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Aussie researchers discover way to reverse drug resistance in major cancer

Source: www.xinhuanet.com
Author: staff

Australia’s University of Queensland researchers on Thursday said they have discovered a way to reverse drug resistance in skin and mouth cancers, by adding a new drug to an existing treatment.

The squamous cell carcinoma form of skin and mouth cancer “was curable when diagnosed early but difficult to eradicate once the cancer spread,” the university’s Associate Professor Nicholas Saunders said in a statement. The cancer kills about 1,400 Australians each year, he said.

“The drugs used to treat squamous cell carcinomas that have spread to other parts of the body only work for a small fraction of patients.

“In our study, we successfully added a new drug to an existing treatment to make squamous cell carcinomas responsive to treatment,” said Saunders.

The researchers found that a particular protein was controlling drug resistance in the affected cells and by administering a drug that helps keep it in the relevant cell nucleus, the cancer cells would react to existing chemotherapeutic treatments, said Saunders.

Doctors push HPV vaccine, Merck asks FDA to expand Gardasil 9 age range

Source: www.drugwatch.com
Author: Michelle Llamas, Emily Miller (editor)

Doctors, national cancer organizations and 70 nationally recognized cancer centers banded together in June to increase HPV vaccinations and improve cervical cancer screening. But they’re not the only ones pushing for more vaccinations.

HPV vaccine maker Merck requested the FDA expand the recommended age range for Gardasil 9. Gardasil 9 is currently the only HPV vaccination available in the U.S.

Nearly 80 million Americans get HPV infections each year. Of those people, about 32,500 get HPV-related cancers, according to the CDC.

Studies show the HPV vaccine is effective in protecting against the human papilloma virus. The virus can lead to several cancers. These include cervical, vaginal, vulvar, anal, penile or throat cancers.

HPV vaccination rates in the U.S. remain low. Doctors and cancer centers say low vaccination rates are a public health threat.

“HPV vaccination is cancer prevention,” Dr. Deanna Kepka, assistant professor in the University of Utah’s College of Nursing, said in a statement. “It is our best defense in stopping HPV infection in our youth and preventing HPV-related cancers in our communities.”

Right now, the vaccination rate among teens ages 13 to 17 is 60 percent. Doctors are pushing for an 80 percent HPV vaccination rate in pre-teen boys and girls.

“[Vaccination] combined with continued screening and treatment for cervical pre-cancers … could see the elimination of cervical cancer in the U.S. within 40 years,” Dr. Richard Wender, chief cancer control officer for the American Cancer Society, said in a news release. “No cancer has been eliminated yet, but we believe if these conditions are met, the elimination of cervical cancer is a very real possibility.”

Gardasil 9 requires two to three doses to be complete. Only 43 percent of teens get all required doses.

Studies show the vaccine is safe for most people. The most common side effects are headache, nausea, vomiting and fever.

But, the HPV vaccine may cause rare but serious side effects. The FDA’s Vaccine Adverse Event Reporting System has reports of autoimmune diseases, deaths and premature ovarian failure linked to the vaccine.

The National Vaccine Injury Compensation Program (VICP) has paid out millions to a few people who said the vaccine injured them. Since 2006, VICP has paid out or settled 126 HPV claims and dismissed 157.

Current campaigns urge pre-teens and teens to get the HPV vaccine. Merck wants more adults to get the vaccine, too.

At the beginning of June, the FDA accepted Merck’s application to expand the age range for Gardasil 9. The agency granted it priority review. The FDA originally approved Gardasil 9 for people ages 9 to 26. But Merck wants that age range expanded to include adults ages 27 to 45.

“Women and men ages 27 to 45 continue to be at risk for acquiring HPV, which can lead to cervical cancer and certain other HPV-related cancers and diseases,” Dr. Alain Luxembourg, Merck Laboratories’ director of clinical research, said in a statement.

HPV is a group of about 150 related viruses. Gardasil 9 protects against nine strains. The FDA hopes to reach a decision on the application by Oct. 2, 2018.

State not allowed to investigate death at cancer center

Source: kdvr.com
Author: Rob Low

Lakewood, Colo. – When 80-year-old Virginia Cornelius died at a Rocky Mountain Cancer Care Centers’ location in Lakewood on February 27, the on-site doctor insisted it must’ve been a heart attack.

But the adult children of Cornelius aren’t convinced and tell the FOX31 Problem Solvers their efforts to find the truth have been stymied, partly because cancer centers generally aren’t regulated by the Colorado Department of Public Health and Environment.

Cornelius was receiving radiation treatment for cancer of the larynx in her throat. But her daughter, Susan Hutt, says her mother’s general health on February 27 was fine.

“They took her vital signs. They were better than mine,” Hutt said.

She said she was later told by a radiation tech that her mother was having trouble swallowing just before the procedure began but the treatment was allowed to continue anyway, when something went very wrong inside the patient room.

“All the sudden the door flies open and a curtain and the therapist is screaming in the hall, somebody call 911, somebody find the doctor,” remembered Hutt.

Hutt and her brother Gary Cornelius always sat in a waiting area next to the radiation room for all of their mother’s treatments having no idea that during every procedure their mother’s hands were strapped to a bed.

“We walk in and there is our mother on the table, hands restrained, the mask for radiation therapy with the oxygen that goes into it is up on a table, is hanging up above her. And there is no one in there. She is not responsive, but no one is doing CPR,” said Hutt.

Hutt said it appeared the radiation tech ran out of the room without ever performing CPR.

“Minutes are passing before the tech returns with not a code cart, which I would expect as I’m a nurse in a hospital and they are readily available, but what looked like a fishing tackle box. She puts it on the floor and can’t open it,” Hutt said.

By the time paramedics arrived her mother was dead.

According to the 911 call obtained by the Problem Solvers, a dispatcher is heard advising paramedics, “They (Rocky Mountain Cancer Care Centers) are asking that you not walk through the main lobby, they don’t want that, they want you to go through the back door. I’m not sure why.”

