Comprehensive Management of HEAD AND NECK CANCER
Comprehensive Management of HEAD AND NECK CANCER
Editor
Narayana Subramaniam MS MRCSEd MCh FICRS
Consultant and Assistant Fellowship Director Department of Head and Neck Oncology and Reconstructive Surgery Mazumdar Shaw Medical Center, Narayana Health City Bengaluru, Karnataka, India
Sivakumar Vidhyadharan MS DNB MCh FICRS FEBORL-HNS
Director The Head And Neck Centre & Hospital (THANC Hospital), Chennai Consultant Department of Head and Neck Surgical Oncology Apollo Proton Cancer Centre Chennai, Tamil Nadu, India
Samskruthi P Murthy MS MCh FHNO
Assistant Professor Department of Head and Neck Oncology Kidwai Memorial Institute of Oncology Director Can-C Superspecialty Centre Bengaluru, Karnataka, India
Forewords
Subramania Iyer
Preface
N Gopalakrishna Iyer
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Comprehensive Management of Head and Neck Cancer
First Edition: 2021
9788194709046
Printed at
All those who have been affected by
head and neck cancer directly or indirectly,
whose struggles inspire us to be better.
- Adharsh Anand MS MCh
- Consultant
- Department of Head and Neck Oncology and Reconstructive Surgery
- St Gregorios Medical Mission Multi-Specialty Hospital
- Parumala, Kerala, India
- Akshat Malik MS MCh
- Senior Clinical Fellow
- Department of Head and Neck Surgery
- Imperial College Healthcare NHS Trust
- London, UK
- Aseem Mishra MS MCh
- Assistant Professor
- Head and Neck Services
- Department of Surgical Oncology
- Homi Bhabha Cancer Hospital
- Varanasi, Uttar Pradesh, India
- Athira Ramakrishnan MS DNB FHNS
- Consultant
- Department of Otolaryngology and Head and Neck Surgery
- Fortis Hospital
- Bengaluru, Karnataka, India
- Dimpy Sharma MS MCh
- Consultant
- Department of Plastic Surgery
- BPL Nursing Home
- Mathura, Uttar Pradesh, India
- Dinesh MG MS MCh FMAS FMAO
- Senior Consultant
- Department of Surgical Oncology
- Chief
- Department of Minimal Access
- Surgical Oncology
- BGS Gleneagles Global Hospitals
- Bengaluru, Karnataka, India
- Federico Biglioli MD
- Professor and Head
- School of Maxillofacial Surgery
- University of Milan
- Head of Maxillofacial Surgery
- San Paolo and San Carlo Hospital
- Milan, Italy
- Federico Bolognesi MD
- Maxillofacial Surgeon
- Oral and Maxillofacial Surgery Unit
- Department of Head and Neck
- S Orsola University Hospital
- University of Bologna, Bologna BO, Italy
- Gaurav Sundar MD FRCR
- Consultant
- Department of Radiology
- Liverpool University Hospitals NHS Foundation Trust, Merseyside, UK
- Hitesh Singhavi MDS
- Consultant
- Department of Head and Neck Oncology
- Fortis Hospital, Mumbai
- Former Fellow
- Head and Neck Services
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- Manish Mair MS MCh
- Clinical Fellow
- Head and Neck Services
- University Hospital of Leicester, UK
- Ex-Consultant
- Head and Neck Services
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- Narayana Subramaniam MS MRCSEd MCh FICRS
- Consultant and Assistant Fellowship Director
- Department of Head and Neck Oncology and Reconstructive Surgery
- Mazumdar Shaw Medical Center
- Narayana Health City
- Bengaluru, Karnataka, India
- Naveen BS MDS FHNS
- Associate Consultant
- Department of Head and Neck Surgical Oncology
- VPS Lakeshore Hospital
- Kochi, Kerala, India
- Nikita Oza MD
- Consultant
- Department of Histopathology
- SRL Diagnostics Centre of Excellence
- Mumbai, Maharashtra, India
- PC Jacob MDS Cert Maxillofacial Prosthetics (UCLA)
- Consultant
- Department of Head and Neck Oncology
- Mazumdar Shaw Medical Center
- Narayana Health City, Bengaluru
- Chief Executive
- Ora-Care Dental Clinic
- Bengaluru, Karnataka, India
- Pranothi Srinivasalu MSc MRes CDE
- Nutrition Counselor and Certified Diabetes Educator
- Owner, Eden Nutrizion
- Bengaluru, Karnataka, India
- Radhika Kapahtia MS MCh
- Specialist Senior Resident
- Department of Plastic and Reconstructive Surgery
- Tata Memorial Centre
