Mr Dilkes has recently retired as ENT lead clinician for the population of Northeast London who have head and neck tumours or cancer. He is concentrating on laser surgery for early cancer, and neck dissection, for his private patients. This clinician group has been established in order to give private patients the same overall quality of care as in the NHS, whilst also allowing a more comfortable, faster, more personal service to its patients.
Our results with laser ablation of early Head and Neck cancer show that 95% have laser treatment only, and achieve long term remission – cure. For laser treatment to be effective, patients must present early – so if any of the following symptoms occur – get a consultation, urgently: Hoarseness, swallowing problems, lump sensation, persistant ulcers, bleeding, unexplained ear pain, lump in neck, one sided nose bleeds, white/red patches.
In treating patients with early-stage head or neck cancer, Mr. Mike Dilkes provides the most current, optimal testing and treatments, based on medical research and consultations with leading experts in the USA and Germany.
Head, neck and throat cancers
A wide variety of cancer-like changes occur in the tissue of the head and neck area , both inside the mouth, throat and nose, and also in the glands around these areas, and the skin. These changes are often caused by excessive smoking and drinking alcohol, plus human papilloma virus (HPV).
The changes can broadly be defined into those conditions which are benign (non- cancerous) and malignant cancerous swellings. Some benign-type diseases can later turn into cancer. These diseases may manifest with many symptoms including voice change, throat pain, the feeling of a lump in the throat, catarrh, nose discharge or blockage, lumps in the neck, ear pain, white patches, bleeding, etc.
What to do if you are worried about head, neck and throat cancer
If you suspect, or are worried about, cancers in this area, it is better that you are checked by a specialist sooner rather than later, since early head and neck cancer is often quite simple to cure. It is one of the best cancers to have, if you have to have one. However, large cancers that are left to grow are much more difficult to cure.
Quality of care
Mr Dilkes is ENT lead clinician for the population of northeast London who have head and neck tumours or cancer. The approach taken is multidisciplinary; the weekly cancer group meetings are attended by over 40 people. The workload is busy, covering a population of over 2,000,000 people. Our group has been established in order to give private patients the same overall quality of care as in the NHS, whilst also allowing a more comfortable, faster, more personal service to its patients.
What we can offer in the treatment of cancer
In private practice, cancer treatments are less common, as there is usually a reasonably good service via the NHS. Some patients will want a second opinion, some will have been kept waiting too long by the NHS, some want guaranteed Consultant care at every step of the treatment. For these patients, the whole range of care is provided, from laser removal of cancer, to concomitant chemoradiotherapy with IMRT.
A typical patient pathway would be as follows: Patient with a neck lump finds us on Google. He/she telephones my secretary and is seen within 24hrs. A one-stop diagnosis is made of Head and Neck cancer, with ultrasound and cytology, imaging for staging is organised over the next 48 hours. The patient is then discussed at the Barts Head and Neck Cancer Multidisciplinary meeting and seen the same day to discuss the treatment plan. If surgery is involved, such as in tonsil cancer, a Holmium-YAG microscope controlled laser resection is performed under general anaesthetic, within 1 week, as a day case. This could be the end of the journey if the staging and treatment plan are suitable. So within 2 weeks, the whole cancer treatment pathway is complete, and the patient only attends for routine follow-up.
Successful treatment of throat cancer – one stop and MDT
The treatment of these diseases is often very successful, however, a Multidisciplinary Team (MDT) approach is required, as well as early access to imaging, endoscopy and the relevant curative treatment options. Same-day access to Ultrasound, Computerised Tomography (CT) and Magnetic Resonance Imaging (MRI) is part of the core standard of the Clinic. Expert cytology and histology is immediately on hand, so that needle aspirates of lumps, etc., can be diagnosed and reported within one hour. Thus, a patient with a neck lump or suspected cancer can be seen, imaged and diagnosed all in the same visit (“one stop”).
One day of the week, the Multidisciplinary group meets to discuss the treatment plan for new patients referred to the Clinic. The decision to treat in a certain manner will be ratified by all members of the group, and this will be formally documented in the patient’s notes. Those patients who are having problems or issues post-treatment will also be discussed in this forum.
Specialist cancer treatments offered
Apart from standard surgical and oncological techniques for head and neck disease, other variations are also offered, such as: Intensity modulated radiotherapy (IMRT – preserves taste and saliva), induction and/or concomitant chemotherapy, Steiner laser surgery, laser ablation of small tumours, Photodynamic Therapy, Image guided surgery, intra-operative nerve monitoring for thyroid and salivary gland disease, revision thyroid surgery. Major head and neck cancer surgery is carried out in conjunction with plastic and maxillofacial surgeons at The London Independant Hospital.
Standards in cancer care
Our audit standard is that 95% of new referrals are seen within 24 hours of the date of referral, except at weekends, when an emergency service will be available. Also, 95% of patients will have completed their imaging and diagnostic work up at the first visit. Within 7 days, full staging endocopy for those with suspected cancer will have been performed, and the patient will have been discussed at the MDT meeting with a treatment plan agreed. The start of definitive treatment will be within 14 days of this date, in 95% of cases. This standard of 1, 7 and 14 days compares well with the NHS standard of 14, 31 and 62 days.
The use of lasers in the treatment of head, neck and throat cancers
The treatment of persistent benign lesions may include surgical removal. Lasers have revolutionised the surgical approach to these types of tumour and allowed for minimal access day case endoscopic surgery — leading to complete and successful removal of a wide variety of benign lesions such as vocal nodules and cysts, pharyngeal cysts and laryngocoeles. True cancers of the mouth, throat and voice box are usually treated by a team of cancer specialists including an ENT surgeon and Radiotherapist. Early cancers of the mouth, throat and larynx are well treated by day case laser ablation. A recent audit showed that out of 60 patients treated, only 5% needed to have chemotherapy and radiotherapy. The rest have long term remission / cure with laser treatment.
Other surgical approaches to the treatment of head, neck and throat cancers
The classical surgical approach to these cancers usually requires opening of the neck and or throat to allow for the removal of the tumour. The wounds in the throat and neck require time to heal before normal functions of swallowing or speech return. Some patients require tracheostomy to establish an airway for breathing or removal of the (larynx ) voice box if cancer is affecting the larynx. Endoscopic laser surgery has provided an invaluable approach to these tumours, allowing us to avoid the need for cutting open the neck. These tumours can be removed from all areas of the throat, voice box or mouth.
The operating microscope and carbon dioxide laser allow for a magnified view of the tumour which can be precisely removed “en-bloc” or “block wise” following the Steiner approach, or biopsied and then vapourised, depending on the extent of the disease. Normal disease-free tissue can be left in place, thus improving the chance of full recovery of function. The need for tracheostomy is minimised as the breathing passages are cleared with minimum collateral damage to normal tissue and so reducing swelling of the throat and voice box / airway. This type of surgery can be repeated until all of the tumour is cleared. This can be used in combination with radiotherapy and chemotherapy (adjunctive treatment) or in cases that have failed after radiotherapy.
Our surgeons treat and have a special interest in the following head, neck and throat cancers
Thyroid gland lumps and cancers; Salivary gland lumps and cancers; Neck glands/nodes – cancer spread; Thyroglossal cysts; Branchial cysts; Mouth cancer; Throat cancer; Nose/sinus cancer; Voice box/laryngeal cancer; Swallowing tube cancer; Skin cancer.