General ENT and H&N cancer

[ski89]

Advertisement - Members don't see this ad

For your average general ENT in private practice, how many H&N cancer patients would you expect to see?

Obviously I'm sure this varies so how about a range.


Sent from my iPhone using SDN mobile

 

[VisionaryTics]

For your average general ENT in private practice, how many H&N cancer patients would you expect to see?

Obviously I'm sure this varies so how about a range.

Sent from my iPhone using SDN mobile

Expect to see daily? Monthly? Operate on?

The average general ENT in private practice doesn't want a ton of H&N patients. You don't want the guy with the trach and a fungating neck mass sitting in the waiting room next to little Timmy with tonsillitis. Hospital stays are long and fraught with complications. You have to round on them daily and wound care issues are common. And there is data showing that patients who get treated at busy head and neck centers have better outcomes.

That being said, there are some general ENTs who do some head and neck. The busiest general guy wrt H&N in our area probably averages ~2 benign parotids a month, a thyroid or two per week. Very occasionally he'll do a neck dissection, minor glossectomy. Once every other year he'll think it's a good idea to try doing a laryngectomy again.

But general ENTs will see these patients on call, will diagnose them with FNAs or DLs, and maybe do the oncologic surveillance for post-treatment patients who don't want to drive to the state university every month.

 

[Pir8DeacDoc]

It partly depends what you call head and neck. I have a "gentleman's" head and neck practice (i.e. tumors that are non squamous cell). I do a decent amount of thyroid. I do partoids. I am often the person diagnosing a problem (with DL and Biopsy and/or FNA). In my smaller area I generally do cancer surveillance- though for some reason my radiation oncologist thinks she can scope people with good success.

With the trend in head and neck cancer being upfront radiation and chemo I have no interest in salvage neck dissection or laryngectomy. I would be happy to do upfront surgery but that's generally limited to small glottic tumors and smaller oral cavity lesions (which are fairly rare).


Anyway you can do some head and neck and keep that part of your practice if you want. But, as mentioned above, the trends are to bigger centers and patients really benefit from the expertise and resources there.

 

[OtoHNS]

The above posts pretty much nail it.

H+N squamous cell CA is actually not that common of a disease outside of tertiary care centers. When I was a resident, our department probably saw 5-10 new H+N SCCA patients a week. In private practice, I probably don't see 5 in a year.

If you're not doing big H+N operations on a regular basis, you're doing the patient a disservice to try and relive your chief resident glory days and do their laryngectomy, etc. Particularly if the hospital you operate in is not used to anyone doing these surgeries and the nursing staff is not used to dealing with postop H+N patients on the floor.

 

[ski89]

Thanks for the helpful responses!


Sent from my iPhone using SDN mobile