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Head and Neck Cancer: Multidisciplinary Management Guidelines

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Head and Neck Cancer: Multidisciplinary Management Guidelines 113803_00_ifc_p001.indd3803_00_ifc_p001.indd i 226/08/116/08/11 55:19:19 PMPM Head and Neck Cancer: Multidisciplinary Management Guidelines 4th edition, 2011 British Association of Otorhinolaryngology Head and Neck Surgery The Royal College of Surgeons of England 35 - 43 Lincoln’s Inn Fields London WC2A 3PE http://www.entuk.org/ 113803_00_fm_pi-xxvi.indd3803_00_fm_pi-xxvi.indd i 226/08/116/08/11 44:40:40 PMPM © ENTUK, 2011 First published in the United Kingdom by ENTUK - British Association of Otorhinolaryngology, Head and Neck Surgery 4th edition ALL RIGHTS RESERVED. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any license permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP You must not circulate this book in any other binding or cover and you must impose the same condition on any acquirer Although every eff ort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. Further copies of this document can be obtained through the following contacts: Tel: (020+) 7404 8373 Fax: (020+) 7404 4200 Email: [email protected] ISBN-13: 978-0-9570138-0-3 This work should be referenced as Roland NJ, Paleri V (eds). Head and Neck Cancer: Multidisciplinary Management Guidelines. 4th edition. London: ENT UK; 2011 The publisher makes no representation, express or implied, that the treatment recommendations in this book are correct for clinical presentations. The authors and the publisher do not accept any liability for any errors in the text or for the misuse or misapplication of material in this work. Typeset by Integra Software Services Pvt. Ltd., India Printed in Newcastle upon Tyne by statexcolourprint 113803_00_fm_pi-xxvi.indd3803_00_fm_pi-xxvi.indd iiii 226/08/116/08/11 44:40:40 PMPM Contents Forewords v Acknowledgements viii Contributors ix Chapter 1 Introduction 1 Chapter 2 Risk Factors, Aetiology and Epidemiology in the United Kingdom 3 Chapter 3 Molecular Biology 9 Chapter 4 Organisation and Provision of Head and Neck Cancer Services in the UK 15 Chapter 5 Pre-treatment Clinical Assessment 21 Chapter 6 Anaesthesia for Head and Neck Surgery 29 Chapter 7 Imaging 35 Chapter 8 Nutrition 45 Chapter 9 Restorative Dentistry/Oral Rehabilitation 57 Chapter 10 Psychological Management 63 Chapter 11 Quality of Life 69 Chapter 12 Tumour Assessment and Staging 75 Chapter 13 Pathological Assessment 83 Chapter 14 Data Collection in Head and Neck Cancer 95 Chapter 15 Radiotherapy 99 Chapter 16 Surgery 103 Chapter 17 Chemotherapy 107 Chapter 18 Laryngeal Cancer 113 Chapter 19 Oral Cavity and Lip 125 Chapter 20 Oropharyngeal Cancer 137 Chapter 21 Nasopharyngeal Cancer 147 Chapter 22 Hypopharyngeal cancer 161 Chapter 23 Nose and Paranasal Sinus Tumours 173 113803_00_fm_pi-xxvi.indd3803_00_fm_pi-xxvi.indd iiiiii 226/08/116/08/11 44:40:40 PMPM iv Contents Chapter 24 Lateral Skull Base Cancer 187 Chapter 25 Non-melanoma Skin Cancer 199 Chapter 26 Head and Neck Melanoma (excluding ocular melanoma) 211 Chapter 27 Salivary Gland Tumours 227 Chapter 28 Thyroid cancer 241 Chapter 29 Neck Metastases 257 Chapter 30 Unknown Primary 273 Chapter 31 Rehabilitation and Speech Therapy 285 Chapter 32 Recurrent cancer 293 Chapter 33 Reconstruction in Head and Neck Surgical Oncology 311 Chapter 34 Palliative and Supportive Care 321 Chapter 35 Follow-up of Head and Neck Cancers 335 Chapter 36 Clinical Research, National Studies and Grant Applications 341 Chapter 37 Education of Trainees, Training and Fellowships 343 Chapter 38 Future Perspectives 349 113803_00_fm_pi-xxvi.indd3803_00_fm_pi-xxvi.indd iviv 226/08/116/08/11 44:40:40 PMPM Forewords There is no doubt that this concise and compre- hensive document is a triumph of collaboration by experts from all disciplines working in Head and Neck Oncology. Its production is part of an ongo- ing process. It builds on the earlier consensus docu- ments and will be the handbook for Multidisciplinary Teams until such time as it too needs revision. The editors and contributors are to be congratulated for producing such a valuable document. It will prove to be essential reading and a key reference document for all those working in this fi eld and will provide a benchmark for high quality care. Alan Johnson MBChB FRCSEd FRCS (Eng,Otol) BSc President, British Association of Otorhinolaryngology – Head and Neck Surgery I am delighted to contribute a short preface to this document. Nick Roland and Vin Paleri deserve our thanks and congratulations for their perseverance in developing a consensus document. Two of the most signifi cant changes to have occurred during my career in head and neck cancer care have been the development of the MDT and, in parallel, the emergence of interface training in head and neck cancer surgery. These two key evolutions have done so much