Monthly Archives: August 2007

Rx Trials Institute Drug Pipeline Alert

  • 8/30/2007
  • web-based article
  • staff
  • FDANews (fdanews.com)

Merck’s Gardasil for Boys: How Will Those Ads Play?
(CNBC’s Pharma’s Market)

In his blog, Mike Huckman writes about Merck testing Gardasil, its cervical cancer vaccine, on young men. The company said it expects data from clinical trials next year and hopes to win approval for both males and females.

Merck hopes to have the shot approved as a treatment for oropharyngeal cancer, a type of oral cancer that occurs as a result of HPV-16/18. Huckman cites an article in the medical journal Cancer written by doctors at the M.D. Anderson Cancer Center that backs the use of the vaccine in young men:

“‘Although the cervical cancer…prevention policy of the HPV-16/18 (another leading cancer-causing strain) vaccination of young women and adolescent females are commended, we fear that vaccination programs limited to females will only delay the potential benefit in prevention of HPV-16/18-associated [oropharyngeal] cancers, which typically occur in men. We encourage the rapid study of the efficacy and safety of these vaccines in males and, if successful, the recommendation of vaccination in young adult and adolescent males.’”

August, 2007|Archive|

Avocados Prove Fruitful in Fighting Oral Cancer

  • 8/30/2007
  • web-based article
  • staff
  • MediaSource (www.mediasourcetv.com)

The next time you reach for the guacamole and chips, you’ll be doing something good for your body. Avocados are loaded with healthy monounsaturated fat,* and now researchers say they might also help your body fight off cancer.

Renee Bean always tries to make fresh fruits and vegetables a part of her recipes. As a chef, she says they can make her dishes taste better. As an oral cancer survivor, she believes they might actually help her feel better.

“I try to eat things that are supposed to keep you from getting any recurrences. Lots of berries and broccoli,” says Bean.

And now there’s a new fruit Renee may want to add to her diet – the avocado. The green meat inside is rich in more than 20 vitamins and minerals, and it may offer much more than that.

For the first time, researchers at Ohio State University’s Comprehensive Cancer Center have discovered that certain compounds in avocados have the ability to find and destroy oral cancer cells, even before they do any damage.

“It’s significant in that the compounds that we’re interested in will only target the pre-cancerous cells and potentially the cancerous cells and not affect the normal cells,” says Steven D’Ambrosio, PhD at Ohio State’s Comprehensive Cancer Center.

Researchers still aren’t sure exactly how the avocados do it, but they think it has something to do with phytonutrients and their ability to help regulate the signals that your body sends to certain cells.

“Signals that tell cells to grow, live or die. And we’re looking at the potential targets of these phytonutrients from the avocados,” says D’Ambrosio.

Researchers say they’ve only tested the avocado in oral cancer, but other types of cancer grow in similar ways. So if scientists can figure out exactly how it works, this one fruit could help fight other forms of cancer too.

In addition to their potential cancer-fighting power, experts say avocados are loaded with nutrients. Two tablespoons have 50 calories and 4 grams of fat. That’s better than using butter, sour cream, cheddar cheese or mayonnaise on your next sandwich.*

August, 2007|Archive|

Smoking Linked to Head and Neck Cancer in Women

  • 8/30/2007
  • Memphis, TN
  • staff
  • CancerConsultants.com

According to an article recently published in the journal Cancer, women have a higher risk than men that smoking will increase their risk of developing head and neck cancer.

Head and neck cancer refers to several types of cancers including, but not limited to, cancer of the tongue, gums, oral cavity, nasal cavity, voice box, and back of the throat. Although men have a higher rate of head and neck cancer than women, incidence of head and neck cancer in women has been increasing significantly throughout the world.

Once head and neck cancer has spread from its site of origin, survival rates decrease dramatically. As well, treatment for more advanced head and neck cancer is often associated with significant declines in quality of life, as surgery often disfigures patients and/or severely impairs their ability to perform basic functions such as chew, swallow, or speak. Radiation that includes the salivary glands may also cause extremely dry mouth or sores in the mouth.

