Nachsorge bei Kopf-Hals-Karzinomen

Abstract

Some principle questions rise in follow up of tumour patients: Is there a chance to detect tumour recurrence or a second primary early enough to give the patient reasonable options of cure or at least lead to a better survival? What means will be necessary to achieve this goal? Do the means justify the outcome? This paper determines and compares current regimens and strategies in the follow up of head and neck cancer patients. It stresses not only the questions stated above, but also stresses additional points of view in the follow up like speech and swallow rehabilitation, as well as social reintegration and psychological support of head and neck tumour patients. Standard follow up includes facilities for speech and swallow rehabilitation. Summarizing the literature follow up mainly is based on the clinical examination and the work up of the recent medical history. Since most relapses occur within the first two years, recommendation of visit-intervals is every two months, range should be risk-adapted. Up to now there is no evidence for better overall survival using sumptuous means like repeated panendoskopies, laboratory parameters, CT's, MRIs or PETs for detecting disease relapse in the asymptomatic patient. In high risk cancer patients the intervals will be shortened compared to the average schedule recommended. Additional tests will be initiated on demand only. Since clinical evaluation of symptoms in head and neck cancer patients is difficult to assess there is an increased responsibility with respect to the indication for extended diagnostic work up. Therefore this should be reserved for well equipped and highly trained ENT Oncologists.