- Palliative care aims to improve quality of life for patients facing life-threatening illness through prevention and relief of suffering via early identification and treatment of pain and other physical, psychosocial and spiritual problems.
- It can begin at diagnosis alongside curative treatment and continues even if curative treatment is no longer an option.
- A multidisciplinary team addresses common issues in head and neck cancer like pain, dysphagia, malnutrition, secretions, and side effects of treatment through pharmacological, nutritional, physical and psychosocial support.
This document discusses oropharyngeal cancers. It begins with the anatomy of the oropharynx and its boundaries. It then discusses the epidemiology, risk factors, clinical features, staging, workup, and management of oropharyngeal cancers. Early stage cancers are often treated with either radiotherapy or surgery alone, while locoregionally advanced cancers may be treated with surgery followed by radiation and chemotherapy or with primary chemoradiation. HPV-associated oropharyngeal cancers often have a better prognosis than HPV-negative cancers.
Organ Preservation Surgery For Laryngeal Cancerfondas vakalis
The document discusses organ preservation surgery options for laryngeal cancer following failed radiation therapy. It presents a case study of a 71-year-old man with recurrent laryngeal cancer and evaluates his diagnosis and treatment options, which include transoral laser surgery, vertical partial laryngectomy, and supracricoid partial laryngectomy. It provides details on the procedures, selection criteria, outcomes, and complications based on literature reviews.
CARCINOMA MAXILLARY SINUS MANAGEMENT RADIATION ONCOLOGYPaul George
This document discusses carcinoma of the maxilla, including epidemiology, histology, clinical presentation, staging, investigations, management, and prognosis. Squamous cell carcinoma is the most common type, presenting more in men in the 5th-6th decade. Clinical evaluation includes imaging like CT and MRI to determine extent. Treatment involves surgery like maxillectomy with clear margins followed by postoperative radiation therapy to improve outcomes. Prognosis remains poor at a 5-year survival of 35-45% even with multimodality treatment. A case example is presented of a 58-year-old female smoker found to have cT2N0M0 carcinoma of the left maxilla who underwent subtotal maxillectomy followed
Principles of Radiotherapy in Head & Neck Surgery and Recent Advances A by Dr...Aditya Tiwari
This document provides an overview of radiotherapy principles for head and neck cancer. It discusses that head and neck cancer represents 6% of new cancer cases worldwide and radiotherapy plays an important role in its treatment. It then summarizes the brief history of radiotherapy and different radiation types used including photon beams, electron beams, and particle radiation. The document also covers radiotherapy techniques such as external beam radiotherapy using linear accelerators, brachytherapy, and fractionation schemes.
This document discusses cancer of the nasopharynx (NPC). Some key points:
- NPC is uncommon globally but more common in certain regions like Southern China.
- Risk factors include EBV infection, consumption of salted fish.
- Staging involves MRI and biopsy. Treatment depends on stage but often involves chemotherapy and radiation therapy.
- Advanced stages may receive neoadjuvant chemo followed by concurrent chemo-radiation. IMRT has improved treatment.
- Sequelae can include cranial neuropathy, xerostomia, endocrine issues. Lifelong follow up is needed due to risk of recurrence or second cancers. Outcomes have improved but salvage options after relapse present challenges
This document provides an overview of management options for carcinoma of the nasal cavity and paranasal sinuses. It discusses the lymphatic drainage, histologic subtypes, treatment options including surgery, radiotherapy, and chemotherapy. Surgical procedures and approaches are described depending on the involved sinus. Post-operative radiotherapy techniques and dose recommendations are provided for different tumor locations and stages. Complications of treatment are also summarized.
This document discusses oropharyngeal cancers. It begins with the anatomy of the oropharynx and its boundaries. It then discusses the epidemiology, risk factors, clinical features, staging, workup, and management of oropharyngeal cancers. Early stage cancers are often treated with either radiotherapy or surgery alone, while locoregionally advanced cancers may be treated with surgery followed by radiation and chemotherapy or with primary chemoradiation. HPV-associated oropharyngeal cancers often have a better prognosis than HPV-negative cancers.
Organ Preservation Surgery For Laryngeal Cancerfondas vakalis
The document discusses organ preservation surgery options for laryngeal cancer following failed radiation therapy. It presents a case study of a 71-year-old man with recurrent laryngeal cancer and evaluates his diagnosis and treatment options, which include transoral laser surgery, vertical partial laryngectomy, and supracricoid partial laryngectomy. It provides details on the procedures, selection criteria, outcomes, and complications based on literature reviews.
CARCINOMA MAXILLARY SINUS MANAGEMENT RADIATION ONCOLOGYPaul George
This document discusses carcinoma of the maxilla, including epidemiology, histology, clinical presentation, staging, investigations, management, and prognosis. Squamous cell carcinoma is the most common type, presenting more in men in the 5th-6th decade. Clinical evaluation includes imaging like CT and MRI to determine extent. Treatment involves surgery like maxillectomy with clear margins followed by postoperative radiation therapy to improve outcomes. Prognosis remains poor at a 5-year survival of 35-45% even with multimodality treatment. A case example is presented of a 58-year-old female smoker found to have cT2N0M0 carcinoma of the left maxilla who underwent subtotal maxillectomy followed
Principles of Radiotherapy in Head & Neck Surgery and Recent Advances A by Dr...Aditya Tiwari
This document provides an overview of radiotherapy principles for head and neck cancer. It discusses that head and neck cancer represents 6% of new cancer cases worldwide and radiotherapy plays an important role in its treatment. It then summarizes the brief history of radiotherapy and different radiation types used including photon beams, electron beams, and particle radiation. The document also covers radiotherapy techniques such as external beam radiotherapy using linear accelerators, brachytherapy, and fractionation schemes.
This document discusses cancer of the nasopharynx (NPC). Some key points:
- NPC is uncommon globally but more common in certain regions like Southern China.
- Risk factors include EBV infection, consumption of salted fish.
- Staging involves MRI and biopsy. Treatment depends on stage but often involves chemotherapy and radiation therapy.
- Advanced stages may receive neoadjuvant chemo followed by concurrent chemo-radiation. IMRT has improved treatment.
