Monthly Archives: July 2003

World’s first tongue transplant for cancer victim

  • 7/23/2003
  • Vienna, Switzerland
  • Tara Womersly

Doctors have carried out what is believed to be the first tongue transplant on a human being. The operation was carried out in Vienna on a 42-year old man with a malignant tumor.

Surgeons spent 14 hours on the operation – one team worked for four hours removing the tongue from the donor while a second team reconnected the tongue’s muscle tissue, nerve endings, arteries and veins into the recipient’s mouth. The team was led by Dr Rolf Ewers, of the cranio-maxillofacial surgery department at the General Hospital in Vienna. He said: “Because of the carcinoma, we needed to remove the tongue.

“We had been planning to do this transplant for some time but we needed both a patient and a donor. The patient was young, 42 years of age, and removing a tongue at that age is very cruel. But the cancer was at a very late stage, he was a heavy smoker.

“You only deal with about two or three cases a year where the whole tongue needs to be removed.” Dr. Ewers said that surgeons would normally remove the tongue and replace it with tissue from the small bowel, or duodenum. He said: “This meant that there was no muscle, just soft tissue coverage. But with the transplant, we hope that the tongue will be able to move and the patient will be able to speak and taste. If the operation is a success we will be planning it again.

“While we do not often get patients who need a whole tongue removed, we have between ten and 15 patients a year with oral cancer who need half their tongue removed, and we will certainly be planning to do the transplant for this. “The operation lasted 14 hours but that is not long in cranio-maxillofacial surgery, where we can be operating for up to 22 hours.”

The patient is said to be in a good condition but it is too early to say whether the operation has been a success.

July, 2003|Archive|

JAY AMBROSE: Smoking out the truth

  • 7/22/2003
  • Scripps Howard News Service

This is an editorial opinion, not a news article

The best is enemy of the good, the ancient Greeks told us, and the meaning of the saying is hardly a puzzle: By insisting on something ideal but extraordinarily difficult to achieve, you may exclude a significant improvement that’s much more likely of accomplishment, if also short of ideal. And that thought brings us to the U.S. Smokeless Tobacco Co., which is asking the Federal Trade Commission if it would be OK to put out an ad recommending a change from cigarettes to something called Revel, described by the Associated Press as “a tobacco-filled packet, like a tea bag, which consumers suck on.”

The pitch of this ad would be that Revel includes no objectionable secondhand smoke. A year ago, the company had a bigger idea, since abandoned. It wanted to promote snuff and chewing tobacco as less a health risk than smoking cigarettes.

Anti-smoking groups aren’t having any of either proposal. Smokeless tobacco can kill, too, they say, and smokers need to quit, not switch. There’s no question that smokeless tobacco can be addictive. It’s a vile, dirty habit. It’s a contributing factor to oral cancer and other diseases. Its use, as the anti-smoking groups are quoted as saying, can be fatal. Nevertheless, it is not as dangerous as smoking, and a scientist whose research is financed by the tobacco company is right: Some people who cannot force themselves to break loose of tobacco’s hold on them might well save their lives by switching.

At the very least, smokers are entitled to know what’s what, even if the anti-smoking groups do not trust their adult judgment. Unless the government believes the ads are false, it should allow them.

Yes, smokers should quit tobacco entirely if they value their health and prospects of longevity more than the sensation of poisonous chemicals in their bodies, and yes, it would be a health-endangering mistake for nonsmokers to take up smokeless tobacco or for smokers to both smoke and suck tea-bag tobacco products, too.

But treating the public like nincompoop children is not the proper role of government, and holding out for the best is getting in the way of the good.

