Monthly Archives: February 2010

Efficacy of the ViziLite System in the identification of oral lesions

Source: Sciencedirect
Author: Esther S. Oh DDS and Daniel M. Laskin DDS, MS

Purpose

Early detection of oral cancer is crucial in improving survival rate. To improve early detection, the use of a dilute acetic acid rinse and observation under a chemiluminescent light (ViziLite; Zila Pharmaceuticals, Phoenix, AZ) has been recommended. However, to date, the contributions of the individual components of the system have not been studied. The present study was done to investigate the efficacy of the individual components of the ViziLite system in providing improved visualization of early oral mucosal lesions.

Patients and Methods

A total of 100 patients, 39 males and 61 females, age 18 to 93 years (mean age, 44 years), who presented to the Virginia Commonwealth University School of Dentistry for dental screening were examined. There were 58 Caucasians, 29 African-Americans, 5 Hispanics, 6 Asians, and 2 of mixed ethnicity. Thirty-five patients smoked, 53 used alcohol, and 25 both smoked and drank. After written consent, the oral cavity was examined under incandescent light for soft tissue abnormalities. After 1-minute rinse with 1% acetic acid, the mouth was re-examined for additional mucosal abnormalities. Then, the mouth was examined once again using the ViziLite system’s chemiluminescent light. Any lesions detected by these 3 examinations that were clinically undiagnosable were brush biopsied (Oral CDx) for determination of cellular representation.

Results

In the original examination of the 100 patients, 57 clinically diagnosable benign lesions (eg, linea alba, leukoedema) and 29 clinically undiagnosable lesions were detected. After the rinse, 6 additional diagnosable lesions (linea alba) and 3 undiagnosable lesions were found. No additional lesions were detected with the chemiluminescent light. Of the 32 undiagnosable lesions that were brush biopsied, 2 were positive for atypical cellular characterization and warranted further investigation with a scalpel biopsy. Neither of these lesions was found to be premalignant or malignant.

Conclusion

Although the acid rinse accentuated some lesions, the overall detection rate was not significantly improved. The chemiluminescent light produced reflections that made visualization more difficult and thus was not beneficial.

February, 2010|Oral Cancer News|

Analysis of primary risk factors for oral cancer from select US states with increasing rates

Source: Tobacco Induced Diseases 2010, 8:5
Authors: Anthony BunnellNathan et al.

Objectives:
To examine the primary risk factor for oral cancer in the US, smoking and tobacco use, among the specific US states that experienced short-term increases in oral cancer incidence and mortality.

Methods:
Population-based data on oral cancer morbidity and mortality in the US were obtained from the National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results (SEER) database for analysis of recent trends. Data were also obtained from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) to measure current and former trends of tobacco usage.

To comprehensive measures of previous state tobacco use and tobacco-related policies, the Initial Outcomes Index (IOI, 1992-1993) and the Strength of Tobacco Control index (SoTC, 1999-2000) were also used for evaluation and comparison.

Results:
Analysis of the NCI-SEER data confirmed a previous report of geographic increases in oral cancer and demonstrated these were state-specific, were not regional, and were unrelated to previously observed increases among females and minorities.  Analysis of the CDC-BRFSS data revealed these states had relatively higher percentages of smokers currently, as well as historically.

In addition, analysis of the IOI and SoTC indexes suggest that many factors, including cigarette pricing, taxes and home or workplace bans, may have had significant influence on smoking prevalence in these areas. Trend analysis of these data uncovered a recent and significant reversal in smoking rates that suggest oral cancer incidence and mortality may also begin to decline in the near future.

Conclusion:
Due to the rising costs of health care in the US and the limited resources available for health prevention efforts, it is essential to organize and direct more effective efforts by public health officials and epidemiologists, as well as funding from local, state and federal governments, to reduce and eliminate identified health disparities.

This study provides evidence how these efforts may be directed to specific geographic areas, and towards the white males, previously thought to be unaffected by the increases in oral cancer among females and minorities.

Authors: Anthony BunnellNathan, PettitNicole, ReddoutKanika, SharmaSusan, O’MalleyMichelle, ChinoKarl Kingsley

February, 2010|Oral Cancer News|

Mayo oral cancer study shows full tumor genome

Source: www.eurekalert.org
Author: public release

Mayo Clinic researchers along with collaborators from Life Technologies are reporting on the application of a new approach for sequencing RNA to study cancer tumors. Their findings from a proof-of-principle study on oral carcinomas appear in the current issue of PLoS One, the online science journal.

To explore the advantages of massively parallel sequencing of genomic transcripts (RNA), the researchers used a novel, strand-specific sequencing method using matched tumors and normal tissues of three patients with the specific cancer. They also analyzed the genomic DNA from one of the tumor-normal pairs which revealed numerous chromosomal regions of gain and loss in the tumor sample.

The key finding of this work was that alterations in gene expression which can arise from a variety of genomic alterations frequently are driven by losses or gains in large chromosomal regions during tumor development.

In addition to the specific tumor findings, this study also demonstrated the value of this RNA sequencing (RNA-Seq) method. It will allow researchers to measure strand-specific expression across the entire sample’s transcriptome. This technology reveals far more detail about genome-wide transcription than traditional microarrays.

“This method allows us to investigate genetic changes at a level that we were never able to see before,” says David Smith, Ph.D., Mayo Clinic genomics researcher and corresponding author of the study. “This provides us with much more information about alterations during cancer development that could reveal important therapeutic targets. We can more completely understand the relationship between an individual’s genome and the alterations to that which result in disease.

This is a huge step in speed, detail and diagnostic power for the field of individualized medicine. This transforms how we are going to study cancer — and how we’re going to practice medicine — in the very near future.”

The urgency of this condition points to the need for more efficient technologies and methods. Head and neck cancers are the sixth most prevalent carcinomas in the world. Advanced stage oral and throat cancers have a five-year survival rate of only 50 percent in the United States. Information provided by these and continued studies will help to better characterize the molecular basis of cancer development. That information can hopefully define better therapeutic strategies for treating an individual’s specific cancer.

Note:
1. Additional audio and video resources, including comments by Dr. Smith, are available on the Mayo Clinic News Blog

February, 2010|Oral Cancer News|

SIBLING proteins may predict oral cancer

Source: www.scienceblog.com
Author: staff

The presence of certain proteins in premalignant oral lesions may predict oral cancer development, Medical College of Georgia researchers said.

SIBLINGs, or Small Integrin-Binding Ligand N-linked Glycoproteins, are a family of five proteins that help mineralize bone but can also spread cancer. SIBLINGs have been found in cancers including breast, lung, colon and prostate.

“Several years ago we discovered that three SIBLINGs — osteopontin, bone sialoprotein and dentin sialophosphoprotein — were expressed at significantly high levels in oral cancers,” said Dr. Kalu Ogbureke, an oral and maxillofacial pathologist in the MCG School of Dentistry. “Following that discovery, we began to research the potential role of SIBLINGs in oral lesions before they become invasive cancers.”

The study, published online this week in the journal Cancer, examined 60 archived surgical biopsies of precancerous lesions sent to MCG for diagnosis and the patients’ subsequent health information. Eighty-seven percent of the biopsies were positive for at least one SIBLING protein — which the researchers discovered can be good or bad, depending on the protein. For instance, they found that the protein, dentin sialophosphoprotein, increases oral cancer risk fourfold, while bone sialoprotein significantly decreases the risk.