- Sequelae can include cranial neuropathy, xerostomia, endocrine issues. Lifelong follow up is needed due to risk of recurrence or second cancers. Outcomes have improved but salvage options after relapse present challenges
This document provides an overview of management options for carcinoma of the nasal cavity and paranasal sinuses. It discusses the lymphatic drainage, histologic subtypes, treatment options including surgery, radiotherapy, and chemotherapy. Surgical procedures and approaches are described depending on the involved sinus. Post-operative radiotherapy techniques and dose recommendations are provided for different tumor locations and stages. Complications of treatment are also summarized.
Mr. Sunil, a 72-year-old male, presented with a 3-month history of a left neck swelling. Further examinations revealed metastatic squamous cell carcinoma in the left neck lymph nodes. He was diagnosed with carcinoma of unknown primary (CUP) and underwent radical neck dissection, followed by chemotherapy and radiotherapy. CUP describes metastatic cancers where the primary site cannot be identified despite various examinations and evaluations. Treatment options for CUP include surgery, radiation therapy, chemotherapy, or concurrent chemoradiation depending on the lymph node involvement and other factors. Prognosis depends on the stage and presence of extracapsular extension, with 5-year survival rates ranging from 30% for upper cervical nodes to 5%
This document describes a 62-year-old female patient who presented with 4 months of dysphagia that progressed to difficulty swallowing both solids and liquids. Examination found an exophytic growth in the post-cricoid area extending to the pyriform sinuses and vallecula. Biopsy revealed poorly differentiated non-keratinizing squamous cell carcinoma of the hypopharynx. CT scan showed enlarged lymph nodes and a nodule in the right lung. The patient received 13 cycles of chemotherapy and radiotherapy and was followed up monthly, with examinations after 5 months finding no remaining abnormalities.
Nasopharyngeal carcinoma is typically treated with radiation therapy. Concurrent chemotherapy and radiation is the standard for locally advanced disease and improves survival compared to radiation alone. Intensity-modulated radiation therapy provides better tumor coverage and reduces side effects. Surgery has a limited role except for biopsy or salvaging recurrent tumors. Temporal lobe necrosis is a serious potential complication, so fractional doses above 2Gy should be avoided. Close follow-up is needed due to risk of recurrence or late effects.
This document discusses various laryngeal surgeries including:
1. Endoscopic resections, vertical partial laryngectomies, and total laryngectomy are discussed as options for glottic cancer treatment. Complications can include bleeding, airway obstruction, and laryngeal stenosis.
2. Supraglottic laryngectomy and supracricoid partial laryngectomy are options for supraglottic cancers while preserving the larynx. Patient selection is important due to risk of aspiration.
3. Voice rehabilitation options after total laryngectomy include electrolarynx, esophageal voice, or tracheoesophageal voice via a puncture and fistula between the trachea and es
The document discusses the classification and techniques of neck dissection for cervical lymph node metastasis. It describes the different types of neck dissection including radical neck dissection (RND), modified radical neck dissection (MRND), and selective neck dissection (SND). It outlines the lymph node levels and boundaries involved in each procedure. Key factors in determining the appropriate procedure include the primary tumor site and extent of lymph node involvement.
This document provides information on head and neck cancer including:
1. It describes the anatomy of the head and neck region including lymph nodes and locations of salivary glands.
2. It discusses imaging techniques like CT and PET scans which are used to detect and stage head and neck cancers.
3. It outlines the AJCC TNM staging system for various head and neck cancers and describes how the cancer can spread from different primary sites.
managment of neck nodes with occult primaryBharti Devnani
This document discusses the management of neck nodes with an occult primary tumor. It defines this condition as biopsy-proven cancer of the neck that cannot be linked to a primary lesion after a full clinical and radiological workup. It notes the estimated incidence is 3-7% of head and neck cancers initially presenting with cervical lymph node metastases. Risk of lymph node metastases depends on factors like density of lymphatics in the potential primary site and histologic characteristics of the lesion. Diagnostic workup involves imaging, biopsies of suspicious areas, and examination under anesthesia. Treatment involves neck dissection, with options like radical, modified radical or selective dissection depending on the extent of disease. Post-surgery management considers disease
This document provides information on carcinoma of the hypopharynx, including its anatomy, characteristics, risk factors, clinical presentation, investigations, staging, and treatment options. Some key points:
- The hypopharynx extends from the oropharynx to the cervical esophagus. Common subsites for cancer are the pyriform fossa, postcricoid area, and posterior pharyngeal wall.
- Hypopharyngeal cancers often present late at Stage III/IV with neck node metastasis. They have a higher rate of submucosal extension and distant metastases compared to other head and neck cancers.
- Risk factors include Plummer Vinson syndrome, alcohol, tobacco
Role of radiotherapy and chemotherapy in oral cavity cancerDr.Rashmi Yadav
Radiotherapy and chemotherapy play important roles in the treatment of oral cavity cancer alongside surgery. Radiotherapy is often used as the primary treatment for early stage cancers or as an adjuvant treatment with surgery for more advanced cancers. Chemotherapy is commonly used neoadjuvantly or concurrently with radiotherapy to improve treatment outcomes, especially for advanced cancers. Brachytherapy can also be used as a radiation boost for early stage oral cavity cancers. The goals of treatment are maximizing local tumor control while preserving function and minimizing side effects through a multidisciplinary approach.
Maxillary sinus carcinoma arises from the maxillary sinus and can spread locally and to lymph nodes. Diagnosis involves physical exam, CT/MRI imaging, and biopsy. Staging evaluates tumor size, lymph node involvement, and distant spread. Treatment depends on stage but may include surgery such as maxillectomy, radiation therapy such as IMRT, and chemotherapy such as cisplatin for locally advanced cases. The goal of treatment is a complete resection with negative margins or effective control with radiation with or without chemotherapy while minimizing side effects to nearby structures like the optic nerves and chiasm. Outcomes depend on stage, with earlier stages having higher survival rates treated with surgery or surgery plus radiation.
Management of supraglottic and glottic larynx cancer has been revised lately. This presentation gives an overview of guidelines for management of laryngeal cancer. includes latest NCCN guidelines.
1) The document discusses treatment guidelines and radiation therapy for malignant parotid gland tumors. It outlines the workup, treatment algorithm, indications for postoperative radiation, and clinical target volume definition.
2) Recommendations include radiation therapy for T3/T4 tumors, incomplete resection, high grade histology, recurrent disease, and node-positive disease. The clinical target volume covers the parotid bed and neck lymph nodes.
