Monthly Archives: October 2013

Dental Implants Installed in Irradiated Jaws – A Systematic Review

Source: Journal of Dental Research
Published: October 24, 2013
By: 
1. L. Chambrone1
2. J. Mandia Jr2
3. J.A. Shibli3
4. G.A. Romito1,*
5. M. Abrahao2
1. 1Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil 
2. 2Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, São Paulo, Brazil 
3. 3Department of Periodontology and Oral Implantology, Dental Research Division, Guarulhos University, SP, Brazil 
1. ↵*garomito@usp.br

 

Abstract

The aim of this study was to assess the survival rate of titanium implants placed in irradiated jaws. MEDLINE, EMBASE, and CENTRAL were searched for studies assessing implants that had been placed in nongrafted sites of irradiated patients. Random effects meta-analyses assessed implant loss in irradiated versus nonirradiated patients and in irradiated patients treated with hyperbaric oxygen (HBO) therapy. Of 1,051 potentially eligible publications, 15 were included. A total of 10,150 implants were assessed in the included studies, and of these, 1,689 (14.3%) had been placed in irradiated jaws. The mean survival rate in the studies ranged from 46.3% to 98.0%. The pooled estimates indicated a significant increase in the risk of implant failure in irradiated patients (risk ratio: 2.74; 95% confidence interval: 1.86, 4.05; p < .00001) and in maxillary sites (risk ratio: 5.96; 95% confidence interval: 2.71, 13.12; p < .00001). Conversely, HBO therapy did not reduce the risk of implant failure (risk ratio: 1.28; 95% confidence interval: 0.19, 8.82; p = .80). Radiotherapy was linked to higher implant failure in the maxilla, and HBO therapy did not improve implant survival. Most included publications reported data on machined implants, and only 3 studies on HBO therapy were included. Overall, implant therapy appears to be a viable treatment option for reestablishing adequate occlusion and masticatory conditions in irradiated patients.

 

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

October, 2013|Oral Cancer News|

Dental hygienist, consultant detects own oral cancer

Source: www.dentistryiq.com
Author: Shelli Castor

Dental hygienist and practice-management consultant Barbara Boland discovered at the young age of 41 that she had oral cancer. Boland is now a 10-year cancer survivor, and she hopes her story and experiences will serve to start a continuing dialogue about oral cancer, especially among dental professionals.

Boland graduated from Temple University in Pennsylvania in 1982 and has been working as a practice-management consultant for 24 years. In December 2002, she discovered a peculiar white spot on her tongue that she knew she hadn’t noticed before. She kept an eye on the spot for a month, and because it was changing, she showed her tongue to a head and neck surgeon. The surgeon responded that it couldn’t be cancer for various reasons: she didn’t smoke or drink, she was female, and she was “too young” — there was no way the spot could be cancer.

While such an almost flippant response to a patient’s concerns seems wildly out of place and unexpected today, Boland notes that 10 years ago, dental and medical professionals were not well-educated on the signs, symptoms, and risk factors of oral cancer. For dental and medical professionals 10 years ago, the most common risk factors included tobacco and alcohol use, age, and the fact that males had a higher incidence of oral cancer than females. Boland fit none of those categories, and so her concerns were not seen as pressing.
Still, the spot on her tongue “didn’t feel right” to her. By this time, not only had the white spot grown, but a red spot had appeared as well. In April 2003, she again went to the head and neck surgeon, but received the same response.

Through her consultant practice, Boland worked with about 30 dentists. After the head and neck surgeon’s second dismissal, she began to go around to her clients and asked them to take a look at the spots. The dentists had the same response as the neck surgeon. She didn’t fit the categories, so what chance was there that the spots would be cancer?

Throughout the time Boland was seeking advice, the spots continued to grow.

Finally, a breakthrough presented itself: One of her clients had information on a new procedure called a brush biopsy that wasn’t even on the market yet. The client offered to try out the product on her, and she had a biopsy performed on the white spot only, as she hadn’t shown the client the red spot. The white spot biopsy came back atypical, which meant she needed to have a scalpel biopsy. That biopsy came back on May 16, 2003, and the result confirmed Boland’s growing fears that something was very wrong: oral cancer.

