Head and neck cancer includes a range of cancers that originate in the head and neck. According to Parkin et al it is the fifth most common cancer worldwide [Parkin, 2005 #5], but it is uncommon in young women and very rare in pregnancy
Counselling pregnant patients with head and neck cancer can be a challenge and prognosis and survival are dependent on the tumor type, stage and grade. One thing is certain and that is optimum management is provided within the realm of a multidisciplary approach.
Radiological studies including CT and MRI play an integral role in establishing the extent of local invasion, whether lymph nodes are involved and to help stage the disease by detecting metastases. Lungs, liver and bone are the most common sites for metastatic spread.
The maximum recommended radiation doses in pregnancy are 50 mGy [Stovall, 1995 #6]. A CT has a dose of _________ which is well below the max recommended. A MRI is a preferable mode of assessment and even when contrast has been used it has not been associated with any teratogenic effect. CT scans may be more widely available and a diagnosis in a suspected case should not be delayed because...
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...jor salivary gland cancers published by Hocwald et al in Laryngoscope, positive prognostic factors included female gender, younger age and lack of perineural invasion, lack of facial nerve involvement and negative nodes.
The management of head and neck cancers is quite variable, highlighting the importance of multidisciplinary input. Symptoms can be non-specific but investigations should not be delayed, if indicated. Ideally while management in pregnancy should conform to standard practices in the non-pregnant population, this may not always be feasible.
Further studies are required to help determine whether the benefits of radiotherapy in pregnancy in terms of reduced tumor recurrence and death can be balanced against the risks to the fetus. The role of concurrent chemoradiation needs further evaluation for head and neck cancer in pregnancy.
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