3) Guidelines provide organ at risk contours and trial management group recommendations on radiation doses and volumes based on tumor and node characteristics. Elective neck irradiation is advised for high grade tumors, T3/T4 disease, and certain histologies.
Metastasis of Neck Node with Unknown Primary Himanshu Soni
1) An unknown primary is defined as squamous cell carcinoma presenting in cervical lymph nodes with no identifiable primary tumor site after examination. This clinical entity is known as carcinoma of unknown primary (CUP).
2) Evaluation involves physical examination, imaging like PET-CT, and panendoscopy with biopsies of suspicious sites to identify the occult primary tumor. Bilateral tonsillectomy and tongue base biopsy can identify occult tumors in the tonsillar crypts in many cases.
3) Treatment depends on tumor stage but often involves combined modality treatment with surgery, radiation, and/or chemotherapy aimed at locoregional control while minimizing morbidity.
This document discusses laryngeal transplantation, including:
1. Pioneering attempts at laryngeal transplantation in the 1960s-1980s faced technical limitations and ethical concerns.
2. Advances in microsurgery, immunosuppression, and organ preservation have made laryngeal transplantation a possibility once deemed too risky.
3. The first reported successful human laryngeal transplantation was in 1998, where the patient regained voice function and swallowing abilities over time despite facing some complications.
This document discusses electro-acoustic stimulation (EAS), which combines cochlear implantation for high frequencies with acoustic amplification for low frequencies. EAS aims to restore hearing in both high and low frequencies by using electric stimulation to improve hearing in high frequencies and acoustic amplification to improve residual hearing in low frequencies. Studies have found that EAS users score significantly higher on speech tests compared to users of hearing aids alone. The document discusses various EAS devices and features that aim to preserve residual hearing, such as shorter or thinner electrodes. It also covers aspects of the surgery and post-operative programming to optimize the benefits of combined electric and acoustic stimulation.
Carcinoma nasopharynx anatomy to managementDrAyush Garg
The document provides information on carcinoma of the nasopharynx, including its anatomy, epidemiology, etiology, clinical features, patterns of spread, diagnostic evaluation, and metastatic workup. The key points are:
1) Nasopharyngeal carcinoma is most common in Southern Chinese populations and has a bimodal age distribution. Viral, genetic, and environmental factors like Epstein-Barr virus and salted fish contribute to its etiology.
2) The tumor can spread superiorly into the skull base, anteriorly into the nasal cavity/sinuses, and posteriorly into neck muscles and brain. Distant metastases most often involve bones and lungs.
3) Diagnostic evaluation includes endoscopic
This document provides an overview of head and neck cancers, including definitions, classifications, epidemiology, etiology, molecular biology, clinical features, and tumor metastasis. Specifically, it discusses that head and neck cancers most commonly present as squamous cell carcinomas involving oral cavity, larynx, and hypopharynx. It also reviews risk factors such as tobacco, alcohol, infections, and genetics. Clinical features may include lumps, ulcers, bleeding, pain, and lymph node enlargement. Proper examination and staging are important for determining prognosis and treatment options.
This document discusses treatment options for head and neck cancer including radiation therapy. It notes that treatment decisions should be made by a multidisciplinary team including surgeons, radiation oncologists, medical oncologists, and support staff. For early stage cancer, options are surgery or radiation alone, while more advanced cancers may receive chemo-radiation or surgery plus radiation and chemotherapy. Radiation uses CT and PET imaging to precisely target the tumor and spare normal tissues. Short term side effects include skin irritation, mouth sores, and difficulty swallowing. Long term side effects can include permanent dry mouth and dental problems. The document provides images showing results of treatment and side effects over time.
This document discusses brachytherapy techniques for head and neck cancers. It describes different types of brachytherapy based on positioning of the radionuclide (interstitial, intracavitary, surface moulds), dose rate (LDR, MDR, HDR, PDR), and technique (temporary, permanent). It also discusses dosimetry systems like Patterson-Parker, Quimby, Paris and computerized planning. Key aspects of treatment planning, delivery, and post-treatment care are summarized. Advantages include localized high dose with rapid falloff and organ preservation, while limitations include inaccessibility and quality dependence on implant. American Brachytherapy Society guidelines emphasize accurate assessment and dental
1. Carcinoma of the larynx is most commonly squamous cell carcinoma, usually caused by smoking and alcohol consumption. It can occur in the supraglottis, glottis, or subglottis regions.
2. Diagnosis involves laryngoscopy, CT/MRI imaging, and biopsy of visible lesions. Staging uses the TNM system and determines treatment approach and prognosis.
3. Treatment depends on stage but may include surgery such as laryngectomy, radiation therapy alone or with chemotherapy for advanced stages, or organ preservation with radiation/chemoradiation for early stages. The goal is cure of the cancer or organ function preservation.
This document discusses palliative care, which aims to improve quality of life for patients facing life-threatening illnesses. It defines palliative care as preventing and relieving suffering through early assessment and treatment of pain and other problems. The goals of palliative care are to relieve suffering, treat pain and distressing symptoms, and provide psychological, spiritual and social support. Common symptoms addressed in palliative care are discussed, including pain, nausea, vomiting, dyspnea, constipation and fungating wounds. The importance of psychological care and social support for patients and families is also outlined.
Building on the lecture I gave (and uploaded) "Palliative Care: what every primary care doctor should know" I built this talk. It is geared for 1st year medical students who are learning anatomy, physiology, and perhaps some pharmacology and pathophysiology.
In this talk, I do not explicitly address hospice care - as that was provided in an online chapter for students at UMass. I will later upload another slide set on that topic.
I hope you enjoy it.
FYI- the link to the youtube video: http://www.youtube.com/watch?v=XHtHXGhTIC4
Link to PDF of the slide show: https://files.me.com/s.mak/8fzat6
Mr. Sunil, a 72-year-old male, presented with a 3-month history of a left neck swelling. Further examinations revealed metastatic squamous cell carcinoma in the left neck lymph nodes. He was diagnosed with carcinoma of unknown primary (CUP) and underwent radical neck dissection, followed by chemotherapy and radiotherapy. CUP describes metastatic cancers where the primary site cannot be identified despite various examinations and evaluations. Treatment options for CUP include surgery, radiation therapy, chemotherapy, or concurrent chemoradiation depending on the lymph node involvement and other factors. Prognosis depends on the stage and presence of extracapsular extension, with 5-year survival rates ranging from 30% for upper cervical nodes to 5%
This document describes a 62-year-old female patient who presented with 4 months of dysphagia that progressed to difficulty swallowing both solids and liquids. Examination found an exophytic growth in the post-cricoid area extending to the pyriform sinuses and vallecula. Biopsy revealed poorly differentiated non-keratinizing squamous cell carcinoma of the hypopharynx. CT scan showed enlarged lymph nodes and a nodule in the right lung. The patient received 13 cycles of chemotherapy and radiotherapy and was followed up monthly, with examinations after 5 months finding no remaining abnormalities.
