Monthly Archives: February 2004

$12 Million SPORE Grant Spurs Head and Neck Cancer Research

  • 2/29/2004
  • Houston, TX
  • MD Anderson Cancer Center Press Release

Nearly 38,000 men and women in this country will develop head and neck cancers in 2002, according to the American Cancer Society. Now, the first Specialized Programs of Research Excellence (SPORE) grant to study these cancers has been awarded to a national cancer center. The National Cancer Institute recently presented M. D. Anderson with a $12 million SPORE grant to study head and neck cancers, which include cancers of the:

* jaw
* mouth
* throat
* nose
* nasal cavity
* salivary gland
* sinuses
* thyroid
* larynx

“M. D. Anderson has made great strides in treating head and neck cancer patients while maintaining quality of life for our patients,” says Dr. Waun Ki Hong, the lead investigator on M. D. Anderson’s latest SPORE.

Hong is head of the institution’s Division of Cancer Medicine and chairman of the Department of Thoracic/Head and Neck Medical Oncology. The grant’s co-lead investigators are Drs. Reuben Lotan, professor of medicine, and Gary Clayman, professor of head and neck surgery, both in the Department of Thoracic/Head and Neck Medical Oncology. “We are already hard at work, and with this addition, we hope to make more progress in reducing head and neck cancer and ensure that patients with these diseases receive state-of-the-art medical care with cutting-edge therapeutic approaches.”

The head and neck SPORE grant will support research in five key areas:

Genetic Susceptibility Markers: Although head and neck cancer is known to be associated with tobacco and alcohol use, only a small subset of users will ever develop the disease. To find better methods to identify high-risk subgroups for screening, early detection, behavioral modification and chemoprevention, researchers will evaluate a group of patients with newly diagnosed oral cancers and/or precancerous lesions.

Angiogenic Therapy: The major cause of death from squamous cell carcinomas of the head and neck is the metastasis, or spread, to other organs. Researchers hypothesize that the aggressive nature of head and neck cancer is associated with an imbalance between pro- and anti-angiogenic molecules that feed or starve tumors. A Phase II clinical trial studying the anti-angiogenic agent PEG-IFN will be conducted in patients with surgically resectable squamous cell cancers of the head and neck.

Targeting EGF receptors for chemoprevention in head and neck cancer: Researchers will enroll 102 patients with precancerous oral lesions in a clinical trial to study the EGF receptor inhibitor Iressa® to determine its effectiveness in preventing oral cancers.

P53 therapy for reversal of pre-malignancies of the oral cavity: Pre-malignancies of the oral cavity and oropharynx have a high risk of progression to invasive squamous carcinomas. Biochemoprevention studies conducted at M. D. Anderson suggest that these cancer sites are resistant to even the most active preventive agents. Response rates to cis-retinoic acid and interferon, for example, are just 15%. A Phase I/II study will be conducted to test p53 gene therapy as a chemopreventive agent in patients with pre-malignant oral lesions.

Apoptosis or cell death: Studies have shown that a resistance to the normal and anticipated death of cells over time, rather than increased multiplication of cancer cells, is how malignant cells accumulate in patients. Researchers will examine numerous retinoids – alone and in combination – to assess their potential as head and neck cancer therapies.

Since 1992, NCI has awarded grants to cancer centers for concentrated research projects that promote interdisciplinary and translational laboratory research (research that can be quickly converted, or translated, from knowledge into direct patient care applications). The M. D. Anderson SPORE team includes researchers and specialists in head and neck surgery, as well as medical oncology, pathology, basic science, genetics, and biostatistics. Funds from the SPORE grant will also establish a career development program to train physicians and scientists with a focus on translational research in head and neck cancer. “The SPORE grant pushes M. D. Anderson’s already strong translational research efforts in head and neck cancer to a new level, enhancing our multidisciplinary approach to the disease,” Dr. Hong says. “With this grant, we want to rapidly increase our progress in the basic understanding of the disease, so we can develop new approaches to prevention, treatment and early diagnosis of head and neck cancer.”

February, 2004|Archive|

Oral sex linked to mouth cancer

  • 2/28/2004
  • Baltimore, Maryland
  • Michael Day
  • New Scientist Print Edition

Oral sex can lead to oral tumours. That is the conclusion of researchers who have proved what has long been suspected, that the human papilloma virus can cause oral cancers.

