Monthly Archives: September 2009

High incidence of multiple primary carcinomas in HCV-infected patients with oral squamous cell carcinoma

Source: Med Sci Monit, September 1, 2009; 15(9)
Authors: Y Nagao and M Sata

Hepatitis C virus (HCV) infection has been associated with several extrahepatic manifestations. Oral cancer is one of them. We investigated the association among oral squamous cell carcinoma (OSCC), multiple primary cancers (MPCs), insulin resistance and HCV infection.

Upper gastrointestinal tract examination and determination of the presence of HCV infection were routinely done for 60 primary OSCC patients. Occurrence of MPCs was evaluated between 1992 and 2008.

Of the 60 patients, 21 (35%: 15 males and 6 females; mean age 67.3+/-11.9 years) developed MPCs. Antibodies to HCV were found in 26.7% (16/60) of cases. The incidence of MPCs in HCV-infected OSCC cases was 62.5% (10/16 cases, P<0.01 vs the non-HCV-infected OSCC group); for cases without HCV infection it was 25% (11/44 cases). In HCV-infected cases, 10 MPCs with patients, hepatocellular carcinoma (HCC) was the most common outcome (5 cases), whereas gastric cancer was the most common outcome (6 cases) in non-HCV-infected 11 MPCs. In logistic regression analysis, the adjusted odds ratios on staging IV, anti-HCV positive, and over 70 years old were 15.50, 13.45, and 4.46, respectively, indicating that there were significant differences. Furthermore, the patients with HCV-infected MPCs had hyperinsulinemia.

HCV infection was strongly associated with the occurrence of MPCs as well as primary OSCC. HCV-infected OSCC patients in Japan should receive medical treatment to inhibit development of HCC. In patients with HCV infection, it is important to clinically examine organs other than the liver.

Authors’ affiliation:
Department of Digestive Disease Information & Research, Kurume University School of Medicine, Kurume, Japan.

September, 2009|Oral Cancer News|

Group acupuncture to relieve radiation induced xerostomia: a feasibility study

Source: Acupuncture in Medicine 2009;27:109-113
Author: Richard Simcock et al.

A distressing complication of radiotherapy treatment for head and neck cancer is xerostomia (chronic oral dryness). Xerostomia is difficult to treat conventionally but there are reports that acupuncture can help. We conducted a feasibility study to examine the acceptability of a standardised group acupuncture technique and adherence to group sessions, together with acceptability of the objective and subjective measurements of xerostomia.

12 males with established radiation induced xerostomia were treated in three groups of four. Each received eight weekly sessions of acupuncture using four bilateral acupuncture points (Salivary Gland 2; Modified Point Zero; Shen Men and one point in the distal radial aspect of each index finger (LI1)). Sialometry and quality of life assessments were performed at baseline and at the end of treatment. A semi-structured interview was conducted a week after completing the intervention.

Adherence to and acceptability of the treatment and assessments was 100%. There were objective increases in the amounts of saliva produced for 6/12 patients post intervention and the majority also reported subjective improvements. Mean quality of life scores for domains related to salivation and xerostomia also showed improvement. At baseline 92% (11/12) patients reported experiencing a dry mouth “quite a bit/very much” as compared to 42% (5/12) after the treatment. Qualitative data revealed that the patients enjoyed the sessions.

Conclusion: The pilot study shows that a standardised group technique is deliverable and effective. The tools for objective and subjective assessment are appropriate and acceptable. Further examination in a randomised trial is now warranted.

Richard Simcock1, Lesley Fallowfield2, Valerie Jenkins2

Authors’ affiliations:
1 Brighton & Sussex University Hospitals Trust, Brighton, East Sussex, UK
2 Cancer Research UK Psychosocial Oncology Group, Brighton & Sussex Medical School, University of Sussex, Brighton, East Sussex, UK

September, 2009|Oral Cancer News|

HPV virus linked to some forms of breast cancer, vaccine may help

Author: staff

Scientists working out of the University of South Wales have found that a vaccine for the HPV virus could prevent some forms of breast cancer. The study proves another important link between viral infections and more complex disease.

