Head & Neck Oncology

WHAT WE DO

SURGICAL ONCOLOGY

1. Surgery is one of the main stay of treatment of head and neck cancers. MICC has expert team of surgeons who has experience to remove tumours completely and preserving the normal structures. Our aim in surgery is to give maximum result with minimum morbidity.

Our head and neck surgeons are expert in doing surgeries for all head and neck subsites.

1. Buccal mucosa (cheek) cancers- We take out tumour completely and if feasible, try to preserve the normal structures around the tumour, e.g. preservation of lower jaw bone (mandible) by preserving it completely or partial removal of bone(marginal mandibulectomy)
2. Tongue cancers- aim is adequate tumour removal and preservation of voice and swallowing
3. Larynx (voice box) carcinoma- Try to give voice back to the patient even after total laryngectomy (complete voice box removal) by inserting voice prosthesis. Also early stage tumours can be removed completely with TransoralLaser surgery with good preservation of voice.
4. Oropharynx (throat cancers)- usually these tumours treated with radiotherapy and chemotherapy but early stage tumour and recurrent tumours can be removed with Transoral robotic surgery (TORS)with good results in MICC.
5. Thyroid cancers- We have well trained doctors for thyroid surgery and they work in coordination with nuclear medicine and endocrinology department. We have full facility of post operative adjuvant radioactive iodine therapy. We also do intra operative nerve monitoring.
6. Parathyroid tumours- our emphasis of removal of parathyroid adenomas with focused approach with minimal invasive technique with good cosmetic effect. We have facility of intra operative PTH sampling and frozen section.
7.  Skull base tumous – we have trained surgeons in endoscopic skull base tumour removal along with expert team of neurosurgery.
8. Salivary gland tumour- our aim to remove salivary gland tumour removal with preservation of cranial nerves. We have facility of intra operative nerve monitoring.
9. Reconstructive surgery- Reconstructive surgery is now a days an integral part of any head and neck cancer unit. If in case cancer surgery needs major tissue removal, for instance removing the jaw, skin, pharynx, or tongue, so, reconstructive or plastic surgery may be done to restore the missing tissue. This sort of operation helps restore a patient’s looks and the function of the affected area.Good reconstruction is required for good functional outcome in terms of speech and swallowing and good cosmetic outcome. We have the facility of complex microvascular free flap reconstruction.

WHY TO CHOOSE MICC FOR HEAD AND NECK SURGERY?

1. We treat a good number of head and neck patients in MICC.  We have expert and experienced surgeons who are capable of doing all kind of complex head and neck surgeries. We have cutting edge technology e.g. Transoral robotic surgery and Transoral Laser surgery.
2. We have experienced team of anesthetists who look after the patients during surgery. We have experienced nursing staff and physiotherapists who are trained to look after specifically head and neck post operative patients.
3. We audit our results regularly for patient satisfaction not only in terms of surgery but also overall stay in hospital and try to improve each time.

RADIATION ONCOLOGY

The aim of radiation therapy is to use beams of radiation to kill cancer cell with as little risk as possible to normal cells. Radiation treatment, like surgery,is a local treatment .It affect the cancer cells only in a specific areas of the body. Radiation therapy can be used before surgery to shrink a tumor called as neoadjuvant Radiation. Radiation therapy may be used after surgery to stop growth of cancer cells that may remain called as adjuvant Radiation. Radiation therapy can be used at the time of surgery known as Intraoperative Radiation (IORT).

The source of radiation may be from a machine outside the body also called as EBRT or External Beam Radiation therapy or from radioactive material placed as close as possible to the cancer cells (Brachytherapy).

EBRT is usually given during outpatient visits to a hospital .In this, a machine directs the high energy rays at the tumor and a small margin of normal tissue surrounding it. The type of machine used for radiation therapy at MAX cancer centre is called as a Linear Accelerator, True Beam STX . It has the facility for IMRT (Intensity Modulated Radiation Therapy), IGRT (Image Guided Radiation Therapy),SRS (Stereotactic Radiation Therapy), SBRT(Stereotactic Body Radiation Therapy).

Intensity-modulated radiation therapy (IMRT) and Image Guided Radiation Therapy (IGRT) for head and neck cancers or carcinomas refers to a new approach that uses computer based optimization process to carefully create a gradient or a dose fall-off between the target tissues and the surrounding normal tissues at risk. This fall of dose saves he surrounding normal structures effectively. Therefore these techniques and technology offers the prospect of increasing the locoregional

control probability while decreasing the complication and side effects rate.

Image guided radiotherapy is classically defined as radiation therapy that is delivered only after verification of position of structures of interest by performing either an X-Ray or  CT based image. The same are done by an imaging system mounted on the linear accelerator itself.

True beam STX is an advanced radiotherapy system to deliver more powerful cancer treatments with pinpoint accuracy and precision. It uniquely integrates advanced imaging and motion management technologies within a sophisticated new architecture that makes it possible to deliver treatments more quickly while monitoring and compensating for tumor motion.

While technology always opens the doors it is always a skilfuldoctors who can get inside it. To make the best skills available to our patients, we at Max have super-specialised “Head and Neck Disease Management Group” which is composed of individuals who are skilled in management of head and neck cancers from all disciplines of surgery, radiation therapy, chemotherapy, speech and swallowing rehabilitation, plastic surgery, physiotherapy, nutrition and dietetics, dentistry and implantology. 

MEDICAL ONCOLOGY

Medicines form an important armamentarium in the fight against head neck cancers. It's used primarily in the following scenarios

1. Concurrent partner to radiotherapy to increase the efficacy 
2. Neoadjuvant modality- To make inoperable tumours operable by reducing the size to control Metastatic ( cancer which has spread beyond the site of origin) or locally advanced tumour not amenable to surgery or radiotherapy. 

The medicines include 

1. chemotherapy drugs - these can be intravenous or oral. Examples are paclitaxel or cisplatin etc.
2. monoclonal antibodies - these are new class of drugs which are more specific in their actions and include immunotherapy drugs and other types of drugs. Examples include CetuximabNimotuzumab or Nivolumab

At MICC we are equipped to admister all types of chemotherapies or monoclonal antibodies as per latest international protocols at our state of art and the largest Day care facility or as an Indoor patient.

REHABILITATION

• Speech and swallowing:

  We have experienced speech and swallowing therapists who are integral part of head and neck team to help all the patients who underwent head and neck surgery, radiation therapy or chemotherapy. They do it with individualistic approach as requirement for each head and neck patient is different according to therapy and surgery is done.

  They also help in restoration of speech in post laryngectomy patients (tracheoesophageal speech , Esophageal speech)

• Physiotherapy:

  Physiotherapists are part of head and neck team who work with patient for early rehabilitation in terms of early mobilization after surgery.

• Pain management:

  We have specialist palliative care and pain management doctors who can help in decrease your pain during and after treatment.

• Nutritionists :

  We have a team of dieticians who take care of each patient’s specific diet according to his/her treatment and comorbidities

Relevant tumour boards