Hutt says she found that suspicious but what she said was even more concerning was learning the “Code Blue” panic button on the wall, which meant to summon emergency help, didn’t work. Plus, the radiation tech who had been treating her mother left before the Jefferson County Coroner arrived.

“Extremely suspicious, that the person present that finds a person down is not able to be interviewed by the coroner,” said Hutt.

The coroner’s report listed the final cause of death as “Acute Heart Failure.” But no autopsy was done.

Minutes after their mother’s death and in a state of shock, Hutt and her brother Gary Cornelius said the cancer care center’s on-site doctor convinced them no autopsy was needed. It’s a decision they now regret.

Several weeks after their mother’s death, Hutt and her brother were able to obtain their mother’s radiation logs.

According to the logs shared with the Problem Solvers, Virginia Cornelius’ treatments normally lasted three to four minutes. But on the day of her death, the treatment appeared to have lasted ten minutes.

Hutt and her brother wonder if their mother received too much radiation at once, or worse was forgotten about and possibly left to choke to death, unable to sit up and remove her oxygen mask.

“A side effect of head and neck radiation is a mucus that is so thick you don’t just clear your throat and get rid of it,” said Hutt.

More than three hours after Virginia died, her radiation log shows someone made new entries at 6:03 p.m., 6:05 p.m., and 6:07 p.m.

Hutt and her brother wonder if someone was attempting to recreate their mother’s chart after the fact. The siblings filed a complaint with the Colorado Department of Public Health and Environment but were shocked to learn the agency was powerless to investigate.

“We have no jurisdiction,” confirmed Dr. Randy Kuykendall. He’s the Director of Health Facilities and Emergency Medical Services for CDPHE.

Dr. Kuykendall says the state can investigate potential wrong-doing inside a hospital because CDPHE licenses hospitals. But he admits all 20 Rocky Mountain Cancer Centers in Colorado aren’t licensed or accredited by anyone.

It’s easy to be confused.

After all there’s a sign outside St. Anthony’s Hospital with an arrow that states “St. Anthony’s Cancer Center,” but it’s really pointing to Rocky Mountain Cancer Centers which isn’t owned or operated by the hospital even though they’re physically connected.

Rocky Mountain Cancer Centers is owned by U.S. Oncology and leases space inside the medical complex but faces none of the regulations of an actual hospital, like having a cardiac crash cart on site or a defibrillator.

“So this cancer care center doesn’t have to have a panic button, doesn’t have to have any of these emergency procedures or policies in place?” asked investigative reporter Rob Low to Kuykendall, who responded, “That would be correct, Rob.”

“We cannot allow these centers just to focus on profits over patient safety. Unfortunately, that`s a real concern,” said Hollynd Hoskins a medical malpractice attorney, who added, “If you have a facility that is not accredited and has no oversight by the state, they could be cutting corners and they could be hiring just techs at a cheaper wage rate than you would have to pay a qualified registered nurse and unfortunately that is a threat to patient safety.”

The Problem Solvers had lots of questions for Rocky Mountain Cancer Centers but Executive Director Glenn Balasky would only release a statement, that reads in part, “For a number of reasons, we cannot discuss the care provided to any particular patient treated at Rocky Mountain Cancer Centers. We can however assure you that patient care remains one of our highest priorities.”

Hutt finds it curious that Rocky Mountain Cancer Centers won’t discuss her mother’s care with the Problem Solvers when she’s willing to sign a consent form releasing RMCC from patient confidentiality restrictions.

“What’s really hard for me, I picture my mother restrained on a table with no monitor, choking to death and they brush it off like she was 80 she had a heart attack. It`s over and done. We`ll report what we want to,” said Hutt.

After repeated phone calls from FOX31, Rocky Mountain Cancer Centers had its attorney call Hutt and her brother Gary Cornelius.

The siblings told the Problem Solvers the attorney and an office manager for the cancer center told them safety changes have been made because of their mother’s death.

As for regulating cancer centers, that would take state legislation and so far lawmakers have no appetite to regulate them.

Praised West Palm attorney fought for many, but is now fighting for his life

Source: www.mypalmbeachpost.com
Author: Daphne Duret – Palm Beach Post Staff Writer

A knock on a door stopped Richard Tendler mid-sentence. His back straightened almost instinctively in his chair, just as it has at the first sign of every verdict. Two decades as a criminal defense attorney in Palm Beach County have taught the 51-year-old West Palm Beach man to never predict how things will go.

“I’ve had cases I thought I won come back guilty,” Tendler had said hours earlier. “Then there were cases I was sure I lost, and the jury would come back not guilty.”

Another certainty: Tendler knew was that he would go home a free man that night, regardless of his client’s fate. This time was different.

Tendler was seated in an examination room at Moffitt Cancer Center in Tampa, where he is one of 10 patients in an exclusive clinical trial for cancer patients whom other doctors have told to prepare to die. Knocking on the door was Dr. Christine Chung, who is treating Tendler and nine others with an immunotherapy regimen as part of a trial that includes 500 patients in the U.S. and around the world.

Chung, the chief of head and neck oncology at Moffitt, was ready to deliver her own verdict — on the results of Tendler’s third six-week cycle. She greeted Tendler’s larger-than-usual entourage that day with polite handshakes and a tight smile.

After the first two cycles, she said, the treatments have cut in half the size of one lesion on Tendler’s lung and slightly shrunk another. A pair of smaller lesions on his liver remained the same size. That much was welcome — though it’s still early in the treatments.

Regardless of whether it’s good or bad news, Tendler has been here before.

By the time he first felt a lump in his throat in December 2015, Tendler was just several months past one of his most high-profile cases. It ended with what was widely considered a great plea deal allowing Boynton Beach mother Heather Hironimus to escape criminal charges for running away with her then-4-year-old son to prevent his father from having him circumcised.