Smoking has already been established as a risk factor for developing head and neck cancer. However, data is limited about female smokers and their particular risk of head and neck cancer. Researchers affiliated with the National Cancer Institute recently conducted a clinical study to explore the association between cigarette smoking and head and neck cancer in women. This study included over 476,000 men and women, aged 50–71 years. From 1995 through 2000, 584 men and 175 women were diagnosed with cancer.

* Overall, men had a higher incidence of head and neck cancer than women.

* Smoking, however, caused a greater proportion of head and neck cancer in women than in men (75% versus 45%, respectively).

The researchers concluded: “Cigarette smoking is a strong risk factor for head and neck cancer in both men and women. Incidence rates of head and neck cancer were higher in male smokers than female smokers, but smoking may explain a higher proportion of head and neck cancer in women than in men.” Individuals who smoke may wish to speak with their physician regarding smoking cessation programs.

Reference:
Freedman N, Abnet C, Leitzmann M, et al. Prospective investigation of the cigarette smoking-head and neck cancer association by sex. Cancer [early online publication]. August 10 2007. DOI: 10.1002/cncr.22957.

August, 2007|Archive|

Smoking Increases Risks For Head And Neck Cancers For Men And Women

  • 8/27/2007
  • web-based article
  • press release
  • ScienceDaily.com

Smoking significantly increases the risk for head and neck cancers for both men and women, regardless of the anatomic site. Published in the journal Cancer, a large, prospective study confirmed strong associations between current and past cigarette smoking and malignancies of the head and neck in both genders.

Cancers of the head and neck include cancers of the larynx, nasal passages/nose, oral cavity, and pharynx. Worldwide, more than 500,000 people are diagnosed with these cancers every year. According to the National Cancer Institute (NCI), men are more than three times more likely than women to be diagnosed with head and neck cancer and almost twice as likely to die from their disease.

While tobacco use has long been identified as an important risk factor for head and neck cancers, the new study finds that smoking plays a greater role in the development of head and neck cancer in women than men.

Dr. Neal Freedman from the NCI and co-investigators analyzed data from 476,211 men and women prospectively followed from 1995 to 2000 to assess gender differences in risk for cancer in specific head and neck sites. Analysis showed that the risk of smoking leading to any type of head and neck cancer was significantly greater in women than in men. While 45 percent of these cancers could be attributed to smoking in men, 75 percent could be attributed to smoking in women.

“Incidence rates of head and neck cancer were higher in men than in women in all categories examined,” conclude the authors, “but smoking was associated with a larger relative increase in head and neck cancer risk in women than in men.” To reduce the burden of head and neck cancer, public health efforts should continue to aim at eliminating smoking in both women and men.

Reference:
“Prospective Investigation of the Cigarette Smoking-Head and Neck Cancer Association by Sex,” Neal D. Freedman, Christian C. Abnet, Michael F. Leitzmann, Albert R. Hollenbeck, Arthur Schatzkin, CANCER; Published Online: August 27, 2007, 2007 (DOI: 10.1002/cncr.22957); Print Issue Date: October 1, 2007.

August, 2007|Archive|

Virus Linked To Throat Cancer Trend

  • 8/27/2007
  • New York, NY
  • Salynn Boyles
  • CBS News (www.cbsnews.com)Unlike most head and neck cancers, throat cancer rates in the United States have not dropped in recent years, and infection with the sexually transmitted infection human papilloma virus (HPV) may be the cause.

HPV is a virus that causes genital warts and most cervical cancers, but its transmission through oral sex has only recently been identified as a potential cause of throat cancer.

In a newly published analysis of head and neck cancer rates in the U.S., researchers from Houston’s M.D. Anderson Cancer Center found the incidence of throat cancer to be stagnant and even rising in some populations, defying a downward trend in other head and neck cancers linked more closely with smoking.