On July 1, 2003, Boland underwent surgery to remove 25% of her tongue. She also had lymph nodes removed from her neck to see if they contained cancer. Since the lymph nodes came back cancer-free, she did not have to undergo radiation or chemotherapy.
For the next few months, Boland gradually regained full functionality in her mouth. It took eight months for her speech to return to normal. Ten years later, the only lasting effects are a significant lack of taste buds and sensation on the affected right side of her tongue, and the fact that the right side of her face continues to be numb. However, she says, she can live with that; those are small side effects compared to the gravity of cancer.

In the 10 years since Boland’s diagnosis and treatment, new discoveries about the causes of oral cancer have been made. HPV — the human papillomavirus — is rapidly becoming one of the most common causes of oral cancer. The HPV link was not known at the time of Boland’s diagnosis, but is becoming better known as researchers continue to conduct tests on the disease. The HPV link was also briefly featured in the news media when Michael Douglas mentioned he had had treatment for oral cancer linked to HPV. Boland says that it is unlikely that her cancer is HPV-related because of the location of her lesion—most HPV-related oral cancers appear at the back of the mouth, while hers was located under her tongue.

While HPV is now increasingly recognized as a possible cause for oral cancer, the major risk factors are still drinking and smoking. However, age is no longer as much of a concern because of the HPV link; the under-50 population is at growing risk for developing oral cancer. Males are still diagnosed at a greater rate than females, but females are catching up. Still, about 25% of people do not fall within the above major categories, and about 6% of cases have undefined causes. Even so, most oral cancer patients today do find out what caused the cancer—most cancer patients’ tumors get tested for HPV.

Boland’s story offers a chance for the general public as well as dental and medical professionals to become more knowledgeable about oral cancer. It is important to remember that, while oral cancer is more common than cervical cancer and about as common as leukemia, 95% of oral changes aren’t cancerous. However, Boland informs, you can’t tell with your naked eye whether an oral change is cancerous or not.

Since Boland’s diagnosis and treatment, she has been speaking to dental professionals on the topic of oral cancer. She laments, however, that there doesn’t seem to have been a changed response to early signs of oral cancer — most professionals respond the way the surgeon and her dentist clients did years ago. Boland attributes the lack of knowledge and seeming indifference to the topic of oral cancer to how dental professionals are taught about it in school. She said that dental schools feature photographs of large lesions and teach future dental professionals to search for those large lesions when discussing oral cancer. Boland says that this type of training is why the five-year survival rate for oral cancer is so low — by the time oral cancer is detected, the cancer is at an advanced stage, which reduces the survival rate. Instead, dental professionals should be taught to pay attention to things that probably are benign, but shouldn’t be there, such as tissue changes. Small spots like Boland’s should also be paid attention to — the earlier the detection, the greater chance of survival rate.

In addition to changed curriculum in dental schools, Boland advocates that states should mandate a continuing education course every couple of years on the detection of oral cancer. The combination of better information on oral cancer with a frequent refresher on that information would, in Boland’s words, keep the dental professional from “getting complacent” about oral cancer.

Since she has been both a patient and a dental hygienist, Boland has advice for both dental professionals and patients about how to promote awareness and/or be aware about oral cancer.

She says dental hygienists and dentists should talk to their patients about oral cancer at every checkup. New tools, such as the brush biopsy that first indicated the presence of Boland’s cancer, should be incorporated into the dental armamentarium. Since younger people are now more likely to develop oral cancer because of the HPV link, Boland advocates starting regular oral conversations and oral cancer screenings with patients at age 12. The CDC, she notes, has fact sheets about HPV that could be given to patients. As far as how often screenings should be given, every checkup would be ideal, but screenings should be given at least annually. She says she wants patients to get in the habit of scheduling an oral cancer screening every year, just as women of a certain age schedule their mammograms every year.