His previous cases ranged from the most tragic to the most bizarre, earning Tendler a reputation as a survivor of the grueling grind of private practice. Among his clients: People involved in deadly car wrecks, a university gunman in the wake of another college shooting, and a teenager charged with killing a goose.

Comforting his mother
Two weeks before Tendler discovered the lump in his throat, he had consoled his mother, Sonia, through a doctor’s tragic prognosis giving her just two months more to live with end-stage pancreatic cancer.

Her sister, his aunt Vera Muller, noticed the lump when he came to visit his mother at her Miami apartment.

“I said, ‘Oh, my God, Richard’ and he said ‘Shhh!’” she said before Tendler’s visit to Moffitt last month, putting her finger to her lips to mimic the gesture her nephew made back then. “He didn’t want his mother to worry.”

Doctors by then had confirmed Tendler’s suspicion. The lump was cancer, brought on by an illness Tendler didn’t know he, too, would soon be diagnosed with.

According to the Centers for Disease Control and Prevention, 79 million Americans had been infected with human papillomavirus, or HPV, as of last year. With 200 strains, most of which carry no symptoms and go away on their own, HPV is the most common sexually transmitted infection in the nation.

The strain Tendler contracted at some point in his life was the rare variety that caused his cancer, his doctors informed him. Although there now exists a vaccine for the virus that is recommended for teenage girls and boys alike, no such prevention existed when Tendler was growing up.

On Jan. 25, 2016, Tendler’s 49th birthday, he underwent a nine-hour surgery to remove the cancer from his throat. He had to be on a feeding tube for a month and recovered at his mother’s Miami apartment, with aunt Vera playing nurse to both her sister and her nephew.

Now 75, and moving to South Florida from Tendler’s native Venezuela, Vera Muller remembers her sister died six weeks into Tendler’s recovery. She was 68.

With his grief still fresh, Tendler then went through a grueling round of radiation and chemotherapy, which required him to live on the feeding tube for another four months.

“It was worse than the surgery,” Tendler remembered. “I couldn’t drink water. I couldn’t even swallow a pill.”

Three months later, Tendler returned to the courthouse much thinner and scarred from his surgery, but cancer-free according to his tests. His doctor reassured him that the worst was behind him.

“He told me ‘I’ve never had one come back,’” Tendler remembers.

His did.

In May 2017, doctors noticed a spot on his chest, and eventually discovered three cancerous lesions on his liver. The cancer had spread, or metastasized, the doctors told him.

Tendler remembers one oncologist telling him he only had months to live. The doctor suggested, matter-of-factly, that he prepare for his death.

“That oncologist talked to me like a piece of dirt,” Tendler said.

He visited several others, and although they were more gentle in their delivery, their news was largely the same. The sentence for the defense attorney was death, they told him, and it would be coming soon.

A doctor offers cautious hope
That summer, Tendler visited Chung at Moffitt. Having immigrated to the United States from Korea with her single mother and two brothers as a child, Chung went to medical school and decided she wanted to be an oncologist.

Tendler and Chung soon learned that, while in different professions, they shared similar views and experiences. Like Tendler’s clients, Chung’s patients are a varied group, including former smokers and people like Tendler, who contracted throat cancer from a rare strain of HPV. The common denominator: They all have a right to treatment.

“None of us is guaranteed good health tomorrow. It is a gift,” Chung said.

Tendler, like most criminal defense attorneys, believes every person accused of a crime, no matter how heinous, is entitled to a fair and just journey through the legal system.

Chung received grants from a pair of foundations that paid off all her medical school loans, a fact she says makes her believe her work is to serve the public. Tendler, who started his career as a public defender, understands.

And with Chung, he found not just an advocate for his life but a doctor who Tendler said was the first to really treat him like a human being. Tendler says her presence in his life tops the list of blessings he makes a habit of thanking God for daily.

Chung told him they would fight the three lesions with CT ablation, a form of targeted radiation that successfully obliterated the three spots. But soon afterward, two more lesions appeared on his liver, and another pair of cancer lesions were now in his lungs.

Chung is clear, both in her conversations with Tendler and in an interview on the day he receives his test results, that there is currently no cure for Tendler’s cancer. She calls the current clinical trial a form of palliative care, meant to reduce the cancer’s severity and alleviate Tendler’s symptoms in hopes of keeping him healthy long enough for researchers to find a cure.

The clinical trial, sponsored by Bristol-Myers Squibb, is a blind study in a treatment that involves immunotherapy, a process that stimulates parts of the patient’s own immune system to fight the cancer.

All patients in the study receive doses of the immunotherapy agent Nivolumab. Two-thirds of the patients also receive a second drug, and the others receive a placebo.

No one — not even Chung — knows which patients are receiving the second agent, a secret she says is vital to the research to see if the two agents together work better than the single Nivolumab treatment alone.

Tendler’s lesions are not as severe as some of her other patients, Chung says, and after two cycles, the results are promising.

Although he is on pain medication, his treatment has been a breeze compared to his radiation, he said. And the fight for his life has brought with it an unanticipated life lesson.

Tendler, who for 20 years poured his life into his work, is learning how to celebrate.

How often should you see a dentist?

Source: www.bbc.com
Author: staff


Margie Taylor says seeing a dentist once a year – or even once every two years – is enough for many patients. Some dentists argue this could make it harder for them to spot diseases such as mouth cancer. And they say it could see the wealthy paying for private dental care – while the poor have less access to a dentist.

Ms Taylor met representatives of the British Dental Association (BDA) in Stirling on Wednesday afternoon to discuss their concerns.

What is the Scottish government proposing?
The Scottish government published its Oral Health Improvement Plan earlier this year, which says NHS dental services should focus on preventing oral health disease, meeting the needs of the ageing population, and reducing oral health inequalities between Scotland’s rich and poor.