Nasopharyngeal carcinoma is typically treated with radiation therapy. Concurrent chemotherapy and radiation is the standard for locally advanced disease and improves survival compared to radiation alone. Intensity-modulated radiation therapy provides better tumor coverage and reduces side effects. Surgery has a limited role except for biopsy or salvaging recurrent tumors. Temporal lobe necrosis is a serious potential complication, so fractional doses above 2Gy should be avoided. Close follow-up is needed due to risk of recurrence or late effects.
This document discusses various laryngeal surgeries including:
1. Endoscopic resections, vertical partial laryngectomies, and total laryngectomy are discussed as options for glottic cancer treatment. Complications can include bleeding, airway obstruction, and laryngeal stenosis.
2. Supraglottic laryngectomy and supracricoid partial laryngectomy are options for supraglottic cancers while preserving the larynx. Patient selection is important due to risk of aspiration.
3. Voice rehabilitation options after total laryngectomy include electrolarynx, esophageal voice, or tracheoesophageal voice via a puncture and fistula between the trachea and es
The document discusses the classification and techniques of neck dissection for cervical lymph node metastasis. It describes the different types of neck dissection including radical neck dissection (RND), modified radical neck dissection (MRND), and selective neck dissection (SND). It outlines the lymph node levels and boundaries involved in each procedure. Key factors in determining the appropriate procedure include the primary tumor site and extent of lymph node involvement.
This document provides information on head and neck cancer including:
1. It describes the anatomy of the head and neck region including lymph nodes and locations of salivary glands.
2. It discusses imaging techniques like CT and PET scans which are used to detect and stage head and neck cancers.
3. It outlines the AJCC TNM staging system for various head and neck cancers and describes how the cancer can spread from different primary sites.
managment of neck nodes with occult primaryBharti Devnani
This document discusses the management of neck nodes with an occult primary tumor. It defines this condition as biopsy-proven cancer of the neck that cannot be linked to a primary lesion after a full clinical and radiological workup. It notes the estimated incidence is 3-7% of head and neck cancers initially presenting with cervical lymph node metastases. Risk of lymph node metastases depends on factors like density of lymphatics in the potential primary site and histologic characteristics of the lesion. Diagnostic workup involves imaging, biopsies of suspicious areas, and examination under anesthesia. Treatment involves neck dissection, with options like radical, modified radical or selective dissection depending on the extent of disease. Post-surgery management considers disease
This document provides information on carcinoma of the hypopharynx, including its anatomy, characteristics, risk factors, clinical presentation, investigations, staging, and treatment options. Some key points:
- The hypopharynx extends from the oropharynx to the cervical esophagus. Common subsites for cancer are the pyriform fossa, postcricoid area, and posterior pharyngeal wall.
- Hypopharyngeal cancers often present late at Stage III/IV with neck node metastasis. They have a higher rate of submucosal extension and distant metastases compared to other head and neck cancers.
- Risk factors include Plummer Vinson syndrome, alcohol, tobacco
Role of radiotherapy and chemotherapy in oral cavity cancerDr.Rashmi Yadav
Radiotherapy and chemotherapy play important roles in the treatment of oral cavity cancer alongside surgery. Radiotherapy is often used as the primary treatment for early stage cancers or as an adjuvant treatment with surgery for more advanced cancers. Chemotherapy is commonly used neoadjuvantly or concurrently with radiotherapy to improve treatment outcomes, especially for advanced cancers. Brachytherapy can also be used as a radiation boost for early stage oral cavity cancers. The goals of treatment are maximizing local tumor control while preserving function and minimizing side effects through a multidisciplinary approach.
Maxillary sinus carcinoma arises from the maxillary sinus and can spread locally and to lymph nodes. Diagnosis involves physical exam, CT/MRI imaging, and biopsy. Staging evaluates tumor size, lymph node involvement, and distant spread. Treatment depends on stage but may include surgery such as maxillectomy, radiation therapy such as IMRT, and chemotherapy such as cisplatin for locally advanced cases. The goal of treatment is a complete resection with negative margins or effective control with radiation with or without chemotherapy while minimizing side effects to nearby structures like the optic nerves and chiasm. Outcomes depend on stage, with earlier stages having higher survival rates treated with surgery or surgery plus radiation.
Management of supraglottic and glottic larynx cancer has been revised lately. This presentation gives an overview of guidelines for management of laryngeal cancer. includes latest NCCN guidelines.
1) The document discusses treatment guidelines and radiation therapy for malignant parotid gland tumors. It outlines the workup, treatment algorithm, indications for postoperative radiation, and clinical target volume definition.
2) Recommendations include radiation therapy for T3/T4 tumors, incomplete resection, high grade histology, recurrent disease, and node-positive disease. The clinical target volume covers the parotid bed and neck lymph nodes.
3) Guidelines provide organ at risk contours and trial management group recommendations on radiation doses and volumes based on tumor and node characteristics. Elective neck irradiation is advised for high grade tumors, T3/T4 disease, and certain histologies.
Metastasis of Neck Node with Unknown Primary Himanshu Soni
1) An unknown primary is defined as squamous cell carcinoma presenting in cervical lymph nodes with no identifiable primary tumor site after examination. This clinical entity is known as carcinoma of unknown primary (CUP).
2) Evaluation involves physical examination, imaging like PET-CT, and panendoscopy with biopsies of suspicious sites to identify the occult primary tumor. Bilateral tonsillectomy and tongue base biopsy can identify occult tumors in the tonsillar crypts in many cases.
3) Treatment depends on tumor stage but often involves combined modality treatment with surgery, radiation, and/or chemotherapy aimed at locoregional control while minimizing morbidity.