“The proteins could be used as biomarkers to predict [the potential of a lesion to become cancerous],” said Dr. Ogbureke, the study’s lead author. “That is very significant, because we would then be in a position to modify treatment for the individual patient’s need in the near future.”

Precancerous oral lesions, which can develop in the cheek, tongue, gums and floor and roof of the mouth, are risk factors for oral squamous cell carcinoma, which accounts for over 95 percent of all oral and pharyngeal cancers. Oral cancer, the sixth most common cancer in the world, kills about 8,000 Americans annually, Dr. Ogbureke said.

Treatment has been stymied up to this point because of clinicians’ inability to predict which lesions will become cancerous. Surgery is standard for oral cancer, but treatment methods vary for precancerous lesions.

“When we treat these lesions now, there’s an implied risk of under- or over-treating patients,” Dr. Ogbureke said. “For example, should the entire lesion be surgically removed before we know its potential to become cancer, or should we wait and see if it becomes cancer before intervening?”

Further complicating the matter is that the severity of dysplasia, or abnormal cell growth, in a lesion can be totally unrelated to cancer risk. Some mild dysplasias can turn cancerous quickly while certain severe dysplasias can remain harmless indefinitely. The protein findings, which help eliminate the guesswork in such cases, “are fundamental,” Dr. Ogbureke said. “If we’re able to recognize these lesions early and biopsy them to determine their SIBLING profile, then oral cancer could be preventable and treatable very early.”

Dr. Ogbureke’s next step is to design a multi-center study that incorporates oral cancer risk factors, such as smoking and alcohol consumption, to further investigate their relationship with SIBLING protein expression.

February, 2010|Oral Cancer News|

Journal of Nuclear Medicine: 18F-FDG PET+CT cost-effective in screening head and neck cancer patients

Source: www.healthimaging.com
Author: staff

Whole-body 18F-FDG PET combined with chest CT is cost-effective in pretreatment screening for distant metastases in head and neck squamous cell carcinoma (HNSCC) patients with risk factors, according to a study published in the February issue of the Journal of Nuclear Medicine.

The presence of distant metastases at initial evaluation influences the prognosis and the treatment choice in HNSCC patients and hybrid PET/CT scanners was superior in sensitivity and cost effective when compared to FDG PET and CT alone, according to Otto S. Hoekstra, MD, PhD, of the VU University Medical Center in Amsterdam.

In the study, 145 patients underwent chest CT and whole-body 18F-FDG PET for screening of distant metastases. The researchers analyzed the cost data of 80 patients in whom distant metastases developed or who had a follow-up of at least 12 months.

Hoekstra said that cost-effectiveness analysis, including sensitivity analysis, was performed to compare the results of 18F-FDG PET, CT and a combination of CT and 18F-FDG PET.

Hoekstra and colleagues identified distant metastases in 21 percent of patients by pretreatment screening.

According to Hoekstra and colleagues, CT plus 18F-FDG PET had the highest sensitivity of 63 percent, while 18F-FDG PET had a sensitivity of 53 percent versus 37 percent with CTand positive predictive value of 80 percent versus 75 percent with CT.

“CT + 18F-FDG PET resulted in savings between €203 ($303) and €604 ($903) ”, wrote Hoekstra and colleagues.

The average costs in the CT + 18F-FDG PET group was found to be €37,954 ($56,801) in the first year after screening, € 38,558 ( $57,705) with CT alone and €38,355 ($57,402) with 18F-FDG PET alone.

The prices of 18F-FDG PET and hospital days could differ between countries and could be higher in other countries, noted Hoekstra and colleagues. However, “the most important value of 18F-FDG PET lies in offering patients a better (and more efficient) diagnostic strategy,” concluded Hoekstra and colleagues.

February, 2010|Oral Cancer News|

Oral Cancer Foundation donates screening devices to West Virginia Free Clinics

Source: www.prnewswire.com
Author: press release

In 2009 the Oral Cancer Foundation initiated a program of donating VELscope® Oral Cancer Screening Systems to free clinics. The most recent recipients of this program are two West Virginia clinics: WV Health Right in Charleston, and the Susan Dew Hoff Memorial Clinic in West Milford.

“Our intent is to identify free clinics in areas that have a high concentration of people who are both at risk for oral cancer and without the financial means to pay for comprehensive oral exams,” said Oral Cancer Foundation founder and executive director Brian Hill. “It is difficult to think of an area that better fits those criteria than West Virginia.” The state ranks highest in the country in tobacco usage, and next-to-last in per capita income. In identifying free clinics to be potential recipients of the device which identifies loss of tissue auto-fluorescence, an indicator of abnormal tissues, the Oral Cancer Foundation is careful to ensure that each candidate clinic has at least one dentist on staff who can be trained to use the device and can train other staff members.

Oral cancer belongs to the head and neck cancer group, and is often referred to by other names such as; tongue cancer, mouth cancer, tonsil cancer, lip cancer, and throat cancer. While some people think this is a rare cancer, it is not. Approximately 100 people in the U.S. will be newly diagnosed with oral cancer each day, and it takes a life in the U.S. every hour of every day.

WV Health Right was founded in 1982 by a small group of physicians and nurses who recognized the need for a source of ongoing health care for Charleston’s low-income uninsured. The clinic has grown so much since its’ founding that it is now in its third location. In 2001, it added a three-unit dental operatory, making it West Virginia’s first free dental clinic. It now serves almost 20,000 patients per year thanks to over 180 medical and dental professional volunteers.

According to WV Health Right executive director Patricia White, “West Virginia has some of the worst oral health statistics in the country, in large part because of the relatively high percentage of residents who are spit tobacco users and smokers.” Because of the well-established connection between tobacco usage and oral cancer, WV Health Right’s dental clinic has always insisted on giving all patients a conventional oral cancer examination regardless of their reason for visiting the clinic. The conventional exam is a manual palpation and visual inspection of the oral cavity and the neck. “Now,” says Ms. White, “our clinicians can also view the oral cavity using fluorescence visualization technology, which will enhance our ability to detect cancerous and pre-cancerous lesions that might be hard to see with the naked eye.”

The Susan Dew Hoff Memorial Clinic serves over 1,800 active patients in West Virginia’s Harrison County. Volunteers include five dentists, five dental assistants, and one hygienist. Roughly half of the patients are employed but without health insurance, while the other half are elderly and rely largely on Medicare.

“A high percentage of our patients use chewing tobacco, smoking tobacco or both,” said clinic director Sister Mary Rebecca Fidler, Ph. D., RSM. “If patients have cancer or any other serious condition, they will want to know about it at the earliest possible time, when survival rates are the highest, and treatment related morbidity the lowest,” she said. She added, “Up until now, we’ve discovered oral lesions on several patients merely by having our clinicians examine them using a visual and tactile conventional screening. Now, with this technology, we look forward to doing not only a better job of detecting early stage oral cancer, but even pre-cancerous tissues changes.”

