The role of otolaryngologist - head and neck surgeon's in the treatment of thyroid cancer.

INTRODUCTION: Thyroid gland is an integral part of the neck region. In the topographic anatomy of the head and neck the gland is located in the middle triangle of the neck. Therefore, it is an organ which is also subject for diagnostic and treatment by otorhinolaryngologists - head and neck surgeons. Material and methods The study group consists of 50 patients aged from 22 to 76 years (mean 48). All patients were treated for suspected thyroid tumor. The ratio of women to men was 35:15. In all patients the same panel of diagnostic tests was used including: endocrinologic consultation, ENT examination with stroboscopic examination with assessment of vocal cord mobility, neck ultrasound examination to assess the thyroid gland and lymph nodes. Results In 50 patients following surgical methods were used: total resection of the thyroid - 28 patients (56%), resection of one lobe of the thyroid - 17 (34%), open biopsy - 6 (12%) patients. In 5 cases tracheotomy was performed. In the case of malignancy (excluding unresctable lesions - 6 patients) selective lymph node dissection of the neck was performed (field III, IV, VI) - 11 patients (22%). Discussion Results of surgical treatment (relative to the percentage damage to the recurrent laryngeal nerve) achieved by head and neck surgeons are at levels comparable or higher compared to the results achieved by general surgeons - 1.3% for primary benign lesions (Enomoto et al.).

[Dental examination integral part of preventive testing head and neck cancers].

In recent years, in Poland and in Europe, we have seen a steady increase in the incidence of malignant tumors of the head and neck. On the basis of national cancer registries, the increase in new cases in the last ten years is over 15% and that worries epidemiologists and the medical community. Taken in Europe prevention programs aimed at reducing new cases. In Grater Poland from 2012 has initiated an innovative program for Early Detection of Cancer, Department of Head and Neck Surgery Medical University in Poznan and the Department of Health Marshal's Office in Poznan. The aim of the study was to evaluate dental and oral hygiene habits analysis of patients reporting to the Programme for Early Detection of Head and Neck Cancer. The study conducted involved 678 patients reporting to the Department of Head and Neck Surgery in Grater Poland Cancer Center under the prevention of cancers of the head and neck. All patients underwent ENT assessment and standard dental examination assessing condition of teeth and oral mucosa. All patients were asked to fill out prepared questionnaire, which included questions concerning socio-economic conditions of the patient, hygiene habits and risk factors for oral cancer. Most of the patients participating in the study, 441 people (65.9%) smoke or smoked cigarettes. Smoking habit among female dominated. Within smokers responders declared, at the same time,consumption of alcohol at least three times a week; 192 people (81.1%). Almost half (49.8%) of all respondents reported consuming alcohol occasionally. Regular practice of oral sex with frequent change of partner, belonging to the high risk of head and neck cancer, were found in 21.9% of patients. During the assessment of oral hygiene was observed 155 patients (23.4%) correctly cleansing the teeth and oral cavity, while more than half (62.4%) did not abide rules of daily oral hygiene. The use of additional tools to correct hygienization (dental floss, interdental brushes, rinses the mouth) was recorded in 51.7% of patients. As a result, 85% of the patients of the head and neck cancer prevention program was found bad condition of the oral cavity, and dental procedures in 30% of patients were applied. Patients diagnosed with invasive cancer was in 19 cases. Results of this study indicate that, the dentist should be an integral part of interdisciplinary team treating patients with head and neck cancer, and regular dental care plays a key role in the early diagnosis of patients with head and neck cancer.

National Programme for Prevention and Early Detection of Head and Neck Cancer.

550,000 new cases of cancer of the oral cavity and pharynx and 160,000 of larynx are diagnosed each year worldwide. It is estimated that each year because of head and neck cancer 400,000 of patients will die. Head and neck neoplasms are the tumors which, because of their location, secretly develop and produce uncharacteristic symptoms identical to those that accompany the banal infections of the upper respiratory tract. Results of treatment of patients with head and neck cancer in Poland are highly unsatisfactory. This is due to significant advancement of tumor at the moment of diagnosis. Therefore, raising awareness and improving knowledge of health care workers on head and neck cancers by creating access to prevention research is a priority that will ensure improvement in treatment outcomes in this group of tumors in Poland and abroad.

Oral cavity and oropharyngeal squamous cell carcinoma in young adults: a review of the literature.

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is a disease of middle-aged to elderly adults. However, an increased incidence of HNSCC in young people under 45 years of age has been reported recently. In the present review, we focused on the epidemiology and aetiology of HNSCC in adults under 45 years of age. METHODS: We reviewed literature related to HNSCC in adult patients less than 45 years of age and discussed current treatment options and prognosis. RESULTS: HNSCC in young adults is associated with a higher incidence rate in nonsmokers, lower female-to-male ratio, a higher percentage of oral cavity and oropharynx tumours, and fewer second primary tumours. However, aside from traditional risk factors of tobacco and alcohol exposure, the causes of these cancers in young adults remain unclear. Agents that might contribute to risk include infection with high-risk human papillomavirus subtypes as well as genetic factors or immunodeficiency status. The expected increase in incidence and mortality of the young with HNSCC may become a major public health concern if current trends persist, particularly lifestyle habits that may contribute to this disease. CONCLUSIONS: Given the younger age and potential long-term adverse sequelae of traditional HNSCC treatments, young adults should be treated on a case-by-case basis and post-therapy quality of life must be considered in any treatment-decision making process.

[The expression assessment of the estrogen, progesterone and HER2 receptors in selected malignant tumors of the salivary glands]. / Ocena ekspresji receptora estrogenowego, progesteronowego i receptora HER2 w wybranych nowotworach zlosliwych slinianek.