For professionals and patients worried about the extra cost of a screening, Boland states that cancer screening should be considered a part of a comprehensive exam, and that patients not be charged an extra fee for that procedure. If the patient needs or requests a procedure such as a brush biopsy, for example, that could be considered a separate exam, and that dentists could charge for it if they absolutely had to. Boland does admit that there is some cost for the screenings and procedures, but that they are not much. For her, dental professionals should have the goal to screen as many people as possible. Dental professionals “have the professional responsibility to get the word [about oral cancer] out there to people,” Boland says, and that “public awareness needs to be increased.”

When asked, Boland said that people could do a “self-exam” for oral cancer. She said people can check for unusual things. If a person does see something new (not something that’s been there for a long time) or a change, Boland says to keep an eye on it for a couple of weeks; most trauma (such as cheek or tongue bites or burns) will heal within that time frame. If two weeks go by and the unusual thing is still there and/or has gotten bigger, Boland advises people to have it checked out. She says not to let someone check you with his or her naked eye. As for how often a person should check their mouth for possible signs of oral cancer, Boland says to check monthly or every three months; if you notice something, then check every day.

Barbara Boland has taken her admittedly scary experience with oral cancer and turned it into an opportunity to educate others, especially dental professionals, on the new information surrounding oral cancer. Her persistence in trying to find an answer to the curious lesions on her tongue, even after countless dismissals, paid off, and saved her life. Boland herself says that if she wasn’t a hygienist, she wouldn’t have been diagnosed with stage 1 cancer — if she had been a regular patient without dental hygiene training, had gone to her dentist, and had received the same dismissal, she wouldn’t have been worried about it, she says. Boland hopes her story will educate others about oral cancer. She also hopes that it will lead to changes in dental education and practice regarding oral cancer so that more people will be diagnosed earlier and therefore have a better chance of survival. Boland’s 10-year survival rate is “the exception, not the rule” — but Boland hopes to change that.

October, 2013|Oral Cancer News|

Michael Douglas: ‘Throat cancer’ was really tongue cancer

Source: cnn.com
Author: Jen Christensen, CNN

Michael Douglas never had throat cancer, as he told the press in 2010.

The actor now says he had tongue cancer. Douglas said he hid the diagnosis at the urging of his doctor to protect his career.

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“The surgeon said, ‘Let’s just say it’s throat cancer,’ ” Douglas told fellow actor Samuel L. Jackson for a segment that ran on British television as a part of Male Cancer Awareness Week.

Douglas says that the doctor told him if they had to do surgery for tongue cancer, “it’s not going to be pretty. You could lose part of your tongue and jaw.”

When Douglas first talked about his cancer diagnosis in the summer of 2010, he was on a worldwide publicity tour for the movie “Wall Street: Money Never Sleeps.”

Douglas and Jackson joked that could have been the end of his acting career. Douglas said if he had surgery he could see the director saying, “What’s your good side? I’ve got no side over here.”

“There really is no such thing as throat cancer per se,” explained Brian Hill, an oral cancer survivor and the founder of the Oral Cancer Foundation. Douglas has taped a public service announcement to raise awareness about oral cancer for Hill’s foundation.

“Throat” cancer and tongue cancer are both colloquial terms that fall under the oral cancer umbrella. Throat cancer usually refers to cancerous tumors that develop in your pharynx, voice box or tonsils. Tongue cancer refers to cancerous cells that develop on your tongue.

“The treatment up until just recently can be very brutal,” Hill said of tongue cancer. “Your career as a leading man could be over. If you have signed a contract to promote a movie, you would have a strong motivation not to say … ‘Maybe in six months I won’t have a tongue or lower jaw.’ ”

Douglas apparently did not need the potentially disfiguring surgery. He told Jackson he was instead treated with an aggressive form of radiation and chemotherapy. The treatment, he said, lasted five months.

In June, Douglas kicked off an animated conversation about the cause of oral cancer when he told The Guardian that he got throat cancer after engaging in oral sex. Oral sex can expose individuals to the human papilloma virus, which can cause cancer.

