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The non-surgical management of advanced head and neck cancer

Frances Calman

in Palliative Care Consultations in Head and Neck Cancer

This chapter discusses non-surgical management of advanced head and neck cancer. The first section looks at the choice of treatment modality, along with radiotherapy treatment and systemic ... More

This chapter discusses non-surgical management of advanced head and neck cancer. The first section looks at the choice of treatment modality, along with radiotherapy treatment and systemic chemotherapy. Radiotherapy treatment is the most important non-surgical treatment for head and neck cancer. Systemic chemotherapy, on the other hand, is often used along with radiotherapy for advanced disease. The acute side effects of radiotherapy, reducing the morbidity of the treatment, and some types of cancer – laryngeal cancer, cancer of the nasopharynx and paranasal sinuses, and oral and oropharyngeal cancer – are discussed as well. The chapter ends with a section on treating metastatic and recurrent disease, and the future of these diseases.Less

Head and Neck Surgery

Stuart Winter and Declan Costello (eds)

in Title Pages

Assessment and management of respiratory symptoms of malignant disease

Jennifer Chard, Peter Hoskin, and Sam H. Ahmedzai

in Supportive Care in Respiratory Disease

Supportive care is a major component in the management of malignant diseases that affect the respiratory system. It should be included in the overall management plan for the patient from the very ... More

Supportive care is a major component in the management of malignant diseases that affect the respiratory system. It should be included in the overall management plan for the patient from the very outset. Many patients who present with new respiratory or systemic symptoms of lung cancer will need urgent palliation of these problems, even before a definitive histological diagnosis can be made. Indeed, some patients who present late with advanced disease may be too ill for invasive diagnostic investigations, and palliative interventions will be planned on the basis of a working diagnosis of lung cancer, guided on radiological findings and clinical history. This chapter discusses the prevalence of symptoms in cancer, causes and assessment of symptoms in cancer, approaches to symptom management, technical advances in radiotherapy delivery, chemotherapy, comprehensive palliation of symptoms, and management of effusions.Less

Adjuvant therapy in pain control

CICELY SAUNDERS, MARY BAINES, and ROBERT DUNLOP

in Living with Dying: A Guide to Palliative Care

This chapter examines the use of adjuvant therapy in the management of pain in terminally ill patients. It explains that analgesics are sometimes not enough to relieve the pain in some patients and ... More

This chapter examines the use of adjuvant therapy in the management of pain in terminally ill patients. It explains that analgesics are sometimes not enough to relieve the pain in some patients and that radiotherapy and nerve blocks are usually indicated for patients experiencing higher levels of pain. The chapter discusses the concept of palliative radiotherapy, anaesthetic techniques for pain control, and adjuvant analgesic drugs.Less

Principles of radiotherapy

Peter Hoskin and Wendy Makin

in Oncology for Palliative Medicine

This chapter provides an overview of radiotherapy. Radiotherapy is the method of treatment using ionizing radiation. Normally, radiation is in the form of X-rays or gamma rays which, when directed ... More

This chapter provides an overview of radiotherapy. Radiotherapy is the method of treatment using ionizing radiation. Normally, radiation is in the form of X-rays or gamma rays which, when directed through a cell, result in the ionization and destruction of DNA. Methods of delivering radiation include external X-ray beams and the use of radioisotopes. Radiation is potentially dangerous, hence administration of radiotherapy is usually done within a radiotherapy department. Radiotherapy plays a significant role in palliative care: it aids in the management of local symptoms such as pain, haemorrhage, and obstruction. Topics discussed in the chapter include the different kinds of radiation, radioisotope therapy, biological effects of radiation, and fractionation. The chapter also discusses the practicality of radiotherapy, and the practicality and efficiency of radiotherapy in palliative care.Less

Therapeutic Approaches to Malignant Mesothelioma

Harvey I. Pass, Stephen Hahn, and Nicholas Vogelzang

in Asbestos and Its Diseases

This chapter focuses on malignant mesothelioma (MM). Topics discussed include prognostic indicators, staging, treatment, surgery, radiotherapy, prevention of recurrences of MM in chest scars, ... More