In the words of the Oral Cancer Foundation’s Hill, “The key to reducing the death rate of oral cancer is earlier detection, and the key to that is for all adults to receive opportunistic oral cancer examinations at least once a year.” Mr. Hill pointed out that tobacco users, heavy alcohol users, and those with a prior history of cancer should be examined more frequently Even people who do not share those traits should be examined annually in light of the mounting evidence of a link between oral cancer and the sexually-transmitted human papilloma virus.

Peter Whitehead, founder and chief executive officer of VELscope manufacturer LED Dental, said, “When we started our company, our goal was to help achieve a significant reduction in the incidence of oral cancer, by elucidating pre-malignant tissue abnormalities. Unfortunately, many times the people who are most at risk for the disease are also the people who cannot afford the regular dental exams that can allow us to discover these early or pre-malignant changes.” According to Mr. Whitehead, “Now, thanks to the efforts of the Oral Cancer Foundation, our potentially life-saving technology is able to reach people we otherwise would likely have missed. Our relationship with OCF in this effort speaks to the core reasons that most of us at LED worked in the arena of adapting high technologies to enable better outcomes in the area of oral cancer. We could not be more pleased to see our technology end up in these underserved areas.”

About the Oral Cancer Foundation: The Oral Cancer Foundation, founded by oral cancer survivor Brian R. Hill, is a non-profit 501(c)(3) public service charity that provides information, patient support, sponsorship of research, and advocacy related to this disease. It maintains a Web site at http://www.oralcancer.org, which receives millions of hits per month. At the forefront of this year’s agenda is the drive to promote solid awareness in the minds of the American public about the need to undergo an annual oral cancer screening, and an outreach to the dental community to provide this service as a matter of routine practice. Supporting the foundation’s goals is a scientific advisory board composed of leading cancer authorities from varied medical and dental specialties, and from prominent educational, treatment, and research institutions in the United States.

Source: Oral Cancer Foundation

Roger Ebert: the essential man

Source: Esquire Magazine
Author: Chris Jones

It has been nearly four years since Roger Ebert lost his lower jaw and his ability to speak. Now television’s most famous movie critic is rarely seen and never heard, but his words have never stopped.

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For the 281st time in the last ten months Roger Ebert is sitting down to watch a movie in the Lake Street Screening Room, on the sixteenth floor of what used to pass for a skyscraper in the Loop. Ebert’s been coming to it for nearly thirty years, along with the rest of Chicago’s increasingly venerable collection of movie critics. More than a dozen of them are here this afternoon, sitting together in the dark. Some of them look as though they plan on camping out, with their coats, blankets, lunches, and laptops spread out on the seats around them.

The critics might watch three or four movies in a single day, and they have rules and rituals along with their lunches to make it through. The small, fabric-walled room has forty-nine purple seats in it; Ebert always occupies the aisle seat in the last row, closest to the door. His wife, Chaz, in her capacity as vice-president of the Ebert Company, sits two seats over, closer to the middle, next to a little table. She’s sitting there now, drinking from a tall paper cup. Michael Phillips, Ebert’s bearded, bespectacled replacement on At the Movies, is on the other side of the room, one row down. The guy who used to write under the name Capone for Ain’t It Cool News leans against the far wall. Jonathan Rosenbaum and Peter Sobczynski, dressed in black, are down front.

“Too close for me,” Ebert writes in his small spiral notebook.

Today, Ebert’s decided he has the time and energy to watch only one film, Pedro Almodóvar’s new Spanish-language movie, Broken Embraces. It stars Penélope Cruz. Steve Kraus, the house projectionist, is busy pulling seven reels out of a cardboard box and threading them through twin Simplex projectors.

Unlike the others, Ebert, sixty-seven, hasn’t brought much survival gear with him: a small bottle of Evian moisturizing spray with a pink cap; some Kleenex; his spiral notebook and a blue fine-tip pen. He’s wearing jeans that are falling off him at the waist, a pair of New Balance sneakers, and a blue cardigan zipped up over the bandages around his neck. His seat is worn soft and reclines a little, which he likes. He likes, too, for the seat in front of him to remain empty, so that he can prop his left foot onto its armrest; otherwise his back and shoulders can’t take the strain of a feature-length sitting anymore.

The lights go down. Kraus starts the movie. Subtitles run along the bottom of the screen. The movie is about a film director, Harry Caine, who has lost his sight. Caine reads and makes love by touch, and he writes and edits his films by sound. “Films have to be finished, even if you do it blindly,” someone in the movie says. It’s a quirky, complex, beautiful little film, and Ebert loves it. He radiates kid joy. Throughout the screening, he takes excited notes — references to other movies, snatches of dialogue, meditations on Almodóvar’s symbolism and his use of the color red. Ebert scribbles constantly, his pen digging into page after page, and then he tears the pages out of his notebook and drops them to the floor around him. Maybe twenty or thirty times, the sound of paper being torn from a spiral rises from the aisle seat in the last row.

The lights come back on. Ebert stays in his chair, savoring, surrounded by his notes. It looks as though he’s sitting on top of a cloud of paper. He watches the credits, lifts himself up, and kicks his notes into a small pile with his feet. He slowly bends down to pick them up and walks with Chaz back out to the elevators. They hold hands, but they don’t say anything to each other. They spend a lot of time like that.

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Roger Ebert can’t remember the last thing he ate. He can’t remember the last thing he drank, either, or the last thing he said. Of course, those things existed; those lasts happened. They just didn’t happen with enough warning for him to have bothered committing them to memory — it wasn’t as though he sat down, knowingly, to his last supper or last cup of coffee or to whisper a last word into Chaz’s ear. The doctors told him they were going to give him back his ability to eat, drink, and talk. But the doctors were wrong, weren’t they? On some morning or afternoon or evening, sometime in 2006, Ebert took his last bite and sip, and he spoke his last word.

Ebert’s lasts almost certainly took place in a hospital. That much he can guess. His last food was probably nothing special, except that it was: hot soup in a brown plastic bowl; maybe some oatmeal; perhaps a saltine or some canned peaches. His last drink? Water, most likely, but maybe juice, again slurped out of plastic with the tinfoil lid peeled back. The last thing he said? Ebert thinks about it for a few moments, and then his eyes go wide behind his glasses, and he looks out into space in case the answer is floating in the air somewhere. It isn’t. He looks surprised that he can’t remember. He knows the last words Studs Terkel’s wife, Ida, muttered when she was wheeled into the operating room (“Louis, what have you gotten me into now?”), but Ebert doesn’t know what his own last words were. He thinks he probably said goodbye to Chaz before one of his own trips into the operating room, perhaps when he had parts of his salivary glands taken out — but that can’t be right. He was back on TV after that operation. Whenever it was, the moment wasn’t cinematic. His last words weren’t recorded. There was just his voice, and then there wasn’t.

Now his hands do the talking. They are delicate, long-fingered, wrapped in skin as thin and translucent as silk. He wears his wedding ring on the middle finger of his left hand; he’s lost so much weight since he and Chaz were married in 1992 that it won’t stay where it belongs, especially now that his hands are so busy. There is almost always a pen in one and a spiral notebook or a pad of Post-it notes in the other — unless he’s at home, in which case his fingers are feverishly banging the keys of his MacBook Pro.

