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Scientists map interactions between head and neck cancer and HPV virus

Source: medicalxpress.com
Author: staff, Gladstone Institutes

Human papillomavirus (HPV) is widely known to cause nearly all cases of cervical cancer. However, you might not know that HPV also causes 70 percent of oropharyngeal cancer, a subset of head and neck cancers that affect the mouth, tongue, and tonsils. Although vaccines that protect against HPV infection are now available, they are not yet widespread, especially in men, nor do they address the large number of currently infected cancer patients.

Patients with head and neck cancer caused by HPV respond very differently to treatments than those whose cancer is associated with the consumption of tobacco products. The first group generally has better outcomes, with almost 80 percent of patients surviving longer than 5 years after diagnosis, compared to only 45-50 percent for patients with tobacco-related cancers.

To better understand what might cause these differences, a team of scientists led by Nevan J. Krogan, Ph.D., senior investigator at the Gladstone Institutes, is taking a unique approach by focusing on the cancer-causing virus. They recently mapped the interactions between all HPV proteins and human proteins for the first time. Their findings are published today in the journal Cancer Discovery.

“With our study, we identified several new protein interactions that were previously not known to cause cancer, expanding our knowledge of the oncogenic roles of the HPV virus” said Krogan, who is also a professor of cellular and molecular pharmacology at UC San Francisco (UCSF) and the director of the Quantitative Biosciences Institute (QBI) at UCSF. “The human proteins we found interacting with HPV are involved in both virus- and tobacco-related cancers, which means they could be potential targets for the development of new drugs or therapies.”

A Complete Picture of Virus-Cancer Connections
Krogan and Manon Eckhardt, Ph.D., a postdoctoral scholar in his laboratory at Gladstone, developed an integrated strategy to identify all the interactions between HPV proteins and human proteins. First, using a method called mass spectrometry, they discovered a total of 137 interactions between HPV and human proteins.

Then, in collaboration with computational biologist Wei Zhang, Ph.D., in the laboratory of Trey Ideker, Ph.D., at UC San Diego School of Medicine, they looked at entire networks of each protein—rather than only individual proteins—to detect the most important players. They also compared their list of proteins with data from HPV-associated cancer samples published by The Cancer Genome Atlas project. This large consortium catalogued genetic mutations in tumors of various cancers.

“We integrated together these two sets of data to get a comprehensive look at potential cancer-causing interactions between HPV and head and neck cancers,” said Krogan, who is co-director of the Cancer Cell Map Initiative. “This combined proteomic and genetic approach provided us with a systematic way to study the cellular mechanisms hijacked by virally induced cancers.”

Common Pathways in HPV-Induced and Smoking-Related Cancers
By overlaying the protein interaction and genomics data, the scientists discovered that the HPV virus targets the same human proteins that are frequently mutated in smoking-related cancers. Interestingly, those proteins are not mutated in HPV-positive cancers.

For example, their findings reconfirmed a well-established interaction between the human protein p53 and an HPV protein called E6. In HPV-negative cancers (those related to smoking), p53 is mutated in nearly all cases. However, the same protein is rarely ever mutated in HPV-positive cancer patients.

“In both cases, when p53 is inactivated, it leads to cancer,” explained Eckhardt, one of the first authors of the paper. “The difference is that the HPV virus finds a different way of attacking the same protein.”

In smoking-related cancers, p53 is mutated, which causes the cancer. Instead, in HPV-positive cancers, the viral protein E6 interacts with p53 and inactivates it, resulting in the same cancer, but without the mutation. This suggests the establishment of the viral infection and the development of tumors share common pathways.

“We thought there must be more proteins that can cause cancer either by being mutated or hijacked by HPV, so we developed a new method to detect them,” added Eckhardt. “Our study highlighted two interesting instances where the interaction of HPV and human proteins play a role in the development or invasiveness of the cancer.”

