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The role of surgery in oncology – curative

The role of surgery in oncology – curative . Carole Glover Head & Neck Clinical Nurse Specialist & Hugh McGrath Patient representative . AIM OF SESSION . Have an understanding of the patient’s cancer journey from diagnosis to surgery

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The role of surgery in oncology – curative

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  1. The role of surgery in oncology – curative Carole Glover Head & Neck Clinical Nurse Specialist & Hugh McGrath Patient representative

  2. AIM OF SESSION • Have an understanding of the patient’s cancer journey from diagnosis to surgery • Overview of the head and neck cancer surgery, including flap reconstruction • Impact head and neck surgery has to patient

  3. How treatment decisions are made • Diagnostic biopsy / tissue sample • Staging scans, MRI / CT / PET • Staging of the cancer e.g. TNM • MDM discussion including pt’s co morbidities, performance status, social, psychological factors

  4. Resections that need reconstruction (from where) • Functional outcome post surgery (QOL) • Cure vers QOL • Surgery vers radiotherapy / chemotherapy

  5. Centralisation of Head and Neck Cancer Surgery • 2009 Centralised services from Herts and Beds to L&D • Diagnostics at Bedford and Lister Hospital • Surgery L&D • Follow up Bedford / Lister • RT / Chemo Mount Vernon • Transport issues pts and relatives • Close liaison / communication

  6. MDT Team • Surgeon ENT / Maxillo facial • Oncologist • Radiologist • Histologist • CNS /Support Nurse • Dietitian • Speech and Language Therapist • Nutrition Nurse • Physiotherapist • ENT Nurse Practitioner

  7. Head and Neck Cancer • NAME THE SITES

  8. Oral cavity • Lips • Pharynx • Larynx • Tongue • Salivary glands • Nasal cavity and paranasal sinuses. • Ear • Nose

  9. Types • Squamous cell carcinoma - 95% • Adenocarcinoma • Adenocystic carcinoma • Salivary gland/spindle cell cancers • Verouccous carcinoma. • Thyroid cancers- several subtypes

  10. T4 SCC of Larynx (with fixed right vocal cord

  11. Neck nodes

  12. Surgery • Early stages(T1 / 2) – resection and primary closure / laser excision • Larger cancers – resection and reconstruction (flap / obturator) • Neck dissection if spread (metastases) to lymph nodes • Post operative radiotherapy

  13. T1 N0 SCC Tongue with primary closure

  14. Types of Flaps

  15. Right hemiglossectomy with radial forearm free flap

  16. Post surgery • Drips / drains / PCA • NG / PEG feeding • Tracheostomy tube • Laryngectomy • Supported by MDT • Histo discussed in MDM 2 – 3 weeks post op (Margins, positive lymph nodes) • Further treatment chemoradiotherapy, radiotherapy

  17. Patient experience • DISCUSS

  18. Patient experience • GP • Diagnosis • Pre operative • Surgery / Inpatient stay • Home

  19. QUESTIONS

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