This chapter focuses on malignant mesothelioma (MM). Topics discussed include prognostic indicators, staging, treatment, surgery, radiotherapy, prevention of recurrences of MM in chest scars, multimodality treatment, novel intrapleural approaches, and chemotherapy and newer agents.Less

Mouth care for haematology patients

Ilora Finley, Pia Amsler, and Rosemary Wade

in Palliative Care Consultations in Haemato-oncology

Disease or treatment-related mouth problems, particularly those associated with chemotherapy or radiotherapy and other immunosuppresion strategies, often pose severe pain in haematology patients. ... More

Disease or treatment-related mouth problems, particularly those associated with chemotherapy or radiotherapy and other immunosuppresion strategies, often pose severe pain in haematology patients. Oral problems often posit challenges in the social interactions and eating and breathing patterns of patients. They also increase systematic and local infections, impede treatment schedules, and change dose requirements and drug combinations. This chapter discusses the causes of oral problems in haematological patients, the assessment and incidence of oral mucositis, the pathogenesis of chemotherapy and radiotherapy-induced mucositis, and prevention and treatment. Stomatitis and mucositis are defined to provide clinicians with a better understanding of oral problems, since the task of assessing and addressing these are commonly left to trained nursing staff.Less

The Prevention and Treatment of Seizures in Intra-Cranial Malignancy

David Oliver

in Palliative Care Consultations in Primary and Metastatic Brain Tumours

This chapter covers the prevention and treatment of seizures in intra-cranial malignancy, a crucial part of palliation as seizures are one of the dominant concerns of patients and their families. It ... More

This chapter covers the prevention and treatment of seizures in intra-cranial malignancy, a crucial part of palliation as seizures are one of the dominant concerns of patients and their families. It begins with the incidence, assessment, and diagnosis of seizures. The rest of the chapter focuses on the palliation of this symptom. Management of seizures depends on the first episode and the recurrence of the problem. The primary treatment for seizures is through the use of anticonvulsant medication; however, this is administered with great care as it poses adverse effects. Other seizure management methods discussed in the chapter include the use of corticosteroids, radiotherapy, and surgery. It also discusses status epilectus and the management of seizures in unconscious patients.Less

Assessment and management of respiratory symptoms of malignant disease

Sam H. Ahmedzai and Martin F. Muers

in Supportive Care in Respiratory Disease

This chapter examines the diagnosis and management of respiratory syndromes associated with malignant diseases and evaluates the supportive care needs of patients with primary thoracic cancers. Some ... More

This chapter examines the diagnosis and management of respiratory syndromes associated with malignant diseases and evaluates the supportive care needs of patients with primary thoracic cancers. Some of the common symptoms in patients with thoracic malignancy include dyspnoea, cough, and haemoptysis. Mild symptoms can be effectively managed by pharmacological methods, but for malignant ones radiotherapy and brachytherapy are recommended.Less

Criticism and the Redefinition of Clinical Cancer Trials as an Autonomous Form of Research

Peter Keating and Alberto Cambrosio

in Cancer on Trial: Oncology as a New Style of Practice

This chapter discusses how clinical cancer trials ceased to be seen as a mere extension of the Cancer Chemotherapy National Service Center (CCNSC) and became an autonomous form of clinical research. ... More

This chapter discusses how clinical cancer trials ceased to be seen as a mere extension of the Cancer Chemotherapy National Service Center (CCNSC) and became an autonomous form of clinical research. First, it discusses the reorganization of screening and clinical trials in the United States. It also discusses the emergence of cooperative cancer research and then examines how surgery and radiotherapy participated in clinical cancer research.Less

Cancer Clinical Trials

in Contested Medicine: Cancer Research and the Military

This chapter investigates work in the mid-1970s of a distinguished oncology researcher, Bernard Fisher, in order to bring out a number of salient characteristics of clinical trial culture. It ... More