He’s also developed a kind of rudimentary sign language. If he passes a written note to someone and then opens and closes his fingers like a bird’s beak, that means he would like them to read the note aloud for the other people in the room. If he touches his hand to his blue cardigan over his heart, that means he’s either talking about something of great importance to him or he wants to make it clear that he’s telling the truth. If he needs to get someone’s attention and they’re looking away from him or sitting with him in the dark, he’ll clack on a hard surface with his nails, like he’s tapping out Morse code. Sometimes — when he’s outside wearing gloves, for instance — he’ll be forced to draw letters with his finger on his palm. That’s his last resort.

C-O-M-C-A-S-T, he writes on his palm to Chaz after they’ve stopped on the way back from the movie to go for a walk.

“Comcast?” she says, before she realizes — he’s just reminded her that people from Comcast are coming over to their Lincoln Park brownstone not long from now, because their Internet has been down for three days, and for Ebert, that’s the equivalent of being buried alive: C-O-M-C-A-S-T. But Chaz still wants to go for a walk, and, more important, she wants her husband to go for a walk, so she calls their assistant, Carol, and tells her they will be late for their appointment. There isn’t any debate in her voice. Chaz Ebert is a former lawyer, and she doesn’t leave openings. She takes hold of her husband’s hand, and they set off in silence across the park toward the water.

They pass together through an iron gate with a sign that reads ALFRED CALDWELL LILY POOL. Ebert has walked hundreds of miles around this little duck pond, on the uneven stone path under the trees, most of them after one operation or another. The Eberts have lost track of the surgeries he has undergone since the first one, for thyroid cancer, in 2002, followed by the one on his salivary glands in 2003. After that, they disagree about the numbers and dates. “The truth is, we don’t let our minds dwell on these things,” Chaz says. She kept a journal of their shared stays in hospitals in Chicago and Seattle and Houston, but neither of them has had the desire to look at it. On those rare occasions when they agree to try to remember the story, they both lose the plot for the scenes. When Chaz remembers what she calls “the surgery that changed everything,” she remembers its soundtrack best of all. Ebert always had music playing in his hospital room, an esoteric digital collection that drew doctors and nurses to his bedside more than they might have been otherwise inclined to visit. There was one song in particular he played over and over: “I’m Your Man,” by Leonard Cohen. That song saved his life.

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Seven years ago, he recovered quickly from the surgery to cut out his cancerous thyroid and was soon back writing reviews for the Chicago Sun-Times and appearing with Richard Roeper on At the Movies. A year later, in 2003, he returned to work after his salivary glands were partially removed, too, although that and a series of aggressive radiation treatments opened the first cracks in his voice. In 2006, the cancer surfaced yet again, this time in his jaw. A section of his lower jaw was removed; Ebert listened to Leonard Cohen. Two weeks later, he was in his hospital room packing his bags, the doctors and nurses paying one last visit, listening to a few last songs. That’s when his carotid artery, invisibly damaged by the earlier radiation and the most recent jaw surgery, burst. Blood began pouring out of Ebert’s mouth and formed a great pool on the polished floor. The doctors and nurses leapt up to stop the bleeding and barely saved his life. Had he made it out of his hospital room and been on his way home — had his artery waited just a few more songs to burst — Ebert would have bled to death on Lake Shore Drive. Instead, following more surgery to stop a relentless bloodletting, he was left without much of his mandible, his chin hanging loosely like a drawn curtain, and behind his chin there was a hole the size of a plum. He also underwent a tracheostomy, because there was still a risk that he could drown in his own blood. When Ebert woke up and looked in the mirror in his hospital room, he could see through his open mouth and the hole clear to the bandages that had been wrapped around his neck to protect his exposed windpipe and his new breathing tube. He could no longer eat or drink, and he had lost his voice entirely. That was more than three years ago.

Ebert spent more than half of a thirty-month stretch in hospitals. His breathing tube has been removed, but the hole in his throat remains open. He eats through a G-tube — he’s fed with a liquid paste, suspended in a bag from an IV pole, through a tube in his stomach. He usually eats in what used to be the library, on the brownstone’s second floor. (It has five stories, including a gym on the top floor and a theater — with a neon marquee — in the basement.) A single bed with white sheets has been set up among the books, down a hallway filled with Ebert’s collection of Edward Lear watercolors. He shuffles across the wooden floor between the library and his living room, where he spends most of his time in a big black leather recliner, tipped back with his feet up and his laptop on a wooden tray. There is a record player within reach. The walls are white, to show off the art, which includes massive abstracts, movie posters (Casablanca, The Stranger), and aboriginal burial poles. Directly in front of his chair is a black-and-white photograph of the Steak ‘n Shake in Champaign-Urbana, Illinois, one of his hometown hangouts.

He believes he’s had three more surgeries since the removal of his lower jaw; Chaz remembers four. Each time, however many times, surgeons carved bone and tissue and skin from his back, arm, and legs and transplanted them in an attempt to reconstruct his jaw and throat. Each time, he had one or two weeks of hope and relief when he could eat a little and drink a little and talk a little. Once, the surgery looked nearly perfect. (“Like a movie star,” Chaz remembers.) But each time, the reconstructive work fell apart and had to be stripped out, the hole opened up again. It was as though the cancer were continuing to eat away at him, even those parts of him that had been spared. His right shoulder is visibly smaller than his left shoulder; his legs have been weakened and riddled with scars. After each attempt at reconstruction, he went to rehabilitation and physical therapy to fix the increasing damage done. (During one of those rehabilitation sessions, he fell and broke his hip.) He still can’t sit upright for long or climb stairs. He’s still figuring out how to use his legs.

At the start of their walk around the pond, Ebert worries about falling on a small gravel incline. Chaz lets go of his hand. “You can do it,” she says, and she claps when Ebert makes it to the top on his own. Later, she climbs on top of a big circular stone. “I’m going to give my prayer to the universe,” she says, and then she gives a sun salutation north, south, east, and west. Ebert raises his arms into the sky behind her.

They head home and meet with the people from Comcast, who talk mostly to Chaz. Their Internet will be back soon, but probably not until tomorrow. Disaster. Ebert then takes the elevator upstairs and drops into his chair. As he reclines it slowly, the entire chair jumps somehow, one of its back legs thumping against the floor. It had been sitting on the charger for his iPhone, and now the charger is crushed. Ebert grabs his tray and laptop and taps out a few words before he presses a button and speakers come to life.

“What else can go wrong?” the voice says.

The voice is called Alex, a voice with a generic American accent and a generic tone and no emotion. At first Ebert spoke with a voice called Lawrence, which had an English accent. Ebert liked sounding English, because he is an Anglophile, and his English voice reminded him of those beautiful early summers when he would stop in London with Chaz on their way home after the annual chaos of Cannes. But the voice can be hard to decipher even without an English accent layered on top of it — it is given to eccentric pronunciations, especially of names and places — and so for the time being, Ebert has settled for generic instead.

