This document discusses cancers of the oral cavity and salivary glands. It describes the different types of malignant and benign epithelial tumors and salivary gland tumors that can occur. It provides details on squamous cell carcinoma, including epidemiology, signs and symptoms, diagnosis, staging and treatment approaches. Management depends on the stage and location of the cancer, and may involve surgery, radiation therapy or chemoradiation. Advanced disease is generally treated with a multimodal approach including surgery and postoperative radiation or chemoradiation.
Includes most common tumors of oral cavity including scc,bcc, melanoma, ameloblastoma, odontoma, fibromas, pindborg tumors etc.
Presented by Dr. Binaya Subedi
Squamous cell carcinoma of skin | management -all medical aspects.martinshaji
Squamous cell carcinoma of the skin is a common form of skin cancer that develops in the squamous cells that make up the middle and outer layers of the skin. Squamous cell carcinoma of the skin is usually not life-threatening, though it can be aggressive. Squamous cell carcinomas may appear as flat reddish or brownish patches in the skin, often with a rough, scaly, or crusted surface. They tend to grow slowly and usually occur on sun-exposed areas of the body, such as the face, ears, neck, lips, and backs of the hands.
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Benign, locally aggressive tumor of odontogenic epithelium, Previously called adamantinoma, Second most common odontogenic tumor after odontoma, Mandible is most common site, Usually asymptomatic and can be found incidentally on routine dental examinations
Includes most common tumors of oral cavity including scc,bcc, melanoma, ameloblastoma, odontoma, fibromas, pindborg tumors etc.
Presented by Dr. Binaya Subedi
Squamous cell carcinoma of skin | management -all medical aspects.martinshaji
Squamous cell carcinoma of the skin is a common form of skin cancer that develops in the squamous cells that make up the middle and outer layers of the skin. Squamous cell carcinoma of the skin is usually not life-threatening, though it can be aggressive. Squamous cell carcinomas may appear as flat reddish or brownish patches in the skin, often with a rough, scaly, or crusted surface. They tend to grow slowly and usually occur on sun-exposed areas of the body, such as the face, ears, neck, lips, and backs of the hands.
this is a detailed discussion on the topic
please comment
thank u
Benign, locally aggressive tumor of odontogenic epithelium, Previously called adamantinoma, Second most common odontogenic tumor after odontoma, Mandible is most common site, Usually asymptomatic and can be found incidentally on routine dental examinations
Carcinoma esophagus is the common cause for dysphagia for solids. These patients usually present too late to do any definitive curative surgical procedure.
In Depth review of the Surgical management of esophageal carcinoma including management overview, endoscopic management, Type of surgeries, Open, and minimally invasive, Extent of lymphadenectomy. Literature review of evidence for type of surgery and complications
CARCINOMA OF THE ORAL CAVITY. Diagnosis and management.tDr. RIFFAT KHATTAK
The Oral Cavity, with it's seven subsites,is a host of multiple epithelial, mesenchymal & glandular structures. Thus, if exposed to multiple risk factors, either in isolation or in combination, could undergo drastic histological changes leading to malgnancies. A thorough clinical examination, diagnosis and timely intervention followed by rehabilitation of the patient, via a multi disciplinary approach is the mainstay of treatment.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
10. SQUAMOUS CELL
CARCINOMA(SCC)
Definition- An invasive epithelial neoplasm with
varying degrees of squamous differentiation
and a propensity to early and extensive lymph
node metastases, occurring predominantly in
alcohol and tobacco-using adults in the 5th and
6th decades of life.
Etiology-
Tobacco smoking & alcohol
Tobacco chewing
Human Papilloma Virus (HPV) infection
12. MICROSCOPIC APPEARANCE
• Moderately differentiated SCC.
•Cells formlarge anastomosing
areas in which keratin pearls are
formed.
•Main component consists of cells
with pronounced cytonuclear atypia
•Well-differentiated SCC
•Characterized by abundant
formation of keratin pearls.