OCF Note: Here we go again, another news story about smokeless tobacco being the “safe alternative”. While this writer has made a valid point, many questions remain. OCF believes that a switch to conventional spit tobaccos is merely trading one poison for another. The argument that there would be fewer lung cancers as a result of this type of switch is attractive, but no clinical trials have actually proven that to be the case, logical as it may seem. Only in the last 5 years have we seen new studies which reveal tobacco carcinogens showing up as cofactors and promoters of other diseases in remote parts of the body that one would never have suspected, included the female reproductive organs, and in breast cancers. The total extent and routes of distribution of these many tobacco carcinogens are not fully understood, and the benefits that the few small studies, sponsored by big tobacco money, might produce, may not be as exceptional when actual negative end results in other diseases are added to the equation. Further, we know the downsides of conventional spit tobacco and its relationship to oral cancers. We also know that besides oral cancers, less deadly conditions are created by chewing tobaccos such as chronic and severe periodontal infections. We now know that chronic infections such as those of the periodontal tissues and other areas are contributors to heart disease, strokes, and even diabetes. These other factors would likely be increased if the use of conventional chew were increased, potentially reducing the benefits touted by the proponents of this substitution.

The issue of advertising a product in the marketplace and what the criteria are for allowing that, is an important point brought up in this article. The government’s position on advertising is not new, and certainly not isolated to tobacco products. Claims made by a product manufacturer must be substantiated, no matter what the product. Smokeless-tobacco makers face a difficult balance in marketing the products, for if they tout them as being safer, they face scrutiny from the Federal Trade Commission and state attorneys general and would have to prove their claims based on clinical trials they now are not required to conduct. Some anti-smoking program directors also fear that although there may be less carcinogenic risk in the new smokeless products, (referring to the newer “Snus” type of chew and not conventional chewing tobacco) no one can be sure they won’t pose other potential dangers because they have not been independently tested. “It’s likely they are less hazardous, though we don’t know much about them because nobody has done any independent analyses,” said Dr. Richard Hurt, professor of medicine and director of Mayo’s nicotine dependency program. “What if they’re found to have strychnine in them? They can put anything they want in them because they’re not regulated by the FDA.” So substantiation of their safety would be a precursor to making claims, which would be a precursor to advertising. It is unlikely that the big tobacco firms will go there as it opens a Pandora’s box related to the bulk of their products not currently regulated by any oversight.

While we will not conclusively state that the findings from tobacco sponsored studies are suspect, nothing that the tobacco industry has told the American public in the past, and their consistent and overt attempts to discourage the revelation of data that would be harmful to their sales, makes them suspect sources of information. OCF would like to see these products required to go through FDA testing and recommendations…. if they stand up to the claims, they should be allowed to market and advertise them. But please be aware that we are referring to the new teabag, Snus types of tobacco, and not conventional chew as we know it in the US market today. While the direct benefits to the oral cancer community do not exist, we would welcome a reduction in deaths around the world related to the smoking of tobacco. Of course as we have stated many times, our first choice would be to have the FDA allow over-the-counter tobacco cessation products to have an increased nicotine content so that their effectiveness would be enhanced, and we would also like to see greater use of the currently available prescription nicotine inhalers which pose no health threat, both to assist smokers to leave the world of tobacco altogether. *(Once again OCF editor Brian Hill proves that the phrase “economy of words” and his name are seldom used in the same sentence……)

OCF Note #2 posted 11/16/04 Anyone who was starting to think that snus type spit tobaccos were a safe alternative to smoking, should rethink their arguments. This recent study published in Sweden regarding the long term experience in users of these products shows a 67% increase in cancers in people who use them….. This link will take you to the swedish article directly and you may find the article posted in OCF’s news section dated November 16, 2004. Study in Sweden

July, 2003|Archive|

Esophageal cancer treatment keeps pace with technology

  • 7/21/2003
  • Baltimore MD
  • Shalmali Pal
  • The International Journal of Radiation Oncology, Biology, and Physics

The standard of care for the treatment of esophageal cancer advanced
significantly at the close of the 20th century, including the increased use
of esophageal ultrasound and a combination of chemoradiation and surgery.