This document discusses laryngeal transplantation, including:
1. Pioneering attempts at laryngeal transplantation in the 1960s-1980s faced technical limitations and ethical concerns.
2. Advances in microsurgery, immunosuppression, and organ preservation have made laryngeal transplantation a possibility once deemed too risky.
3. The first reported successful human laryngeal transplantation was in 1998, where the patient regained voice function and swallowing abilities over time despite facing some complications.
This document discusses electro-acoustic stimulation (EAS), which combines cochlear implantation for high frequencies with acoustic amplification for low frequencies. EAS aims to restore hearing in both high and low frequencies by using electric stimulation to improve hearing in high frequencies and acoustic amplification to improve residual hearing in low frequencies. Studies have found that EAS users score significantly higher on speech tests compared to users of hearing aids alone. The document discusses various EAS devices and features that aim to preserve residual hearing, such as shorter or thinner electrodes. It also covers aspects of the surgery and post-operative programming to optimize the benefits of combined electric and acoustic stimulation.
Carcinoma nasopharynx anatomy to managementDrAyush Garg
The document provides information on carcinoma of the nasopharynx, including its anatomy, epidemiology, etiology, clinical features, patterns of spread, diagnostic evaluation, and metastatic workup. The key points are:
1) Nasopharyngeal carcinoma is most common in Southern Chinese populations and has a bimodal age distribution. Viral, genetic, and environmental factors like Epstein-Barr virus and salted fish contribute to its etiology.
2) The tumor can spread superiorly into the skull base, anteriorly into the nasal cavity/sinuses, and posteriorly into neck muscles and brain. Distant metastases most often involve bones and lungs.
3) Diagnostic evaluation includes endoscopic
This document provides an overview of head and neck cancers, including definitions, classifications, epidemiology, etiology, molecular biology, clinical features, and tumor metastasis. Specifically, it discusses that head and neck cancers most commonly present as squamous cell carcinomas involving oral cavity, larynx, and hypopharynx. It also reviews risk factors such as tobacco, alcohol, infections, and genetics. Clinical features may include lumps, ulcers, bleeding, pain, and lymph node enlargement. Proper examination and staging are important for determining prognosis and treatment options.
This document discusses treatment options for head and neck cancer including radiation therapy. It notes that treatment decisions should be made by a multidisciplinary team including surgeons, radiation oncologists, medical oncologists, and support staff. For early stage cancer, options are surgery or radiation alone, while more advanced cancers may receive chemo-radiation or surgery plus radiation and chemotherapy. Radiation uses CT and PET imaging to precisely target the tumor and spare normal tissues. Short term side effects include skin irritation, mouth sores, and difficulty swallowing. Long term side effects can include permanent dry mouth and dental problems. The document provides images showing results of treatment and side effects over time.
This document discusses brachytherapy techniques for head and neck cancers. It describes different types of brachytherapy based on positioning of the radionuclide (interstitial, intracavitary, surface moulds), dose rate (LDR, MDR, HDR, PDR), and technique (temporary, permanent). It also discusses dosimetry systems like Patterson-Parker, Quimby, Paris and computerized planning. Key aspects of treatment planning, delivery, and post-treatment care are summarized. Advantages include localized high dose with rapid falloff and organ preservation, while limitations include inaccessibility and quality dependence on implant. American Brachytherapy Society guidelines emphasize accurate assessment and dental
1. Carcinoma of the larynx is most commonly squamous cell carcinoma, usually caused by smoking and alcohol consumption. It can occur in the supraglottis, glottis, or subglottis regions.
2. Diagnosis involves laryngoscopy, CT/MRI imaging, and biopsy of visible lesions. Staging uses the TNM system and determines treatment approach and prognosis.
3. Treatment depends on stage but may include surgery such as laryngectomy, radiation therapy alone or with chemotherapy for advanced stages, or organ preservation with radiation/chemoradiation for early stages. The goal is cure of the cancer or organ function preservation.
This document discusses palliative care, which aims to improve quality of life for patients facing life-threatening illnesses. It defines palliative care as preventing and relieving suffering through early assessment and treatment of pain and other problems. The goals of palliative care are to relieve suffering, treat pain and distressing symptoms, and provide psychological, spiritual and social support. Common symptoms addressed in palliative care are discussed, including pain, nausea, vomiting, dyspnea, constipation and fungating wounds. The importance of psychological care and social support for patients and families is also outlined.
Building on the lecture I gave (and uploaded) "Palliative Care: what every primary care doctor should know" I built this talk. It is geared for 1st year medical students who are learning anatomy, physiology, and perhaps some pharmacology and pathophysiology.
In this talk, I do not explicitly address hospice care - as that was provided in an online chapter for students at UMass. I will later upload another slide set on that topic.
I hope you enjoy it.
FYI- the link to the youtube video: http://www.youtube.com/watch?v=XHtHXGhTIC4
Link to PDF of the slide show: https://files.me.com/s.mak/8fzat6
Palliative care for family medicine trainees 2015Chai-Eng Tan
This document provides an overview of palliative care for family medicine trainees. It defines palliative care as improving quality of life for patients and families facing life-threatening illness. It discusses pain control using the WHO analgesic ladder and managing non-pain symptoms. It covers prognostication using performance status scales and discussing prognosis with patients. Finally, it describes the role of community-based palliative care providers in delivering multidisciplinary care to allow patients to die at home.
PALLIATIVE CARE AND PRINCIPLES OF MANAGEMENT OF TERMINALLY ILL - ITANKA.pptxUbong Itanka
This document outlines palliative care and the management of terminally ill patients. Palliative care aims to improve quality of life for patients with life-limiting illnesses through early identification and treatment of pain and other symptoms. It takes a holistic, multidisciplinary approach. The principles of management for terminally ill patients focus on proper evaluation, symptom management, counseling, and respecting patient wishes regarding end-of-life care. Palliative care faces some challenges in resource-limited settings like Nigeria due to lack of policies, healthcare workers, and access to palliative medications.
Three hour slide deck for basics of palliative care including what is palliative care, symptom management (pain, dyspnea, nausea, constipation), goals-of-care, family meetings, comfort care, and issues around artificial nutrition.
This document provides an overview of palliative care for first year medical students. It defines palliative care as improving quality of life for patients with life-threatening illnesses through pain and symptom management. Palliative care is not just end-of-life care and can benefit patients at any stage of illness. Hospice provides similar care but requires a prognosis of 6 months or less and is focused on comfort. The document discusses common symptoms patients may experience at end of life like pain, bleeding, and breathing issues and how physicians can address these symptoms.