The findings underscore the importance of research aimed at determining if the newly available HPV vaccine is effective in males, researcher Erich Sturgis, M.D., MPH, tells WebMD.

“The vaccine has been shown to be almost 100% effective for preventing cervical infection,” he says. “We would encourage the medical community and [vaccine] industry to study its role in preventing this oral cancer.”

Tobacco use and drinking alcohol are by far the biggest risk factors for head and neck cancers. About 90% of patients with these malignancies either smoke or chew tobacco or have done so in the past, and up to 80% of oral cancer patients also drink a lot of alcohol, according to the American Cancer Society.

In their newly published analysis of head and neck cancer trends in the U.S., Sturgis and co-author Paul M. Cinciripini, M.D., showed that the decline in smoking has led to a decline in most head and neck cancers over the past two decades.

“These decreasing incidence rates trail by 10 to 15 years the declines in smoking prevalence, which began in the 1970s,” they wrote in the Oct. 1 issue of the journal Cancer.

The main exception to this trend has been throat cancer, more specifically defined as cancer of the oropharynx, which includes the tonsils, base of the tongue and soft palate, and side and back of the throat.

These cancers are rare, accounting for just 10,000 of the roughly 45,000 head and neck malignancies diagnosed each year in the U.S. But their incidence has remained steady, overall, Sturgis and Cinciripini write, and tongue cancer rates among young adults have increased.

They conclude that this is likely due to HPV infection, spread through oral sex.

Sturgis tells WebMD that over the last five years, 35% of the throat cancer patients treated at M.D. Anderson Cancer Center had no history of smoking and that close to 90% of patients who had never smoked showed evidence of oral infection with HPV.

In the conclusion of their analysis, the researchers write that vaccinating only females against HPV, which is currently the policy in the U.S., could result in a missed opportunity to prevent throat cancers.

The HPV vaccine is being offered to males in Australia, Mexico, and some other countries, but there is, as yet, no clinical proof that it works to prevent HPV infection in men, says Debbie Saslow, PhD, of the American Cancer Society.

In the U.S. the vaccine, marketed as Gardasil by Merck & Co., is recommended for 11- to 12- year-old girls, and for women up to age 26 who have not received it.

Studies are under way to determine if the vaccine protects boys against genital HPV infection.

“The HPV vaccine is very effective protection against cervical cancer, and there is a good chance that it will reduce the incidence of other types of HPV-promoted cancers as well,” Saslow tells WebMD. “But we have no data to confirm that, and we won’t have any in the near future.”

By Salynn Boyles
Reviewed by Louise Chang

August, 2007|Archive|

Dry mouth? Here’s how you can lick it

  • 8/23/2007
  • United Kingdom
  • Roger Dobson
  • Daily Mail (www.dailymail.co.uk)

An electrical saliva ‘stimulator’ is being used for patients who suffer from a chronically dry mouth. The battery-powered device is embedded in a mouthguard that fits over the teeth and is operated by a handheld remote control. It sends out mild pulses of electricity, not felt by the patient, to stimulate the nerves that control the release of saliva.

Dry mouth and lack of saliva is a common problem that affects around one in ten adults at some time. It occurs when the glands in the mouth that make saliva are not working properly, and there are several possible reasons for this.

More than 400 medicines, including some over-the-counter formulations, can cause the salivary glands to make less saliva, or to change its composition so it doesn’t work properly.

Some chemotherapy cancer treatments make saliva thicker, so less lubricating, and injury to the head or neck can damage the nerves that activate the salivary glands.

According to the journal Advances In Clinical Neuroscience And Rehabilitation, there are up to 10 million people with dry mouth in the UK.

Other symptoms can include bad breath, a sore throat, a burning mouth and an altered sense of taste. These symptoms have an effect on digestion and dental health because the low levels of saliva mean people with dry mouth lack the enzymes that help break down food. A number of other compounds contained in saliva fight the bacteria that form dental plaque and cause decay and gum disease.

