cambridge), BM BCh (Oxford), MRCS (Eng), DLO, DOHNS, FRCS ORL-HNS (Eng), FAMS (ORL) History radical neck Henry Butlin proposed enbloc removal of upper

More information

How to Manage a Case of Stage-I Oropharyngeal Cancer with Very Close Cutting End Post-Operatively?

How to Manage a Case of Stage-I Oropharyngeal Cancer with Very Close Cutting End Post-Operatively? How to Manage a Case of Stage-I Oropharyngeal Cancer with Very Close Cutting End Post-Operatively? Case Number: RT2008-07(M) Potential Audiences: Intent Doctor, Oncology Special Nurse, Resident Doctor

More information

Head and Neck Cancer Service

Head and Neck Cancer Service Dr Hoda Al Booz. MMedSci, MD, FFRRCSI, FRCR. Head and Neck Cancer Service Dr Hoda Al Booz Consultant in Clinical Oncology Bristol Cancer Institute Dr Hoda Al Booz. MMedSci, MD, FFRRCSI, FRCR. documents/

More information

Cancer of the Oral Cavity

Cancer of the Oral Cavity The International Federation of Head and Neck Oncologic Societies Current Concepts in Head and Neck Surgery and Oncology Cancer of the Oral Cavity Ashok Shaha Principals of Management of Oral Cancer A)

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

Nasopharynx Cancer. 1 Feb Presenters: Dr Raghav Murali-Ganesh (Radiation Oncology Registrar) Dr Peter Luk (Pathology Registrar)

Nasopharynx Cancer. 1 Feb Presenters: Dr Raghav Murali-Ganesh (Radiation Oncology Registrar) Dr Peter Luk (Pathology Registrar) Nasopharynx Cancer 1 Feb 2016 Presenters: Dr Raghav Murali-Ganesh (Radiation Oncology Registrar) Dr Peter Luk (Pathology Registrar) Expert Panels Prof Mo Mo Tin Prof Michael Boyer Dr Raewyn Campbell Prof

More information

Self-Assessment Module 2016 Annual Refresher Course

Self-Assessment Module 2016 Annual Refresher Course LS16031305 The Management of s With r. Lin Learning Objectives: 1. To understand the changing demographics of oropharynx cancer, and the impact of human papillomavirus on overall survival and the patterns

More information

North of Scotland Cancer Network Clinical Management Guideline for Malignant Melanoma

North of Scotland Cancer Network Clinical Management Guideline for Malignant Melanoma Nth of Scotland Cancer Netwk Clinical Management Guideline f Malignant Melanoma Based on WOSCAN CMG with further consultation within NOSCAN UNCONTROLLED WHEN PRINTED Prepared by Approved by Issue date

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

Laryngeal Conservation

Laryngeal Conservation Laryngeal Conservation Sarah Rodriguez, MD Faculty Advisor: Shawn Newlands, MD, PhD The University of Texas Medical Branch Department of Otolaryngolgy Grand Rounds Presentation February 2005 Introduction

More information

ESMO Perceptorship H&N cancer Epidemiology, Anatomy and Workup 16 March 2018

ESMO Perceptorship H&N cancer Epidemiology, Anatomy and Workup 16 March 2018 ESMO Perceptorship H&N cancer Epidemiology, Anatomy and Workup 16 March 2018 Dr. Victor Ho-Fun Lee MBBS, MD, FRCR, FHKCR, FHKAM (Radiology) Clinical Associate Professor Department of Clinical Oncology

More information

Surgery in Head and neck cancers.principles. Dr Diptendra K Sarkar MS,DNB,FRCS Consultant surgeon,ipgmer

Surgery in Head and neck cancers.principles. Dr Diptendra K Sarkar MS,DNB,FRCS Consultant surgeon,ipgmer Surgery in Head and neck cancers.principles Dr Diptendra K Sarkar MS,DNB,FRCS Consultant surgeon,ipgmer Email:diptendrasarkar@yahoo.co.in HNC : common inclusives Challenges Anatomical preservation R0 Surgical

More information

Clinical Study Regional Failures after Selective Neck Dissection in Previously Untreated Squamous Cell Carcinoma of Oral Cavity

Clinical Study Regional Failures after Selective Neck Dissection in Previously Untreated Squamous Cell Carcinoma of Oral Cavity International Surgical Oncology, Article ID 205715, 8 pages http://dx.doi.org/10.1155/2014/205715 Clinical Study Regional Failures after Selective Neck Dissection in Previously Untreated Squamous Cell

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

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

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

Adjuvant therapy for thyroid cancer

Adjuvant therapy for thyroid cancer Carcinoma of the thyroid Adjuvant therapy for thyroid cancer John Hay Department of Radiation Oncology Vancouver Cancer Centre Department of Surgery UBC 1% of all new malignancies 0.5% in men 1.5% in women

More information

Rola brachyterapii w leczeniu wznów nowotworów języka i dna jamy ustnej. The role of brachytherapy in recurrent. oral cavity

Rola brachyterapii w leczeniu wznów nowotworów języka i dna jamy ustnej. The role of brachytherapy in recurrent. oral cavity Rola brachyterapii w leczeniu wznów nowotworów języka i dna jamy ustnej The role of brachytherapy in recurrent tumours of the tongue and fundus of the oral cavity Janusz Skowronek, MD, PhD, Ass. Prof.