Ebert is waiting for a Scottish company called CereProc to give him some of his former voice back. He found it on the Internet, where he spends a lot of his time. CereProc tailors text-to-speech software for voiceless customers so that they don’t all have to sound like Stephen Hawking. They have catalog voices — Heather, Katherine, Sarah, and Sue — with regional Scottish accents, but they will also custom-build software for clients who had the foresight to record their voices at length before they lost them. Ebert spent all those years on TV, and he also recorded four or five DVD commentaries in crystal-clear digital audio. The average English-speaking person will use about two thousand different words over the course of a given day. CereProc is mining Ebert’s TV tapes and DVD commentaries for those words, and the words it cannot find, it will piece together syllable by syllable. When CereProc finishes its work, Roger Ebert won’t sound exactly like Roger Ebert again, but he will sound more like him than Alex does. There might be moments, when he calls for Chaz from another room or tells her that he loves her and says goodnight — he’s a night owl; she prefers mornings — when they both might be able to close their eyes and pretend that everything is as it was.

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There are places where Ebert exists as the Ebert he remembers. In 2008, when he was in the middle of his worst battles and wouldn’t be able to make the trip to Champaign-Urbana for Ebertfest — really, his annual spring festival of films he just plain likes — he began writing an online journal. Reading it from its beginning is like watching an Aztec pyramid being built. At first, it’s just a vessel for him to apologize to his fans for not being downstate. The original entries are short updates about his life and health and a few of his heart’s wishes. Postcards and pebbles. They’re followed by a smattering of Welcomes to Cyberspace. But slowly the journal picks up steam, as Ebert’s strength and confidence and audience grow. You are the readers I have dreamed of, he writes. He is emboldened. He begins to write about more than movies; in fact, it sometimes seems as though he’d rather write about anything other than movies. The existence of an afterlife, the beauty of a full bookshelf, his liberalism and atheism and alcoholism, the health-care debate, Darwin, memories of departed friends and fights won and lost — more than five hundred thousand words of inner monologue have poured out of him, five hundred thousand words that probably wouldn’t exist had he kept his other voice. Now some of his entries have thousands of comments, each of which he vets personally and to which he will often respond. It has become his life’s work, building and maintaining this massive monument to written debate — argument is encouraged, so long as it’s civil — and he spends several hours each night reclined in his chair, tending to his online oasis by lamplight. Out there, his voice is still his voice — not a reasonable facsimile of it, but his.

“It is saving me,” he says through his speakers.

He calls up a journal entry to elaborate, because it’s more efficient and time is precious:

When I am writing my problems become invisible and I am the same person I always was. All is well. I am as I should be.

He is a wonderful writer, and today he is producing the best work of his life. In 1975 he became the first film critic to win the Pulitzer prize, but his TV fame saw most of his fans, at least those outside Chicago, forget that he was a writer if they ever did know. (His Pulitzer still hangs in a frame in his book-lined office down the hall, behind a glass door that has THE EBERT COMPANY, LTD.: FINE FILM CRITICISM SINCE 1967 written on it in gold leaf.) Even for Ebert, a prolific author — he wrote long features on Paul Newman, Groucho Marx, and Hugh Hefner’s daughter, among others, for this magazine in the late 1960s and early ’70s and published dozens of books in addition to his reviews for the Sun-Times — the written word was eclipsed by the spoken word. He spent an entire day each week arguing with Gene Siskel and then Richard Roeper, and he became a regular on talk shows, and he shouted to crowds from red carpets. He lived his life through microphones.

But now everything he says must be written, either first on his laptop and funneled through speakers or, as he usually prefers, on some kind of paper. His new life is lived through Times New Roman and chicken scratch. So many words, so much writing — it’s like a kind of explosion is taking place on the second floor of his brownstone. It’s not the food or the drink he worries about anymore — I went thru a period when I obsessed about root beer + Steak + Shake malts, he writes on a blue Post-it note — but how many more words he can get out in the time he has left. In this living room, lined with thousands more books, words are the single most valuable thing in the world. They are gold bricks. Here idle chatter doesn’t exist; that would be like lighting cigars with hundred-dollar bills. Here there are only sentences and paragraphs divided by section breaks. Every word has meaning.

Even the simplest expressions take on higher power here. Now his thumbs have become more than a trademark; they’re an essential means for Ebert to communicate. He falls into a coughing fit, but he gives his thumbs-up, meaning he’s okay. Thumbs-down would have meant he needed someone to call his full-time nurse, Millie, a spectral presence in the house.

Millie has premonitions. She sees ghosts. Sometimes she wakes in the night screaming — so vivid are her dreams.

Ebert’s dreams are happier. Never yet a dream where I can’t talk, he writes on another Post-it note, peeling it off the top of the blue stack advising.wisc.eduSometimes I discover — oh, I see! I CAN talk! I just forget to do it.

In his dreams, his voice has never left. In his dreams, he can get out everything he didn’t get out during his waking hours: the thoughts that get trapped in paperless corners, the jokes he wanted to tell, the nuanced stories he can’t quite relate. In his dreams, he yells and chatters and whispers and exclaims. In his dreams, he’s never had cancer. In his dreams, he is whole.

These things come to us, they don’t come from us, he writes about his cancer, about sickness, on another Post-it note. Dreams come from us.

We have a habit of turning sentimental about celebrities who are struck down — Muhammad Ali, Christopher Reeve — transforming them into mystics; still, it’s almost impossible to sit beside Roger Ebert, lifting blue Post-it notes from his silk fingertips, and not feel as though he’s become something more than he was. He has those hands. And his wide and expressive eyes, despite everything, are almost always smiling.

There is no need to pity me, he writes on a scrap of paper one afternoon after someone parting looks at him a little sadly. Look how happy I am.

In fact, because he’s missing sections of his jaw, and because he’s lost some of the engineering behind his face, Ebert can’t really do anything but smile. It really does take more muscles to frown, and he doesn’t have those muscles anymore. His eyes will water and his face will go red — but if he opens his mouth, his bottom lip will sink most deeply in the middle, pulled down by the weight of his empty chin, and the corners of his upper lip will stay raised, frozen in place. Even when he’s really angry, his open smile mutes it: The top half of his face won’t match the bottom half, but his smile is what most people will see first, and by instinct they will smile back. The only way Ebert can show someone he’s mad is by writing in all caps on a Post-it note or turning up the volume on his speakers. Anger isn’t as easy for him as it used to be. Now his anger rarely lasts long enough for him to write it down.

There’s a reception to celebrate the arrival of a new ownership group at the Chicago Sun-Times, which Ebert feared was doomed to close otherwise. Ebert doesn’t have an office in the new newsroom (the old one was torn down to make way for one of Donald Trump’s glass towers), but so long as the newspaper exists, it’s another one of those outlets through which he can pretend nothing has changed. His column mug is an old one, taken after his first couple of surgeries but before he lost his jaw, and his work still dominates the arts section. (A single copy of the paper might contain six of his reviews.) He’s excited about seeing everybody. Millie helps him get dressed, in a blue blazer with a red pocket square and black slippers. Most of his old clothes don’t fit him anymore: “For meaningful weight loss,” the voice says, “I recommend surgery and a liquid diet.” He buys his new clothes by mail order from L. L. Bean.

He and Chaz head south into the city; she drives, and he provides direction by pointing and knocking on the window. The reception is at a place that was called Riccardo’s, around the corner from the Billy Goat. Reporters and editors used to stagger into the rival joints after filing rival stories from rival newsrooms. Riccardo’s holds good memories for Ebert. But now it’s something else — something called Phil Stefani’s 437 Rush, and after he and Chaz ease up to the curb and he shuffles inside, his shoulders slump a little with the loss of another vestige of old Chicago.