Researchers around the world are finding remarkable connections between common viral infections and the later onset of complex and life-threatening diseases. Recent stories have found viral links to prostate cancer, to Parkinson’s disease, to skin cancer, to mouth cancer, and to autism and schizophrenia.

Some forms of breast cancer can now be added to this list. Australian scientists working out of the University of South Wales announced an important link between the very common HPV virus and a variety of breast cancers. Their findings suggest that an HPV vaccine could prevent these cancers from presenting themselves years later.

The research suggests that tens of thousands of lives could be saved every year by administering the HPV vaccine to young females.

The HPV virus is the most commonly distributed sexually transmitted disease, and it is well known to have a direct causal relationship with 90 to 95 percent of all cervical cancers. It has also been linked to mouth cancers.
The study linking the HPV virus to these breast cancers was published in the British Journal of Cancer and was conducted using genetic probes of cancerous breast cells. The scientists were able to confirm the presence of HPV nuclei across a variety of tissues sampled.

“The finding that high risk HPV is present in a significant number of breast cancers indicates they may have a causal role in many breast cancers,” UNSW researcher, Dr Noel Whitaker, a co-author of the new report told Science Daily. “Confirming a cancer-causing role for HPV in some breast cancers establishes the possibility of preventing some breast cancers by vaccination against HPV.”

Worldwide, 1.1 million women were newly diagnosed with breast cancer in 2004 – and 500,000 women lost their lives to the disease in the same year.

September, 2009|Oral Cancer News|

Surfers’ Hall Of Fame to honor Chris Hawk on September 18th

Author: press release

In a special tribute to one of the southland’s legendary surfer-shapers, the Surfers’ Hall of Fame is set to induct Chris Hawk at 10 a.m. on Friday, September 18, 2009. The induction ceremony – which will include the traditional “hands and feet” in cement and presentation of the coveted Surfers’ Hall of Fame trophy – will take place in front of Huntington Surf & Sport (corner of PCH and Main).

According to Aaron Pai, Surfers’ Hall of Fame Founder, the unusual timing of the induction is due to Chris’ terminal illness (he is suffering from throat cancer). “Chris Hawk is a local surf legend of Huntington Beach,” said Pai. “Back in the day he was one of the best surfers in Huntington Beach and he has been a master shaper since the 70’s. We are super stoked to be able to induct Chris Hawk into the Surfers’ Hall of Fame.”

As one of the renowned Hawk brothers surfing clan that includes Sam and Tom, Chris helped shape the Huntington Beach surf culture in the 1960s and ’70s. While the brothers often travelled to Hawaii and charged Sunset and Pipeline, Chris chose to make his mark as a master surfboard shaper.

During one of these famous Hawaiian trips, Chris met legendary shaper Dick Brewer and was taken under his tutorage alongside Reno Abellira and Davie Abbott. Chris soon became a household name on the mainland and the “go to” guy for many hard-core surfers up and down the California coast for years and years.

Chris was recently diagnosed with throat cancer and began his fight against this terrible disease. Now immersed in a debilitating chemotherapy treatment program, doctors have prohibited Chris from shaping or engaging in any type of physical activity.

In 1997 the Surfers’ Hall of Fame celebrated its first induction inside of specialty retailer Huntington Surf & Sport where several slabs remain. Four years later with the blessing of the City Council and a stunning bronze statue of sport’s spiritual leader Duke Kahanamoku serving as a backdrop, the ceremony moved outside to the corner of PCH and Main; less than 100 feet from the famed Huntington Beach Pier.

Chris Hawk’s Surfers’ Hall of Fame induction ceremony is open to the public, free-of-charge. Further information is available at

September, 2009|Oral Cancer News|

Comparison of genotoxic effect between smokeless tobacco (Maras powder) users and cigarette smokers by the alkaline comet assay

Authors: S Sardas et al.

Maras powder (MP) is a kind of smokeless tobacco used in the south-eastern region of Turkey and in several other countries of Middle and Far East. The present study was performed to assess the impacts of MP and cigarette smoking on the possible DNA damaging effect.