The document says there is no clinical evidence that all patients need basic check-ups every six months – regardless of their oral health – as is currently the case. It quotes National Institute for Health and Care Excellence (NICE) guidelines, which state that “patients who have repeatedly demonstrated that they can maintain oral health and who are not considered to be at risk of or from oral disease may be extended over time up to an interval of 24 months.”

Risk assessment
Under the new system outlined by the government plans, an Oral Health Risk Assessment (OHRA) would be introduced for every patient – with the frequency of check-ups determined by their overall score.

This may mean that people will no longer have to attend every six months if they have good oral health and a healthy lifestyle. But patients who have poorer oral health and higher risk factors are likely to be seen more frequently.

The improvement plan also says that the traditional theory that the scale and polish procedure prevents gum disease has been thrown into considerable doubt in recent years. Instead, it says that “the most effective option for routine care is adequate oral hygiene by the patient themselves”.

What does Ms Taylor say about the plans?
The chief dental officer told BBC Scotland that medical evidence suggests many people can leave two years between basic check-ups without any problem. But she stressed that it was important to be realistic – and that it was not reasonable to expect people who are accustomed to having two check-ups a year to suddenly start seeing a dentist just once every two years.

She said: “At the moment, quite a lot of people come yearly and that’s fine for patients who are not at risk and who know how to look after their mouth and who have got a healthy diet.

“But it will be absolutely dependent on the risk as assessed by their own dentist, and there is no suggestion that everybody is to move to two-yearly checkups.

“And in fact we may want to see some patients more often than six months”.

Ms Taylor also insisted there was no intention to take NHS money from dentists in wealthier areas and giving it to those in poorer areas.

She added: “What we are talking about is making sure people in the poorer areas are able to get treatment”.

Ms Taylor stressed that everybody who needs a scale and polish – such as those suffering from periodontal disease – will still get one. But she conceded that the government had “more communicating to do” on the changes, which she said were about “evolution and not revolution”.

What do dentists say?
Ahead of their meeting with Ms Taylor, BDA Scotland released the results of a survey which it said suggested many of its members had “deep concerns” over the Oral Health Improvement Plan.

According to the survey:

  • Nearly two thirds of NHS dentists (62%) who responded had a “negative” or “very negative’ impression of the overall plan.
  • Three quarters had concerns about financial viability, and how the plan will be funded.
  • Almost 70% of respondents viewed the proposals to reduce the frequency of dental checks negatively.
  • About 80% had concerns about the proposed reduction in scale and polish treatments.

The BDA’s chairman in Scotland, Robert Donald, said: “Talk from government on prevention and tackling health inequalities is long overdue, but will remain warm words until they are backed up with needed investment.

“Vulnerable older patients deserve oral health care tailored to their needs, but this plan fails to spell out how it can be provided safely and effectively, or how it will be paid for. Sadly while officials have sketched out the big issues, they have skimped on the detail.”

Meanwhile, dentist John Davidson, who runs a practice in Edinburgh, told BBC Scotland that oral cancer is on the increase in Scotland and “the more often we see patients, the more likely we are to pick that up”.

He added: “We feel it is important that patients are seen more regularly, and it may get to the stage where patients pay themselves to come in and have their routine examinations and scale and polishes done.

“For a lot of patients it will not make a lot of difference for them (financially), but there are patients who just cannot afford to do that”.

The rise of HPV-related cancers in men

Source: www.tmc.edu
Author: Alexandra Becker

Scott Courville admired his full beard and round belly in the mirror: He was ready for the upcoming holiday season. It was November 2015 and Courville, who plays Santa Claus in Lafayette, Louisiana, was too excited about his favorite time of year to worry much about the pain developing in his jaw.

By February, though, the ache had worsened and was accompanied by new symptoms: white spots on his right tonsil, difficulty swallowing and lumps in his throat. He finally made his way to a walk-in clinic where he was diagnosed with tonsillitis and prescribed antibiotics.

“They sent me home and said, ‘In two weeks everything should clear up,’” Courville recalled.

But his symptoms only worsened. Courville made an appointment with a local ear, nose and throat (ENT) specialist who also diagnosed Courville with tonsillitis. The doctor prescribed more antibiotics and steroids, but two weeks later there were no improvements. Courville was referred to a dentist—“In case they see something we don’t”—but that, too, was a dead end.

Courville’s dentist insisted he return to his ENT, where he ultimately had a CT scan that revealed a mass in his throat. That was June 6, 2016. Two days later, Courville underwent a biopsy. When he awoke from the surgery, his doctor was standing over him.

Courville always gets choked up retelling this part of his story.

“The hardest part for me is always remembering when the doctor said, ‘I’m sorry, but you’ve got cancer.’”

Courville was referred to The University of Texas MD Anderson Cancer Center, where doctors confirmed that he had squamous cell carcinoma of the right tonsil. But there was more: Courville learned that his cancer had been caused by the human papillomavirus—HPV.

11 million men
Courville’s story is becoming increasingly common, with the annual incidence of HPV-related cancers of the throat, tonsils and the base of the tongue in men in the United States now outnumbering cases of cervical cancer in women, according to the U.S. Centers for Disease Control and Prevention (CDC). A 2017 research paper authored by scientists at Baylor College of Medicine and The University of Texas Health Science Center at Houston School of Public Health, among others, found the overall prevalence of oral HPV in men in the U.S. to be upwards of 11 million—much higher than previously believed.

“This has implications, because pretty much everyone is exposed to HPV,” said Andrew Sikora, M.D., Ph.D., one of the authors of the paper and vice chair for research and co-director of the Head and Neck Cancer Program at Baylor College of Medicine. “When we’re talking about the prevalence of oral HPV infection, we’re talking about that infection persisting inside the tonsils or on the base of the tongue of these men, and I think that’s what sets you up for cancer later in life—it may happen decades after you were exposed to HPV.”