13. Poorly differentiated SCC.
Cells with atypical nuclei and a small rim of
eosinophilic cytoplasm form strands and small
nests.
MICROSCOPIC APPEARANCE
14. SIGNS & SYMPTOMS
Small oral and oropharyngeal SCC are often
asymptomatic or may present with vague symptoms
Red lesions, mixed red and white lesions, or white
plaques.
Mucosal growth, pain and ulceration
Referred pain to the ear
Malodour from the mouth
Difficulty with speaking, opening the mouth, chewing
Pain with swallowing
15. DIAGNOSIS
Physical examination- Visual inspection and
palpation of all mucosal surfaces, bimanual
palpation of the floor of the mouth and clinical
assessment of the neck for lymph node
involvement.
Biopsy- Confirmatory test
Fine needle aspiration cytology
Routine pan endoscopy
Three-dimensional imaging with computed
tomography (CT) and magnetic resonance
imaging (MRI)
16. LYMPHOEPITHELIAL CARCINOMA
Definition- Lymphoepithelial carcinoma (LEC) is
a poorly differentiated squamous cell carcinoma
(SCC) or undifferentiated carcinoma,
accompanied by a prominent reactive
lymphoplasmacytic infiltrate.
Etiology-Epstein- Burr Virus
Clinical Features - Intra-oral mass, which may
be ulcerated
17. PAPILLOMAS
Definition- Localised hyperplastic exophytic and
polypoid lesions of hyperplastic epithelium with a
verrucous or cauliflower-like morphology
Etiology- HPV infection
19. TREATMENT OF EARLY DISEASE
Surgical Excision
Management of choice
Excellent cure rates with minimum morbidity
Radiotherapy (Interstitial or External)
Equally effective as surgery for the treatment of
early disease
Long-term sequelae including xerostomia,
dysphagia and osteoradionecrosis are major
limitations
Requires daily therapy for 6–7 weeks
Reserved for those patients who are unable to
undergo surgery
20. UICC/AJCC STAGING FOR
ADVANCED ORAL CAVITY
CANCER
Small Tumor with neck metastasis
T1-T2, N2-3
Tumor < 4 cm with 2 or more cervical metastasis,
one or more contralateral cervical metastases, or
cervical metastasis > 3cm
21. PRIMARY SURGERY + RADIATION
INDICATED FOR ADVANCED ORAL
CAVITY CANCER
Low local control for primary radiotherapy for
advanced oral cavity (30-40%) and poor survival
(25%)
Increased local control with surgery +
radiotherapy (60%) and improved survival (55%)
Zelefsky et al, Head Neck. 1990 Nov-Dec;12(6):470-5
Local control significantly improved for locally
advanced T3, T4 oral cancers using surgery +
postoperative radiotherapy vs. primary RT
Fein et al. Head Neck. 1994 Jul-Aug;16(4):358-65
23. SURGICAL APPROACHES
Transoral and Visor Approaches
Cosmetic but may limit exposure
Lip Splitting
Modest cosmetic disadvantage with excellent
posterior exposure for mandibulotomy
Paramedian or midline mandibulotomy
Avoidance of alveolar nerve
24. SURGICAL APPROACHES
CAVEATS
Approach determined before incision and
mandibulectomy or mandibulotomy
Accurate assessment of bone erosion, involvement of neural
structures
25. SURGICAL RESECTION
ADVANCES
Reconstruction
Reconstruction
Free Tissue Transfer
Mandibular reconstruction (fibula, scapula, etc.)
Soft tissue/tongue (radial forearm, rectus
abdominus, lateral thigh, etc.)
Resection is rarely limited by size or extent of
tumor
27. SURGICAL EXCISION
To achieve a complete resection of the tumor with
free margins
In cases where there are positive or close
margins (tumor within 5 mm of the surgical
margin), surgical re-resection is recommended
In cases where a re-resection is performed and
evidence of microscopically positive margins
remains or if resection cannot be reliably
performed, radiation therapy directed at the
primary site should be considered.