Alkaline comet assay, which is a reliable and an important tool in human biomonitoring studies in the area of genetic toxicology, was used in peripheral lymphocytes of MP users, cigarette smokers, and non-smokers while their frequencies of total comet scores (TCS) were evaluated. The mean TCS (±SD) frequency in the peripheral lymphocytes was 14.4 (±10.04) for MP users and 8.26 (±5.38), 5.94 (±3.87) for cigarette smokers (P < 0.05) and non-smoking control subjects, respectively (P < 0.001). There was no significant effect of daily consumption of MP and the duration of MP usage on comet frequencies. In reply to a wrong belief among MP users ("the use of smokeless tobacco product is substantially less hazardous than cigarettes"), the present study shows that the oral use of smokeless tobacco represents a genotoxic hazard which is even higher than the DNA damage observed in cigarette smokers. Therefore, habitual use of MP should be taken into account and could be considered unsafe, equally harmful, and it should not be viewed as a safe alternative to cigarettes. Authors: S Sardas1, B Cimen2, S Karsli1, T Yurdun1, L Donbak3 Authors' affiliations: 1. Department of Toxicology, Faculty of Pharmacy, Marmara University, Istanbul, Turkey 2. Department of Biochemistry, Faculty of Pharmacy, Erciyes University, Kayseri, Turkey 3. Department of Biology, Division of Molecular Biology, Faculty of Sciences, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey

September, 2009|Oral Cancer News|

Ipsilateral irradiation for well lateralized carcinomas of the oral cavity and oropharynx: results on tumor control and xerostomia

Source: Radiation Oncology 2009, 4:33
Authors: Laura Cerezo et al.

In head and neck cancer, bilateral neck irradiation is the standard approach for many tumor locations and stages. Increasing knowledge on the pattern of nodal invasion leads to more precise targeting and normal tissue sparing.

The aim of the present study was to evaluate the morbidity and tumor control for patients with well lateralized squamous cell carcinomas of the oral cavity and oropharynx treated with ipsilateral radiotherapy.

Twenty consecutive patients with lateralized carcinomas of the oral cavity and oropharynx were treated with a prospective management approach using ipsilateral irradiation between 2000 and 2007. This included 8 radical oropharyngeal and 12 postoperative oral cavity carcinomas, with Stage T1-T2, N0-N2b disease.

The actuarial freedom from contralateral nodal recurrence was determined. Late xerostomia was evaluated using the European Organization for Research and Treatment of Cancer QLQ-H&N35 questionnaire and the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 3.

At a median follow-up of 58 months, five-year overall survival and loco-regional control rates were 82.5% and 100%, respectively.

No local or contralateral nodal recurrences were observed. Mean dose to the contralateral parotid gland was 4.72 Gy and to the contralateral submandibular gland was 15.30 Gy.

Mean score for dry mouth was 28.1 on the 0-100 QLQ-H&N35 scale. According to CTCAE v3 scale, 87.5% of patients had grade 0-1 and 12.5% grade 2 subjective xerostomia.

The unstimulated salivary flow was >0.2 ml/min in 81.2% of patients and 0.1-0.2 ml/min in 19%. None of the patients showed grade 3 xerostomia.

In selected patients with early and moderate stages, well lateralized oral and oropharyngeal carcinomas, ipsilateral irradiation treatment of the primary site and ipsilateral neck spares salivary gland function without compromising loco-regional control.

Laura Cerezo, Margarita Martin, Mario Lopez, Alicia Marin, Alberto Gomez

September, 2009|Oral Cancer News|

Analysis of factors influencing dysphagia severity following treatment of head and neck cancer

Source: Anticancer Res, August 1, 2009; 29(8): 3299-304
Authors: NP Nguyen et al.

The aim was to assess the influence of treatment, tumor stages and sites on the severity of dysphagia following treatment. Sequential modified barium swallow (MBS) examinations were performed in patients who complained of chronic dysphagia following treatment of their head and neck cancer.

Patients were selected if they were cancer free at their last MBS and had 2 or more MBS studies. Dysphagia severity was graded on a scale of 1 to 7. Dysphagia grade was compared between the first and last MBS to assess its evolution.