“These changes reflect a continual progression of technology into routine
clinical practice, as well as a wider acceptance of the results of large
randomized trials supporting the role of combined-modality therapy in the
management of this disease process,” wrote lead author Dr. Mohan
Suntharalingam from the University of Maryland School of Medicine in
Baltimore in the International Journal of Radiation Oncology, Biology, and
Physics (July 2003, Vol. 56:4, pp. 981-987).

The paper compared the latest trends in treatment and care to earlier data
from the nationwide Patterns of Care Study (PCS). The latter was started in
1971 in an effort to improve the quality and accessibility of radiation
oncology in the U.S. The present retrospective study was designed to
evaluate patients who received radiotherapy for esophageal cancer from 1996
to 1999 and compare these numbers to PCS data obtained between 1992 and
1994.

Suntharalingam’s co-authors are from the American College of Radiology and
the University of Pennsylvania, both in Philadelphia; the Community Medical
Center in Toms River, NJ; Boston University School of Medicine and
Massachusetts General Hospital in Boston; the Cancer Center at St. Agnes in
Fresno, CA; and Memorial Sloan-Kettering Cancer Center in New York City.

For this study, site visits took place at 20 large academic centers, 19
large nonacademic centers, and 20 small academic facilities. Data for a
total of 414 patients were deemed eligible. The majority of the patients
(77%) were male and Caucasian (75%). Half were identified as having
adenocarcinoma. Only 16% were stage I, according to the American Joint
Committee on Cancer (AJCC) guidelines.

In 96% of the cases, endoscopy was used for pre-treatment evaluation. CT
scans of the chest were obtained in 87% of cases; abdominal CT in 75%.

“The use of esophageal ultrasound (EUS) increases significantly during the
period studied as compared to the initial PCS survey (18% versus 2%),” the
authors wrote. “Patients treated at a large center were more likely to
undergo EUS than those treated at a small center (23% versus 12%).”

More than half of the patients (56%) received concurrent chemoradiation as
their definitive treatment plan. In 27% of the cases, surgical resection was
planned after neoadjuvant chemoradiation. Once again, the authors found an
increase in preoperative chemoradiation followed by surgery in their data
(27%) when compared with the previous PCS survey (10%), most often in
patients with adenocarcimona.

All patients received external-beam radiation therapy with a medial total
dose of 50.4 Gy delivered. The majority of patients (93%) completed the full
course of radiotherapy (50 days or more). Ninety-seven percent of the
patients received concurrent chemotherapy, including 5-fluorouracil (82%),
cisplatin (67%), and paclitaxel (22%).

The authors pointed out that there has been a significant increase in the
use of paclitaxel (22% in this study versus 0.2% in the PCS study), despite
the lack of phase III data. They attributed paclitaxel’s popularity to the
“desire to improve local control and overall survival associated” with
more-established chemotherapy drugs.

Finally, they found that patients treated at large facilities were more
likely to undergo 3-D CT treatment planning than patients at smaller
institutions.

“(These) results will be shared with investigators from the American College
of Surgeons, along with researchers from various other countries…in an
attempt to identify possible opportunities to improve the outcomes for this
patient population,” they concluded.

July, 2003|Archive|

Combidex shows promise

  • 7/13/2003
  • Cambridge, MA
  • Advanced Magnetics

Combidex, an investigational MRI iron oxide nanoparticle contrast agent
manufactured by Advanced Magnetics of Cambridge, MA, has shown encouraging results in the non-invasive diagnosis of metastatic lymph nodes. In two presentations at the International Society for Magnetic Resonance in Medicine, the product was determined to be a useful tool in characterizing cancerous lymph nodes.

The first presentation, by Dr. Mukesh Harisinghani, an assistant radiologist at Massachusetts General Hospital in Boston, offered data on the use of the contrast agent for characterizing lymph nodes in patients with breast cancer. Harisinghani found that the product had advantages in assisting physicians in staging cancers.

The second presentation, by Dr. Ralph Weissleder, director of the Center for Molecular Imaging Research at Massachusetts General Hospital, concluded that Combidex is a useful MRI contrast agent for characterizing lymph nodes in patients with prostate cancer, and that Combidex-enhanced images alone may suffice for lymph node characterization.