1 Examination, evaluation, diagnosis and treatment planningShruti MISHRA
The document provides an overview of the process of examination, evaluation, diagnosis and treatment planning in endodontics. It discusses the importance of collecting a thorough medical and dental history from the patient, as well as performing a clinical examination. A variety of diagnostic tests and methods are outlined, including palpation, percussion, pulp testing, radiography and more. The document also covers factors to consider in a patient's medical history that could impact endodontic treatment, such as cardiovascular disease, diabetes and pregnancy. Finally, it emphasizes that correct diagnosis is essential before providing a treatment plan to avoid worsening the patient's condition or providing the wrong treatment.
Palliative care focuses on reducing suffering and improving quality of life for patients with serious illnesses rather than curing disease or reversing its progression. Its goals include preventing and relieving suffering, improving quality of life, and supporting holistic care for both patients and their families. A palliative care team provides medical, psychological, spiritual and social support. Hospice care is palliative care provided to patients with a life expectancy of 6 months or less, focusing on comfort care in the home with support from an interdisciplinary team.
This document discusses emergencies and management in the last 48 hours of life in palliative care. It covers spinal cord compression, hypercalcemia of malignancy, and superior vena cava syndrome as common emergencies. For the last 48 hours, the goals are comfort, communication, and preparation for death. Symptoms addressed include weakness, secretions, pain, agitation, incontinence, and breathing issues. Care focuses on hydration, nutrition, oral hygiene, skin care, positioning, and supporting family members.
The document provides an overview of palliative care, including its goals, definitions, history, and differences from hospice care. Some key points:
- Palliative care focuses on improving quality of life and reducing suffering for those with serious illnesses through comprehensive pain and symptom management.
- It can begin at diagnosis and be provided alongside curative treatment.
- The WHO defines palliative care as relief from pain and symptoms, affirming life, and addressing psychological and spiritual needs.
- It aims to help patients live as actively as possible until death.
Palliative care aims to improve quality of life and relieve suffering for patients with serious illnesses. It can be provided along with curative treatment or on its own for comfort care. Total dyspnea involves physical, psychological, social and spiritual factors causing breathing distress. Signs that a patient is actively dying include profound weakness, disorientation, changes in breathing, and vocalizations like grunting.
Palliative class presentation slid3.pptxssuser504dda
1. Symptom control in palliative care requires a systematic approach including thorough assessment of each symptom, diagnosis of the underlying cause, explanation to the patient, individualized treatment, and continuous monitoring.
2. Common gastrointestinal symptoms like nausea, vomiting, diarrhea, and constipation are addressed through both pharmacological and non-pharmacological management depending on the specific cause.
3. Breathlessness, wound care, and malignant spinal cord compression are also managed based on identifying and treating their underlying causes while providing pain relief and other supportive care measures.
Physiotherapy in wards
physiotherapy in ICU
physiotherapy in Cardiology
physiotherapy in Gynecology
post operative physiotherapy
physiotherapy in PICU
Palliative patients physiotherapy
Geriatric patients
Benefits of the chest physiotherapy in ward patients
Benefits of Exercise Specific to Breast Cancer
Palliative care focuses on reducing the intensity and severity of symptoms from disease to improve quality of life. It is provided by an interdisciplinary team and addresses physical, emotional, and spiritual needs through pain and symptom management. Palliative care can be provided alongside curative treatment from the time of diagnosis for diseases like cancer, organ failure, Alzheimer's, and AIDS. Radiotherapy can help manage bone metastases, spinal cord compression, and other symptoms in palliative care.
45 minutes of suffering (or Anesthesia Grand Rounds on Palliative Care)Mike Aref
This document summarizes a presentation on palliative care. It discusses:
- The definition and goals of palliative care in alleviating suffering for patients with chronic illnesses
- How palliative care differs from hospice in focusing on symptom management rather than a prognosis of 6 months or less
- The concept of primary palliative care conducted by primary providers to assess physical, psychosocial and spiritual needs
- The importance of establishing goals of care through discussions of patient values, priorities and understanding of their illness
- Strategies for managing common symptoms like pain, depression and dyspnea
Dr Catherine Hayle - Regional ELC - Complex decision making Innovation Agency
Presentation by Dr Catherine Hayle - Arrowe Park Hospital - Regional Emergency Laparotomy Collaborative - Complex decision making collaborative at Arrowe Park Hospital on 24 January 2020
Dr. Fatma Al-Dammas is an anesthesiology professor and director of the anesthesia and acute/chronic pain management programs. She specializes in managing pain, which requires a multidisciplinary team approach. The goals of pain treatment are to improve quality of life, facilitate recovery, reduce morbidity, and allow for early hospital discharge. Pain management involves both pharmacological and non-pharmacological approaches, including the WHO pain ladder and various methods of drug delivery like epidural analgesia. Epidural analgesia provides effective post-operative pain relief, improves pulmonary function, and enables earlier ambulation.
This document outlines a lesson plan for a nursing class on palliative care. It defines palliative care as care given to improve quality of life for patients with serious illnesses like cancer. The goal is to prevent/treat symptoms and side effects of the disease in addition to psychological, social and spiritual problems, not to cure. Palliative care is given throughout the cancer experience from diagnosis to end of life. It discusses that palliative care teams include doctors, nurses, dieticians, pharmacists and social workers, and can be provided in cancer centers, hospitals or hospice. It also differentiates palliative care from hospice care.
Palliative care aims to improve quality of life for patients facing life-limiting illnesses through comprehensive pain and symptom management as well as psychosocial and spiritual support. It can be provided alongside curative treatment or as the main focus of care. The goals are to prevent and relieve suffering through early identification of issues, addressing physical, psychological, social and spiritual needs using a multidisciplinary team approach. Palliative care strives to help patients and their families cope with illness and bereavement.