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

Head and Neck Service

Head and Neck Service Head and Neck Service University of California, San Francisco, Department of Radiation Oncology Residency Training Program Head and Neck and Thoracic Service Educational Objectives for PGY-5 Residents

More information

Case Report Postoperative Radiation Therapy for Parotid Mucoepidermoid Carcinoma

Case Report Postoperative Radiation Therapy for Parotid Mucoepidermoid Carcinoma Case Reports in Oncological Medicine, Article ID 345128, 4 pages http://dx.doi.org/10.1155/2014/345128 Case Report Postoperative Radiation Therapy for Parotid Mucoepidermoid Carcinoma Meghan P. Olsen,

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

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

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

performed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management.

performed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management. Hello, I am Maura Polansky at the University of Texas MD Anderson Cancer Center. I am a Physician Assistant in the Department of Gastrointestinal Medical Oncology and the Program Director for Physician

More information

Case Scenario 1. The patient agreed to a CT guided biopsy of the left upper lobe mass. This was performed and confirmed non-small cell carcinoma.

Case Scenario 1. The patient agreed to a CT guided biopsy of the left upper lobe mass. This was performed and confirmed non-small cell carcinoma. Case Scenario 1 An 89 year old male patient presented with a progressive cough for approximately six weeks for which he received approximately three rounds of antibiotic therapy without response. A chest

More information

CANCERS of OROPHARYNX and HYPOPHARYNX. STAGING and TREATMENT

CANCERS of OROPHARYNX and HYPOPHARYNX. STAGING and TREATMENT 1 CANCERS of OROPHARYNX and HYPOPHARYNX STAGING and TREATMENT 2 1. Staging 2. General Principles of Treatment 3. Site Specific Treatment Guidelines 4. Selected Abstracts from Relevant Studies 3 1. Staging

More information

Exercise 15: CSv2 Data Item Coding Instructions ANSWERS

Exercise 15: CSv2 Data Item Coding Instructions ANSWERS Exercise 15: CSv2 Data Item Coding Instructions ANSWERS CS Tumor Size Tumor size is the diameter of the tumor, not the depth or thickness of the tumor. Chest x-ray shows 3.5 cm mass; the pathology report

More information

8. The polyp in the illustration can be described as (circle all that apply) a. Exophytic b. Pedunculated c. Sessile d. Frank

8. The polyp in the illustration can be described as (circle all that apply) a. Exophytic b. Pedunculated c. Sessile d. Frank Quiz 1 Overview 1. Beginning with the cecum, which is the correct sequence of colon subsites? a. Cecum, ascending, splenic flexure, transverse, hepatic flexure, descending, sigmoid. b. Cecum, ascending,

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

4/22/2010. Hakan Korkmaz, MD Assoc. Prof. of Otolaryngology Ankara Dıșkapı Training Hospital-Turkey.

4/22/2010. Hakan Korkmaz, MD Assoc. Prof. of Otolaryngology Ankara Dıșkapı Training Hospital-Turkey. Management of Differentiated Thyroid Cancer: Head Neck Surgeon Perspective Hakan Korkmaz, MD Assoc. Prof. of Otolaryngology Ankara Dıșkapı Training Hospital-Turkey Thyroid gland Small endocrine gland:

More information

PILOT STUDY OF CONCURRENT CHEMO-RADIOTHERAPY FOR ADVANCED NASOPHARYNGEAL CARCINOMA (Forum for Nuclear Cooperation in Asia)

PILOT STUDY OF CONCURRENT CHEMO-RADIOTHERAPY FOR ADVANCED NASOPHARYNGEAL CARCINOMA (Forum for Nuclear Cooperation in Asia) PILOT STUDY OF CONCURRENT CHEMO-RADIOTHERAPY FOR ADVANCED NASOPHARYNGEAL CARCINOMA (Forum for Nuclear Cooperation in Asia) Dr. Miriam Joy C. Calaguas Dept. of Radiation Oncology St. Luke s Medical Center

More information

Clinical Trials of Proton Therapy for Breast Cancer. Andrew L. Chang, MD 張維安 Study Chair

Clinical Trials of Proton Therapy for Breast Cancer. Andrew L. Chang, MD 張維安 Study Chair Clinical Trials of Proton Therapy for Breast Cancer Andrew L. Chang, MD 張維安 Study Chair AndrewLChangMD@gmail.com Disclosure Proton Center Development Corporation Scripps San Diego Proton Therapy Center

More information

ORIGINAL ARTICLE CHEMOTHERAPY ALONE FOR ORGAN PRESERVATION IN ADVANCED LARYNGEAL CANCER

ORIGINAL ARTICLE CHEMOTHERAPY ALONE FOR ORGAN PRESERVATION IN ADVANCED LARYNGEAL CANCER ORIGINAL ARTICLE CHEMOTHERAPY ALONE FOR ORGAN PRESERVATION IN ADVANCED LARYNGEAL CANCER Vasu Divi, MD, 1 * Francis P. Worden, MD, 1,2 * Mark E. Prince, MD, 1 Avraham Eisbruch, MD, 3 Julia S. Lee, MD, 4

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

Practice teaching course on head and neck cancer management

Practice teaching course on head and neck cancer management 28-29 October 2016 - Saint-Priest en Jarez, France Practice teaching course on head and neck cancer management IMPROVING THE PATIENT S LIFE LIFE THROUGH MEDICAL MEDICAL EDUCATION EDUCATION www.excemed.org

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES HEAD AND NECK HYPOPHARYNX Head & Neck Site Group Hypopharynx 1. INTRODUCTION 3 2. PREVENTION 3 3. SCREENING AND EARLY DETECTION 3 4. DIAGNOSIS

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

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

Refresher Course EAR TUMOR. Sasikarn Chamchod, MD Chulabhorn Hospital

Refresher Course EAR TUMOR. Sasikarn Chamchod, MD Chulabhorn Hospital Refresher Course EAR TUMOR Sasikarn Chamchod, MD Chulabhorn Hospital Reference: Perez and Brady s Principles and Practice of radiation oncology sixth edition Outlines Anatomy Epidemiology Clinical presentations

More information