The risk, thankfully, is tiny. Only around 1 in 10,000 people develop oral tumours each year, and most cases are probably caused by two other popular recreational pursuits: smoking and drinking. The researchers are not recommending any changes in behaviour.

The human papilloma virus (HPV), an extremely common sexually transmitted infection, has long been known to cause cervical cancers. Several small studies have suggested it also plays a role in other cancers, including oral and anal cancers.

“There has been tremendous interest for years on whether it has a role in other cancers. Many people were sceptical,” says Raphael Viscidi, a virologist at Johns Hopkins University School of Medicine in Baltimore, Maryland, a member of the team that did the latest work.

The researchers, working for the International Agency for Research on Cancer in Lyon, France, compared 1670 patients who had oral cancer with 1732 healthy volunteers. The participants lived in Europe, Canada, Australia, Cuba and Sudan. HPV16, the strain seen most commonly in cervical cancer, was found in most of the oral cancers too.

Antibodies against HPV

The people with oral cancers containing the HPV16 strain were three times as likely to report having had oral sex as those whose tumour did not contain HPV16. There was no difference between men and women in terms of how likely the virus was to be present in the cancers. The researchers think both cunnilingus and fellatio can infect people’s mouths.

Patients with mouth cancer were also three times as likely to have antibodies against HPV as the healthy controls. For cancers of the back of the mouth, the link was even stronger.

The results prove the connection between HPV and oral cancer beyond any reasonable doubt, Viscidi says. “This is a major study in terms of its size,” he says. “I think this will convince people.”

Cancer specialist Newell Johnson of King’s College London agrees. “We have known for some time that there is a small but significant group of people with oral cancer whose disease cannot be blamed on decades of smoking and drinking, because they’re too young,” he says.

“In this group there must be another factor, and HPV and oral sex seems to be one likely explanation. This study provides the strongest evidence yet that this is the case.”

Cancer-causing strains

Genital HPV infections are common. At any one time, around a third of 25-year-old women in the US are infected. It is thought that only 10 per cent of infections involve cancer-causing strains, and that 95 per cent of women will get rid of the infection within a year. But even this does not explain why so few develop cancer.

The latest findings could improve treatments of oral cancers. Many scientists think that HPV infection must persist for tumours to grow, so giving antiviral drugs to people with oral cancers caused by the virus could improve their chances of recovery.

Prevention could soon be a possibility as well. Several research groups are developing vaccines against HPV, intended to reduce the 250,000 deaths worldwide each year due to cervical cancer. It is thought the vaccines would prevent oral infections as well as genital infections.

February, 2004|Archive|

Aspirin May Ward Off Some Cancers

  • 2/18/2004
  • By Daniel DeNoon, Reviewed By Brunilda Nazario, MD
  • WebMD Medical News

Evidence Mounts: Aspirin Prevents Cancers of Esophagus, Blood

Regular use of aspirin is a cost-effective way to prevent cancer of the esophagus. And it may also prevent Hodgkin’s disease. The findings come from two separate reports in the Feb. 18 issue of the Journal of the National Cancer Institute.

The most provocative of these reports suggests that regular aspirin use may prevent Hodgkin’s disease, a lymphoma or cancer of the white cells in the blood. The finding holds true only for aspirin and not for other drugs of its class such as ibuprofen. “If aspirin use is indeed found to protect against Hodgkin’s lymphoma, this relationship could afford insight into the [cause] of the disease and offer possible clues toward its prevention,” conclude Harvard researcher Ellen T. Chang, ScD, and colleagues.

Regular use of another common pain reliever, acetaminophen (Tylenol), seemed to increase the odds of having Hodgkin’s disease. It’s not the first time acetaminophen has been linked to cancer. However, the researchers think this association is more likely due to the fact that people coming down with Hodgkin’s disease may have used more pain relievers.

In the second study, Massachusetts General Hospital researcher Chin Hur, MD, and colleagues find that aspirin is the key to preventing esophageal cancer. Hur’s team looked at whether aspirin is a good way to prevent a condition known as Barrett’s esophagus, a result of chronic acid reflux. People with Barrett’s esophagus are at high risk of cancer. Aspirin is known to help prevent cancer in people with Barrett’s esophagus. But aspirin also can cause gastrointestinal bleeding. The researchers found that aspirin — with or without regular endoscopy to check for early signs of cancer — was the most effective way to prevent cancer of the esophagus.