Later, Douglas’ publicist told CNN that Douglas did not blame HPV solely for his cancer; Douglas said he was also a smoker and a drinker. Smoking and drinking, particularly when combined, are considered the most significant contributing factors to oral cancer, according to the Centers for Disease Control and Prevention. So is Douglas’ gender. Men are twice as likely to develop oral cancer as women.

Oral cancers account for 2% to 4% of all cancer diagnoses in the United States. An oral cancer diagnosis is particularly serious; only half of the people diagnosed with oral cancer are still alive after five years, according to the CDC. In large part, that’s because of the late diagnoses of this disease. Most signs of this cancer are difficult to detect and are often painless.

Douglas told Jackson that initially his doctors treated him with antibiotics. Douglas had been complaining of a soreness at the back of his teeth. Three months later when it still hurt, the doctor gave him another round of antibiotics. Nine months later, after talking to a friend who was a cancer survivor, he went to the oncology department where a doctor did an initial exam and then a biopsy. He was diagnosed with stage four oral cancer in 2010.

Douglas is not the first celebrity to misidentify the kind of cancer they have.

Actress Valerie Harper, who first came to fame on the TV show “Mary Tyler Moore,” announced her cancer on the cover of People magazine in March. The story said she had little time left to live and was suffering from terminal brain cancer. It turns out the “Dancing With the Stars” celebrity actually had lung cancer that had spread to the lining of her brain.

“I see a lot of people with ‘brain cancer’ who actually have… lung cancer or breast cancer or some other cancer (that spread) to the brain,” Dr. Otis Brawley, the American Cancer Society’s chief medical and science officer, told CNN. “We treat cancer according to its origin.”

Harper’s kind of cancer, leptomeningeal carcinomatosis, can be slowed but the cells are adaptable and can develop a resistance to treatment. A complete remission is unlikely.

Douglas, on the other hand, has had regular check-ups since the diagnosis. At his two-year mark, he told Jackson, his doctors said he was clear of the cancer.

“There is a 95% chance it’s not coming back,” he told Jackson.

October, 2013|Oral Cancer News|

Positive results for Acacia in cancer drug trials

Source: http://www.businessweekly.co.uk/
Author: staff

Positive results from a Phase II study of APD515 – a drug to treat xerostomia (dry mouth) in advanced cancer patients – have been reported by Cambridge UK medical technology business Acacia Pharma.

The study showed that APD515 significantly reduced the symptoms of dry mouth compared to placebo.

Dr Julian Gilbert, Acacia Pharma’s CEO said: “Dry mouth is a common and distressing issue in advanced cancer patients that is significantly under-recognised.

“It is associated with a wide range of oral and systemic complications and can contribute to a greatly reduced quality of life. Our market research indicates that a locally delivered, liquid formulation of a suitable salivary stimulant would be of major benefit to many cancer sufferers, and these data indicate that APD515 should meet this profile.”

The trial was conducted in 11 centres in the UK and Denmark and enrolled 32 patients with advanced cancer and a persistently dry mouth http://kodu.ut.ee/~roma1956/images/phocagallery2/gallery/generic-cialis.html.

The study met its primary endpoint of a significant improvement in the subjective scoring of mouth dryness after one week of treatment with APD515 compared to placebo.

Dr. Gabriel Fox, Acacia Pharma’s chief medical officer, added: “This was a robust trial, whose cross-over design allowed us to compare the effects of APD515 and placebo in the same patient.

“The study has shown an unequivocal benefit for APD515 in advanced cancer patients suffering with a dry mouth. APD515 is the first product opportunity to be developed in this hitherto poorly managed patient group.”

Initially, Acacia Pharma intends to develop APD515 in advanced cancer patients, up to 80 per cent of whom suffer from some degree of xerostomia, either as a direct result of their disease or as a consequence of their chemotherapy or other medicines they are taking.

APD515 also has the potential to be developed for other xerostomic patient populations. The company will be optimising the formulation and presentation in preparation for Phase III testing in an advanced cancer population.