to strengthen the collaboration between all our specialties and this has, in my view, led to enormous gains for our patients in terms of the quality of their care. This consensus document can only add to the accuracy of decision-making within the MDT envi- ronment and, on behalf of my colleagues in oral and maxillofacial surgery involved in the care of patients with a diagnosis of head and neck cancer, I look forward to this publication being available to all head and neck MDT members. Robert Woodwards MBBcH BDS FDSRCS FRCS President, British Association of Oral and Maxillofacial Surgeons 113803_00_fm_pi-xxvi.indd3803_00_fm_pi-xxvi.indd v 226/08/116/08/11 44:40:40 PMPM vi Forewords I am pleased to read these guidelines which are being published under the joint auspices of four surgical specialties. The increasing recognition of the added value that all disciplines can bring to the manage- ment of complex tumours is refl ected in the multidis- ciplinary approach to such documents. Since I took up a Consultant position 20 years ago, the cross fer- tilisation of ideas between specialties has developed in many centres, with much improved patient out- comes as a consequence. The institution of Training Interface Groups running specialised Fellowships in the fi nal years of training has encouraged such work- ing practices, and I hope that we will see greater and more rapid take up of such opportunities in the next few years. Sharing of ideas in an environment of mutual respect can only be to the benefi t of good patient care and future research, and is the way forward for mature health care systems. I wholeheartedly commend this document for widespread use. Tim Goodacre MBBS BSc FRCS FRCSEd President, British Association of Plastic, Reconstructive and Aesthetic Surgeons The editors of the UK Multi-disciplinary Consensus Guidelines for Head and Neck Oncology are indeed to be congratulated for producing this “Tour de Force”. Consensus implies a harmonious agree- ment involving some compromise, in order to reach an accord. Achieving this from such a wide group of professionals is no small feat! This docu- ment conveys the current thoughts on management of head and neck cancer patients from all parts of the UK and from all of the many and varied spe- cialties which are involved in providing care. Head and Neck Cancer is a relatively rare condition, and within that global term, there are an almost infi nite number of sub-divisions, with every patient requir- ing personalised treatment planning. It therefore comes as no surprise that many of the recommendations within the guidelines are not supported by the highest levels of evidence. Nonetheless, these guidelines repre- sent the combined experience of most of the units treating Head and Neck Cancer in the UK, and therefore are of enormous value. I am certain they will be widely used to inform and stimulate the debate in our MDTs. Perhaps of most importance they identify where there is signifi cant variation in practice, and highlight the need for 113803_00_fm_pi-xxvi.indd3803_00_fm_pi-xxvi.indd vivi 226/08/116/08/11 44:40:40 PMPM Forewords vii better combined data collection and analysis. Only by close collaboration and pool- ing of our resources will we be able to answer some of the most pressing and dif- fi cult questions. The British Association of Head and Neck Oncologists represents the multi-disciplinary head and neck community within the UK, and as President I am delighted to offer the grateful thanks of our association to both the editors and the many contributing authors for their collective efforts in publishing this most valuable set of clinical guidelines. Ian C Martin LLM FDSRCS FRCS FRCS(Ed) President, British Association of Head and Neck Oncologists President, Federation of Surgical Specialist Associations On behalf of the British Association of Endocrine and Thyroid Surgeons, we wel- come the publication of Head and Neck Cancer: Multidisciplinary Management Guidelines. We fully endorse the multidisciplinary approach to working with cancer and particularly support recording of prospective data and outcomes. We hope that this will be the fi rst of many documents to come with support from all stakeholder profes- sional organisations. With an impressive number of contributors from all relevant specialities, this publi- cation comes highly recommended and will serve as a handy text for all practising clinicians involved in head and neck cancer care. John C Watkinson MSc MS FRCS(ENT) DLO President, British Association of Endocrine and Thyroid Surgeons 113803_00_fm_pi-xxvi.indd3803_00_fm_pi-xxvi.indd viivii 226/08/116/08/11 44:40:40 PMPM Acknowledgements All the specialty associations involved in the production of the guidelines gratefully acknowledge the efforts of the many contributors and especially the topic leads, who endeavoured to deliver the work despite signifi cant work commitments.
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