Similar to Palliative care in head and neck cancer (20)
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
This presentation was provided by Rebecca Benner, Ph.D., of the American Society of Anesthesiologists, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
-------------------------------------------------------------------------------
Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
ISO/IEC 42001 Artificial Intelligence Management System - EN | PECB
General Data Protection Regulation (GDPR) - Training Courses - EN | PECB
Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
-------------------------------------------------------------------------------
For more information about PECB:
Website: https://pecb.com/
LinkedIn: https://www.linkedin.com/company/pecb/
Facebook: https://www.facebook.com/PECBInternational/
Slideshare: http://www.slideshare.net/PECBCERTIFICATION
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
2. W.H.O DEFINITION
• “an approach that improves the quality of life of patients and their
families facing the problems associated with life threatening illness,
through the prevention and relief of suffering by means of early
identification and impeccable assessment and treatment of pain and
other problems , physical, psychosocial and spiritual”
• Palliate – meaning to ‘cloak’ (Greek)
3. • Different from “Terminal care”
• Though both are aimed at providing comfort and relief
• Terminal care : when patient has less than 6 months to live
• Palliative care can begin as early as the time of diagnosis
4. Palliative care can begin at any point along the cancer care continuum
Hospice: when curative treatment is no longer the goal and the sole focus is quality of life.
5. CHARACTERISTICS OF PALLIATIVE CARE
• Provides relief from pain and other distressing symptoms
• Affirms life and regards death as a normal process
• Intends neither to hasten nor post pone death
• Integrates the psychosocial and spiritual aspects of care
• Offers support system to help patients live as actively as
possible until death
6. CHARACTERISTICS OF PALLIATIVE CARE
• Uses a team approach to address needs of patients and their
families
• Will enhance quality of life and may also positively
influence the course of the illness
• Is applicable early in the course of illness in conjunction
with other therapies that are intended to prolong life
7. MULTI- DISCIPLINARY TEAM
• Doctors ( surgeon/ oncologist / radiation oncologist )
• Nurses
• Speech and Swallow Therapists
• Nutritionists
• Social workers / volunteers
8. PALLIATIVE CARE IN INDIA
• Introduced in mid 1980s
• Palliative care first initiated in Gujrat : Gujrat cancer and research
institute
• 1986 : first Hospice – Shanti Avedna Ashram in Mumbai by Dr.
D’Souza
• Indian Association of Palliative Care : 1994 in association With WHO
• CanSupport: 1st free palliative home care support service in North
india 1997 , Delhi
• At present <3% of cancer patients have access to adequate pain relief
9. COMMON PROBLEMS IN HEAD AND NECK
CANCER
• Pain
• Dysphagia
• Malnutrition
• Airway obstruction
• Retained secretions
• Chemoradiation: mucositis/ xerostomia
10. PAIN
• Most common complain
• Pain is an unpleasant sensory and
emotional experience associated with
actual / potential tissue damage or is
described in terms of such damage
11. PAIN
• Nociceptive pain: due to activation of afferent nerves by a noxious stimuli
Somatic pain : piercing pain, tissue damage : eg skin, muscle, mucosa.
Visceral pain : constant pressing type. Thoracic, abdominal, pelvic viscera
• Non – nociceptive pain : neuropathic pain , plexus infiltration by the
tumour/ post chemoradiotherapy
Burning pain
In cancer patients : mixed type of pain
12. PAIN MANAGEMENT
• Goal of optimum pain management : relieve pain to a level that allows
quality of life that is acceptable to the patient
• Weigh the risks and benefits to maximise quality of life
• Pharmacological : mainstay
• Others : Radiotherapeutic/ surgical/ physiotherapy
psychological / spiritual and social intervention also play a role
15. WHO : ADMINISTRATION
• BY MOUTH : orally preferable
• BY THE CLOCK : At regular interval
• BY THE LADDER: based on severity and response to treatment
• FOR THE INDIVIDUAL : correct dose is the dose that relieves the patients
pain to an acceptable level
• ATTENTION TO DETAILS : Patient must be warned regarding adverse effects
18. • BREAKTHROUGH : transient flare
• short acting / Immediate release morphine : oxynorm or
oramorph
• Fentanyl : sublingual tablet / intranasal spray
• Transdermal patch : after adequate pain control has been
achieved
changed every 72 hours
Fentanyl , Buprenorphine
19. Parenteral route
Subcutaneous preferred over I.M
subcutaneous : morphine,
oxycodone, fentanyl or alfentanil
if patient requires regular
injections : subcutaneous
infusion pump CSCI (end of life)
20. DYSPHAGIA
• Associated with the disease / post surgical / chemoradiation
• Maybe a cause of malnutrition , dehydration , aspiration
• Swallowing assessment in suspected aspiration : (FEES/VFSS)
• Targeted swallowing exercises and oral intake encouraged
• Diet modification : change food texture
21. • Manoeuvres :
• Effortful swallow : increase pressure generated by pharynx and
oral musculature
• Supraglottic swallow : adduct vocal cords longer during swallow
• Super supraglottic swallow : close airway before, during and
after swallow
• Mendelsohn manoeuvre : Prolongs the opening & diameter of
cricopharyngeal sphincter
22. • Exercises :
Masako ( tongue – holding )
Shaker (head lift)
• Postures : Chin tuck, head turn, head tilt, chin up
• Enteral tube feeding
23. MALNUTRITION
• Decreased oral intake
• Pain/ dysphagia : management discussed
• Cachexia: mediated by cytokines : TNF α, IL1,6 γInterferon
• Rx. Glucocorticoids , megestrol acetate, dronabinol
• Nutritional assessment by a dietician
• Nutritional support : fortifying foods with macronutrients,
oral nutritional supplements
24. • Enteral tube feeding : inadequate oral intake
• Nasogastric tube : short term feeding <4weeks
• Gastrostomy/ jejunostomy : long term feeding
• Parenteral nutrition rarely required in Head and neck cancers as
most have functioning GI tract
26. MUCOSITIS
• Painful and can interfere with food intake
• Symptomatic management: Oral hygiene /saline/
bicarbonate mouth rinses/ topical anaesthesia
• Benzydamine hydrochloride (nsaid) approved in
Europe for topical application
27. XEROSTOMIA
• c/o dryness/ increased thirst/ mouth burning/ dental caries
• At doses above 54 Gy Xerostomia is irreversible
• Measures: plenty of water, Pilocarpine or Cevimeline
artificial saliva ( rises/ spray )
• Amifostine: prior to radiotherapy
28. TERMINAL HEMORRHAGE
• 3-5% patients have carotid artery blow out post major head and neck
resections
• Neck Radiation most important risk factor
• Exposed into oral cavity / externally through skin breakdown / tumor invasion
• Impending CBS in terminally ill patients
caregiver must be present to reduce anxiety
keep dark towels
anxiolytics
29. PALLIATIVE SURGERY
• Refers to surgery that is non curative by intent
• Airway obstruction ( Tracheostomy )
• Tumour debulking
• Nutritional: Gastrostomy
• Reconstructive procedure : Orocutaneous/ Pharyngocutaneous fistula/
Osteoradionecrosis
30. PALLIATIVE RADIOTHERAPY
• To reduce symptom burden due to progressive local disease
• Conventional radiotherapy : 2 Gy/day for 5 days a week i.e 5
fractions per week for 7 weeks
• In palliative RT : Hypofractionation with reduced overall time: > 2
Gy/day
• Regimens : 30 Gy in 10 fractions
35 Gy in 15 fractions
20 Gy in 5 fractions
32. ACUPUNCTURE
• Modality of Chinese medicine
• Needles to stimulate certain
points in body that
correspond to energy
meridians
• Clinical trials: found to be
effective in chemotherapy
induced nausea and
vomiting
33.