That lag time, coupled with an absence of symptoms, is part of the reason HPV-related oropharyngeal cancers, also referred to as head and neck cancers, are increasing.

“What makes this cancer interesting is that it’s one of the only cancers in the body that we’re actually seeing more cases of year over year,” explained Ron J. Karni, M.D., who serves as chief of the division of Head and Neck Surgical Oncology at McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center. “In the U.S., we can expect a certain number of breast cancer cases and lung cancer cases every year, but this is actually starting to look a bit like an epidemic in that we are seeing more every year. It’s alarming.”

Holy grail
HPV is the most common sexually transmitted disease in the U.S., with an estimated 79 million individuals infected. According to the CDC, HPV is so common that most people who are sexually active will get the virus at some point in their lives if they do not get the HPV vaccine.

The virus is spread through vaginal, anal and oral sexual activity, and often exhibits no signs or symptoms. In many cases, HPV is cleared by the immune system and does not cause health problems, but it can also persist and show up decades later alongside conditions such as genital warts and cancer—including cervical cancer, anal cancer and oropharyngeal cancers. For reasons not well understood, oropharyngeal cancers predominately affect men.

Currently, there is no annual screening test for men to determine whether they have the virus. Women, on the other hand, are advised to get regular pap smears.

The Papanicolaou test, commonly known as the pap smear, involves collecting cells from inside a woman’s cervix to detect pre-cancerous changes. It is performed during a woman’s annual exam and has been widely credited for detecting early signs of HPV-related cervical cancer and saving countless lives. No such screening test has been successfully developed for oropharyngeal cancer—another reason cited for its steady rise.

“We’re at a huge disadvantage,” said Sikora, who, in addition to his research, treats patients at the Michael E. DeBakey VA Medical Center in Houston. “The pap smear, in terms of global health impact, is probably one of the best, most cost-effective things ever invented in terms of just the sheer number of women who have not had cancers because of it. We have nothing like that for men.”

Sikora explained that anatomy is, in part, to blame. Whereas the cervix is easily sampled, the tonsils are full of “nooks and crannies,” he said, and scientists have yet to develop a reliable technique for obtaining a representative sample of cells inside the throat, tonsils and back of the tongue.

“It’s sort of a holy grail for researchers in the field,” Sikora said. “It would be a game-changer in terms of prevention and early detection of cancer.”

Scientists at MD Anderson, where Courville was treated, may be closing in on some answers. Researchers, including Erich M. Sturgis, M.D., MPH, the Christopher & Susan Damico Chair in Viral Associated Malignancies, are currently conducting a clinical trial for an antibody test that could be used to screen for HPV-related throat cancer.

The HOUSTON study, an acronym for “HPV-related Oropharyngeal and Uncommon Cancers Screening Trial of Men,” is looking to recruit 5,000 men ages 50 to 64 years to provide blood and saliva samples for serologic HPV testing and oral HPV testing, respectively. If a subject is found to have a positive antibody test, he will be asked to participate in a second phase of the study, which includes an intensive screening program run through MD Anderson’s oral pre-cancer clinic.

“A researcher at Arizona State University, Dr. Karen Anderson, developed a serologic test that predicts extremely well the risk for HPV-related oropharyngeal cancer,” Sturgis explained. “We have been able to show that serum antibodies to HPV early proteins, which are rare in the general population, are markers for oropharyngeal cancer. Specifically, we found that those who had antibodies to certain HPV antigens have a greater than 450-fold higher risk of oropharyngeal cancer compared with those who do not have the antibodies.”

The hope is that this study will reveal that serological HPV antibody testing is an effective screening tool for HPV-related cancer in men: the equivalent to a pap smear.

A lump in the neck
If and when HPV-related cancer does develop, men often notice a pain in their jaw or throat, trouble swallowing, change or loss of voice that lasts more than a week or two, a sore spot on the tongue and, most often, a lump in the neck.

“There’s often a very small, primary tumor, which is the tumor that is in the tongue or in the tonsil, and it travels early to the lymph nodes,” Sikora explained. “Depending on what your neck looks like, lymph nodes can get pretty big before they become noticeable. But a lump in the neck is by far the most common symptom, and unfortunately it’s often detected much later than we would like.”

Even more troubling, many individuals who have these symptoms are commonly misdiagnosed and handed antibiotics, as in Courville’s case.

“The most important message I can convey is that if you have a lump in your neck, go see an ear, nose and throat doctor,” Karni said, emphasizing the importance of an informed diagnosis and specialized care.

Treatment for oropharyngeal cancers varies depending on the case and often involves a multidisciplinary team of clinicians, as well as some form of combined modality therapy such as radiation and chemotherapy. In the future, Sturgis sees novel therapies, including immunotherapy options, changing the landscape of treatment protocols.

Karni hopes UTHealth’s dedicated HPV-related throat cancer program will carry patients through the entire arc of treatment by offering minimally invasive robotic surgery for qualifying cases, as well as annual community-wide screening clinics, rehabilitation therapists, and numerous other specialists.

“We want to think about cancer the way Target thinks about shopping or the way the best airlines think about flying,” Karni said. “We designed a program that is patient-centered. We asked, ‘What does the patient need on their fourth week of radiation? What do they need on their third month post-radiation? How can we get that into one clinic space?’ It’s a large team and it’s all centered around this one disease.”

47th in the nation
In 2006, an HPV vaccine named Gardasil hit the market. It was originally intended to prevent HPV in females and, ultimately, HPV-related cervical cancer. But as scientists learned more about HPV—first that males could be carriers and later that it causes cancer in men, as well—public health professionals and clinicians unanimously recommended the vaccine to everyone. The CDC recommends all young women through the age of 26 and all young men through age 21 receive two doses for the vaccine to be effective.