October, 2013|Oral Cancer News|

A woman died from throat cancer after doctors initially believed she had an eating disorder

Source: Wales Online
Author: Liz Day

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A woman died from throat cancer after doctors initially believed her swallowing problems were caused by an eating disorder. Rosemary Young was 63 when she died five months after being admitted to hospital with depression following the suicide of her 33-year-old son Andrew Hillier. Sister Lynne Middleton said: “Her condition deteriorated dramatically until she could not swallow at all. She weighed 9st when she was admitted to hospital and less than 5st when she died. It was very distressing – every time we left the hospital, we were in turmoil.”

Mrs Young, who lived in Blackwood and had two children and one grandchild, had complained of difficulty swallowing six weeks before she was admitted to the Ty Sirhowy mental health unit in September 2011. She had been due to see an ear, nose and throat specialist at the Royal Gwent Hospital, but missed the appointment due to her depression, prompting her family to ask for a referral during her admission. Mrs Middleton, who is a registered mental health nurse, said: “A week after she was admitted, I was very worried about her. She looked unkempt and was not eating, but the staff were adamant it was an eating disorder. “When they said it over and over again, I started to think they might be right, but it did not make any sense. My sister was a lady whose one joy in life was cooking. It was absolute nonsense. At dinner, they forced her to eat aggressively and she was terrified.”

When Ty Sirhowy closed in November 2011, Mrs Young was transferred to the Ty Cyfannol ward of Ysbyty Ystrad Fawr in Ystrad Mynach, but her family say they were not informed of the move. Mrs Middleton, who regularly travelled from Lampeter to visit her sister, said: “I pleaded with them to do an assessment of her throat, but the doctors did not listen. It was obvious to me that there was something wrong. “I would watch her try to eat and she would manage one fork full, then cough and start to inhale the food. “I pointed this out time and time again, but nobody listened.” In December 2011, Mrs Middleton received a phone call informing her that her sister was due to be discharged from hospital.

Recalling the conversation, she said: “They told me there was nothing wrong with her and suggested she was bed blocking. I dropped what I was doing and drove straight to the hospital.” She added: “The doctor repeatedly told me there was nothing wrong with my sister. He grudgingly agreed to refer her to a specialist, but warned me they would tell me the same thing.” Mrs Young was referred to an ear, nose and throat consultant at the Royal Gwent Hospital in January 2012, where she was immediately diagnosed with throat cancer.

Mrs Middleton said: “The consultant told us that if a doctor had shone a torch into her mouth, he would have been able to see the tumour. He told me he was ashamed of his fellow professionals.” By the time Mrs Young was diagnosed, the tumour had already spread and it was too late to operate. She died three weeks after the referral at the Royal Gwent Hospital on February 20, 2012. According to Mrs Middleton’s lawyers, she complained about her sister’s treatment to the Aneurin Bevan Health Board in November 2012. The lawyers also claim the organisation accepted that it had breached its duty of care to Mrs Young due to the delay in diagnosing her tumour, but  maintained she would have died anyway.

Mrs Middleton said: “She may have died, but what they could have done, had they treated her in a more timely fashion, was to prolong her life by a year or two and stop her from having to endure such an awful death.” Mrs Middleton says she was offered £2,000 in compensation by the health board, which she turned down.

Emma Doughty, clinical negligence lawyer at Slater and Gordon, said: “Rosemary’s family are still understandably distressed and grief-stricken at her death. It is always difficult when you lose a family member, but to lose a loved one in such a distressing way has been extremely hard for them to come to terms with.” She added: “They believe more could have been done to help Rosemary and want to know why this much-loved woman was allowed to die in such awful circumstances.” The firm are now considering whether an earlier referral could have saved or prolonged Mrs Young’s life and whether to pursue the matter further. Mrs Middleton hopes the health board will accept that they treated her sister badly and put procedures in place to prevent similar cases from happening in the future.

A spokesman for the Aneurin Bevan Health Board said: “We would again wish to offer our sincere condolences to the family and friends of Mrs Young. A full investigation into this case has been undertaken and our medical director has met with the family.” He added: “We are unable to comment further as the matter is the subject of ongoing litigation.”