34. MEDICAL MARIJUANA
Pain, nausea and reduced appetite
Country : legal in 20 states of USA, Canada, Spain,
Portugal, Austria, Finland, Germany, Israel, Italy
Medicinal cannabis (plant form) :
smoked/ingested
Oral medication : Nabilone, Nabiximol
Dronabinol (synthetic THC) FDA approved as anti
emetic and appetite stimulant /
H&N: Oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, paranasal sinus, salivary gland tumors, and ear
8th most common CA in world, 3rd most common in india
Rehablitation : restoration of an individuals function and or role mentally and physically to the maximum degree possible within their family , social network and work place whenever possible.
Impairment: any loss or abnormality of anatomical / physiological/ psychological structure / function
Disablitity : loss of function
Handicap: reduction of a persons capacity to fulfil a social role as a consequence of impairment
Shows continuum of care associated with curative and palliative care.
Treatment intended to modify the disease decreases, while palliative care increases as the person reaches the end of life.
Palliative care also provides support for the family during this entire period.,
After death : bereavement counselling for family and friends is important.
Bereavement : period of mourning by family members: care givers are provided with psychosocial support.
Hospice care : end of life care with relieving discomfort, maintaining dignity , and facilitating transition for patient and family
centre that provides care for terminally ill patients
8 characteristics of palliative care given by who
Life affirming: value to life
Best achieved by a multidisciplinary team
Concept of palliative care is relatively new in india
Gujrat cancer and research institute : ahemadabad
Neuropathic pain: direct caner infiltration of nerves/ post chemotherapy neurotoxicity/
CINP : Platinum based drugs : cisplatin carboplatin/ oxaliplatin/ vinca-alkaloids/ taxanes : paclitaxel / docetaxel
Mixed pain : either due to the growth itself or due to the previous treatment : surgical / radiotherapy
5 principles given by who for administration of analgesia
( next dose given before previous dose wears off)
Who pain ladder introduced in 1986
1-3, 4-6, 7-10
Alfentanil : renal safe
Adjuvant therapy : Neuropathic component / anxiolytics
Breakthrough pain: transient exacerbation of pain that occurs spontaneously or in relation to a specific trigger despite adequate pain control
25mcg/ hr
If unable to tolerate orally : dysphagia, nausea and vomiting, or unresponsiveness towards the end of
Normal swallowing :
Oral phase : mastication : trismus / xerostomia /
Radiotherapy : Reduced pharyngeal contraction, reduced base of tongue retraction, incomplete epiglottic deflection, incomplete or delayed laryngeal closure, abnormal esophageal opening
Xerostomia : antihistamines, anti htn tobacco , dehydration ,
Pharyngeal : supraglottic growth , base of tongue growth
Masako exercise : tongue holding exercise : protrude tongue and hold between incissors. When posterior part of tongue doesn’t move
Causes anterior bulging of the posterior pharyngeal wall.
Shaker : lie down and raise head. Hold for 30-60 seconds :
For inadequate laryngeal elevation during swallowing. Remanants left in pyriform fossa
Chin tuck: closes the larynx
Head tilt :
Enteral tube feeding : unsafe airway and inadequate oral intake
Severe muscle wasting with/without loss of adipose tisse which cannot be reversed with nutrition or enteral feedingsCytokine mediated muscle wasting
Megestrol acetate: female progesterone tablets. Increases appetite glucocorticoids/ oxandrolone/ somatropin/ dronabinol
Newer drugs under trial Resveratrol, ecosapentanoic acid (?nutriceuticals);
Feeds : enteral tube feeding formula : 50ml/hour , increase 25ml/hr every 4-8 hours.
Bolus administration of liquid feeds by syringe / bolus set
Continuous : feeding pump set : 125ml/hr
TPN: 30-40ML/KG/DAY 30-35kcal/kg/day
Anticholinergic
In patients with head and neck cancer as disease progresses there can be increasing difficulty in speech
Aritifcially generated speech :
Written communication
Chemo : 5FU, , taxanes, vincristine, vinblastine
Who grading : no signs
erythema/ edema / ulcer: able to eat
Unable to eat
Parenteral/ enteral nutrition
Benzydamine hydrochloride: nsaid for topical application
Newer drug : palifermin : keratinocyte growth factor
Factors increasing the risk: tumor proximity to carotid artery
Previous rnd with radiotherapy
Systemic factors : coagulopathy/ DM
Ubagoga and harris
WITHOUT REMOVAL Of ALL GROSSLY VISIBLE DISEASE
positive margins
Nr abalation : neurotomy, cryoablation, rhizotomy , Radiofrequency abalation
Radiotherapy : cell death by dna strand breaks, genetic mutation, apoptosis
Water around DNA is ionised creating hydroxyl particles and oxygen radicals
Cell arrest
Mitochondrial damage
Cetuximab : Monoclonal antibody against Epidermal growth factor
Stimulates somatosensory regions in brain, cingulated, prefrontal, insular cortices amygdala, hippocampus hypothalamus
Tetrahydrocannabidiol (THC) is the psychoactive agent
Cannabidiol : anti-inflammatory , and modulates the psychoactive effects of THC
Must address Spiritual , emotional and social aspects
Spiritualilty. how an individual finds meaning and purpose in life
may help to ask : how are you coping? What gives you strength ? Do you ever question why?
Depression and anxiety is common : psychotherapy , antidepressants should be prescribed if necessary
Counselling of family members regarding the possible course of the disease