A healthy adult produces around three pints of saliva a day, but as people age, this reduces – a problem compounded as they are also more likely to be taking medication, some of which – including antihistamines, high blood pressure medications and muscle relaxants
– can cause dry mouth.

The problem can also be an underlying symptom of a number of serious medical conditions, including the autoimmune disease Sjogren’s syndrome, diabetes, Alzheimer’s, stroke and depression.

There are a several products on the market designed to provide moisture – usually gels or sprays to make the mouth moist – but the new device is the first to restore natural saliva production through electro-stimulation.

The stimulated nerves excite both the salivary glands directly to get them to secrete more natural saliva, and also stimulate the salivation control centre in the brain.

Putting in the device is straightforward. First a dentist makes an impression of the patient’s teeth which is sent to developers Saliwell Medical.

They embed the equipment in a mouthguard that sits over the teeth and which can be removed by the patient when not in use.

The device can also be incorporated into a dental crown. It needs to be replaced once a year, the expected lifetime of the battery.

Patients are advised to use the device initially for ten minutes whenever there are symptoms of dry mouth. The company says users will learn to adjust the length of use, which can be as short as one minute, according to their needs. SOME patients report sufficient effect by using it for one minute three to four times a day, others need more time, about five minutes, they say.

Clinical trials have demonstrated a significant increase in saliva secretion and relief to patients.

Saliwell says: “Compared to the available treatments it offers a permanent, cost-effective and side-effect-free treatment for xerostomia or dry mouth.”

Gordon Watkins, a member of the British Dental Association’s health committee, said: “It sounds very interesting, although we would need to see the results of trials.

“Dry mouth is a significant and debilitating problem for many people and anything new that worked would be welcomed. All we can really offer people is saliva substitutes which are not very satisfactory.”

August, 2007|Archive|

Microfluidic Lab-on-a-Chip Detects Oral Cancer Marker in Minutes

  • 8/23/2007
  • Sydney, Australia
  • staff
  • Azonano.com

Using a microfluidic device designed to capture and enrich cells from biological samples, a research team at The University of Texas at Austin has developed a test that can detect an important early marker for oral squamous cell carcinoma, which accounts for more than 90 percent of oral cancers. Oral cancer is the sixth most common cancer worldwide and is difficult to detect early enough to treat successfully.

John McDevitt, Ph.D., led the research team that developed this microfluidic cell capture and interrogate device. The research appears in the journal Lab on a Chip.

The device is simple in design and use. The key component is an etched membrane that gently captures cells in biological fluids, such as saliva, flowing through microfluidic channels. Once captured on the membrane, the cells are exposed to a solution containing fluorescently labeled antibodies that bind specifically to epidermal growth factor receptor (EGFR), a protein found on the surface of tumors removed from 90 percent of oral cell carcinoma patients. Labeled cells, that is, those with EGFR, are readily visible using a standard fluoresence microscope. The entire assay takes less than 10 minutes to complete.

Research by other investigators has demonstrated that EGFR is present on cells during the early stages of tumor development. In addition, an EGFR-targeted antibody has been approved to treat oral squamous cell carcinoma, although the drug is not used widely to treat this form of cancer because of the difficulty in determining which patients would benefit from its use. With further development, this microfluidic device could provide the means for identifying such patients rapidly and inexpensively. The investigators note that this device should be suitable for rapidly measuring any tumor cell-surface biomarker.

Reference:
This work is detailed in the paper “Cell-based sensor for analysis of EGFR biomarker expression in oral cancer.” An abstract of this paper is available at http://nano.cancer.gov

August, 2007|Archive|

Combined 18F-fluorodeoxyglucose-positron emission tomography and computed tomography as a primary screening method for detecting second primary cancers and distant metastases in patients with head and neck cancer

  • 8/23/2007
  • South Korea
  • SY Kim et al.
  • Annals of Oncology, doi:10.1093/annonc/mdm270

Background:
The aim of this study was to evaluate the ability of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) to detect second primary cancers and distant metastases in patients with head and neck cancer (HNC).