The contrast agent is the lead product in the firm’s development pipeline, and has received an approval letter, subject to certain conditions, from the U.S. Food and Drug Administration for use in the diagnosis of metastatic lymph nodes. Advanced Magnetics is continuing to work with the FDA to resolve the outstanding issues from the approvable letter in an effort tobring Combidex to the market, according to the company.

July, 2003|Archive|

An Uncaring Message

  • 7/12/2003
  • Sarasota, Florida
  • Brad Rodu, D.D.S.
  • The Sarasota Herald Tribune

OCF Note: This article only appears here because of the absurdity of its author’s perspective. This is an editorial comment By Brad Rodu DDS, which appears in this paper. It is not a news article. See OCF editorial note at end.

Dr. Richard Carmona, the U.S. surgeon general and the Bush administration’s primary adviser on the nation’s public health, demonstrated that he is sadly ill informed about the nation’s No.1 health problem, cigarette smoking, during testimony at a recent House Energy and Commerce subcommittee hearing.

Carmona’s first blunder was his contention that “There is no significant scientific evidence that suggests smokeless tobacco is a safer alternative to cigarettes.” Carmona rejected decades of published research and the prestigious British Royal College of Physicians, who reported last year that smokeless tobacco products are “on the order of 10 to 1,000 times less hazardous than smoking.” Surely Dr. Carmona knows that cigarette smoking is a major risk factor for lung and other cancers, heart diseases and emphysema, resulting in 440,000 deaths annually in the United States. But he doesn’t seem to appreciate that smokeless tobacco use carries no risk for lung cancer, heart disease, or emphysema. The only consequential risk for long-term smokeless use is mouth cancer. Fifty years of research prove that even this risk is very low (less than half that associated with smoking). In fact, smokeless tobacco use is about as safe as automobile use. That’s 98 percent safer than smoking.

Saying that smokeless tobacco is as dangerous as cigarettes is more than a blunder. It is an uncaring message to smokers from America’s number one doctor: Quit or die. With stable smoking rates, this is an approach cigarette manufacturers can live with. For more than half of inveterate smokers (those who simply cannot quit), it’s a prescription they will die with.

Carmona’s second blunder was his support for banning tobacco products. Asked if he “would support banning or abolishing all tobacco products,” Carmona responded, “I would at this point, yes.” This marked the first time a surgeon general has called for outright prohibition, and he sent would-be supporters running from the Hill. Even the Campaign for Tobacco-Free Kids, which has shown little interest in helping inveterate adult smokers, couldn’t support Carmona. Its spokesman commented that “We would all like to see a tobacco-free world … (But) we can’t just take away their tobacco.”

Carmona’s boss can’t be happy; Bush administration officials responded quickly with disclaimers. “That is not the policy of the administration,” commented Bush spokesman Scott McClellan, saying that Carmona’s comments represented his views as a doctor. But Carmona’s views as a doctor are just the point. He occupies one of the most trusted positions in American medicine and in American government.

The Bush administration should do more than distance itself from these dangerous and irresponsible positions. It should direct Carmona to read the dozens of scientific papers on tobacco harm reduction. It should direct him to review the evidence from Sweden that smokers can quit by substituting smokeless tobacco.

Finally, it should require that he tell American smokers the truth about all available options for quitting. After all, the 10 million smokers who will die over the next two decades are, in a very tangible way, his responsibility and his legacy.

Brad Rodu, D.D.S., is a professor in the department of pathology at the University of Alabama at Birmingham School of Medicine.