Eckhardt showed that the HPV protein E1 interacts with the human protein KEAP1, which is often mutated in smoking-related cancers. In HPV-positive cancers, KEAP1 is not mutated. But, through its interaction with the protein E1, KEAP1 is inactivated, which helps cancer cells survive.

The researchers also found that the HPV protein L2, which is part of the virus’s packaging, interacts with two human proteins called RNF20 and RNF40. They demonstrated that in HPV-positive cancers, this protein interaction increases the tumor’s ability to spread and invade new parts of the body.

These results confirm that the HPV virus causes head and neck cancer by targeting the same proteins that go awry in response to smoking-induced mutations.

Connecting Cancer and Infectious Diseases
Krogan and his collaborators have shown that integrating HPV-human interaction with tumor genome data, and focusing on genes that are mutated in HPV-negative but not HPV-positive tumors, constitutes a powerful approach to identify proteins that serve as both viral targets and genetic drivers of cancer.

The scientists’ work should lay the groundwork to find better therapeutic options for both HPV-negative and HPV-positive head and neck cancers. In addition, Krogan’s long-term goal is to define a pipeline that will enable the study of many other virally induced cancers, including those linked to Hepatitis B and C, Epstein-Barr virus, and adenoviruses.

“Science can be siloed, and through these unbiased, holistic approaches we can start to find common pathways between different systems,” said Krogan, who also leads the Host Pathogen Map Initiative, which aims to compare protein and genetic interactions across many pathogens and identify similarities. “Our work is helping connect the dots between cancer and infectious diseases in ways that have never been considered.”

September, 2018|Oral Cancer News|

Study: HPV cancer survivors at risk for second HPV cancer

Source: www.bcm.edu
Author: Dipali Pathak

A retrospective study led by researchers at Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth) School of Public Health found that survivors of HPV-associated cancers have a high incidence of developing second HPV-related cancers. Their findings, which were reported today in JAMA Network Open, suggest the need for increased screening for HPV-associated precancerous and early cancerous lesions among people who are survivors of the disease.

Human papillomavirus, or HPV, is a sexually transmitted infection that can lead to gynecological (cervical, vaginal and vulvar), anogenital (anal and penile) and oropharyngeal (throat and mouth) cancers. Cervical cancer is the most common HPV-associated cancer in women, and oropharyngeal cancers are the most common in men.

“HPV is a virally mediated cancer, so it makes sense if somebody is infected in one site with the virus that they would be infected in other sites as well. It is important for people who have had one HPV-related cancer to know that they are at increased risk for HPV-related cancers in another site, and they are encouraged to have screening for these other cancers, if screening is available. Currently, screening is available for cervical and anal precancers,” said Dr. Elizabeth Chiao, professor of medicine in the section of infectious diseases at Baylor and with the Houston VA Center for Innovations in Quality, Effectiveness and Safety.

Chiao also is a member of the NCI-designated Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine.

For the study, researchers used data from the Surveillance, Epidemiology, and End Results (SEER) Program database, which collects cancer incidence data from registries across the United States. They identified survivors of HPV-associated cancers diagnosed from January 1973 to December 2014 and looked at patients who developed a second primary HPV-associated cancer at the same site or a different site at least two months after the diagnosis.

They found that individuals who had primary HPV-related cancer had an increased risk of HPV-related cancer in other sites later in life.

According to the study, the risk for most types of second primary HPV-associated cancers is high after 1) initial vaginal and vulvar cancers in women, 2) after initial penile cancer in men and 3) after anal cancer in both women and men. The researchers found no association with secondary non-HPV associated cancers.

“Future research needs to be prioritized to determine effective as well as cost-effective ways to screen for HPV-associated second cancers in this high-risk group,” said Dr. Ashish Deshmukh, assistant professor in the department of management, policy and community health at UTHealth School of Public Health in Houston.

The researchers recommend investigating the efficacy of screening and prevention measures for survivors of HPV-associated cancers. They also recommend being vaccinated against HPV. The vaccination series can begin at 9 years of age in males and females and can go through age 26 for females and age 21 in males.