And it is. A recent report published in May by Cochrane, a global independent network of clinical researchers and health care professionals, concluded that the HPV vaccine protects against cervical cancer in young women, especially when they are vaccinated between the ages of 15 and 26.

Which begs the question: Will the vaccine protect young men against the development of oropharyngeal cancers?

“There is a lot more data on cervical cancer in women and the vaccine than there is on head and neck cancer in men and the vaccine, but what data exists suggests that it is going to be a very effective intervention,” Sikora said.

Yet despite scientific evidence that prophylactic HPV vaccination of children and young adults will drastically reduce HPV-related cancers, vaccination rates in the U.S. remain alarmingly low—and Texas ranks 47th. Even more, several generations did not have the vaccine available to them and are currently at risk for HPV-related cancer.

As Karni said, it is alarming.

“Because the median age of oropharynx cancer related to HPV is about 55 and, in some studies, 60, and because the vaccine does not seem to work in individuals who have already been exposed, the benefits of vaccination on HPV-related cancer will not be realized for several decades,” Sturgis said. “Even if we vaccinate 100 percent of our boys and girls tomorrow, we have a whole generation or two who are at risk for this cancer and cannot do anything about it.”

Courville endured six rounds of chemotherapy and 33 daily rounds of radiation to treat his cancer. He lost a year of his life, 100 pounds, his taste buds and salivary glands, and can no longer grow his full beard— but his therapy was successful. He has now made it his life’s mission to inform the public about the importance of the vaccine as well as ongoing advocacy and research surrounding HPV-related cancers.

“If you can educate the public and educate the parents, they will vaccinate their kids,” Courville said. “And if we can vaccinate this generation, we could eliminate these types of cancers.”

Ask the Dentist: Cancer patients should be aware how radiotherapy can affect saliva

Source: www.irishnews.com
Author: Lucy Stock

SALIVA – we normally give little thought to our spit but we definitely notice when it’s not there. Every day in the UK 31 people are diagnosed with a head and neck cancer. With increasing numbers of people undergoing radiotherapy for head and neck cancers there are more people living with the side-effects of not having enough saliva.

Dry mouth, termed xerostomia, is common after radiotherapy. It’s not only extremely uncomfortable, it makes speaking and swallowing more difficult and alters how things taste. Food can taste saltier, metallic; you can lose your sense of taste totally; and perhaps even worse, foods can taste foul, like sour milk.

Not being able to chew and swallow easily can reduce how much you eat and how well you eat, leading to weight loss and poor nourishment.

Saliva performs numerous jobs. It starts digestion by breaking down food and flushes food particles from between the teeth. Crucially, saliva contains minerals such as calcium and phosphate that keep teeth strong. So no saliva means that teeth decay rapidly and extensively. Even voice quality can change.

Without enough saliva, bacteria and other organisms in the mouth take the opportunity to grow uncontrollably. Nasty sores and mouth infections, including yeast thrush infections, are run-of-the-mill.

Luckily a dry mouth is usually a temporary nuisance that clears up in about two to eight weeks but it can take six months or longer for the salivary glands to start producing saliva again after radiotherapy ends.

In a 2017 study, out of several treatments tested, the drug pilocarpine gave the most significant improvement in dry mouth following radiotherapy. However, you may experience a side effect, albeit short lived, from this medication and it can take a couple of months to work.

Artificial salivas are available as lozenges, sprays and gels, the downside being that their benefits last only a few hours. The Biotene range is specially designed to help relieve dry mouths and includes toothpastes, mouthwashes and gels to give comfort and protect the teeth.

You can buy small atomiser spray bottles from most chemists and fill them with water or fluoride mouthwash. If you cannot swallow, your nurse or doctor can give you a nebuliser to moisten your mouth and throat. Always visit your dentist before cancer treatments to maximise the health of your mouth.

Relieve a dry mouth by:

  • Sipping water often
  • Avoiding drinks with caffeine which dry out the mouth
  • Chewing sugarless gum
  • Avoiding spicy or salty foods, which may cause pain
  • Avoiding tobacco or alcohol
  • Using a humidifier at night.

Eight-time GRAMMY® winner Ziggy Marley partners with the Oral Cancer Foundation

Source: ww.prnewswire.com
Author: press release

The Oral Cancer Foundation has a new relationship with eight-time GRAMMY® winner, Emmy winner, humanitarian, singer, songwriter and producer, Ziggy Marley. Mr. Marley has generously offered to allow CharityBuzz to auction off three (3) VIP events for two (2) on his REBELLION RISES TOUR. The winner(s) will enjoy this highly anticipated tour that only a select few get to experience up close and personal, meeting Mr. Marley. After the concert at a tour city of the winners choosing, a photo opportunity will be provided during their meet & greet with Ziggy Marley himself. The tour starts in America and travels to several European cities. Raising funds for the oral cancer issue via OCF, this auction will help support awareness campaigns, research, early discovery initiatives, and outreach that will help save lives. The auction begins today; May 20, 2018. Available tour dates are here: https://bit.ly/2dZPCcR (Dates may be subject to change).

Grammy winning artist Ziggy Marley partners with the Oral Cancer Foundation to raise awareness of the disease, and funds for its many missions to reduce impact of oral cancers. (PRNewsfoto/Oral Cancer Foundation)

Reggae icon Ziggy Marley will release his seventh full-length solo studio album, Rebellion Rises, on May 18th through Tuff Gong Worldwide. Fully written, recorded and produced by Marley, this passionate and indelible new collection of music encourages people to stand together in activism through love.