SOURCES: Chang, E.T. Journal of the National Cancer Institute, Feb. 18, 2004; vol 96: pp 305-315. Hur, C. Journal of the National Cancer Institute, Feb. 18, 2004; vol 96: pp 316-325. News release, Journal of the National Cancer Institute.

February, 2004|Archive|

Poor Oral Health Linked to Coronary Heart Disease

  • 2/17/2004
  • Laurie Barclay, MD
  • Medscape Medical News 2004

Information sources/original article in the medical publication Circulation. Published Feb. 16, 2004

Asymptotic dental scores (ADS) reflecting poor oral health are linked to coronary heart disease (CHD), according to the results of a study published in the March 9 issue of Circulation, and published online Feb. 16. “Oral infections are thought to produce inflammation that might be associated with CHD, so we examined all oral pathologies that might generate inflammation,” lead author Sok-Ja Janket, DMD, MPH, from Boston University School of Dental Medicine in Massachusetts, says in a news release. “The ADS is a noninvasive risk indicator that can be measured easily at the time of dental check-up.”Using a logistic regression model, the investigators determined the weight that each of five oral diseases should be assigned to create the ADS as a predictor of cardiac risk. The strongest predictor of CHD was pericoronitis, followed by root remnants and gingivitis; then dental caries and missing teeth. Comparing oral health records from 256 Finnish patients with CHD to those of 250 matched controls without CHD revealed that individuals with high ADS, low levels of high-density lipoprotein (HDL) cholesterol and high levels of fibrinogen had an 82% probability of having CHD. A model that included ADS, C-reactive protein, and HDL cholesterol and fibrinogen levels was at least as good a predictor of cardiac risk as was the Framingham heart score High ADS alone was associated with a 70% probability of having CHD, low HDL cholesterol level with 63%, HDL to total cholesterol ratio with 62%, high fibrinogen level with 60%, and high triglyceride level with a 60% probability of having CHD. “If you see that a patient has five poor oral health pathologies, then chances are that 70% of the time he or she would have CHD,” Dr. Janket says. “People who do not have teeth cannot chew their food well and therefore do not get as much heart-healthy nutrients or fiber. Future studies should look at nutrition, oral health, and [CHD].”Study limitations include potential selection bias because the controls were selected from hospital patients. Although these findings suggest an association between oral pathology and CHD, they do not indicate a cause-effect relationship. However, Dr. Janket recommends that dentists encourage their patients with poor oral health to have cardiac examinations even if they are asymptomatic.”Individuals who are un- or underinsured, those of low socioeconomic status, or even those who simply have poor general health habits, have poor dental health,” says American Heart Association president Augustus O. Grant. “They are also likely to have less access to preventive care that would protect them from coronary artery disease, so this association may simply reflect the fact that our society needs to do much better in promoting health in all individuals.” In an accompanying editorial, Gordon D.O. Lowe, from the Royal Infirmary in Glasgow, U.K., suggests that these findings may not be generalizable to the general population. “We should continue to emphasize proven risk factors, such as age, sex, smoking habit, diabetes, blood pressure and total cholesterol/HDL ratio,” he writes. “Further studies are needed to evaluate the additive predictive value of ’emerging’ risk predictors, including dental health scores.”

February, 2004|Archive|

Cancer radiation risk estimated Medical X-rays cause thousands of cases of cancer every year.

  • 2/12/2004
  • HELEN R. PILCHER

A British study has quantified the cancer risk from diagnostic X-rays. Radiation from medical and dental scans is thought to cause about 700 cases of cancer per year in Britain and more than 5,600 cases in the United States1.

The benefits of using X-rays still far outweigh the potential increase in cancer risk, says Amy Berrington de González from Oxford University, UK, who coordinated the study. But it’s important to know what that risk is, she says, so doctors can weigh up the pros and cons of using the technique.

X-rays and their computerized cousin, CT scans, are routinely used to diagnose cancer and examine bone breaks. But the radiation can penetrate through cells and damage DNA. In some people, this can trigger cancer.

To minimize the risks, doctors use low doses. A chest X-ray, for example, delivers just three days’ worth of low, background radiation. But X-rays are commonplace in hospitals and huge numbers of people receive them — there are 500 X-rays for every 1,000 people every year in Britain.