OCF editorial note: I wonder how many people, who read Brad Rodu’s editorial regarding the relative safety of smokeless tobacco vs. inhaled tobacco and subsequently die of an oral cancer, or live the rest of their lives physically or emotionally disfigured by surgeries and treatments for it, he would like to take responsibility for? After all, he’s asking the surgeon general to take responsibility for those affected by his comments and positions. Picking and choosing your statistics to make a point can be done by anyone. Certainly an argument can be made that by eliminating the deaths (as a result of lung cancer) from inhaled tobacco would reduce tobacco related deaths, since spit tobacco is not associated with these diseases. But you can reduce a portion of those saved lives by the addition of new deaths of individuals who will lose their lives to oral cancer, or another tobacco related illness instead. I wonder what Rodu’s motivation to go on the attack against Carmona and in support of tobacco is? As a doctor, would he not like to see a tobacco free world? It kills millions every year around the world. The costs of treating tobacco related disease are staggering. The human toll in suffering these diseases would be reason enough to rid ourselves of tobacco. Apparently Rodu would not, since he calls Carmona’s desire for a tobacco free world his second blunder. And the Bush administration’s disclaimers? What do you expect from an administration that uniformly favors big business over the public good? Why not suggest an alternative non-tobacco nicotine replacement instead of another form of tobacco with its associated deaths? For a dentist to take this position, which would likely make oral cancer, periodontal disease, etc. more prevalent, is an embarrassment at best. This dentist’s priorities are grossly misplaced. Suggesting chewing tobacco as a nicotine supplement because it is not linked to heart disease or lung cancer is a joke. It is linked to different diseases, some as remote as pancreatic cancer, let alone the obvious one of oral cancer. It is particularly telling that he does not mention in this article (or others of his) alternative nicotine replacement possibilities, such as nicotine inhalers or nose drops to aid in cessation. These would certainly help those that he dramatically states would have “to quit or die.” Of course as a doctor he knows about these things, but seems to have forgotten to mention that there are alternatives to spit tobacco as a nicotine replacement. There is even a tobacco free chew made from black tea and nicotine… essentailly a replacement therapy without the carcinogens ( Blue Whale)… did he suggest this? No. If he wasn’t personally vested in the tobacco side of things, he might mention that it is not “quit or die”, it is replace the nicotine with a safer alternative like nicotine inhalers, with the long term goal of quitting the addiction altogether. Yes, doctor, let’s just increase the rates of oral cancer in the US instead. Absurd is the only word that comes to mind. Although perhaps not so absurd… if your funding is coming from the tobacco companies themselves.

In 2006 OCF was contacted by Rodu and his associates complaining that calling his perspectives and comments absurd was uncalled for, and I should “take care” when critical of others scientific work. Let’s be clear here. Rodu wrote an editorial here, not a peer reviewed scientific study. In it he calls the surgeon general’s comments a blunder. He puts words in the surgeon general’s mouth like “Quit or Die”, a sensationalized phrase that Carmona never made to attempt to make Carmona look uncaring, or worse. He is promoting something that in this very piece he states, “The only consequential risk for long-term smokeless use is mouth cancer. Fifty years of research prove that even this risk is very low (less than half that associated with smoking).” I don’t know about others, but 50% of the risk of smoking is pretty damn high, and he would have us increase the number of Americans with oral cancers by getting people to switch to spit tobacco. That statement is absurd. He is certainly entitled to his perspective and words. Likewise, I choose to call his perspective absurd in my editorial of his Op/Ed piece. Is he the only one allowed to make a characterization of their personal viewpoint in writing?

July, 2003|Archive|

Light up Oral Cancer

  • 7/11/2003
  • Baltimore, MD

The American Cancer Society says there will be about 30,000 new cases of oral cancer diagnosed this year. Nearly one-third will be cancers of the throat. Surgery is standard treatment. Now, a special light can kill the cancer.

Two years ago, Allison Jaccard was diagnosed with cancer of the larynx. Although this type of cancer is usually thought to be in people who have smoked for years, Jaccard was never a smoker or a drinker. She had surgery, but it didn’t get all the cancer. Then Jaccard was offered an alternative treatment at the University of Maryland using laser light therapy.
“It is extremely exciting, I will tell you, for several reasons, not the least of which it’s working,” says Paul Castellanos, M.D., a head and neck surgeon at University of Maryland.