This chapter investigates work in the mid-1970s of a distinguished oncology researcher, Bernard Fisher, in order to bring out a number of salient characteristics of clinical trial culture. It specifically addresses Fisher's multicenter trials that were governed by a tightly regimented system of practices that were capable of producing highly reliable results. It follows the growth of cancer clinical trials from the end of the Second World War until the early 1970s and President Richard Nixon's War on Cancer. The principle that adding prolonged, and aggressive, chemotherapy to conventional local treatments with surgery and radiotherapy had improved cancer cures was proved. With the growing postwar concerns with clinical conduct, medical investigators also had to show that their research was produced ethically.Less

Multiple Primary Cancers

Lindsay M. Morton, Sharon A. Savage, and Smita Bhatia

in Cancer Epidemiology and Prevention

As prognosis following a cancer diagnosis has improved and survival has increased, so has the occurrence of multiple primary cancers diagnosed in the same individual. In the United States, one in ... More

As prognosis following a cancer diagnosis has improved and survival has increased, so has the occurrence of multiple primary cancers diagnosed in the same individual. In the United States, one in five cancer diagnoses involves an individual with a previous history of cancer. These new primary cancer diagnoses, or “subsequent neoplasms” (SN), are a substantial cause of morbidity and mortality in cancer survivors. The risk of developing SN varies substantially depending on age, the type of initial primary cancer, chemotherapy, radiotherapy, genetic susceptibility, and exposure to other cancer risk factors. Childhood cancer survivors have particularly elevated SN risks associated with radiotherapy and, to a lesser extent, systemic therapy. Genetic susceptibility to cancer is also thought to play an important role in SN development after childhood cancer. Survivors of many adulthood cancers also have elevated SN risks, likely with a multifactorial etiology.Less

Surgical Decompression of the Orbit

J.D. Perry and Craig Lewis

in Surgery of the Eyelid, Lacrimal System, and Orbit

In 1835 Graves first described the characteristic exophthalmos of thyroid eye disease, and his name has since become synonymous with thyrotoxic ophthalmopathy. Graves disease is relatively common, ... More

In 1835 Graves first described the characteristic exophthalmos of thyroid eye disease, and his name has since become synonymous with thyrotoxic ophthalmopathy. Graves disease is relatively common, with a prevalence and incidence of 1% and 0.1%, respectively. Although subtle signs of ophthalmopathy are present in most patients with Graves disease, only 30% have obvious eye findings, and only 5% develop ophthalmopathy severe enough to warrant specific treatment with radiotherapy, immunosuppression, or orbital decompression surgery. Graves disease and Graves ophthalmopathy are more common in females than in males, though males tend to have more severe eye disease. Cigarette smokers have an increased risk of developing Graves disease, an increased risk of developing associated ophthalmopathy, and a progressively increased risk of severe ocular manifestations. While the onset of Graves disease usually occurs when people are in their forties, thyroid optic neuropathy tends to occur in the fifties and sixties, underscoring the importance of careful long-term follow-up of these patients. The ophthalmopathy of Graves disease is usually associated with hyperthyroidism, but it occurs in euthyroid and hypothyroid patients as well. The clinical course of the ophthalmopathy does not directly correlate with the thyroid status, although more than 80% of thyroid patients who develop severe ophthalmopathy do so within 18 months of the detection of the thyroid disease. The early findings of thyroid ophthalmopathy include conjunctival injection, lacrimation, ocular surface irritation, orbital and periorbital swelling, and mild eyelid retraction. Progression of the disease can result in severe orbital congestion, massive enlargement of the extraocular muscles with secondary diplopia, proptosis, compressive optic neuropathy, prominent eyelid retraction, spontaneous subluxation of the globe anterior to the eyelids, and exposure keratopathy. Treatment options for these serious complications of Graves disease include systemic corticosteroids, radiation therapy, and orbital decompression surgery. The role of radiation therapy in the management of Graves ophthalmopathy remains controversial. In 1973, Donaldson et al. first reported results of radiotherapy for Graves ophthalmopathy using a megavoltage linear accelerator. This series and multiple subsequent series have reported favorable results in approximately 60% of patients. Less