Patients and methods:
Patients with previous untreated HNC, between 2004 and 2005, underwent head and neck CT and whole-body FDG-PET/CT, before and at fixed intervals after therapy, for staging and detection of second primary cancers and distant metastases. Patients with malignant or equivocal findings on FDG-PET/CT underwent further imaging, endoscopy and/or biopsy.

Results:
Of the 349 eligible patients (267 men and 82 women), 14 (4.0%) had second primary cancers and 26 (7.4%) had distant metastases at initial staging or during mean follow-up of 15 months after treatment. FDG-PET/CT correctly identified second cancers or distant metastases in 39 of these 40 patients; there was one false negative and 23 false positive FDG-PET/CT results. Therefore, FDG-PET/CT had a sensitivity of 97.5%, a specificity of 92.6%, a positive predictive value of 62.9% and a negative predictive value of 99.7% in detecting second primary cancers and distant metastases.

Conclusion:
Combined FDG-PET/CT is useful as a primary method for detecting second cancers and distant metastases in patients with HNC.

Authors:
SY Kim1, J-L Roh1,*, N-K Yeo1, JS Kim2, JH Lee3, S-H Choi1 and SY Nam1

Authors’ affiliations:
1 Department of Otolaryngology
2 Department of Nuclear Medicine
3 Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

August, 2007|Archive|

UCSF Scientists Aim to Use Saliva to Detect Oral Cancers

  • 8/23/2007
  • San Francisco, CA
  • Rachel Tompa
  • UCSFToday (pub.ucsf.edu/today)

Could scrutiny of spit save your life? Cancer researchers may soon know the answer.

More than 30,000 new cases of oral cancer are diagnosed each year in the US alone, many when it’s too late to prevent death. Dentists and hygienists find oral cancers during exams, but researchers at UCSF now are developing ways to detect cancers earlier — before tumors become visible to the naked eye.To do so they are examining telltale proteins in saliva.

Saliva, besides helping your digestion, reflects the state of your body. It contains the same proteins found in your blood, but at much lower levels. Cancers produce proteins abnormally. Cancer researchers have wondered if these abnormalities are reflected in a measurable way in the molecular contents of saliva as well as blood.

A few researchers who study oral cancer also have been intrigued by the possibility that relatively high levels of proteins and other molecules from oral cancer cells might end up in saliva.

Current methods for oral cancer detection are visual.The dentist and hygienist examine the mouth. Suspicious looking bumps or patches are sampled, so that on the microscopic scale a pathologist can look for cancerous cells. These biopsies are a useful screening tool, but they are time consuming. Furthermore, cutting out tissue can be painful for the patient.

Disease screening in saliva might prove to be faster, less invasive, and potentially less expensive than blood tests or biopsies, according to UCSF oral and maxillofacial surgeon Brian Schmidt, DDS, MD, PhD. Schmidt runs a research lab focused in part on molecular sleuthing in saliva. The tricky part, he says, is to reliably detect molecules of interest that may be present only in low amounts.

Modified DNA Points to Cancer Risk

While Schmidt and others in the lab track telltale proteins, Chi Viet, a second year dental student in Schmidt’s lab, examines DNA. She has discovered that it is possible to detect a certain form of DNA in the saliva of oral cancer patients that is not present in healthy patients.

Viet is looking at a specific DNA modification called methylation. Cancerous cells often have different patterns of DNA methylation in comparison to normal cells. Viet had the idea to test patterns of DNA methylation in the saliva of oral cancer patients.

Viet chose five genes that often become methylated in oral cancers. She measured and compared levels of DNA methylation in these specific genes in saliva and tissue, both in healthy patients and patients with oral cancer.

In cases where the genes were truly methylated in the tissue sample, Viet also detected methylation in saliva close to 80 percent of the time. That is not sensitive enough for a diagnostic test. She hopes to add more genes to this testing set to increase the detection rate to 100 percent. While Viet has not yet used this method to try to diagnose patients, these results give her hope that her test could become a useful diagnostic tool in the future.

