SOME USEFUL THINGS TO KNOW ABOUT HEAD AND NECK CANCER IN 2016

Transcription

1 SOME USEFUL THINGS TO KNOW ABOUT HEAD AND NECK CANCER IN 2016 Ann Dingle Mid Cheshire Hospitals ENT Surgeon in a DGH with an interest in Head and Neck disease Cancer Lead

2 Plan for today Facts and figures NICE referral guidelines Real Red flags Oropharyngeal cancer Thyroid cancer Recent developments in treatment

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4 laryngeal Thyroid oral

5 Trends: Time and Age Increasing Incidence (England) 1975: 7/100, : 12/100,000 Age - Getting younger Much related to HPV related oropharynx cancer

6 Comparative Geographical Incidence

7 Head and Neck Cancer Incidence: MCCN: 24% higher than English average Liverpool: 83% higher than English average Male : female: ~3:1 Mortality Overall 50% Low for early stage disease Associations: Deprivation Poverty Smoking Drinking Obesity HPV

8 Incidence and deprivation

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10 A NICE Macmillan health warning! Laryngeal cancer Unexplained hoarseness >45yrs Lump in neck Oral cancer Red patches Lump in neck Lump on the lip Thyroid cancer Unexplained Thyroid lump

11 National Head and Neck Audit 2014 Of 8,429 cases: So what happened to: 32% oral cavity 21% laryngeal 29% oropharyngeal 5% hypopharyngeal 6% major salivary gland 4% nasal cavity and sinus 2% nasopharyngeal Dysphagia Sore throat Salivary masses Unilateral nasal obstruction with blood stained discharge Orbital symptoms

12 1400 2ww referrals received No fo referrals Year Breast Symptomatic Breast Skin Colorectal Gynaecology Urology Head & Neck Upper GI Lung Haematology Paediatrics Other Sarcoma Brain/CNS

13 Red Flag symptoms Most lumps in the Throat are reflux related Most Salivary lumps are benign Most variable hoarseness is functional But they still need to be referred and the 2WW is appropriate Most nasal obstruction is rhinitis or a deviated septum Most Thyroid lumps are benign Only a unilateral conductive deafness is a red flag symptom Acoustic neuromas are slow growing and benign Real Red Flag symptoms Oral/Oropharyngeal lesions Lateral neck lumps Dysphagia and weight loss Persistent hoarseness Unilateral nasal obstruction with unilateral glue ear

14 Who gets Head and Neck cancer?

15 Who gets Head and Neck cancer?

16 Who gets Head and Neck cancer?

17 Who gets Head and Neck cancer?

18 Facts about Oropharyngeal cancer Male:Female 4:1 100% increase in incidence Relationship to HPV first detected in 1980 s HPV positive by Subsite Tonsil 61.8% Base of Tongue49.4% Soft palate 9.1%

19 Incidence of OPSCC in the UK Age Standardized Rate (per ) Year of diagnosis OPSCC M OPSCC M+F OPSCC F OPSCC increasing Predominantly in men No equivalent increase at other H&N sites

20 Incidence of OPSCC in the UK Age Standardized Rate (per ) Year of diagnosis OPSCC M Larynx M OPSCC M+F OPSCC F Larynx F OPSCC increasing Predominantly in men No equivalent increase at other H&N sites

21 OPSCC HPV positive over time HPV postitive (%) Age Standardised Rate error bars = 95% CI Year of Diagnosis OPSCC Incidence Year of Diagnosis HPV positive tumours contribute to increased incidence Incidence of both HPV positive and negative increasing

22 87% 65%

23 What do you tell the patient? 80% people sexually active people have HPV infection at some point 5% keep virus Not related to number of partners Not infective (DNA in basal membrane)

24 When to worry about the asymmetrical tonsil

25 When to worry about the asymmetrical tonsil

26 When to worry about the asymmetrical tonsil

27 When to worry about the asymmetrical tonsil

28 When to worry about the asymmetrical tonsil

29 When to worry about the asymmetrical tonsil

30 What you need to know about Thyroid Cancer Benign thyroid disease Majority of nodules will be benign Up to 50% population have nodular disease Nodules are commonly detected incidentally Thyroid Cancer 149% increase since 1970s 1% malignancies 80-90% 10 years survival 5-10% have local recurrence 9% die of disease Micro-papillary cancer increasingly common

31 Chernobyl By 2011: 5000 cases thyroid cancer in children By ,000 thyroid cancer 25,000 other cancers

32 Radioactive fallout

33 Thyroid cancer: Age-Standardised Incidence Rates per 100,000 Population, by Sex, Great Britain

34 Thyroid Cancer: Average Number of New Cases Per Year and Age-Specific Incidence Rates per 100,000 Population, UK

35 Changes in management of Thyroid cancer Not all nodules need investigation The U classification

36 Clinical Endocrinology pages 1-122, 3 JUL 2014 DOI: /cen /cen.12515/full#cen12515-fig- 0002

37 Changes in management of Thyroid cancer Not all nodules need investigation The U classification Recognition of good prognosis

38 Changes in management of Thyroid cancer Not all nodules need investigation The U classification Recognition of good prognosis Less aggressive surgery Total thyroidectomy not always necessary Post op Risk assessment Age Size Invasion Nodal disease

39 Changes in management of Thyroid cancer Not all nodules need investigation The U classification Recognition of good prognosis Less aggressive surgery Total thyroidectomy not always necessary Post op Risk assessment Less aggressive Radioiodine High dose/low dose/no dose Dynamic Risk assessment Excellent Intermediate Indeterminate

40 Changes in management of Thyroid cancer Not all nodules need investigation The U classification Recognition of good prognosis Less aggressive surgery Total thyroidectomy not always necessary Post op Risk assessment Less aggressive Radioiodine High dose/low dose/no dose Dynamic Risk assessment Less aggressive suppression Full/Low/Low normal/none

41 The future for patients with Thyroid cancer Less Treatment surgery Radioiodine Less TSH Suppression Stratified follow up T1 and micropapillary discharged from follow up Remote follow up for low risk Relaxation of TSH suppression at 10 years

42 Recent advances in treatment Trans Oral Laser Resection Post code lottery 10-60%

43 Recent advances in treatment Trans Oral Laser Resection Post code lottery 10-60% Shift towards organ preservation Where the airway is safe

44 Recent advances in treatment Trans Oral Laser Resection Post code lottery 10-60% Shift towards organ preservation Where the airway is safe IMRT Reduced long term effects

45 Recent advances in treatment Trans Oral Laser Resection Post code lottery 10-60% Shift towards organ preservation Where the airway is safe IMRT Reduced long term effects Chemotherapy More widely used particularly for HPV

46 Recent advances in treatment Trans Oral Laser Resection Post code lottery 10-60% Shift towards organ preservation Where the airway is safe IMRT Reduced long term effects Chemotherapy More widely used particularly for HPV Immune Therapy Recent evidence of dramatic results

47 Recent advances in treatment Trans Oral Laser Resection Post code lottery 10-60% Shift towards organ preservation Where the airway is safe IMRT Reduced long term effects Chemotherapy More widely used particularly for HPV Immune Therapy Recent evidence of dramatic results PET surveillance Reliable diagnostic tool for disease clearance

48 Questions?