Anam Hameed, Zain A Sobani, Ressam Nazir, Shehzad Ghaffar.
Recurrence Patterns of Head and Neck Cancer at a Tertiary Care Center in Karachi, Pakistan.
Pak J Otolaryngol Jan ;28(3):72-4.

BACKGROUND: Pakistan in the high risk zone for Head and Neck cancers (HNC) with an age standardized incidence rate of 37.1/100,000 in males and 21.7/100,000 in females. These cases are managed by a multi-disciplinary team and subjected to a thorough follow-up schedule. This follow up may not be feasible for most patients and may even be doing more harm than good as the financial burden may eventually force patients to discontinue follow up. Keeping this in mind, we concluded that specific follow up programs need to be designed to cater to the Pakistani population. In order to aid the development of further guidelines in this regard, we conducted a retrospective audit of Head and Neck Cancer (HNC) patients to determine the trends of recurrent disease in our population. SUBJECTS METHODS: A retrospective review of patient charts was carried out in November 2010 for patients, diagnosed with HNC at our institution between Jan 2006 and June 2008. Total 288 patients identified were included in the study. The data was recorded in a predesigned questionnaire. All case notes, records and investigations were reviewed for possible associations. RESULTS: Of the total of 288 cases, 210(72.91%) were primary oral cavity tumors followed by 55(19.09%) laryngeal, 12(4.16%) hypopharyngeal, 6(2.08%) oropharyngeal, and 5(1.73%) unknown primaries. Recurrence occurred in 111(38.54%) of the cases. The median time period for recurrence was 236 (range: 45 - 2803) days, in 73(65.8%) recurrence was identified by the patient. CONCLUSION: Keeping these factors in mind, in our opinion high frequency follow up must be reserved for the first year during which patient education should encompass self-examination and the signs of recurrence. After this period of high frequency follow up the clinical schedule can be relaxed.

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