Spitting to Save Lives

A successful saliva test could greatly improve oral cancer screening, according to Viet. Screening would be much easier, she says — anyone would rather spit in a cup than have a piece of their mouth cut out for a biopsy.

But beyond making patients happier, a saliva test would permit earlier screening that would be especially appropriate for high risk patients — smokers, for instance. If dentists can catch oral cancer before visible tumors or lesions appear, chances are better for long-term survival.

A saliva test also would be useful for early detection of oral cancers that grow back despite surgery and treatment. Oral cancer recurs in many cases, and the likelihood of survival falls when it does.

Unfortunately, patients who have had tumors removed from their mouths often are more difficult to screen visually. That’s because their mouths may have abnormal-looking features from previous tumors and surgeries. A saliva test for a cancer biomarker would greatly improve odds of catching recurrences before they spiral out of control, Schmidt explains.

Dentists Do Research

Viet’s interest in DNA methylation started long before her work on oral cancer. As an undergraduate at UC Davis, she studied the enzymes responsible for DNA methylation. Although she chose to pursue a career in dentistry, her interest in research did not wane.

“When I applied to dental school, I still had the mindset of continuing in research,” Viet says, “I talked to some people at UCSF about DNA methylation, but to no avail, because nobody in the school was doing anything with that.”

Viet decided to focus on oral cancer and to come to UCSF early for a summer research project in the Schmidt lab. Once here, however, she had the idea to incorporate her knowledge of DNA methylation into a test for oral cancer. “Brian was extremely supportive of me developing that assay,” she says.

“We thought it was kind of a stab in the dark,” Schmidt says. “But Chi was very enthusiastic about the project and it happened to work out very nicely.” Viet’s research presentation won first place at UCSF’s School of Dentistry Research Day in 2006. She also won the 2008 American Association for Dental Research (AADR) Johnson and Johnson Oral Health Products Hatton Award, junior category, at the AADR’s most recent annual meeting in March.

Viet plans to continue her research in the Schmidt lab while finishing her dental training.

August, 2007|Archive|

‘I’m sorry, said the doctor. I’m going to have to cut your throat’

  • 8/22/2007
  • Derbyshire, United Kingdom
  • Angela Brooks
  • DailyMail (www.dailymail.co.uk)

About 2,200 people a year are diagnosed with cancer of the voice-box, or larynx. In conventional surgery, the voice-box is removed, leaving patients unable to speak. But a new technique leaves it intact.

The Patient – Roger Stone

My work involves travelling around the world. In February 2001, I was in Nigeria when I couldn’t shake off a sore throat.

When I got back home five months later, my GP prescribed antibiotics, but the sore throat continued over the summer when I went to work in Mozambique.

By the time I went back to see my GP four months later, swallowing had become painful. He noticed the lymph nodes in my neck were swollen and referred me to a specialist at Derbyshire Royal Infirmary.

Mr Sean Mortimore, an ear, nose and throat surgeon, examined my throat and said I needed a biopsy, where pieces of tissue are removed under a general anaesthetic for laboratory testing.

When he asked if I could come in for it the next day, alarm bells started ringing.

As soon as I came round, I asked Mr Mortimore straight out whether he had found a malignancy on my larynx. He told me they wouldn’t know for certain until they got the results back from the laboratory a couple of weeks later.

My results came back on Christmas Eve and I had an appointment with Mr Mortimore the same day. He introduced the Macmillan cancer nurse specialist to me as soon I came into the room, but I had already prepared myself for the worst.

I had a medium-sized cancer of the epiglottis – part of the voice-box on top of the vocal cords. It was probably caused by heavy smoking – I was on 20 cigarettes a day at the time – and drinking.

I feared I’d need a total laryngectomy – I’d lose my voice-box and be left mute. But Mr Mortimore suggested a new technique: minimally invasive laser surgery to cut out the laryngeal tumour.