Others who took part in the study include Ryan Suk and Dr. Kalyani Sonawane with UTHealth School of Public Health; Dr. Parag Mahale with the National Cancer Institute; Dr. Andrew G. Sikora with Baylor College of Medicine; Dr. Jagpreet Chhatwal with Harvard Medical School; Dr. Kathleen Schmeler and Dr. Scott B. Cantor with The University of Texas MD Anderson Cancer Center and Dr. Keith Sigel with the Icahn School of Medicine at Mount Sinai.

Note: This work was supported by grants K07180782 and R01 CA163103 from the National Cancer Institute, part of the National Institutes of Health.

September, 2018|Oral Cancer News|

Head and neck Cancer: Overcoming Challenges in Treatment

Source: www.curetoday.com
Author: staff

Itzhak Brook, M.D., M.Sc., shares the story of his initial diagnosis and treatment for cancer of the head and neck, outlining the challenges that came along with treatment, with fellow board member of the Head and Neck Cancer Alliance Meryl Kaufman, M.Ed., CCC-SLP, BRS-S.

Transcript:
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Dr. Brook, can you please share your story about your cancer diagnosis in 2006 and the treatment that followed and also the subsequent surgery that you went through?

Itzhak Brook, M.D., M.Sc.: Once I learned I had cancer and my doctors removed it when they had to biopsy, I needed to receive radiation therapy. I did not get any chemotherapy, and the radiation therapy lasted six weeks, five days a week. It was very difficult to experience the radiation, and the side effects start to accumulate within a few days. And I had to deal with inflammation of the mouth, mucositis, difficulty in swallowing and pain in my throat, and I experienced a burning of the skin around the area of radiation, weakness and then difficulty maintaining intake of food. After a while, I could lose weight, and I tried to persevere because I knew that I had to receive the treatment to get better and soldier through it until it was over.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Exactly. And some people have such severe side effects from the radiation that they actually require a feeding tube to support them during their treatment. In that case, often patients are encouraged to eat and drink and use that feeding tube to supplement what they’re able to eat and drink. Did you find that there were certain foods that were difficult for you to swallow and you needed to avoid during that time?

Itzhak Brook, M.D., M.Sc.: I was fortunate that I was able to maintain my hydration and nutrition without the feeding tube. And in my trial and error, I found solid food, cold food, such as watermelon, ice cream and sour cream. I tried to consume high-calorie food so that even though I don’t eat as much, I would still take calories in and not lose a lot of weight. I was lucky I lost only 5 pounds, but some people lose more. The most important thing is to stay hydrated, get enough food and get enough water, which at that time was a real challenge, as the nausea increased over time. But fortunately, I had a very good support system in the place where I got it. I had a radiation oncologist who had advised me and told me and helped me cope with the side effects.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Exactly. And how important was your support system at home? Who supported you and helped get you through that treatment?

Itzhak Brook, M.D., M.Sc.: Obviously, that’s very, very important. My wife and children were very supportive of me, and they knew that I was going through a rough time and tried to help me in all the other ways possible. Also, at work, I got a lot of understanding and support from my team of co-workers. I was then in the military. I was in the U.S. Navy and got my treatment at Walter Reed, and they were very, very helpful in trying to ease it.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: And then when the cancer came back, you faced a laryngectomy. Can you talk to us about what that meant to you and what sort of associated fear and stigma you experienced?

Itzhak Brook, M.D., M.Sc.: Well, the most important thing was that they caught the cancer, and that was because I saw an otolaryngologist every month, and this is done for the first year and second year because that’s the time when more recurrences happen, in those two years. And when the cancer was diagnosed, they tried to remove it through an endoscopy and direct biopsy, but it was already too difficult, as it had gotten into the areas where simple procedures couldn’t work. And then they realized that I needed an experienced physician to do it, and I went for a second opinion to another otolaryngologist in a different city. And he referred me to another one because he felt that person would be the best to do it.