He won’t last long at the reception, maybe thirty or forty minutes. The only chairs are wooden and straight-backed, and he tires quickly in a crowd. When he walks into the room of journalistic luminaries — Roeper, Lynn Sweet, Rick Telander — they turn toward him and burst into spontaneous applause. They know he’s earned it, and they don’t know even half of what it’s taken him just to get into the room, just to be here tonight, but there’s something sad about the wet-eyed recognition, too. He’s confronted by elegies everywhere he goes. People take longer to say goodbye to him than they used to. They fuss over him, and they linger around him, and they talk slowly to him. One woman at the party even writes him a note in his notepad, and Ebert has to point to his ears and roll his eyes. He would love nothing more than to be holding court in a corner of the room, telling stories about Lee Marvin and Robert Mitchum and Russ Meyer (who came to the Eberts’ wedding accompanied by Melissa Mounds). Instead he’s propped on a chair in the middle of the room like a swami, smiling and nodding and trying not to flinch when people pat him on the shoulder.

He took his hardest hit not long ago. After Roeper announced his departure from At the Movies in 2008 — Disney wanted to revamp the show in a way that Roeper felt would damage it — Ebert disassociated himself from it, too, and he took his trademarked thumbs with him. The end was not pretty, and the break was not clean. But because Disney was going to change the original balcony set as part of its makeover, it was agreed, Ebert thought, that the upholstered chairs and rails and undersized screen would be given to the Smithsonian and put on display. Ebert was excited by the idea. Then he went up to visit the old set one last time and found it broken up and stacked in a dumpster in an alley.

After saying their goodbyes to his colleagues (and to Riccardo’s), Ebert and Chaz go out for dinner, to one of their favorite places, the University Club of Chicago. Hidden inside another skyscraper, there’s a great Gothic room, all stone arches and stained glass. The room is filled mostly with people with white hair — there has been a big push to find younger members to fill in the growing spaces in the membership ranks — and they nod and wave at him and Chaz. They’re given a table in the middle of the room.

Ebert silently declines all entreaties from the fussy waiters. Food arrives only for Chaz and a friend who joins them. Ebert writes them notes, tearing pages from his spiral notepad, tapping his fingers together for his words to be read aloud. Everyone smiles and laughs about old stories. More and more, that’s how Ebert lives these days, through memories, of what things used to feel like and sound like and taste like. When his friend suddenly apologizes for eating in front of him, for talking about the buttered scallops and how the cream and the fish and the wine combine to make a kind of delicate smoke, Ebert shakes his head. He begins to write and tears a note from the spiral.

No, no, it reads. You’re eating for me.

Gene Siskel died eleven years ago, in February 1999, from a brain tumor. He was fifty-three years old. He had suffered terrible headaches in those last several months, but he was private about his pain. He didn’t talk about being sick or how he felt or what he expected or hoped for. He was stoic and solitary and quiet in his death. Siskel and Ebert were both defined, for most of their adult lives, by comparative measures: the fat one, the bald one, the loud one, the skinny one. Siskel was also the careful one. He joked that Ebert’s middle name was “Full Disclosure.” Ebert’s world has never had many secrets in it. Even at the end, when Siskel knew what was coming, he kept his secrets. He and Ebert never once spoke about his looming death.

There are pictures of Siskel all over the brownstone — on the grand piano, in the kitchen, on bookshelves. The biggest one is in the living room; Ebert can see it from his recliner. In almost all the pictures, Siskel and Ebert — never Ebert and Siskel — are standing together, shoulder to shoulder, smiling, two big thumbs-up. In the picture in the living room, they’re also wearing tuxedos.

“Oh, Gene,” Chaz says, and that’s all she says.

All these years later, the top half of Ebert’s face still registers sadness when Siskel’s name comes up. His eyes well up behind his glasses, and for the first time, they overwhelm his smile. He begins to type into his computer, slowly, deliberately. He presses the button and the speakers light up. “I’ve never said this before,” the voice says, “but we were born to be Siskel and Ebert.” He thinks for a moment before he begins typing again. There’s a long pause before he hits the button. “I just miss the guy so much,” the voice says. Ebert presses the button again. “I just miss the guy so much.”

Last February, to mark the tenth anniversary of Siskel’s death, Ebert wrote an entry in his online journal called “Remembering Gene.” He calls it up on his screen. It is beautifully written, filled with stories about arguments, even pitched battles, but nearly every memory is tinged with love and humor. Ebert scrolls through each paragraph, his eyes brimming, the smile winning again. The first lousy balcony set had painted pop bottles for rail supports. Siskel had courtside tickets for the Bulls and thought Phil Jackson was a sage. His beautiful daughters, Cate and Callie, were the flower girls for the Eberts’ wedding.

And then comes the turn. Gene’s first headache struck in the back of a limo on their way to be on Leno, which was broadcasting from Chicago. In front of the audience, Siskel could manage only to agree with everything Ebert said; they made it a gag. That night Siskel went to the Bulls game because they were in the playoffs, but the next day he underwent some tests. Not long after that, he had surgery, but he never told anyone where he was going to have it. He came back and for a time he continued taping the show with Ebert. Siskel’s nephew would help him to his seat on the set, but only after the set was cleared.

Our eyes would meet, the voice reads from Ebert’s journal, unspoken words were between us, but we never spoke openly about his problems or his prognosis. That’s how he wanted it, and that was his right.

Gene Siskel taped his last show, and within a week or two he was dead. Ebert had lost half his identity.

He scrolls down to the entry’s final paragraph.

We once spoke with Disney and CBS about a sitcom to be titled “Best Enemies.” It would be about two movie critics joined in a love/hate relationship. It never went anywhere, but we both believed it was a good idea. Maybe the problem was that no one else could possibly understand how meaningless was the hate, how deep was the love.

Ebert keeps scrolling down. Below his journal he had embedded video of his first show alone, the balcony seat empty across the aisle. It was a tribute, in three parts. He wants to watch them now, because he wants to remember, but at the bottom of the page there are only three big black squares. In the middle of the squares, white type reads: “Content deleted. This video is no longer available because it has been deleted.” Ebert leans into the screen, trying to figure out what’s happened. He looks across at Chaz. The top half of his face turns red, and his eyes well up again, but this time, it’s not sadness surfacing. He’s shaking. It’s anger.

Chaz looks over his shoulder at the screen. “Those fu — ” she says, catching herself.

They think it’s Disney again — that they’ve taken down the videos. Terms-of-use violation.

This time, the anger lasts long enough for Ebert to write it down. He opens a new page in his text-to-speech program, a blank white sheet. He types in capital letters, stabbing at the keys with his delicate, trembling hands: MY TRIBUTE, appears behind the cursor in the top left corner. ON THE FIRST SHOW AFTER HIS DEATH. But Ebert doesn’t press the button that fires up the speakers. He presses a different button, a button that makes the words bigger. He presses the button again and again and again, the words growing bigger and bigger and bigger until they become too big to fit the screen, now they’re just letters, but he keeps hitting the button, bigger and bigger still, now just shapes and angles, just geometry filling the white screen with black like the three squares. Roger Ebert is shaking, his entire body is shaking, and he’s still hitting the button, bang, bang, bang, and he’s shouting now. He’s standing outside on the street corner and he’s arching his back and he’s shouting at the top of his lungs.

