Discuss the role of the Multidisciplinary Team (MDT) in the management and successful rehabilitation of patients presenting with head and neck cancer.

Introduction

In the Western World cancer is the second highest cause of death after coronary heart disease. Head and neck cancer is a relatively rare type of cancer compared to other types, the most common being lung, prostate and breast. Oral cancer makes up only 3-5% of all cancers, but still affects a significant number of people every year. In the UK there are about 13,000 new cases of cancer in the head and neck region per year. Approximately 35% of patients die within 2 years of being diagnosed with the disease (2004). Patients with head and neck cancer require care from a variety of specialists due to the fact that the disease negatively affects crucial functions such as: respiratory, mastication and speech.

Head and Neck Cancer Multidisciplinary Team – definition

As mentioned before people with head and neck cancer require specialist care from multiple members of the healthcare team, including, doctors, nurses and other health professionals. This group of specialists take an active part in diagnosis, treatment and management of people with head and neck cancer. Close co-operation exists between all members of MDT. They usually meet once a week to discuss newly referred patients with suspected or confirmed diagnosis of cancer in the head and neck region. The aim is to agree on the best plan of treatment for each individual patient, considering their specific needs. The MDT approach should result in quality care for patients and the best possible outcome from treatment.. Current NHS guidelines are that head and neck patients should be under the care of MDT in all UK hospitals treating oncology patients.

Head and Neck Cancer Multidisciplinary Team – members of the team

The number of specialists composing the MDT can vary among hospitals. Larger centres tend to have teams consisting of more professionals from various disciplines than smaller hospitals. The Head and Neck MDT usually consists of:
1) specialist head and neck surgeons (ENT surgeons, consultant maxillofacial surgeons, consultant head and neck surgeons, consultant reconstructive surgeons, neurosurgeons)
2) consultant oncologist (radiotherapy and chemotherapy)
3) restorative dentist (prosthodontist)
4) head and neck cancer clinical nurse specialist
5) dietician
6) speech and language therapist
7) consultant radiologist
8) consultant pathologist
9) occupational therapist
10) clinical psychologist
11) physiotherapist
12) radiographers
13) social workers
14) reconstructive scientists (maxillofacial prosthetists)
15) other

Head and Neck Cancer – disease characteristics

Depending on the location, cancer in the head and neck region can be divided into the following main groups:
1) oral cavity cancer
2) cancer of oropharynx
3) cancer of nasopharynx
4) salivary gland cancer
5) paranasal sinus cancer

The most common type of head and neck malignancy is squamous cell carcinoma (SCC) which arises in the epithelium (ectodermal or endodermal tissue). There are also other, less common types of head and neck cancers. They relate to tissues, each of which originates from: melanomas (skin), sarcomas (messodermal tissue), lymphomas (lymphatic system).

Management by MDT – diagnosis

Patients that are suspected of having a cancer in any location within the head and neck region are usually referred by the primary health care practitioner to see the specialist. In most cases patient referral is urgent, which means that the patient has to be seen by a specialist within a specified period of time – currently 2 weeks. To come up with a diagnosis and evaluate the extent of the disease, numerous tests and screenings are usually required. To begin with the specialist obtains the medical history, undertakes a clinical examination, which may include examination with endoscope, depending on the location of the tumour. He or she