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Incidence: Nasopharyngeal cancer (NPC) is a rare disease in Caucasians and is commonly WHO Type 1 (squamous cell carcinoma) histology. NPC is endemic in southern China (the Guangdong Province), Hong Kong and Taiwan, and is usually WHO Type 3 (undifferentiated) histology. These differing patient cohorts and different staging systems have hampered the rate of progress in optimizing the management of NPC patients.

Changing demographics: Melbourne's population demographics have changed significantly since 1985. Our NPC population currently bridges the endemic and non-endemic populations.

Treatment: There have been major improvements in radiation therapy techniques. The optimal conformal radiation technique(s) to be used if IMRT is not available is discussed. Concurrent chemotherapy and radiation therapy (chemoradiation) is the current standard of treatment in NPC. The role of additional sequential chemotherapy is controversial. A randomized trial comparing induction chemotherapy and chemoradiation versus chemoradiation alone would be very informative.

Nasopharyngeal Cancer is a radiosensitive disease. About 60% of all patients are cured with radiotherapy alone, and this figure is likely to increase with the use of chemotherapy. The use of Intensity Modulated Radiotherapy (IMRT) will improve local control and reduce the morbidity of irradiation. Salvage surgery is used for local and regional relapses, but the use of radiosurgery may result in comparable outcomes. In the metastatic setting, the use of new molecules involved in signaling pathways and the use of immunotherapy strategies are being investigated.

Prognosis of patients with hepatocellular carcinoma (HCC) depends on both residual liver function and tumor extension. An accurate staging system for cancer patients with HCC provides guidance in terms of both patient assessment and therapeutic decisions. Staging is also essential for comparison of groups in clinical trials and for comparison between different studies. Because numerous studies have reported divergent outcomes and predictors of survival after resection in patients with HCC, a number of different classification schemes for HCC have been proposed. Several of these staging systems rely heavily on clinical parameters and integrated scoring schemes (Okuda, Barcelona Clinic Liver Cancer Staging, Cancer of the Liver Italian Program). Others, such as the Liver Cancer Study Group of Japan and the Japanese Integrated Staging Score incorporate pathologic data after resection, yet still rely on the computation of a score to determine prognosis. Recently, a new staging system validated in Japan, the United States, and Europe has been adopted by the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC). This HCC staging system is based on a multivariate analysis and has been independently validated. Because the new AJCC/UICC staging system is easily obtained, is objective, and has been independently validated, we strongly propose it as the prognostic staging system of choice for HCC after resection of HCC.

The practice of thoracic surgery is a model of using a multidisciplinary approach to the care of patients, particularly in the area of cancer. These diseases include primary malignancies of the lung, esophagus, pleura, chest wall, airway and mediastinum; less commonly, metastatic deposits to the lung, pleura, chest wall and mediastinum require the thoracic surgeon's attention for diagnosis, for potential curative resection, or for palliative intervention. The optimal and efficient approach to diagnosing, staging, and managing patients with thoracic malignancies is constantly evolving, with the choices available to the patient becoming ever more complex. Yet, the care is moving toward personalization, based on certain factors such as demographics, staging characteristics, and biologic markers. Thus, the traditional roles of the individual disciplines managing these patients are constantly being challenged and are becomes less frequent. As a result of advanced imaging technologies and patient demand for ‘minimally invasive’ procedures, several disciplines are now providing overlapping services. The input from a wide range of these specialists demonstrates the importance of a multidisciplinary approach to optimize treatments and to streamline care. Weekly conferences are held to discuss these complex patients, and a list of those whose services are often required is listed in Table 1. This chapter will focus on the common diagnostic, staging, and therapeutic modalities that are available to the clinician taking care of the patients with non-small cell lung cancer (NSCLC). In particular the aspects of management that fall ‘in-between’ disciplines will be the focus of this discussion.

Over 95% of all oesophageal cancers are either adeno- or squamous cell carcinomas. With increasing growth they cause dysphagia, weight loss and bleeding. Diagnosis is made with endoscopy and biopsy, and staging is completed by endoscopic ultrasound, abdomino-thoracic CT scan and PET. The UICC TNM classification is used to stage oesophageal tumours, and in gastro-oesophageal junction tumours the anatomical classification described by Siewert is commonly used when planning surgical resection.

Patients with locally resectable tumours and no distant metastases are classified as curative candidates. For these patients the gold standard for treatment is surgery with or without neoadjuvant radio-chemotherapy. Tumours stage T2 or higher and/or N1 are usually considered for neoadjuvant treatment. Additional to the oncological staging, a risk analysis for each individual patient should be performed as oesophagectomy is associated with significant risks of morbidity and mortality. Co-morbidity, age and the number of surgical procedures performed by the treating institution are important predictors of outcome. Surgery is performed either with open, or minimal invasive techniques. The stomach is most commonly used conduit to replace the oesophagus, with a segment of large bowel an alternative in some individuals. Post-operative morbidity includes anastomotic leak, empyaema, chylothorax, and most importantly respiratory complications. After multimodal treatment, survival is between 20% and 40% at five years.

In patients with locally advanced tumours, metastases, or who are unfit for surgery, definitive radio-chemotherapy is the treatment of choice. Standard treatment regimens include radiotherapy (50 to 60 Gy) and chemotherapy with 5-FU and Cisplatin. If stenosis or obstruction is present, adjuvant interventions such as stent placement, dilatation and argon plasma ablation may be used.

Through the use of an ethnographic narrative analysis, the cultural nature of the proliferation of racism is examined in order to introduce a change management model for an individual utilizing the Seven Principles of True Storytelling. Racism often sets its roots very early in the life of a child through the creation of implicit biases supported through parents, siblings, and the usual mechanisms utilized in the transfer of culture. Examination of this process through the lens of True Storytelling permits an objective view, acknowledging and respecting the stories already there while making room for futuring that creates space for re-storying that is then manifested in the new future. The new (non-racist) story finds support in its journey through a Kierkegaardian view of a “true” self, the use of plot, timing, and effective staging, to include the use of artifacts, ultimately being actualized and sustained with an ongoing process of embodied reflection.