Between 1996 and 2005, 63 patients with chronic dysphagia underwent MBS to assess dysphagia severity for nutritional support. Twenty-one patients (33%) had improvement of their dysphagia. Two of these patients (3%) achieved normalization of the swallowing. Twenty-five patients (40%) had no change of the dysphagia severity. Dysphagia grade increased in 17 patients (27%). Analysis of patient characteristics did not show any significant difference between these three groups of patients.

MBS is a useful tool to monitor dysphagia severity and to identify aspiration risk. Stages of disease and treatment modality do not seem to impact on the course of dysphagia.

NP Nguyen, C Frank, CC Moltz, U Karlsson, PD Nguyen, HW Ward, P Vos, HJ Smith, S Huang, LM Nguyen, C Lemanski, A Ludin, and S Sallah

Authors’ affiliation:
Radiation Oncology Department, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ 85724-5081, US

September, 2009|Oral Cancer News|

Tobacco giants challenge law

Author: David Kesmodel, Lauren Etter & Alicia Mundy

Reynolds American Inc., Lorillard Inc. and several other tobacco companies filed a lawsuit Monday seeking to block various provisions of a new federal tobacco law on the grounds that the provisions violate the companies’ First Amendment rights.

The tobacco companies said the recently enacted law, which placed the industry under the oversight of the Food and Drug Administration, sharply restricts the companies’ right to advertise their products to adult tobacco users.

The companies object to such provisions as a requirement that cigarette makers expand the size of warning labels so that they cover the top half of the front and back of cigarette packs, and include graphic images such as diseased lungs. This change, they say, would leave manufacturers with only a small and often-obscured portion of a cigarette pack to print their own messages.

The companies also challenged a rule that restricts their ability to publicize the relative health risks of certain products such as smokeless tobacco.

The suit was filed against the FDA in a federal district court in Bowling Green, Ky., the home of one of the plaintiffs, Commonwealth Brands Inc. An FDA spokeswoman said the agency doesn’t comment on lawsuits.

The FDA recently announced that its choice for its “tobacco czar” to run the new tobacco regulation center is Lawrence Deyton, who led antismoking efforts at the Department of Veterans Affairs. Many of the FDA regulations won’t take effect until next year and the years that follow.

Altria Group Inc., the maker of Marlboro cigarettes, is absent from the lawsuit. The largest U.S. cigarette maker by sales has expressed concerns in the past about how the bill might restrict free speech and advertising, even though it generally supported the overall FDA bill. A spokesman for Altria declined to comment on the lawsuit, but said that “our goal is to work constructively with the FDA around some of our concerns.”

In the lawsuit, the companies say they aren’t challenging the provisions of the law that directly address tobacco sales to minors. “The case will be about whether Congress has gone too far about preventing tobacco companies from communicating with adults, and keeping adults from receiving the information that tobacco companies want to send to them,” said Floyd Abrams, a First Amendment lawyer representing Lorillard, the maker of Newport cigarettes.

Mr. Abrams, of Cahill Gordon & Reindel LLP in New York, said so-called tombstone provisions requiring tobacco packages to show large images reflecting the long-term health risks associated with cigarette smoking violate First Amendment rights because cigarette makers would only be able to promote their products on the bottom half of each side of a package. That part of cigarette packs, he noted, is often obstructed from the view of a customer at a retailer.

Another major complaint by tobacco companies is that they are barred from making truthful statements about the relative health risks of tobacco products if the FDA determines that such statements wouldn’t benefit the health of the U.S. population as a whole. The issue could be of importance to companies such as Reynolds that make smokeless tobacco products, like Camel Snus, a type of spit-free smokeless tobacco. Some research has shown that such products are less harmful than cigarettes because they generally contain fewer carcinogens and don’t enter the lungs.

Advertisers are also rankled by a provision that requires sponsors of sports, cultural or musical events such as rock concerts to mention only the company’s corporate name in their promotions, not its tobacco products.

