Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010
interactive format, inviting audience participation in the discussion of various reconstructive options and controversies. EDUCATIONAL OBJECTIVES: 1) Understand the evidence for reconstructive decision making for defects of the tongue, mandible, and pharyngoesophagus. 2) Understand the tradeoffs of different reconstructive approaches and their impact on functional outcome. 3) Understand the impact of patient factors and co-morbidities on the choice of a reconstructive option.
HPV & Oropharyngeal Cancer: Many Questions: Now Some Answers Daniel Deschler, MD (moderator); F Christopher Holsinger, MD; James Rocco, MD, PhD; John R Clark, MD; Richard Smith, MD PROGRAM DESCRIPTION: While the overall incidence of head and neck cancer in the United States continues a gradual decline, mimicking the national decline in tobacco use, there has been a significant increase in the incidence of oropharyngeal squamous cell carcinoma. This rise has been attributed to oncogenic subtypes of the Human Papilloma Virus (HPV). Studies of patients with oropharyngeal squamous cell carcinomas demonstrate not only the rise of HPV⫹ tumors, but important demographic differences from the traditional head and neck cancer patient. We are all seeing more of these patients: They are younger and lack the classic risk factors of tobacco and alcohol abuse. Important differences have also been noted in the response of HPV⫹ to treatment, demonstrating a significantly improved prognosis in larger series. As this information disseminates through the medical field and into the lay community, many important questions are raised concerning the implications of HPV⫹ squamous cell carcinoma. Caregivers will consider: In which patients should I suspect HPV⫹ disease? How do I diagnose HPV⫹ carcinoma? What tests should be ordered? Should the follow-up differ? Will all HPV⫹ patients have a better prognosis than those with HPVdisease? Caregivers must also be prepared to address patients questions on HPV⫹ disease: Did I cause this? When did I get this? Is this a sexually transmitted disease? Am I still infectious? Is my partner at risk? Should I get vaccinated? Should my spouse get vaccinated? Through a series of short presentations and brief case discussions, these questions will be specifically discussed by a panel of experts in the surgical and medical treatment of head and neck cancer. Ample time will be reserved to address questions directly from the audience. This miniseminar will serve as a forum for practitioners with both general and head and neck specific practices to obtain the latest information concerning the increasing number of patients with HPV⫹ head and neck cancer as well as give an opportunity to ask practical and important questions in the management of this emerging sub-group of head and neck cancer patients. EDUCATIONAL OBJECTIVES: 1) Understand the critical factors in evaluating and diagnosing patients with HPV⫹
squamous cell carcinoma. 2) Develop a framework for discussing issues specific to HPV⫹ SCCa with patients and their families. 3) Learn the impact of molecular markers and epidemiologic risk factors on prognosis in HPV⫹ disease.
New Medullary Thyroid Cancer Guidelines: What We Need to Know David Steward, MD (moderator); Richard Kloos, MD; Ralph Tufano, MD; Gary Clayman, DMD, MD, DDS; Brendan Stack, MD, FACE PROGRAM DESCRIPTION: Medullary thyroid carcinoma is a neuroendocrine malignancy whose diagnosis and treatment differs significantly from well differentiated thyroid carcinoma. Surgeons performing thyroidectomy must be familiar with the unique diagnostic, treatment, and follow-up paradigms for medullary thyroid cancer to optimize outcomes. The American Thyroid Association published comprehensive Medullary Thyroid Carcinoma Management Guidelines in 2009, with over 100 evidence based recommendations (http:// www.thyroid.org/professionals/index.html). This miniseminar will review those guidelines most relevant to the diagnosis, treatment and surveillance of patients with medullary thyroid cancer. Particular emphasis will be given to those guidelines with which the otolaryngologist head and neck surgeon should be familiar. Specifically this presentation will include: 1) The role and timing of Ret testing and prophylactic thyroidectomy for hereditary FMTC, MEN2a, and MEN2b; 2) Diagnosis, biochemical testing, preoperative imaging, and extent of initial surgical management for clinically evident disease; 3) Testing and extent of surgery for disease detected following hemithyroidectomy; and 4) Long-term follow-up and management of persistent as well as progressive disease. This miniseminar will include an internationally recognized endocrinologist specializing in thyroid malignancy who chaired the ATA Guidelines Taskforce on Medullary Thyroid Carcinoma. The panel will also include surgeons with expertise in management of these patients. Presentations will be didactic, followed by panel discussion of the more complex and controversial topics. EDUCATIONAL OBJECTIVES: 1) Describe indications for Ret proto-oncogene testing and timing of prophylactic thyroidectomy for hereditary MTC. 2) Describe initial work-up and extent of surgical treatment of medullary thyroid carcinoma. 3) Describe surveillance, surgical management of recurrence, and novel chemotherapy for progressive medullary thyroid carcinoma.
New Techniques to Image Head and Neck Cancer Eben Rosenthal, MD (moderator); Gregory Farwell, MD; Mark Wax, MD; Ken Hoyt, PhD PROGRAM DESCRIPTION: There have been rapid advances in imaging techniques over the past decade that have