Dr. Castellanos uses a light-sensitive drug activated by a laser to destroy cancer cells. Through this device, the laser is directed to the cancer cells, killing them while healthy cells survive. The laser activates the drug to produce a toxic form of oxygen that kills the cancer. He says, “It’s allowing us to take care of cancers of the throat and oral cavity without having to do ablations of those tissues that can have a devastating effect on the patient’s voice.”
In a University of Maryland study of people with early stage cancers of the mouth, throat and larynx, after one treatment, nearly 90 percent showed no evidence of the disease. It worked for Jaccard. She’s been cancer-free since getting the treatment. “The thing that it’s done for me is to make you realize just how precious everything you have is,” she says. “So, it just gives you a perspective of what’s important.” Dr. Castellanos says the main side effect of the treatment is an extreme sensitivity to sunlight. Patients are required to stay completely out of the sun for up to six weeks. The light sensitive drug reacts to red light from the sun, so sunblock will not work.

OCF NOTE: PDT has been around for about 8 years, it is just now going through clinical trials for oral cancers at some institutions, and that is likely the reason that Baltimore put out this news article. Photodynamic therapy (also called PDT, photoradiation therapy, phototherapy, or photochemotherapy) is a treatment for some types of cancer. It is based on the discovery that certain chemicals known as photosensitizing agents can kill one-celled organisms when the organisms are exposed to a particular type of light. PDT destroys cancer cells through the use of a fixed-frequency laser light in combination with a photosensitizing agent.

In PDT, the photosensitizing agent is injected into the bloodstream and absorbed by cells all over the body. The agent remains in cancer cells for a longer time than it does in normal cells. When the treated cancer cells are exposed to laser light, the photosensitizing agent absorbs the light and produces an active form of oxygen that destroys the treated cancer cells. Light exposure must be timed carefully so that it occurs when most of the photosensitizing agent has left healthy cells but is still present in the cancer cells.

The laser light used in PDT can be directed through a fiber-optic (a very thin glass strand). The fiber-optic is placed close to the cancer to deliver the proper amount of light. The fiber-optic can be directed through a bronchoscope into the lungs for the treatment of lung cancer or through an endoscope into the esophagus for the treatment of esophageal cancer.

An advantage of PDT is that it causes minimal damage to healthy tissue. However, because the laser light currently in use cannot pass through more than about 3 centimeters of tissue (a little more than one and an eighth inch), PDT is mainly used to treat tumors on or just under the skin or on the lining of internal organs.

Photodynamic therapy makes the skin and eyes sensitive to light for 6 weeks or more after treatment. Patients are advised to avoid direct sunlight and bright indoor light for at least 6 weeks. If patients must go outdoors, they need to wear protective clothing, including sunglasses. Patients should talk with their doctor about what to do if the skin becomes blistered, red, or swollen. Other temporary side effects of PDT are related to the treatment of specific areas and can include coughing, trouble swallowing, abdominal pain, and painful breathing or shortness of breath.

In December 1995, the U.S. Food and Drug Administration (FDA) approved a photosensitizing agent called porfimer sodium, or Photofrin®, to relieve symptoms of esophageal cancer that is causing an obstruction and for esophageal cancer that cannot be satisfactorily treated with lasers alone. In January 1998, the FDA approved porfimer sodium for the treatment of early nonsmall cell lung cancer in patients for whom the usual treatments for lung cancer are not appropriate. The National Cancer Institute and other institutions are supporting clinical trials (research studies) to evaluate the use of photodynamic therapy for several types of cancer, including cancers of the bladder, brain, larynx, and oral cavity. Researchers are also looking at different laser types, photosensitizers that can be applied to the skin to treat superficial skin cancers, and new photosensitizing agents that may increase the effectiveness of PDT against cancers that are located further below the skin or inside an organ.

July, 2003|Archive|