“The law contains provisions that severely restrict the few remaining channels we have to communicate with adult tobacco consumers,” Martin L. Holton III, general counsel for Reynolds, maker of Camel cigarettes, said in prepared remarks.

The plaintiffs include R.J. Reynolds Tobacco Co., Reynolds subsidiary Conwood Co., Lorillard, Commonwealth Brands, Discount Tobacco City & Lottery Inc. and National Tobacco Co.

President Barack Obama signed the new legislation into law in June. Last month, the FDA said it is forming a 12-person panel to advise the agency on certain areas of overseeing the industry, including the use of descriptions such as “light” on tobacco products and the impact of menthol in cigarettes.

The Association of National Advertisers, the Washington lobby for the advertising industry, said earlier this year that First Amendment issues would probably undo parts of the tobacco regulation bill by provoking suits that could delay the law’s implementation.

The advertising industry is watching the issue closely to see how any court ruling could impact not only the tobacco industry, but other industries as well. This case “is extremely significant,” said Dan Jaffe, executive vice president of the advertising lobby.

September, 2009|Oral Cancer News|

Unlocking the body’s defenses against cancer

Author: staff

Scientists have discovered a way of allowing healthy cells to take charge of cancerous cells and stop them developing into tumours in what could provide a new approach to treating early-stage cancers.

University of Manchester researchers found that a special type of the chemicals known as ‘kinase inhibitors’ opened up communication channels on the surface of cells that enabled healthy cells to ‘talk’ to the cancer cells.

“When we added the chemicals to a mixture of healthy and cancerous cells in a flask the diseased cells stopped multiplying and began acting like normal cells again,” said Dr Ian Hampson, who carried out the research with wife Dr Lynne Hampson.

“Further tests revealed that the chemicals helped the cancer cells form connections with surrounding healthy cells that allowed these normal cells to take charge of the mechanism by which cancer cells divide and grow out of control.”

Cell division occurs naturally and continuously in human organs and tissue as part of the body’s normal repair processes to combat wear and tear but in cancer the cells divide in an uncontrolled way.

Dr Hampson says the findings, published in the British Journal of Cancer, are all the more exciting because the chemicals, which were developed with colleagues at the University of Salford, appear to be relatively non-toxic and the positive effect on the cancer cells persists even when the chemicals are withdrawn.

“When the chemicals were added to a culture containing just cancer cells they had little effect,” said Dr Hampson, who is based in Manchester’s School of Cancer and Imaging Sciences. “It was only when we added the chemicals to a mixture of cancer cells and normal cells – similar to how you would find them in the body – that growth was suppressed.

“Intriguingly, the connections that allowed the healthy cells to communicate with the cancer cells stayed open even when the kinase inhibitors were removed indicating that a potential drug based on these chemicals could be given as a short course of treatment.

“Furthermore, the chemicals are non-poisonous and do not actually kill cells like conventional cancer therapies, such as chemotherapy and radiotherapy, so if we were able to develop a drug it is likely to have far fewer side-effects.”

The team say the next stage of their research will be to find out exactly how the chemicals are able to increase the number of connections between cancer and normal cells. Once this is known, it should be possible to produce a drug based on these chemicals that could hopefully be used in humans.

Dr Lynne Hampson added: “We are currently applying for funding to carry out further research into the biochemistry of how these chemicals cause the effect we have observed. We also intend to investigate the use of different types of cell cultures to assess the potency and range of activity of these agents.”

The research was funded by the Association for International Cancer Research, The Humane Research Trust, The Caring Cancer Research Trust, Kidscan and the Cancer Prevention Research Trust.

1. The chemicals that have been developed are a type of kinase inhibitor. Kinases are a specific form of enzyme that uses a phosphate molecule to speed up biological processes in the body. Chemicals that block the actions of kinases are known as kinase inhibitors.

University of Manchester

September, 2009|Oral Cancer News|

National guideline released for the treatment of hoarseness

Author: press release

New recommendations from ENT doctors on the management of a common voice problem in adults and children

The American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) will issue the first–and only–national clinical practice guideline to help healthcare practitioners identify and manage patients with hoarseness, also known as dysphonia. The guideline emphasizes evidence-based management of hoarseness by clinicians, and educates patients on the prevalence of this common vocal health issue.