- Mumbai, Maharashtra, India
- Samskruthi P Murthy MS MCh FHNO
- Assistant Professor
- Department of Head and Neck Oncology
- Kidwai Memorial Institute of Oncology
- Director
- Can-C Superspecialty Centre
- Bengaluru, Karnataka, India
- Saurabha Kumar MD
- Consultant
- Department of Radiation Oncology
- Mazumdar Shaw Medical Center
- Narayana Health City
- Bengaluru, Karnataka, India
- Shabala Paul MD Fellowship in Transplant Anesthesia
- Consultant Anesthesiologist
- Mazumdar Shaw Medical Center
- Narayana Health City
- Bengaluru, Karnataka, India
- Shashikant Limbachiya MS MCh
- Consultant
- Department of Head and Neck Oncology and Reconstructive Surgery
- Narayana Multispeciality Hospital
- Ahmedabad, Gujarat, India
- Sivakumar Vidhyadharan MS DNB MCh FICRS FEBORL-HNS
- Director
- The Head And Neck Centre & Hospital
- (THANC Hospital), Chennai
- Consultant
- Department of Head and
- Neck Surgical Oncology
- Apollo Proton Cancer Centre
- Chennai, Tamil Nadu, India
- Smita Mathias MSc PhD
- Senior Therapist
- Department of Speech and
- Swallow Therapy
- Mazumdar Shaw Medical Center
- Narayana Health City
- Bengaluru, Karnataka, India
- Smitha Chinmay Kulkarni DNB FEBNM FANMB MNAMS
- Assistant Professor
- Department of Nuclear Medicine and Molecular Imaging
- Amrita Institute of Medical Science
- Kochi, Kerala, India
- Soudhamini Shastry MD MRCPsych
- Core Psychiatry Trainee
- Health Education England
- North West, UK
- Suman Bhasker MD
- Professor
- Department of Radiation Oncology
- All India Institute of Medical Sciences
- New Delhi, India
- Sushma Mehta MDS MFDS FHNS
- Honorary Surgeon
- Department of Head and Neck Surgery
- Rangadore Memorial Hospital and
- Fortis Hospital
- Bengaluru, Karnataka, India
- Trupti Kolur MDS Fellowship in Oral Oncology
- Consultant
- Department of Head and Neck Oncology
- Mazumdar Shaw Medical Center
- Narayana Health City
- Bengaluru, Karnataka, India
- Vidita Powle MS MRCSEd FHNS
- Honorary Consultant
- Department of Head and Neck Surgery
- Jehangir Hospital and Aditya Birla Memorial Hospital, Pune
- Saifee Hospital and Research Centre
- Mumbai, Maharashtra, India
- Vidya Bhushan R MS DNB FHNS FUICC
- Consultant
- Department of Head and Neck Oncology and Reconstructive Surgery
- Mazumdar Shaw Medical Center
- Narayana Health City
- Bengaluru, Karnataka, India
- Vijay Kumar Srinivasalu MD DM ECMO (PhD)
- Consultant
- Department of Medical Oncology
- Mazumdar Shaw Medical Center
- Narayana Health City
- Bengaluru, Karnataka, India
- Vijay Pillai MDS MBBS FHNS AO Fellow
- Consultant and Head
- Fellowship Director
- Department of Head and Neck Oncology and Reconstructive Surgery
- Mazumdar Shaw Medical Center
- Narayana Health City
- Bengaluru, Karnataka, India
- Vinay Kumar MD
- Assistant Professor
- Department of Radiation Oncology
- Kidwai Memorial Institute of Oncology
- Bengaluru, Karnataka, India
- Vineeth Sukrithan MD
- Assistant Professor
- Department of Medicine
- Division of Medical Oncology
- Ohio State University and Arthur G James Comprehensive Cancer Center
- Columbus, Ohio, USA
- Vivek Shetty MS FHNS
- Consultant
- Department of Head and Neck Oncology and Reconstructive Surgery
- Mazumdar Shaw Medical Center
- Narayana Health City
- Bengaluru, Karnataka, India
While considering the cancers affecting the body, head and neck cancers are distinct; they are different from others with several subsites having unique features, diverse and varied pathologies and they require a multidisciplinary treatment for their cure. These cancers, though amongst the most common in several parts of the world, often fare the worst due to the lack of an organized treatment delivery system, with ownership being distributed unevenly among various surgical and oncological specialties. The lack of trained and dedicated professionals required to form a multidisciplinary treatment team is often reflected in the poor outcomes associated with head and neck cancer.