Ziggy Marley has released many albums to much critical acclaim. His early immersion in music came at age ten when he sat in on recording sessions with his father, Bob Marley. As front man to Ziggy Marley & The Melody Makers, the group has released ten live and studio albums, three of which became GRAMMY-winners with such chart-topping hits as “Look Who’s Dancing,” “Tomorrow People,” and “Tumbling Down.” Then, in an effort to pursue his own creative endeavors, 2003 saw the launch of Ziggy’s solo career with the release of Dragonfly (RCA Records). His second solo effort, Love Is My Religion (Tuff Gong Worldwide), won a GRAMMY in 2006 for Best Reggae Album, as did the subsequent release of Family Time (Tuff Gong Worldwide) in 2009 for Best Children’s Album. 2011’s Wild and Free was also nominated for Best Reggae Album, the same year in which Ziggy debuted his first-ever graphic novel, Marijuanaman. In addition to his music, Marley established the U.R.G.E. (Unlimited Resources Giving Enlightenment) organization to help children in poverty.

You can go directly to the auction item and start bidding at the following link: https://www.charitybuzz.com/catalog_items/meet-ziggy-marley-with-2-vip-tickets-to-his-rebellion-1527300

About the Oral Cancer Foundation
While the financial support for the many missions OCF engages in is important, our view of this amazing opportunity is focused elsewhere. The foundation represents a deadly disease that in the US too many people have not even heard of until it directly impacts their lives. That lack of visibility, that lack of the disease having a significant voice, has far reaching implications. The most obvious is that without national awareness, the knowledge of avoidable risk factors that might bring you to it does not exist. Further, absent a well-established national screening program, the early discovery of pre-cancers, and early stage disease does not currently take place often. This means poorer long-term outcomes, a much higher morbidity from the treatments patients must undergo to cope with an advanced stage disease, and a high 5-year death rate.

While OCF may be the largest of the oral cancer charities and within that group have the greatest reach, we still are small when compared to charities that represent larger incidence cancers whose names are household words. These large charities impact hundreds of thousands each year in the US alone, and take in tens, if not hundreds of millions of dollars a year in donations to advance their agendas and serve the populations they represent. We do not have those assets to work with, but we can develop strategic partners that help us in other ways. OCF’s thoughts are on what this relationship means to that paradigm. We may be at a tipping point in the disease if we can raise the awareness of it. When people with this much visibility become associated with a problem, it cascades into CHANGE.

We hope all of you who read this, especially those who have had this disease touch their lives, will Share on FaceBook, Tweet, and post on Instagram about this relationship, the auctions, and spread the word; so that this opportunity of increased visibility for oral cancer, and a change from late to early discovery and diagnosis can be realized.

An AI oncologist to help cancer patients worldwide

Source: www.sciencedaily.com
Author: staff, University of Texas at Austin, Texas Advanced Computing Center

Comparison between predicted ground-truth clinical target volume (CTV1) (blue) and physician manual contours (red) for four oropharyngeal cancer patients. The primary and nodal gross tumor volume is included (green). From left to right, we illustrate a case from each site and nodal status (base of tongue node-negative, tonsil node-negative, base of tongue node-positive, and tonsil node-positive).
Credit: Carlos E. Cardenas, MD Anderson Cancer Center

Before performing radiation therapy, radiation oncologists first carefully review medical images of a patient to identify the gross tumor volume — the observable portion of the disease. They then design patient-specific clinical target volumes that include surrounding tissues, since these regions can hide cancerous cells and provide pathways for metastasis.

Known as contouring, this process establishes how much radiation a patient will receive and how it will be delivered. In the case of head and neck cancer, this is a particularly sensitive task due to the presence of vulnerable tissues in the vicinity.

Though it may sound straightforward, contouring clinical target volumes is quite subjective. A recent study from Utrecht University found wide variability in how trained physicians contoured the same patient’s computed tomography (CT) scan, leading some doctors to suggest high-risk clinical target volumes eight times larger than their colleagues.

This inter-physician variability is a problem for patients, who may be over- or under-dosed based on the doctor they work with. It is also a problem for determining best practices, so standards of care can emerge.

Recently, Carlos Cardenas, a graduate research assistant and PhD candidate at The University of Texas MD Anderson Cancer Center in Houston, Texas, and a team of researchers at MD Anderson, working under the supervision of Laurence Court with support from the National Institutes of Health, developed a new method for automating the contouring of high-risk clinical target volumes using artificial intelligence and deep neural networks.

They report their results in the June 2018 issue of the International Journal of Radiation Oncology*Biology*Physics.

Cardenas’ work focuses on translating a physician’s decision-making process into a computer program. “We have a lot of clinical data and radiation therapy treatment plan data at MD Anderson,” he said. “If we think about the problem in a smart way, we can replicate the patterns that our physicians are using to treat specific types of tumors.”

In their study, they analyzed data from 52 oropharyngeal cancer patients who had been treated at MD Anderson between January 2006 to August 2010, and had previously had their gross tumor volumes and clinical tumor volumes contoured for their radiation therapy treatment.

Cardenas spent a lot of time observing the radiation oncology team at MD Anderson, which has one of the few teams of head and neck subspecialist oncologists in the world, trying to determine how they define the targets.

“For high-risk target volumes, a lot of times radiation oncologists use the existing gross tumor disease and apply a non-uniform distance margin based on the shape of the tumor and its adjacent tissues,” Cardenas said. “We started by investigating this first, using simple distance vectors.”

Cardenas began the project in 2015 and had quickly accumulated an unwieldy amount of data to analyze. He turned to deep learning as a way of mining that data and uncovering the unwritten rules guiding the experts’ decisions.

The deep learning algorithm he developed uses auto-encoders — a form of neural networks that can learn how to represent datasets — to identify and recreate physician contouring patterns.

The model uses the gross tumor volume and distance map information from surrounding anatomic structures as its inputs. It then classifies the data to identify voxels — three-dimensional pixels — that are part of the high-risk clinical target volumes. In oropharyngeal cancer cases, the head and neck are usually treated with different volumes for high, low and intermediate risk. The paper described automating the target for the high-risk areas. Additional forthcoming papers will describe the low and intermediate predictions.

