Oral Cancer

1
Oral Cancer

• Professor Ravi Kant
• MS, DNB, FRCS (Edin.) ,FRCS( Glasg.), FACS ,
  FICS, MNAMS,

2
WHAT IS NEW IN HEAD AND NECK CANCERS?

• Dr. K.A.Pathak, MS, Dip NB, FRCS, FRCSEd.
• Associate Professor in Head Neck Oncology
• Tata Memorial Hospital, Mumbai

3
New Molecular Model
Califano et al , Cancer Research 1996
4
What is New in Imaging?

• Ultrasonography and Guided FNAC
• Real time
• Inexpensive
• Quicker but operator dependent
• Doppler can show flow characteristics
• CT Scan with 3 D views
• Virtual Laryngoscopy

5
CT Scan with 3 D views
6
Virtual Laryngoscopy
7
MRI and MR Angiography
8
18FDG-PET

• Residual / recurrent locoregional disease
• Detection of occult primaries in MUO
• Occult metastatic disease in the neck
• Synchronous primaries or metastasis

9
What is New in Staging ?

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

10
What is New in Surgery?

• Oral cavity Pattern of Mandibular invasion
• Mandible Preservation
• Larynx Endoscopic Laser Excision
• Conservative laryngectomy
• Primary voice rehabilitation
• PNS Tumors Endoscopic Sinus Surgery
• Cranio-facial Excision

11
(No Transcript)
12
What is New in Chemotherapy ?

• Category Hazard ratio CT effect Abs. benefit
• (p) 2yrs 5yrs
• Adjuvant 0.98 0.74
  1 1
• Neo-adjuvant 0.95 0.10
  2 2
• Concomitant 0.81 lt0.0001 7
  8
• Total 0.90 lt0.0001 4 4

MACH-NC, LANCET 2000
13
Laryngeal Preservation

• VALCSG 1991
• Larynx preserved in 64 patients
• No change in overall survival
• EORTC 1996
• 42 functioning larynx-3 yrs, 35 -5 yrs
• RTOG 2003
• 88 functioning larynx at 2 years
• 22 loco- regional failures

14
What is New in Radiotherapy ?

• Techniques
• Alt. Fractionation- Accelerated Hyperfr.
• 3D Conformal Radiotherapy IMRT
• Stereotactic/ Fr. Stereotactic Radiothearpy
• Neutron Beam/Charged Particle RT
• Intraoperative Radiotherapy
• Radiation Induced Xerostomia
• Pharmacological Agents- Amifostin, GMCSF
• Submandibular Gland Transfer (Seikaly et al)

15
(No Transcript)
16
Newer Targets of Therapy

• Photodynamic Therapy Palliation
• Curative intent- Small primary tumor
• Second primary/ Recurrent tumor
• Premalignant lesions
• Antibody based Therapy
• Monoclonal Ab against EGFr-C225
• Inhibitors of EGFr-ZD1839, Erlotinib HCl
• Gene Therapy

17
Gene Therapy- Approaches

• Augmentation therapy
• Immunotherapy
• Cytokine gene transfer- IL-2,IL-12, IFN-
  g
• Vaccination Tumor specific antigen
• Co-stimulator molecule
• Foreign antigen
• Chemotherapy HSV TK
• Drug sensitization / Drug resistance
• Gene replacement
• Replace tumor suppressor gene- p53
• Inhibit an oncogene- Antisense c DNA
• Adjuvant Therapy- Post CT / RT/ Surgery

18
Chemoprevention

• Possible Roles
• Reversal of oral pre-cancerous lesions
• Chemoprevention of SPT
• Primary chemoprevention in high-risk
• Phamacological Agents
• Beta Carotene
• Retinoids- 13cRA,Vitamin A
• Retinamides
• a-tocopherol

19
Thank You!
20
Overview

• Molecular Basis of Carcinogenesis
• Imaging- 3-D CT , MR Angio, FDG-PET
• Staging- Changes in TNM (6th Ed. AJCC)
• Concurrent Chemo- RT- MACH- NC, RTOG
• Advances in Radiotherapy Techniques
• Improved Quality of Life- Post Surgery/RT
• Newer Targets for therapy
• Advances in Chemoprevention