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Oral CancerOral CancerEarly diagnostic Early diagnostic and Treatmentand Treatment

Professor Igor ReshetovProfessor Igor Reshetov

P.A.Hertzen Cancer Research InstituteP.A.Hertzen Cancer Research Institute

MoscowMoscow

www.headneckonco.ruwww.headneckonco.ru

Squamous cell carcinoma of the head and neck

(SCCHN): 98 000 new cases in Europe annually

SCCHN: mortality in Europe is 43 000

annually

SCCHN accounts for

6% of all malignancies

Worldwide annual incidence of SCCHN:

485 000 new patients; 261 000

deaths

Epidemiology of Epidemiology of SCCHNSCCHN

GLOBOCAN 2002 (http://www-dep.iar.fr)

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Etiology factors in oral Etiology factors in oral cancercancer

Reasons for Reasons for early early diagnostic diagnostic oral canceroral cancer

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Pathogeneses oral cancer Pathogeneses oral cancer and depends T(tumor)) and depends T(tumor)) and N (metastases) and N (metastases) factorsfactors

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Rate of survival in Rate of survival in depend with T(tumor) depend with T(tumor) factor factor

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Survival in depend Survival in depend with N(metastases) with N(metastases) factorfactor

{{Sloan-Kettering Cancer Center 2012Sloan-Kettering Cancer Center 2012

Survival in Survival in depend with depend with location of tumorlocation of tumor

Methods of early Methods of early diagnostic oral diagnostic oral cancercancer

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Possibilities ultra=scope in Possibilities ultra=scope in compare with light compare with light endoscopyendoscopy

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White light endoscopy and fluoroscopy – White light endoscopy and fluoroscopy – correct vision margins and areacorrect vision margins and area

Different view in oral Different view in oral mucosa mucosa

{{Mechanism of spectroscope oral Mechanism of spectroscope oral mucosamucosa

Confocal laser microscopy

New method of morphological diagnostic in vivo tumors on skin and mucosa sensitivity - 88,5%Specifity – 97,6%

Strategy of treatment Strategy of treatment – innovation new – innovation new technologiestechnologies

{{Sloan-Kettering Cancer CenterSloan-Kettering Cancer CenterRate of survival in Rate of survival in depend with depend with possibilities of possibilities of combine combine treatmenttreatment

Breast cancer(early, metastatic)

Bev, TZB, LAP..

Colo rectal ca(metastatic)

Bev, CET, PAN

NSCLC(metastatic)Bevacizumab

Renal cancer(metastatic)

Bev, sunitynib, ewerolimusSorafenib, TEMSR,

HCC(advanced)sorafenib

GISTImatinib

Molecularly targeted agents in oncology

Gastric cancer(metastatic)

TZB

Brain tumors(advanced)

Bev

Pancreatic ca(metastatic)

erlotinib

HNSCC(advanced)

CET

EGFR InhibitorsEGFR Inhibitors Gefitinib (TKI)- NSCLCGefitinib (TKI)- NSCLC Erlotinib (TKI)- NSCLC, Erlotinib (TKI)- NSCLC,

pancreatic capancreatic ca Cetuximab (MAB)- colorectal Cetuximab (MAB)- colorectal

ca, head and neck ca, head and neck squamous cell ca, NSCLCsquamous cell ca, NSCLC

Panitumumab (MAB)- Panitumumab (MAB)- colorectal cacolorectal ca

New agentsNew agents

EGFR Receptor

Ryc. Materiały informacyjne Amgen

Intraoperative radiotherapy

Photodynamic diagnostic and therapy Electrochemical lysis

Definition of sentry lymph node

Technologies in surgical oncologyTechnologies in surgical oncology

Clinic example P-t С. 16 year.Clinic example P-t С. 16 year.Diagnosis : recurrent pappilomas of larynx Diagnosis : recurrent pappilomas of larynx with displasia 3 grade with displasia 3 grade

Result – 5 years full remission

Electroresection

PDD (5Аla)

Nd:YAG laser

Befor treatment

Combine treatment

1 year after.

Splan cell pappilomas / ВПЧ 6 + 11 типы

Robotic-assisted surgeryRobotic-assisted surgery

Da Vinci robot–assisted endocrine surgery: Novel

applications in otolaryngology

Neil Tanna, MD, Arjun S. Joshi, MD, Robert S. Glade, MD,

Daniel Zalkind, BS, and Nader Sadeghi, MD, Washington, DC

Otolaryngology–Head and Neck Surgery (2006) 135, 633-635

TORS accessTORS access

Transoral robotic surgery

Neil G. Hockstein, MD,a,b Bert W. O’Malley, Jr, MDbOperative Techniques in Otolaryngology (2008) 19, 67-71

Advantages of Advantages of TORSTORS

Trans cervical surgery with trocards of robotic laparoscopic

surgery

Better orientation and exposition of the tools :Possible surgery of the

hypopharynx

Aim – total Aim – total survival more survival more 90 %90 %

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