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6. Management

​Updated: May 2003

Referal information for the new patient visit.

ENT Conference is held every Monday from 11.00 a.m. - noon.

Thyroid Conference is held on the 1st Thursday of the month from 8.00-9.15 a.m.

Tertiary Triage Criteria (who should be referred to a regional cancer centre)

  • all patients currently on protocol studies
  • all head & neck and ENT cases

Although the majority of physicians and dentists will encounter few patients with cancer of the oral cavity, larynx, pharynx, thyroid or salivary glands, it is essential that the possibility of malignancy should be considered when an abnormality in these areas is encountered. If cancers of the oral cavity, pharynx and larynx are seen when small and before lymph node metastases have occurred, the majority can be cured. If diagnosis is delayed until the lesion is large or has metastasized to lymph nodes in the neck, the many will die of their disease.

There appear to be misconceptions as to the significance of thyroid cancer. When seen in young people, thyroid cancer usually has a very favorable outcome but many do not appreciate that differentiated thyroid cancer in older patients may be lethal.

The treatment of head and neck cancer should be the responsibility of a team of surgeons, radiation oncologists, medical oncologists and dentists. Many patients also require the services of dietitians, physiotherapists and speech therapists. The aim of treatment is to give the best possible chance of cure while reducing functional and cosmetic disability to a minimum. As these types of cancers are not commonly seen, a few specialists across the province have developed a special interest and their advice should be sought.

Many early squamous cell carcinomas of the mouth and oropharynx can be cured by excision, but some form of radiation therapy is the usual preferred primary treatment for early tumours at other sites. Multidisciplinary assessment is mandatory for patients with more advanced cancers. When there is metastatic lymph node involvement, surgical dissection of the lymph nodes is usually required. In selected patients when radiation has failed as a primary treatment, radical surgical excision may still be possible and offer a significant chance of cure with acceptable functional and cosmetic results.

When radiotherapy is prescribed, this usually requires the construction of an immobilization device and subsequent CT based treatment planning which make take 7-10 days before treatment can be started.

SOURCE: 6. Management ( )
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