The lymph nodes in my neck – where the cancer had also spread – would still need to be removed with open surgery.

Laser surgery minimises the loss of healthy tissue around the tumour because instead of removing the whole voice-box, the tumour is pared away inside the throat, with blood vessels being sealed along the way.

I was worried about the cutting around my neck to remove the lymph nodes because there was a risk of paralysis in my face.

During the third week of January 2002, Iwent into hospital. I woke up in intensive care two days after the 12-hour operation. I had a lot of lines coming in and out of me. My face and neck were swollen and bruised.

The surgeon had slit my throat to remove the lymph nodes, so I had stitches across my throat and up to my ears. I felt grim for several weeks.

My epiglottis had been removed and, as this is vital for swallowing, I had intensive therapy to help me use other muscles instead.

Fortunately, my voice wasn’t affected long-term, though it was weaker at first.

For the two-and-a-half weeks I was in hospital and then for more than a month after I was home, I was fed through a tube in my stomach. It was three months before I was on proper food and the tube was removed.

I then had six weeks of radiotherapy to zap any stray cancer cells. My final appointment is this Christmas Eve. I feel as fit as I did before my surgery, except for some slight numbness on one side of my face.

I know the cancer may recur in ten to 20 years, but I’ve had a superb team looking after me and I’ve had more years than I should anyway.

The Surgeon – Sean Mortimore (ENT)

Sean Mortimore, consultant ear, nose and throat surgeon at Derbyshire Royal Infirmary, says: MEN outnumber women five to one in getting cancer of the larynx or voice-box. It is five to seven times more common in people who drink or smoke, and 35 times more common in people who do both.

Early symptoms may include a sore throat, hoarseness, difficulty in swallowing and earache.

The larynx is at the top of the windpipe, and the food pipe or gullet is behind it. The larynx prevents food from entering the windpipe and going into the lungs. Its secondary function is voice production.

The larynx is divided into three parts: the vocal cords (the glottis), the subglottis and the supraglottis.

Roger’s cancer developed in the epiglottis, part of the supraglottis, and had spread to the tongue.

With large tumours, laryngectomy (complete removal of the voice-box) may be necessary; otherwise we try to remove just the cancerous tissue. THIS still leaves patients hoarse, either because we’ve needed to remove tissue or because of scarring.

For small tumours, radiotherapy alone can be enough. For intermediate tumours – such as Roger’s – surgery is advised, sometimes followed by radiotherapy.

Transoral C02 laser resection is minimally invasive surgery to remove the tumour. It is available at only about ten NHS hospitals.

This spares the voice-box and preserves the voice, as we just remove the malignant tissues inside it.

With the patient anaesthetised, the anaesthetist slips a slim breathing tube down their throat. I then put a laryngoscope – a titanium pipe – down the windpipe and examine the tumour through a microscope. All the instruments we use, including the laser, are fed through the pipe.

We cut through the tumour with the laser. With forceps in one hand, I hold the tumour and with a joystick in the other I manoeuvre the beam to cut out the cancerous tissue.

No internal stitches are necessary because the raw tissue seals over itself.

If the cancer has spread to the lymph nodes on either side of the neck – as in Roger’s case – we strip those out next. This is done through an incision from behind the ear across the front of the throat. We close the skin with stitches. This is major surgery, so patients recover for a couple of days in intensive care.

The speech and swallowing therapist is critical in helping patients build up other muscles in the throat to compensate for those removed in surgery.

The success rate for small tumours (treated by radiotherapy only) is 90 to 95 per cent, for intermediate ones it is 70 per cent, and for large tumours, it drops to below 50 per cent.

Laser surgery for intermediate tumours isn’t better than conventional surgery as a cure, but it does spare the patient’s voice.

Transoral C02 laser surgery costs the NHS £20,000. Few private hospitals are equipped to do it.

August, 2007|Archive|