His doctors would like to try one more operation, would like one more chance to reclaim what cancer took from him, to restore his voice. Chaz would like him to try once more, too. But Ebert has refused. Even if the cancer comes back, he will probably decline significant intervention. The last surgery was his worst, and it did him more harm than good. Asked about the possibility of more surgery, he shakes his head and types before pressing the button.

“Over and out,” the voice says.

Ebert is dying in increments, and he is aware of it.

I know it is coming, and I do not fear it, because I believe there is nothing on the other side of death to fear, he writes in a journal entry titled “Go Gently into That Good Night.” I hope to be spared as much pain as possible on the approach path. I was perfectly content before I was born, and I think of death as the same state. What I am grateful for is the gift of intelligence, and for life, love, wonder, and laughter. You can’t say it wasn’t interesting. My lifetime’s memories are what I have brought home from the trip. I will require them for eternity no more than that little souvenir of the Eiffel Tower I brought home from Paris.

There has been no death-row conversion. He has not found God. He has been beaten in some ways. But his other senses have picked up since he lost his sense of taste. He has tuned better into life. Some things aren’t as important as they once were; some things are more important than ever. He has built for himself a new kind of universe. Roger Ebert is no mystic, but he knows things we don’t know.

I believe that if, at the end of it all, according to our abilities, we have done something to make others a little happier, and something to make ourselves a little happier, that is about the best we can do. To make others less happy is a crime. To make ourselves unhappy is where all crime starts. We must try to contribute joy to the world. That is true no matter what our problems, our health, our circumstances. We must try. I didn’t always know this, and am happy I lived long enough to find it out.

Ebert takes joy from the world in nearly all the ways he once did. He has had to find a new way to laugh — by closing his eyes and slapping both hands on his knees — but he still laughs. He and Chaz continue to travel. (They spent Thanksgiving in Barbados.) And he still finds joy in books, and in art, and in movies — a greater joy than he ever has. He gives more movies more stars.

But now it’s getting late, which means he has his own work to do. Chaz heads off to bed. Millie, for the moment, hasn’t been seized by night terrors, and the brownstone is quiet and nearly dark. Just the lamp is lit beside his chair. He leans back. He streams Radio Caroline — the formerly pirate radio station — and he begins to write. Everything fades out but the words. They appear quickly. Perfect sentences, artful sentences, illuminating sentences come out of him at a ridiculous, enviable pace, his fingers sometimes struggling to keep up.

Earlier today, his publisher sent him two copies of his newest book, the silver-jacketed Great Movies III, wrapped in plastic. Ebert turned them over in his hands, smiling with satisfaction — he wrote most of it in hospital beds — before he put them on a shelf in his office, by the desk he can no longer sit behind. They filled the last hole on the third shelf of his own published work; later this year, another book — The Pot and How to Use It, a collection of Ebert’s rice-cooker recipes — will occupy the first space on a fourth shelf. Ebert’s readers have asked him to write his autobiography next, but he looks up from his laptop and shrugs at the thought. He’s already written a lot about himself on his journal, about his little childhood home in Champaign-Urbana and the days he spent on TV and in hospitals, and he would rather not say the same thing twice.

Besides, he has a review to finish. He returns his attention to his laptop, its glow making white squares in his glasses. Music plays. Words come.

Pedro Almodóvar loves the movies with lust and abandon and the skill of an experienced lover. “Broken Embraces” is a voluptuary of a film, drunk on primary colors, caressing Penélope Cruz, using the devices of a Hitchcock to distract us with surfaces while the sinister uncoils beneath. As it ravished me, I longed for a freeze-frame to allow me to savor a shot.

Ebert gives it four stars.

February, 2010|Oral Cancer News|

Both sides take tobacco fight to Supreme Court

Source: www.thesunnews.com
Author: Mark Sherman

The Obama administration asked the Supreme Court Friday to allow the government to seek nearly $300 billion from the tobacco industry for a half-century of deception that “has cost the lives and damaged the health of untold millions of Americans.”

Both sides in a landmark, decade-long legal fight over smoking took their case to the high court Friday.

The administration, joined by public health groups, wants the court to throw out rulings that bar the government from collecting $280 billion of past tobacco profits or $14 billion for a national campaign to curb smoking.

Friday’s filings with the Supreme Court mark the latest phase in a lawsuit that began during Bill Clinton’s presidency.

Philip Morris USA, the nation’s largest tobacco maker, its parent company Altria Group Inc., R.J. Reynolds Tobacco Co., British American Tobacco Investments Ltd. and Lorillard Tobacco Co. filed separate but related appeals that take issue with a federal judge’s 1,600-page opinion and an appeals court ruling that found the industry engaged in racketeering and fraud over several decades.

In 2006, U.S. District Judge Gladys Kessler ruled that the companies engaged in a scheme to defraud the public by falsely denying the adverse health effects of smoking, concealing evidence that nicotine is addictive and lying about their manipulation of nicotine in cigarettes to create addiction. A federal appeals court in Washington upheld the findings. At the same time, however, the courts have said the government is not entitled to collect $280 billion in past profits or $14 billion for a national campaign to curb smoking.

The companies argue that the government improperly used the Racketeer Influenced and Corrupt Organizations, or RICO law, against them. The racketeering law often is employed against the Mafia and other criminal organizations.

The companies also say the courts’ decision to brand their statements about smoking as fraudulent unfairly denied them their First Amendment rights to engage in the public-health debate about smoking. “As long as these statements were true or made in good faith, they fall squarely within the First Amendment’s Speech and Petition Clauses, which provide constitutional protection for ‘debate on public issues,’ ” Miguel Estrada, Philip Morris’ lawyer, said. Philip Morris makes Marlboro cigarettes and more than a dozen other brands.

The administration said the money it seeks from the industry is commensurate with the harm it has caused. “For the last half century, those defendants have engaged in a pattern of racketeering activity and a conspiracy to engage in racketeering that has cost the lives and damaged the health of untold millions of Americans,” Solicitor General Elena Kagan, the administration’s top Supreme Court lawyer, wrote.

The public health groups in the case are: American Cancer Society; American Heart Association; American Lung Association; Americans for Nonsmokers’ Rights; National African American Tobacco Prevention Network and Tobacco-Free Kids Action Fund.

The groups are most interested in forcing the tobacco companies to pay for a wide-ranging education campaign to discourage people from taking up smoking and helping others quit. They asked the court to recall its words from an earlier tobacco case.

“As this Court has recognized, ‘tobacco use, particularly among children and adolescents, poses perhaps the single most significant threat to public health in the United States,'” said Howard Crystal, the groups’ lead attorney.

February, 2010|Oral Cancer News|

New test genetically fingerprints tumors

Source: online.wsj.com
Author: Ron Winslow

In a fresh advance for the burgeoning field of personalized medicine, researchers have developed a blood test based on the DNA of tumors that could help tailor treatment for individual cancer patients.

The report, announced Thursday, represents one of the most tangible examples yet of how the ability to sequence a person’s entire genetic code could have a direct impact on patient care. There have been a flurry of reports on new sequencing technology that is yielding enormous amounts of information about genetics and disease, but that has yet to deliver much in the way of new treatment strategies.