Attempts to quantify the risk of X-rays have been made before. The most recent previous estimate, made in 1981, found that X-rays probably accounted for 0.5% of cancer cases in the United States.

The new study, using more data from 15 different countries, is a much-needed update on those risk estimates, says Berrington de González, particularly because many more X-rays are done today than 20 years ago. The study estimates that diagnostic X-rays account for 0.9% of cancer cases in the United States, although the authors caution that their methodology is very different from that used previously, making it hard to compare the results.

Working backwards

To make their calculations, Berrington de González and colleague Sarah Darby assessed the relationship between high levels of radiation exposure and cancer. This included information on survivors of the Hiroshima bomb, who were exposed to radiation levels far greater than the normal X-ray exposure. The duo then worked backwards to work out the risks from lower doses.

Scaling down from large exposures to small ones is a difficult and controversial calculation, however. So the pair also used a complex computer model to try and weed out the effects of lower doses of radiation.

They found that about 0.6% of cancer cases in Britain are currently caused by X-rays. Poland, Sweden, Kuwait and the Netherlands have similar rates. The highest rate — 3% — was found in Japan, where X-ray use is more common.

X-rays are not the only diagnostic tool available to doctors, says Paul Dubbins, dean of the UK-based Royal College of Radiologists. Ultrasound can be used to image a baby in the womb, for example. But ultrasound doesn’t travel well through air, so is rarely used for lung examinations. Magnetic resonance imaging (MRI) can be used to study brain activity, but is not very good at imaging bones. “We don’t use X-rays unless they’re absolutely necessary,” says Dubbins.

It’s not possible to predict who will develop cancer as a result of X-ray exposure, or what type of cancer they will get, says Berrington de González. Radiation can trigger many different types of the disease. On the other hand, not all cancers are caused by radiation — diet and genetics, for example, also play a role.

February, 2004|Archive|

Cancer survivor gives teens some scary facts to chew on

  • 2/12/2004
  • Lisa Patterson
  • Daily World

A little white dot on the side of Cliff Crawford’s tongue got a lot more significant Tuesday.

Mouth wide – opened, tongue sticking out, the Aberdeen High School ninth – grader asked Rick Bender to take a look. Bender told him to talk with his parents, see a doctor and quit chewing “spit tobacco,” a habit Crawford says he began at the age of 7.

“I’m not a doctor,” Bender said. “But I wouldn’t take any chances.”

Missing part of his tongue, all of his bottom teeth and much of his chin, Bender’s words held more weight with Crawford and his fellow Aberdeen High School students than any wordy warning on the side of chew cans that so many of the students admittedly pack.

Bender barely survived mouth cancer, diagnosed in April of 1989, just days before his 27th birthday. He spoke to students at several area schools this week to share is horrific near – death experience.

OCF Note: What we would like to know is where were the parents responsible for the bringing up of this 7 year old when he started using spit tobacco? How can we make a difference in the incidence and death rate from this disease when parents allow this to occur? How proud they will be of their parenting abilities when their child finds out that oral cancer is now part of his life, due to their lack of involvement or plain stupidity. No matter how you try to spin this… it is just wrong.

February, 2004|Archive|

Americans say they are excited about cancer screening when asked if they would prefer a total-body CT scan or $1,000 in cash, 85% chose the total-body CT.

  • 2/11/2004
  • Schwartz LM, Woloshin S, Fowler FJ, Welch HG

Thanks in part to successful, aggressive marketing campaigns about cancer screening technology, people in the United States are enthusiastic about cancer screening, according to a national survey.

“Most people in the United States are firmly committed to cancer screening,” said Lisa M. Schwartz, MD, MS, from the Veterans Affairs Outcomes Group in White River Junction, VT. She added that false-positive results did not reduce enthusiasm for screening. Schwartz and her colleagues conducted a national telephone survey of 500 adults during 2001 and 2002. None of the participants had a history of cancer. There were 360 women who were at least 40 years old and 140 men who were at least 50 years old. The survey was restricted to these age groups, Schwartz explained, “because it is at these ages that most cancer screening is recommended, a notable exception being Papanicolaou testing.”

The survey included questions about the value of early detection and four cancer screening tests: Papanicolaou (Pap) smear, mammography, prostate-specific antigen (PSA) test and sigmoidoscopy or colonoscopy.