28. MANAGEMENT OF TUMORS
INVADING MANDIBLE
A marginal or a segmental resection
Tumor invasion of the periosteum or cortical
bone, without invasion of the medullary cortex,
can be appropriately managed with a marginal
resection.
Tumors that erode into the medullary canal,
however, require a segmental resection
Postoperative external beam radiation is
mandatory for tumors that invade mandible
29. MANAGEMENT OF TUMORS INVADING
THE BUCCAL MUCOSA
Buccal cancer comprises10% of oral cavity
cancers
It commonly arises from pre-existing leukoplakia.
In early disease, surgical excision can usually be
accomplished transorally
Advanced tumors may require a midline
labiotomy incision.
30. MANAGEMENT OF TUMORS
INVOLVING THE HARD PALATE
Superficial lesions of the palatal mucosa are best
managed with a wide surgical resection including
the underlying palatal periosteum
32. Primary Surgical Therapy Followed by
Postoperative Chemotherapy and Radiation
I: EORTC Bernier et al. NEJM 2004
Previously untreated SCC, all head and neck sites,
n=167, 5 year median follow up
100 mg/m2 cisplatinum day 1, 22, 43 during
postoperative irradiation or postoperative radiation
alone
33. Primary Surgical Therapy Followed by
Postoperative Chemotherapy and Radiation:
EORTC Bernier et al. NEJM 2004
pT3 or pT4, any N, except T3N0 of the larynx,
with negative resection margins
pT1 or T2, N2 or N3
T1 or T2 and N0 or N1 with pathological
extranodal spread, positive resection margins,
perineural involvement, or vascular tumor
embolism
Oral cavity or oropharyngeal tumors with involved
lymph nodes at level IV or V
34. EORTC Bernier et al. NEJM 2004
The overall survival rate 53% vs 40%, p=0.02
Locoregional failure 18% vs. 31%, p=0.007
Severe (grade 3 or higher) adverse effects 41%
vs. 21% p=0.001
35. Postoperative Chemoradiation for
Advanced Head and Neck Cancer
Clear advantage in locoregional control
Survival advantage
Difference in enrollment criteria may suggest survival
advantage for locally aggressive tumors without
significant nodal disease
37. CONCLUSIONS
Early disease (stages I–II) is generally curable
with single modality therapy.
Surgery is preferable in most cases
Advanced disease (stages III–IV) is best
managed with multimodality therapy, generally
with surgery followed by radiotherapy particularly
for high-risk primary lesions
Adjuvant chemoradiotherapy to the neck is
indicated for N2 or greater disease.
38. REFERENCES
Genden EM,Ferlito A et al. Contemporary management
of cancer of the oral cavity. Eur Arch Otorhinolaryngol
(2010) 267:1001–1017.
Cancela M, Voti L, Guerra-Yi M, Chapuis F, Mazuir M,
Curado MP (2010) Oral cavity cancer in developed and
in developing countries: population-based incidence.
Head Neck (in press)
Hashibe M, Brennan P, Chuang SC et al. Interaction
between tobacco and alcohol use and the risk of head
and neck cancer: pooled analysis in the International
Head and Neck Cancer Epidemiology Consortium.
Cancer Epidemiol Biomarkers Prev. 1999, 18:541–550
39. REFERENCES
Hennessey PT, Westra WH, Califano JA (2009)
Human papillomavirus and head and neck squamous
cell carcinoma: recent evidence and clinical
implications. J Dent Res 88:300–306
Chaturvedi AK, Engels EA, Anderson WF, Gillison ML
(2008) Incidence trends for human papilloma virus-
related and -unrelated oral squamous cell carcinomas
in the United States. J Clin Oncol 26:612–619
Smeets SJ, Hesselink AT, Speel EJ, Haesevoets A,
Snijders PJ (2007) A novel algorithm for reliable
detection of human papillomavirus in paraffin
embedded head and neck cancer specimen. Int J
Cancer 121:2465–2472