INTRODUCTION: The incidence of the malignant tumors of the salivary glands is relatelively low. However, rapid locoregional progression, distant metastases occurrence and high local recurrence rate occurring despite radical surgical treatment, significantly affect the outcome. Malignant tumors of the salivary glands are characterized by low radiosensitivity and poor response to systemic therapy. Therefore there is a need for new targeted therapies which may improve the prognosis. In some aspects, malignant tumors of the salivary glands are similar to breast cancers. Efficacy of hormonal replacement therapy and the treatment with the monoclonal antibody (trastuzumab) in the treatment of breast cancer is well known and confirmed. Criterion determining the qualification for treatment is the presence of hormone receptors and HER2 receptors in the tumor. AIM: The aim of this study was to evaluate the expression of estrogen receptor, progesterone receptor and HER2 in selected salivary gland malignancies. MATERIALS AND METHODS: Study group consisted of 51 patients with the salivary glands cancer. In the study group there were 42 tumors in the parotid gland, 7 tumors of the submandibular gland, 1 in the mucosa of the cheek and 1 tumor in the tongue. Histologically material comprised of muco-epidermoid carcinoma (10), adenoid-cystic carcinoma (8), salivary duct (7), adenocarcinoma (6), squamous cell carcinoma (6), mioepithelial carcinoma (5) and other (9). In all cases immunohistochemical analysis of the estrogen receptor, progesterone receptor and HER2 receptor was performed. RESULTS: The expression of the estrogen receptor was found in 18% of tumors (9 patients). The expression of the progesterone receptor was found in 20% (10 patients). HER2 expression was found in 10% of tumors and was related to only one histological type of tumor - salivary duct carcinoma. CONCLUSION: HER2 expression in malignant tumors of the salivary glands, especially in salivary duct carcinoma may be of use in future implementation of new targeted therapies based on monoclonal antibodies.

[The role of the multidisciplinary team in the diagnosis and treatment of patients with laryngeal and hypopharynx cancer]. / Rola zespolu interdyscyplinarnego w diagnostyce i leczeniu chorych z nowotworami krtani i gardla dolnego.

INTRODUCTION: In Poland the annual incidence of cancer of the larynx is about 3,000 cases which accounts 2% of all malignant tumors. Results of treatment of head and neck cancers are still unsatisfactory (five-year survival - 50%). In order to improve the outcome in Greater Poland Cancer Centre in 2010 a multidisciplinary team was created which is involved in the individual qualification of each patient to the best form of therapy. AIM: The aim of the publication is to evaluate the work of the multidisciplinary team in the diagnostic, therapeutic, and post-operative follow-up of patients with larynx and hypopharynx cancer treated in Greater Poland Cancer Centre in 2007-2012. MATERIALS AND METHODS: The analysis included 558 patients (84% men, 16% women) aged 38-82 years who were treated in the Department of Head and Neck Surgery Greater Poland Cancer Centre in the years 2007 to 2012 because of cancer of larynx and hypopharynx. Patients were divided into two groups - the first consisted of patients qualified without the cooperation of the multidisciplinary team - 312 patients (56%), the second - patients qualified with help of the multidisciplinary team - 246 patients (44%). In the two groups of patients evaluated were: mean time required for the implementation of additional tests and specialist consultations before treatment, the average time from the appearance of the patient to the start of treatment, the distribution of qualifications to specific forms of therapy. RESULTS: Evaluating type of treatment administered after the establishment of the team noticed were an increase by 11% the number of patients treated with surgery. There has been a reduction in the time between the appearance of the patient at the clinic and the start of treatment and reduce the waiting time for diagnostic imaging and specialist consultations. It was also an increase in the number of regular check-ups and a decrease in the number of patients who stopped visits. CONCLUSION: The work of the multidisciplinary team improves the effectiveness of treatment by optimizing the process of preparation and organization, and finally by contributing knowledge and experience in decision-making. His creation results in benefits for the patient, his family and the medical staff. Qualification for the most optimal treatment within the multidisciplinary team should be used in all patients with cancer of the head and neck.

[Evaluation of the effectiveness of ¹8F-FDG-PET/CT examination of head and neck cancer--own experience]. / Znaczenie badan PET/CT w diagnostyce nowotworów glowy i szyi--doswiadczenia wlasne.

PURPOSE: The aim of the study was to evaluate the usefulness of ¹8F-FDG-PET/CT in diagnosis of head and neck cancer. MATERIAL AND METHODS: 60 ¹8F-FDG-PET/CT examinations were performed in 50 patients diagnosed and treated for head and neck cancer in Department of Head and Neck Surgery and Nuclear Medicine Department of The Greater Poland Cancer Centre in Poznan, Poland from 2007 to 2011. Patients were divided into 2 subgroups: CUP Syndrome patients (25 PET/CT exams) and patients being under control after treatment (35 PET/CT exams). RESULTS: In the group of CUP Syndrome patients 6 PET/CT examinations were negative, in 7--possible primary tumor was indicated, in 10--only cervical lymph node metastases were diagnosed, in 2 cases--distant metastases occured. Within the second subgroup 14 PET/CT examinations were negative, 11 exams--indicated the recurrent disease, 2--cervical lymph node metastases and 8--distant metastases. The sensitivity and specificity of ¹8F-FDG-PET/CT in this study within the CUP Syndrome patients group were 100% and 55% respectively. The positive predictive value was 74%. The negative predictive value was 100%. The sensitivity and specificity of ¹8F-FDG-PET/CT in this study within the second group of patients were 88% and 66% respectively. The positive predictive value was 71%. The negative predictive value was 86%. CONCLUSIONS: ¹8F-FDG-PET/CT is useful for staging of head and neck cancer, identification of an unknown primary tumor, delineation of the extent of regional lymph node involvement, detection of distant metastases and occasional synchronous primary tumor.