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

October, 2013|Oral Cancer News|

Differences in Imaging Characteristics of HPV-Positive and HPV-Negative Oropharyngeal Cancers: A Blinded Matched-Pair Analysis

Source: American Journal of Neuroradiology

Please address correspondence to Dr Lawrence E. Ginsberg, Department of Diagnostic Imaging, Unit 1482, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; e-mail: lginsberg@mdanderson.org

Abstract

BACKGROUND AND PURPOSE: Human papillomavirus–positive oropharyngeal cancers typically have younger age of onset, limited tobacco exposure, and more favorable prognosis than HPV-negative oropharyngeal cancers. We assessed whether HPV-positive and HPV-negative oropharyngeal cancers have consistent differences in pretreatment imaging characteristics.

MATERIALS AND METHODS: A retrospective review of 136 pretreatment CT examinations of paired HPV-positive and HPV-negative oropharyngeal cancers matched for T stage, tumor subsite, and smoking status was performed with the reviewing radiologist blinded to HPV status and clinical stage. Demographic/clinical characteristics and imaging characteristics of primary lesions and metastatic nodal disease were compared by use of Fisher exact testing. The McNemar χ2 test was used for the matched-pair analysis.

RESULTS: By imaging, HPV-negative tumors were more likely to demonstrate invasion of adjacent muscle (26% versus 6%, P = .013). HPV-positive primary tumors were more likely to be enhancing and exophytic with well-defined borders, whereas HPV-negative primary tumors were more likely to be isoattenuated and demonstrate ill-defined borders, though these results were not statistically significant. HPV-positive tumors were more likely to demonstrate cystic nodal metastases than HPV-negative tumors (36% versus 9%, P = .002).

CONCLUSIONS: In this matched and blinded analysis of the imaging differences between HPV-positive and HPV-negative oropharyngeal cancers, HPV-positive carcinomas often had primary lesions with well-defined borders and cystic nodal metastases, whereas HPV-negative primaries more often had poorly defined borders and invasion of adjacent muscle.

ABBREVIATIONS:

HPV: human papillomavirus
SCCOP: squamous cell carcinomas of the oropharynx
EGFR: epidermal growth factor
*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
October, 2013|Oral Cancer News|

Carcinoma of the oral tongue in patients younger than 30 years: Comparison with patients older than 60 years

Source: oraloncology.com
Published Online” 07 August 2013.

 

Summary 

Objectives

The incidence of oral tongue squamous cell carcinoma is rising in young patients. This study evaluated the clinical, pathological, and prognostic characteristics of oral tongue squamous cell carcinoma in the under-30-year age group.

Materials and methods

The computerized database of the Department of Otolaryngology-Head and Neck Surgery of a tertiary, university-affiliated medical center was searched for all patients with oral tongue squamous cell carcinoma treated by glossectomy with curative intent in 1996–2012. Data were collected by chart review.

Results

Of the 113 patients identified, 16 (14%) were aged ⩽30transparent.gifyears at presentation and 62 (55%) >60transparent.gifyears. Mean follow-up time was 30transparent.gifmonths. Comparison by age group revealed no sex predilection and no differences in histologic grade or rates of advanced T-stage, perineural and vascular invasion, or nodal extracapsular extension. Rates of node-positive disease were 75% in the younger group and 19% in the older group (ptransparent.gif<transparent.gif0.001). Kaplan–Meier analysis yielded no between-group difference in disease-free or overall survival. Recurrence was documented in a similar proportion of patients (38% and 29.9%, respectively), but half the recurrences in the younger group were distant versus none in the older group (ptransparent.gif=transparent.gif0.01) All younger patients with recurrent disease died within 16transparent.gifmonths of its appearance compared to 50% 3-year disease-specific survival in the older group.

Conclusions

Oral tongue squamous cell carcinoma is more advanced at presentation in younger than in older patients, with higher rates of regional metastases and distant failure. Recurrent disease is more aggressive, with a fatality rate of 100%.

 

 *This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 

 

October, 2013|Oral Cancer News|