The head and neck surgical oncologist fits in well as the leader of this multidisciplinary team, as a majority of the cases need primary surgical treatment or continued involvement of the surgeon either to establish a diagnosis or subsequently in post-treatment surveillance or salvage therapy. Only recently have the avenues of structured training in head and neck surgical oncology opened up, paving the way to create a talent pool to fill this void.
A reference book was essential for these trainees, and this book aptly titled Comprehensive Management of Head and Neck Cancer will be a great boon to them. With its well-conceived structure, methodical layout of each chapter and stress on supportive care, rehabilitation and clinical research, I am sure it will soon become a reference book to all those who are interested in head and neck cancer.
Subramania Iyer
MCh FRCS
Chairman
Head and Neck Surgical Oncology and
Reconstructive Surgery
Amrita Institute of Medical Sciences
Amrita Vishwa Vidyapeetham
Kochi, Kerala, India
Preface
Life is short, and art long, opportunity fleeting,
experimentations perilous, and judgment difficult.
– Hippocrates
The last three decades have seen a dramatic shift in paradigms in the management of head and neck malignancies. This shift is reflected in our scientific understanding that encompasses the etiology, pathogenesis, pathologic manifestations and therapeutic strategies that continue to evolve and shape current and future clinical trials. However, the same shift has also forced a change in the art of managing these patients, towards a more holistic approach in dealing with individuals, and their future with the disease or when they are free of disease.
This textbook takes a comprehensive view that attempts to distill the salient issues in each of these topics, and that's what makes it different from many other, more focused, manuscripts currently available to lifelong learners involved in the treatment of these patients.
Each clinical chapter is presented in a systematic manner, to incorporate the most recent evidence-based practice guidelines, while also presenting the controversies in a succinct manner. The addition of chapters that encompass genetics, molecular pathway and translational biology direct the reader to consider current concepts of precision and personalized therapy. Management principles are also presented as a continuum of care, for example in planning surgical resection and reconstruction, or surgical planning in anticipation of radiation or chemotherapy. Furthermore, there is an expanded emphasis on the understanding of anesthesia, nuclear medicine and interventional radiology, and its application to management of various clinical scenarios.
Yet, the art is not lost. Chapters that cover issues surrounding nutrition, speech and swallowing therapy, pain management and psychology support the increasing role the rehabilitation team plays in the holistic management of some of our patients. This emphasis extends beyond treatment and into the realm of quality of life and survivorship, with additional chapters on chronic pain management, long-term psychosocial issues, body self-image (e.g., facial nerve function) and general well-being.
Apart from figures and tables summarizing each relevant section, the book has also included key algorithms and protocols and standardized questionnaires that are useful in planning audits and research protocols, apart from day-to-day management.
The ability to bring all elements of the art and science in managing these patients, who present from all walks of life, is what makes this book stand out from existing textbooks, and also makes it a delight to read and reference.
N Gopalakrishna Iyer
MBBS (Hons) PhD (Cantab) FRCSEd FAMS
Head, Department of Head and Neck Surgery
Singapore General Hospital and National Cancer Centre
Head, Division of Medical Sciences
Humphrey Oei Institute of Cancer Research
Professor, Duke-NUS Medical School, Singapore
Acknowledgments
Writing this book has been a rewarding experience because of the inspiring co-editors and contributors who were instrumental in completing the book.
We are grateful to our teachers who have been a constant source of motivation and have always been supportive throughout our professional journey.
We would like to extend our gratitude to our publishing team for their excellent work editing the text and providing brilliant illustrations. Ms Nikita Chauhan (Senior Development Editor) in particular has added great value to this book. Thank you to our colleagues and our students who propel us to do more. We would also like to thank Dr S Rajasekaran for his guidance and support in bringing this idea to fruition.
We are indebted to our patients who place their faith in us to treat them and embolden us to further our skills, research and care.
We would like to thank our families for their unparalleled support and love and our parents who provided us with an opportunity to follow our dreams. Last but not the least, thank you to our friends for their belief in us.
We also like to thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Ms Chetna Malhotra Vohra (Associate Director—Content Strategy), Ms Pooja Bhandari (Production Head), and the staff of M/S Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India.