Cardenas and his collaborators tested the method on a subset of cases that had been left out of the training data. They found that their results were comparable to the work of trained oncologists. The predicted contours agreed closely with the ground-truth and could be implemented clinically, with only minor or no changes.

In addition to potentially reducing inter-physician variability and allowing comparisons of outcomes in clinical trials, a tertiary advantage of the method is the speed and efficiency it offers. It takes a radiation oncologist two to four hours to determine clinical target volumes. At MD Anderson, this result is then peer reviewed by additional physicians to minimize the risk of missing the disease.

Using the Maverick supercomputer at the Texas Advanced Computing Center (TACC), they were able to produce clinical target volumes in under a minute. Training the system took the longest amount of time, but for that step too, TACC resources helped speed up the research significantly.

“If we were to do it on our local GPU [graphics processing unit], it would have taken two months,” Cardenas said. “But we were able to parallelize the process and do the optimization on each patient by sending those paths to TACC and that’s where we found a lot of advantages by using the TACC system.”

“In recent years, we have seen an explosion of new projects using deep learning on TACC systems,” said Joe Allen, a Research Associate at TACC. “It is exciting and fulfilling for us to be able to support Carlos’s research, which is so closely tied to real medical care.”

The project is specifically intended to help low-and-middle income countries where expertise in contouring is rarer, although it is likely that the tools will also be useful in the U.S.

Cardenas says such a tool could also greatly benefit clinical trials by allowing one to more easily compare the outcomes of patients treated at two different institutions.

Speaking about the integration of deep learning into cancer care, he said: “I think it’s going to change our field. Some of these recommender systems are getting to be very good and we’re starting to see systems that can make predictions with a higher accuracy than some radiologists can. I hope that the clinical translation of these tools provides physicians with additional information that can lead to better patient treatments.”

Story Source:

Materials provided by University of Texas at Austin, Texas Advanced Computing Center. Note: Content may be edited for style and length.

Journal Reference:

1. Carlos E. Cardenas, Rachel E. McCarroll, Laurence E. Court, Baher A. Elgohari, Hesham Elhalawani, Clifton D. Fuller, Mona J. Kamal, Mohamed A.M. Meheissen, Abdallah S.R. Mohamed, Arvind Rao, Bowman Williams, Andrew Wong, Jinzhong Yang, Michalis Aristophanous. Deep Learning Algorithm for Auto-Delineation of High-Risk Oropharyngeal Clinical Target Volumes With Built-In Dice Similarity Coefficient Parameter Optimization Function. International Journal of Radiation Oncology*Biology*Physics, 2018; 101 (2): 468 DOI: 10.1016/j.ijrobp.2018.01.114

Supportive care for patients with head and neck cancer

Source: www.oncnursingnews.com
Author: Melissa A. Grier, MSN, APRN, ACNS-BC

Supporting a patient during cancer treatment is a challenge. From symptom management to psychosocial considerations, each patient’s needs vary and must be reevaluated frequently. This is especially true for patients with head and neck cancer.

Head and neck cancers often result in serious quality of life issues. Surgical resection of the affected area can cause disfigurement that not only affects function (eating, drinking, speaking, etc) but also leads to self-image concerns and depression. Radiation therapy and chemotherapy may cause a variety of unpleasant adverse effects, including burns, xerostomia, dental caries, and mucositis. Below are some considerations to help guide nursing care for this patient population.

CALL FOR REINFORCEMENTS
National Comprehensive Cancer Network guidelines recommend early involvement of a dentist, a dietitian, and a speech therapist to help address pre- and posttreatment concerns and preserve quality of life for people with head and neck cancer. The benefits of multidisciplinary collaboration for these complex cases are many but may also result in confusion and information overload for your patient. As the healthcare team provides care, you can help explain the rationale for interventions and assist them with keeping track of recommendations. Additionally, you have a team of experts you can call on when specific issues present themselves during treatment.

KEEP AN EYE OUT
A lot goes on in the life of a patient with head and neck cancer, which means everyday activities like oral and skin care may fall a little lower on their priority list. Performing frequent assessments and assisting with hygiene is vital to preserving and improving quality of life, for example:

  • Help your patients use a handheld mirror to examine their mouth and throat.
  • Ensure that oral care products don’t contain alcohol or other ingredients that can irritate sensitive tissue.
  • Educate your patients about self-care, and guide them toward performing independent dressing changes and surgical site care.
  • Encourage your patients to report any new adverse effects or concerns so they can be addressed promptly.

MEET IN THE MIDDLE
Several factors contribute to malnutrition associated with head and neck cancers. Pain related to mucositis or radiation burns decreases the likelihood that a patient will maintain adequate oral intake. Functional changes following surgery can lead to dysphagia that impairs a patient’s ability to safely receive nutrition and medication by mouth.

To ensure adequate nutrition, many patients with head and neck cancer receive a percutaneous endogastric (PEG) tube prior to beginning treatment. It’s imperative that the patient, the dietitian, and the nursing staff maintain an open line of communication and work together to meet nutritional needs. The patient will likely struggle with losing the ability to taste food and the satisfaction of choosing what they want to eat, so it’s important to allow them to control when they want to receive tube feedings and to follow up frequently to ensure the feedings are being tolerated.

When administering medication via PEG, pay close attention to administration instructions and drug interactions. Extended-release and sustained-release medications should never be crushed and given via PEG. Each medication should be crushed and administered individually, followed by a flush of room-temperature or lukewarm water. If a patient has several medications scheduled at the same time, assess whether administration times can be changed or allow enough time to administer them slowly to avoid patient discomfort related to a high volume of fluid. Lastly, pay attention to whether medication should be administered on a full or empty stomach and coordinate medication administration with tube feedings accordingly.

Although nurses can’t eliminate the hardship that patients will face during treatment for head and neck cancer, we can support them by providing compassionate and thorough care.

Melissa A. Grier, MSN, APRN, ACNS-BC, is a clinical content developer for Carevive Systems, Inc.