One screening technology that is often aggressively marketed to consumers is total-body computed tomography (CT) scanning. Although there are no data to support benefit or safety for the test and some medical groups discourage patients from receiving it, 86% of survey participants wanted to have a free total-body CT. When those people were asked if they would prefer a total-body CT scan or $1,000 in cash, 85% would choose the total-body CT. Eighty-seven percent of those surveyed believed that routine cancer screening is “almost always a good idea.” Seventy-four percent believed that finding cancer early saves lives “most” or “all of the time.”

Even if screening detected a cancer for which there was no treatment, 66% of participants wanted to know the cancer was there. Fifty-six percent wanted to know about the existence of cancers that would never cause problems in their lifetime because of the disease’s slow growth. The participants were committed to screening based on their own participation. Almost all women reported a Pap test and 89% had a mammography. Among men, 71% had a PSA test. The rate of colonoscopy or sigmoidoscopy was 46% among men and women.

The commitment to screening was strong enough that many participants “would overrule a physician who recommended against cancer screening and could not imagine a time when they would stop being tested,” Schwartz said. She added that although 38% of participants had at least one false-positive result described by many participants as a scary time in their lives, 98% of these participants were glad they had the original test.

“Our work suggests that screening is not seen as a choice but as an obligation,” Schwartz said. During focus groups, participants said they owed it to their children to be screened and that it would be selfish to refuse cancer screening.
The researchers asked survey participants whether a person in average health would be irresponsible if he or she did not have screening. The percentage of people considering this irresponsible for a 55-year-old ranged from 79% for not having a Pap test to 54% for not having colonoscopy.

When asked about an 80-year-old, the responses ranged from 41% who felt not receiving a mammography would be irresponsible to 32% who felt not receiving a colonoscopy would be irresponsible.

February, 2004|Archive|

Midge Mackenzie

  • 2/11/2004
  • London
  • Telegraph news

Midge Mackenzie, who has died aged 65, was a documentary film-maker, writer and historian of film; energetic and determined in all her endeavours, she made uncompromising, honest and stylish documentaries about feminism, human rights and child abuse as well as many other subjects.

With her habitual Stetson setting off flame red hair, tight jeans, extravagant rings and cowboy boots, Midge Mackenzie’s appearance reflected her originality and showmanship, but belied her strong principles and need to expose injustices. Film-making was her real passion, but in her work for the feminist and anti-apartheid movements in the 1960s and 1970s she cut a swathe, excited controversy and made a difference.

Margaret Rose Mackenzie was born in London on March 6 1938, the eldest of three children. After the war, which she spent in Dublin, cared for by a great-aunt, she attended a convent school in north London. But having been left to look after her brothers when her parents divorced, she was determined to escape her home life. She left school at 16 and went to work for an advertising agency in central London, which provided her with an entry into films.

Following a brief marriage to Peter Jepson-Henry, an antiques dealer, she moved to New York where she cut her teeth in film-making as a director of television commercials. Her reputation as a documentary film-maker was established in 1967, when her revolutionary, and widely acclaimed, multimedia Astarte for the Joffrey Ballet made the cover of Time magazine.

Three years later, she brought out Women Talking, a profile of the American feminists Sheila Allen and Kate Millet. Midge Mackenzie was a committed feminist, but she was uneasy with stereotypes and would attend women’s lib demonstrations swathed in fur. “There was no such thing,” she explained, “as politically correct then.” Indeed, at a screening of Women Talking at the ICA in London she included a striptease act.

She showed a similar readiness to court controversy the same year when she successfully staged a re-enactment of the Sharpeville massacre at the Lyceum in London, making full use of the theatre’s revolving stage and a contemporary soundtrack of the massacre.

In 1975 Midge Mackenzie released one of her most memorable works, Shoulder to Shoulder, a drama documentary series recounting the history of the Suffragettes, which she later turned into a book. Throughout the late 1960s and early 1970s she and her companion Frank Cvitanovich, a successful documentary film director, also made commercial films through their company Mohawk Films.

During this period, however, much of her time was taken up with their son, Luke (known as Bunny), who had been born prematurely, severely brain damaged and autistic. Midge Mackenzie unearthed a controversial “patterning” treatment then being pioneered in Pennsylvania, which required her son to have three helpers working on him for five hours every day.

It was a tribute to her resourcefulness, perseverance and organisational skills, and the vast network of acquaintances, friends and helpers she mustered, that the treatment was not only sustained but was successful. Bunny gained some coordination and balance, but died of cancer, aged 11, in 1978.