“For cancer patients there hasn’t been much utility so far. This may prove to be one of the first useful approaches,” said Victor Velculescu, co-director of the cancer biology program at Johns Hopkins University’s Kimmel Cancer Center and senior author of the new study.

Much research involving whole-genome sequencing is aimed at finding differences in the individual letters that make up the genetic code. The belief is that those small alterations will point to molecular pathways that regulate disease, which would be potential targets for drug therapies.

The Hopkins researchers, writing in the journal Science Translational Medicine, took a different approach. They scanned the DNA of tumors taken from six patients with breast or colon cancer, looking not for tiny DNA changes, but what they call rearrangements in large sections of the genome of tumor cells. The DNA of tumors varies genetically from that of normal tissue, and the rearrangements are essentially a fingerprint of the cancer.

The findings suggest that by testing blood for this fingerprint, doctors will be able to learn whether a patient treated for cancer is free of disease or needs additional or more aggressive care.

“It’s a very clever use of the [sequencing] technology,” said Jeffery Schloss, program director for genome technology at the National Human Genome Research Institute, a division of the National Institutes of Health.

Dr. Schloss, who wasn’t involved with the Hopkins study, likened the approach to drawing a map. Sequencing the letters of the genetic code would be akin to plotting every house in a large neighborhood. The Hopkins team was looking only for neighborhoods—in particular, neighborhoods out of place compared with where they would be in normal tissue.

The uniqueness of such “neighborhood” rearrangements is what makes the DNA a good biomarker for the status of tumors, Dr. Velculescu said. A blood test can detect evidence of even minuscule levels of such alterations. That can indicate, for instance, whether a tumor may be progressing after initially responding to treatment or whether any residual disease is present after surgery to remove a tumor. That could help a doctor and patient decide what other treatment options to pursue.

In the study, researchers tracked for two years one patient whose disease initially responded to treatment and then recurred. Levels of the DNA marker in the patient’s blood accurately reflected the course of the disease, researchers said. The test wouldn’t help predict which drugs a patient is likely to respond to—that likely would require a more detailed DNA scan, researchers said.

This advance comes as the cost of sequencing a patient’s entire genome has fallen sharply—to less than $10,000 now from about $1 million three years ago, according to companies that make sequencing machines. Experts predict that the cost will soon get to about $1,000, potentially making it affordable for medical centers to routinely run the genome of patients with cancer and other diseases.

Currently, cancer doctors often use CT scans to check on the status of a tumor—at a cost of about $1,500, the Hopkins researchers said. They estimated the current cost of the DNA test at about $5,000 but suggest the cost will soon be comparable to a CT scan.

Hopkins has filed patents for the technology. Dr. Velculescu and two other co-authors of the paper are entitled to a share of royalties on sales of any products related to the research if it is commercialized. Further research is necessary to validate the approach with more patients and more cancer types, but researchers said such a test could be ready to use within two years and widely available “within several years.”

February, 2010|Oral Cancer News|

Oral cancer’s toll, cruel

Source: CNN
Author: Madison Park

t1larg.ebert.gi

(CNN) — It brought a tough, All-Star NBA coach to tears this week. And it stilled the voice of a famous film critic.

Head and neck cancers are rare, but known to be severe — they can strip away a person’s voice, distort the face and rob the basic abilities to eat, drink and swallow. The cancer can be so disfiguring, some patients seldom appear in public.

In a tear-filled press conference this week, Denver Nuggets coach George Karl announced he has a type of neck and throat cancer.

Karl said he will continue to coach, but will miss some games and practices. His type of cancer — a squamous cell tumor found on his right tonsil — is the most common and expected to be treatable with radiation and chemotherapy.

Also this week, Esquire profiled film critic Roger Ebert, who also had a head and neck cancer. He suffered complications from surgery to treat the cancer that had spread to the salivary gland. The magazine published a full-page photo of the film critic, who no longer has a lower jaw.

Ebert spent little time feeling sorry for himself: “If we think we have physical imperfections, obsessing about them is only destructive. Low self-esteem involves imagining the worst that other people can think about you. That means they’re living upstairs in the rent-free room,” he wrote on his blog after the photo published.

While Ebert cannot speak, he continues to lambaste bad movies online.

Head and neck cancers include abnormalities in the nasal cavity, sinuses, lips, mouth, tongue, esophagus, salivary glands, throat, and voice box.

These types of cancers tend to affect men in their 60s who had histories of alcohol and tobacco, but, they are also striking younger people who don’t drink or smoke. This is believed to be related to the human papillomavirus

All-Star NBA coach George Karl announced he has a type of head and neck cancer this week.
All-Star NBA coach George Karl announced he has a type of head and neck cancer this week.

“Now there’s a viral cause to the cancer,” said Dr. Carol Bradford, director of the head and neck oncology program at the University of Michigan Comprehensive Cancer. “It is not viewed as patients causing their own cancer.”

There are about 50,000 cases of head and neck cancers every year, compared with 200,000 new cases for breast and prostate cancer.

Because of its rarity, there is less awareness of head and neck cancers, said Dr. Christine Gourin, director of the clinical research program in head and neck cancer at the Johns Hopkins School of Medicine.

“There aren’t many celebrities or public figures who have head and neck cancers that we can hold up as an example,” she said. “If you see patients when they come with advanced tumors, they can’t breathe, they can’t swallow their saliva, they look disfigured and their speech is abnormal, their breathing is affected. I don’t think there are many people who want to go out and be a poster child — so there’s little attention.”

The disease and subsequent treatments could result in disfigurement.

More so than any other cancer, people who get head and neckcancer have a visible disability, said Dr. M. Boyd Gillespie, a past president of the South Carolina Head and Neck Cancer Alliance.

After the cancer has been removed, doctors can try to reconstruct the affected areas by using tissue and bone from other areas of the body. Ebert had several surgeries to reconstruct his throat and jaw by taking tissue and bone from his back, arm, and legs. But the reconstructions did not last, according to Esquire.

CNN’s marquee blog: Roger Ebert keeps voice alive

If the cancer is treatable with radiation and chemotherapy, the recovery is more positive.

The cancer affecting Karl is believed to be caused by a virus. This means he has a better prognosis, his doctor, Jacques Saari said in a news conference.

The five-year survival rate for viral-related cancer is 80 percent compared with 40 to 50 percent for nonviral-related cancer.

A doctor discovered a large lump, measuring two inches in diameter in Karl’s neck in December.

Karl’s treatment will force him to miss some games. He expressed hopes to recover in time to coach the Nuggets in the playoffs.

“I think the major desire for me is to kick this cancer’s butt,” Karl said in this week’s press conference. In 2005, he underwent surgery for prostate cancer.

The radiation and chemotherapy have side effects, such as burnt tissue, redness, inflammation of the lining of the mouth, permanent dry mouth, weight loss and difficulty swallowing. Taste buds can be permanently damaged in some cases.

Through the typical seven weeks of treatment, most people continue to work.

“Some feel the need to work during treatment to retain normalcy,” Gourin said.

The voice box is usually not affected, so Karl could do what head coaches often do — yell at referees.

February, 2010|Oral Cancer News|