Order+of+team+member+involvement

= Multi-disciplinary Team Involvement = = = = The individuals in each of the teams are often consulted/ involved in the following order (Fleissig et. Al, 2006; Rapidis et. Al, 1980; Ord and Blanchaert, 2001): =
 * The patient will predominantly see a general physician or dentist, who will pick up on some activity of oral cancer. They will then refer the patient on to:




 * The ENT (Ear, nose and throat specialist) at the outpatient department of their local hospital where the patient with a lesion in the mouth will next seek advice. A radiologist will take an X-ray of the oral cavity to detect any abnormal growths, and the ENT will remove a part of the lesion and send this to:


 * The pathologist who will examine the extracted cells under a microscope and see if there are malignant (cancerous) cells present. When a biopsy HAS been confirmed:

The patient with oral cancer will then ideally be asked to attend a meeting where the major/ tumor treatment team will gather to discuss the option available to the patient, and what the best next step would be to eradicate the tumor. This is often called the “Tumor Board” or “Head and Neck Oncology Team”.
 * Here, the surgeon will state the advantages and disadvantages of surgery.


 * The radiotherapist will discuss radiotherapy and the likelihood of its use with surgery.


 * The medical oncologist will state how antimitotic drugs might help in shrinking the tumor.


 * The pathologist will re-enter to give a detailed account of the likely behaviour of the tumor and its histological character.

At this stage a nutritionist, dentist, general hygienist and prosthodontist may also be involved. If the patient decides to go ahead with surgery and post therapy these are the next team members involved in the treatment:




 * Surgery: The ENT surgeon resects the primary tumour with adequate margins. In Europe, this job may also be done by the maxillofacial surgeon (who stem from a dentistry background) who hold responsibility for dealing with diseases of the mouth. The plastic surgeon will then work on any areas of reconstruction after the removal of the tumor.




 * After the removal of the tumour, radiotherapy is a common option for patients as many studies have suggested that a combination of surgery and radiotherapy reduces the risks. Radiotherapy is often used in an adjuvant manner post-operatively, and this is where the radiotherapist is involved in administering the process.



It must also be noted that during these procedures it is particularly important that the minor/ supportive team be involved. This consists of the patients medical practitioner, dentist and family to help provide information, which may contribute to the patients’ general condition. Post surgery is also where the nursing staff are a crucial part in the patients recovery in preparation for radiotherapy. Rapidis et. Al (1980) reported that local tissue reactions could follow surgery and radiation which could cause a delay in the healing process. Brown and Langdon (1995) suggests that radiotherapy postoperative can cause other difficulties such as functional impairments and long-term problems such as osteoradionecrosis.

This is where nurses and play a huge role in carrying out treatment, which may promote the healing process; including simple procedures such as changing dressings. Nutritionists are also heavily involved at this stage to provide the patient with enough nutrients as this can often be difficult where oral cancer is concerned.

During the process it is also important that we don’t forget the patients immediate support network such as family and friends. Rapidis et. Al (1980) and Edwards (1998), discussed the importance of psychological and social support a person receives when they are going through the treatment process.

Edwards (1998) also found that counseling (social workers) and support groups were an essential part of treatment for the patient as expressed by medical professionals who felt they could not take on this responsibility and patients themselves.