It was a time of extraordinary anguish for Midge Mackenzie. Her relationship with Cvitanovich had broken down and she had been diagnosed with breast cancer. But when she was offered a job teaching film history at Harvard University she managed to pick herself up and returned to America.

There followed a period of intellectual and professional fulfilment. An arresting sight on campus, hailing everyone with a cheery smile, and with her beloved dog, Tex, in tow, Midge Mackenzie loved teaching and relished the access Harvard provided to the intellectual heart of America.

A highlight of these years was the filming in Mexico of interviews with John Huston, talking about his suppressed war films; in 1999 she turned these interviews into a documentary for Channel Four.

In 1989 Midge Mackenzie returned to Britain, settling in Islington. There she would conduct long boozy lunches with her friends, surrounded by antique figurines and cans of archive film. She also continued to make documentaries that reflected her sense of community and social commitment.

Prisoners of Childhood, which she made in 1991, dealt with issues of child abuse through actors working with therapists to unlock their own childhood experiences. Three years later she set up the first Sheffield International Documentary Festival.

Her last finished work was a sensitive documentary about the London Hospital’s facial reconstruction unit and the portraits Mark Gilbert had been commissioned to paint of its patients. These featured in an exhibition, Saving Faces, at the National Portrait Gallery in 2002.

The challenges she faced with her son went some way to prepare her for the ordeal she endured with the recurrence of throat cancer early last year. Her many friends rallied round. Though reduced to scribbling notes in hospital, she never lost her interest in people and her surroundings, and she filmed many of her consultations and treatment.

Midge Mackenzie died on January 28, 2004

February, 2004|Archive|

Despite the risk, oncologists admit they know little about lymphedema

  • 2/11/2004
  • Tammy Dotts
  • Hem/Onc Today

The lifetime risk for lymphedema is about 20% for patients who receive treatment that interferes with lymph transport. Many oncologists and other physicians, however, know little about the condition or about available treatments, said Christine Rymal, MSN, RN, CS, AOCN, a nurse practitioner at the Karmonos Cancer Institute in Detroit. “Lymphology is a neglected field,” she told Hem/Onc Today. “There aren’t many experts around.”

The lack of experts may explain why some patients feel abandoned by the medical community. Rymal mentioned a 1997 paper in the Oncology Nursing Forum that found a primary theme among women treated for lymphedema was that they received little information from their doctors. “Ideally, oncologists should know enough about the condition to counsel patients before referring them to a therapist,” she said. “But oncologists may not have the time or the knowledge to understand how lymphedema and lymphedema therapy affect the patient. Even primary doctors aren’t that knowledgeable about it.”

Dorland’s Illustrated Medical Dictionary defines lymphedema as chronic accumulation of interstitial fluid as a result of stasis of lymph, which is secondary to obstruction of lymph vessels or disorders of the lymph nodes.

Under normal conditions, Rymal explained, lymph does not typically flow across watersheds that are the boundaries between quadrants of the peripheral lymph transport vasculature. Surgery, radiation or both can compromise lymph transport. This can cause lymph stasis, vessel hypertension, quadrant congestion and lymphedema. Untreated lymphedema can lead to decreased or lost function in the limbs, skin breakdown, chronic infections and irreversible complications. Lymphedema is usually found closest to the affected lymph nodal basin, but other areas within the quadrant may be affected. For example, patients may experience breast swelling following lumpectomy, axillary dissection and radiation.

Acquired lymphedema can develop immediately after treatment or up to years later, according to the National Lymphedema Network. They also note that any I.V. fluid, including chemotherapy, administered to an already affected lymph area where surgery was performed can lead to lymphedema.

Treatment options
The best treatment for lymphedema is comprehensive decongestive treatment, which consists of manual lymph drainage, layered compression bandages, specific exercise and meticulous skin care and arm precautions, Rymal said. When dealing with extremeties, the treatment pulls lymph fluid from the extremity into the quadrant, which has greater capacity for lymph transported from the extremity.

Some doctors may be concerned that lymphedema treatment may promote metastasis since the lymphatic and blood vasculatures are known routes of metastasis, she said. Rymal discounted this myth. Lymph transport takes lymph constituents to the nodes for destruction, she said, adding that “no reports of unusually aggressive disease progression exist among patients with active malignancy who received comprehensive decongestive treatment.”