“Hoarseness affects approximately 20 million people in the U.S. at any given time, and about one in three individuals will become hoarse at some point in their life,” said Richard M. Rosenfeld, MD, MPH, an author of the guideline and chair of the AAO-HNSF Guideline Development Task Force. “In addition to the impact on health and quality of life, hoarseness leads to frequent healthcare visits and several billion dollars in lost productivity annually from work absenteeism.”

The terms hoarseness and dysphonia are often used interchangeably, however, hoarseness is a symptom of altered voice quality and dysphonia is a diagnosis. Hoarseness (dysphonia) is defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life. Hoarseness may affect newborns, infants, children, and adults of any age. Individuals with hoarseness have impaired communication with their family and peers, which may result in depression, social isolation, missed work, lost wages, or reduced quality of life.

“Most hoarseness is caused by benign or self-limiting conditions, but it may also be the presenting symptom of a more serious or progressive condition requiring prompt diagnosis and management,” said Seth R. Schwartz, MD, MPH, chair of the Hoarseness Guideline Panel. “This new guideline is intended to enhance diagnosis, promote appropriate therapy, improve outcomes, and to expand counseling and education for prevention.”

Hoarseness is more common in women (50% higher than men), children (peak range 8-14 years), the elderly, and professional voice users (e.g., teachers, performers, telemarketers, aerobics instructors). In spite of how common the condition is, a recent survey by the AAO-HNS revealed that many Americans are unfamiliar with the possible causes and appropriate treatment for hoarseness. The survey revealed that almost half of adults are not aware that persistent hoarseness may be a symptom of cancer. Separate research cited in the guideline also found that only 5.9 percent of those with hoarseness seek treatment.

Recognizing that patients who do seek care may see many different types of healthcare providers, the guidelines are intended for all clinicians who are likely to diagnose and manage patients with hoarseness.

Key features of the new guideline include:

  • Most, but not all, hoarseness is the result of benign underlying or self-limiting factors; however, clinicians should consider the possibility of a serious underlying condition (growth or tumor of the larynx) or medication side effects as a cause.
  • Laryngoscopy is an office procedure to visualize the larynx (voice box and vocal cords) that should be performed if hoarseness persists or if the cause is uncertain.
  • Imaging studies, such as a CT or MRI scans, should not be obtained for a primary complaint of hoarseness prior to visualizing the larynx; laryngoscopy is the primary diagnostic modality and should be done first.
  • Anti-reflux medicines should not be prescribed for hoarseness unless there are (a) signs or symptoms of gastroesophageal reflex disease (GERD), such as heartburn or regurgitation, or (b) signs of inflammation of the larynx seen during laryngoscopy.
  • Steroids or antibiotics given by mouth are not recommended for hoarseness and should not be used routinely.
  • Voice therapy is a well-established intervention for hoarseness that can be performed at any age. Laryngoscopy should be performed prior to voice therapy and results communicated to the speech-language pathologist. Therapy for hoarseness usually includes one to two sessions per week for four to eight weeks.
  • Surgery is not the primary treatment for most hoarseness, but may be indicated for suspected cancer, other tumors or growths, abnormal movement of the vocal cords, or abnormal tone of the vocal cord muscles.
  • The risk of hoarseness may be reduced by preventive measures such as staying well-hydrated, avoiding irritants (especially tobacco smoke), voice training, and amplification during heavy voice use.

“In an era of health reform and comparative effectiveness research, well-crafted guidelines help improve quality, promote optimal outcomes, minimize harm, and reduce inappropriate variations in care,” says Dr. Rosenfeld. “It is hoped that these guidelines will give clinicians the tools they need to spot an issue early, avoid poor outcomes, and reduce healthcare costs.”

The guideline was created by a multidisciplinary panel representing neurology, speech-language pathology, professional voice teaching, family medicine, pulmonology, geriatric medicine, nursing, internal medicine, otolaryngology – head and neck surgery, pediatric medicine, and consumers.

September, 2009|Oral Cancer News|