Knowledge is power
Lymphedema is a chronic condition that may follow cancer treatment. Unfortunately, patients may be reluctant to pursue immediate treatment and many oncologists may not refer patients to lymphedema therapists. Rymal referred to lymphology as an “orphaned” science. Oncologists and other doctors get most of their information about the treatments through meetings or the occasional journal article, she said. To help doctors learn more about the requirements of lymphedema treatment, fitting treatment into existing therapies and lymphology in general, Rymal recommended the following organizations:

* National Lymphedema Network
The organization provides education and guidance on prevention and management of primary and secondary lymphedema to patients, health care professionals and the general public.
* International Society of Lymphology
The society aims to advance and disseminate knowledge in the field of lymphology and allied topics through international meetings and a scientific journal.
* Lymphology Association of North America
Composed of physicians, nurses and massage, physical and occupational therapists, the organization provides certification for lymphedema therapists.

Another concern of doctors is whether their patients can tolerate lymphedema therapy during ongoing cancer treatment. Rymal said doctors should evaluate if their patients have the time and motivation for daily lymphedema therapy. “Patients may have the time but may not have the energy because of ongoing treatment,” she said. “They could be nauseated from chemotherapy or may just not be up for learning something new at that time. Oncologists don’t always know how taxing lymphedema therapy can be.”

The comprehensive decongestive treatment is time and labor intensive. Basic therapy lasts for 2.5 hours each day and continues for two weeks for an arm and at least four weeks for a leg. “If patients are not up to receiving comprehensive treatment, they should consider just wearing a compression sleeve until their other arduous cancer treatment is completed,” she said.

The pneumatic sleeve is a passive therapy. It uses a pump to inflate and deflate sections of the sleeve in sequence from the fingertips to the armpit. It is less effective than comprehensive therapy, but may be an alternative for patients undergoing other treatment. Pneumatic compression requires at least two hours per session. Another option is compression bandages, which need to be left in place for 48 hours or more but do not interfere with activity or rest, Rymal said.

Compression sleeves are not covered by Medicare, she said. The physical therapy aspect of comprehensive decongestive treatment is covered, but supplies are not.

Source: Rymal C., lymphedema therapy during adjuvant therapy for cancer. Clinical Journal of Oncology Nursing. 2003;7:449-455.

February, 2004|Archive|

Joe Eszterhas writes off throat cancer

  • 2/10/2004
  • John Morgan
  • USA Today

Basic Instinct scribe Joe Eszterhas is known for his dark tales populated with seductive killers. But like a character from one of his famous movies, Eszterhas was being slowly murdered by two killers he thought he loved cigarettes and alcohol. Their murder weapon was cancer of the larynx. And they almost got away with it.

“I started smoking when I was 12 years old and drinking when I was 14,” says Eszterhas, whose just-released novel Hollywood Animal will hit the New York Times best-seller list this week. “By 2000, I was smoking four packs of Salem lights every day and drinking a significant amount. My voice began to get hoarse.”

Eszterhas says he wasn’t concerned. He had experienced hoarseness before on several occasions after having nasal polyps removed. So the million-dollar screen writer casually went in to see his “hot shot Beverly Hills ENT guys.”

“I was diagnosed with a benign polyp that was wrapped around my vocal cords,” Eszterhas recalls. “They said that it was nothing alarming. It was outpatient and no rush. It was just a polyp not unlike all the other ones.”

But it wasn’t.

After moving his family back to Ohio in March of 2001, the hoarseness got worse. With the renowned Cleveland Clinic nearby, Eszterhas decided to have the polyp removed rather than wait any longer.

“The Cleveland Clinic throat guy performed the same test as the Beverly Hills doctors,” Eszterhas explains, describing the flexible laryngoscope, a lighted tube with a camera that was snaked up his nose and down into his throat to examine the larynx. “He looked at the ‘polyp’ and kept looking at it and finally said, ‘We might have a problem here.'”

The “problem” was cancer of the larynx, often called the voice box or Adam’s apple.

According to the American Cancer Society, more than 10,000 Americans will be diagnosed with laryngeal cancer this year. A little less than 4,000 will die of the disease. Men are four to five times more likely than women to get laryngeal cancer, and African Americans are more at risk than whites.

Other risk factors include:

• Increased age

• Smoking

• Drinking alcohol

• Poor diet

• Weakened immune system

• Occupational exposure to wood dust, paint fumes, certain chemicals and asbestos

Sobering news

Eszterhas then met with throat cancer specialist Marshall Strome, chairman of the Cleveland Clinic Head and Neck Institute in Cleveland. Strome also immediately suspected cancer.

“If your voice has changed for more than three weeks, then you should have someone look at it, especially if you’ve had a history of smoking, drinking or a family history of cancer in the head and neck,” Strome advises.

Other symptoms of laryngeal cancer include:

• Persistent sore throat

• Constant coughing

• Difficulty or pain when swallowing

• Lump or mass in the neck

But before Eszterhas, 59, could even undergo the biopsy Strome ordered, the writer had to get sober.

“Dr. Strome told me that if I wanted any kind of a chance to live, I had to stop smoking and drinking,” says Eszterhas, who went through withdrawal pre-operatively at the Cleveland Clinic and then had the biopsy performed.

“I think I was both terrified and in absolute denial because I was still hoping there was a mistake,” the screen writer admits. “I kept thinking that the biopsy would reveal it wasn’t cancer. I kept hoping the Beverly Hills guys were right.”

They weren’t.

“He absolutely had squamous cell cancer of the larynx,” Strome says. “He presented at stage two without any evidence of nodal disease. The cancer had crossed across the front of the voice box to the other side so he had cancer involving both vocal cords.”

In April 2001, Eszterhas had two options: radiation therapy or surgical management.

“Dr. Strome felt that he might have to remove my entire larynx which meant I’d have to have a feeding tube because I wouldn’t be able to swallow or talk,” Eszterhas says. “My wife and I talked, and I decided that I really didn’t want to live that way.”

So Strome went back to the drawing board.

Instead of seven weeks of radiation therapy, Strome was then beginning to develop a surgical treatment using a laser followed by cryotherapy to destroy any microscopic disease left behind. To date Strome says the results are “very promising.” Of the 20-plus patients treated so far, there have been no recurrences as long as 2½ years out.

“We believe this new approach is going to completely revolutionize the way early cancers of the larynx are treated,” Strome states.

Survival instinct

This new treatment sends patients home the next day with voices the equivalent to, if not better than, after radiation therapy has healed. The limitation is that the surgeon must be able to expose the tumor through the mouth. Some people’s anatomy precludes getting a scope past the tongue base to view the very front of the larynx.

“If you can’t see it, you can’t remove it,” Strome says. “And that was Joe’s case. Since we could not use this technique, I had to do an open operation and rebuild his vocal cords.”

But neither the doctor nor patient would know if Eszterhas could swallow until after the surgery. “If I couldn’t swallow, I’d have to go on a trach,” says Eszterhas, referring to a tracheostomy, or direct opening into the windpipe below the larynx. “He came into the recovery room and told me to swallow. And I did.”

Strome recently examined Eszterhas and calls the writer’s recovery “remarkable,” considering him cured after almost three years.

But the drama wasn’t over.

“Of course I had immediately stopped smoking and drinking and was going through the worst nightmare of my life because I realized that everything was tied into those two activities,” Eszterhas notes. “I turned my life upside down trying to ease the cravings.”

With his wife’s help, Eszterhas says he changed his diet, religiously walked five miles a day, lost 45 pounds and most importantly re-established his relationship with God.

“I asked God to help me,” Eszterhas says. “I think changing everything about my life and rediscovering prayer were the reasons I was able to get through my addictions. It’s been nearly three years, and I have not had a cigarette or a drink. I consider it one of the great achievements of my life, but I am humble about it.”

Strome gives his patient all the credit for his recovery.

“The reason Joe has done so well is because he has changed his life,” Strome states. “Joe is living proof that if you really change you can achieve great outcomes.”

One outcome Eszterhas hopes to script is educating people, especially kids, about the dangers of smoking.

“I was guilty of glamorizing smoking on the big screen,” Eszterhas says. “I can’t tell you how many people tell me that they started smoking because they saw Robert Mitchum smoking on screen or saw Madonna in Dick Tracy. Yet Hollywood keeps promoting smoking even though all the evidence is in about how smoking on screen influences people, particularly kids. I want to try and wake people up. Because this disease called addiction will at a minimum maim you, and ultimately it will kill you.”

February, 2004|Archive|