And fortunately, we have fewer laryngectomies today, partly because of the experience in doing it is less prevalent and you need to find what I found: the person who knew it best. And they finally removed it, but the understanding that I needed laryngectomy was very difficult. I suddenly realized that my voice would be lost, and I like to speak. Like anyone, I like to lecture, and accepting that I would have to lose my voice was very difficult. I remember that as a medical student some 50 years ago, when I saw laryngectomies, I said to myself, “If I ever have to make a choice, I would never give up my choice even if it cost me my life.” But once I had a choice and I also understood that I could still speak—differently, but I could speak—I made the decision very quickly. There was no doubt in my mind that in order to stay alive, I was going to do it, and I don’t regret it.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: That’s so important for people to understand that there is life after laryngectomy or glossectomy, in the case of having your tongue removed or part of your jaw. There is life, there is rehabilitation and there are ways to go about learning how to speak and swallow again in the face of these challenges. What is something that you wish you had known prior to the diagnosis or during that time period that you can give to other people facing the same situation?

Itzhak Brook, M.D., M.Sc.: I wish I had known that I needed to go to the best physicians who are experienced in the field to do the procedure, and I should not have avoided to make the decision right away but take the time to search for the best person who could help me. I also wish that I had known that even though I was prepared for the procedure, my physicians, nurses and speech pathologists did prepare me, helped me, and they explained to me that experiencing this is completely different from all the words and explanations. And it’s still a very difficult period to undergo this major surgery and be in the hospital completely helpless. But it was worth it because even though it was difficult, I got my life back, and I still believe that life is a very, very precious thing. And if you need to lose something to gain life, it’s worth it.

September, 2018|Oral Cancer News|

Head and neck cancer: An overview of head and neck cancer

Source: www.curetoday.com
Author: staff

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, discuss the prevalence of cancers of the head and neck, emphasizing the potential risk factors and importance of prevention.

Transcript:
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Welcome to this CURE Connections® program titled “Head and Neck Cancer: Through the Eyes of a Patient.” I’m Meryl Kaufman, a certified speech-language pathologist and founder of Georgia Speech and Swallowing LLC. I am joined today by Dr. Itzhak Brook, a professor of pediatrics and medicine at Georgetown University School of Medicine, who was diagnosed with throat cancer in 2006. Together we will discuss the prevalence of head and neck cancer, what unique challenges patients may face and how one can adjust to life after receiving treatment for their disease. Dr. Brook and I also serve as board members on the Head and Cancer Alliance.

Dr. Brook, let’s talk about head and neck cancer in general. What’s the difference between head and neck cancer associated with the traditional risk factors, such as smoking and drinking, and HPV-related head and neck cancers?

Itzhak Brook, M.D., M.Sc.: The traditional head and neck cancer is related to smoking and alcohol consumption. It’s usually associated with a high rate of laryngeal cancer. And HPV-related cancer is a relatively new arrival on the scene of head and neck cancer, and it’s associated with a condition of infection by a venereal disease. The virus HPV is usually associated with a posterior tongue cancer or an oropharyngeal cancer.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Exactly, yes. So the HPV viruses typically in the oropharynx, the tonsil and the tongue basis are certainly rising in incidence as compared with the traditional head and neck cancers, which are decreasing in incidence. In fact, it’s anticipated that in the year 2020, the HPV-related oropharyngeal cancers are going to surpass HPV-related cervical cancers, which are typically what you think of with the HPV virus. So that is a new patient population, but the good news is that the survival rates are better for the HPV-related head and neck cancers versus the non-HPV-related cancers. Can you speak a little bit about the incidence of the two?

Itzhak Brook, M.D., M.Sc.: The incidence of head and neck cancer is not as high as others like colon cancer, breast cancer in women or lung cancer, but it’s around the ninth or 10th cause of cancer in the world in this country. In countries where there is smoking and alcohol consumption, it’s a higher rate. HPV is usually happening in younger people, in the late 30s or early 40s. And fortunately, we hope that it could be prevented by vaccination. Although it’s approved that it can, it’s not yet available because the incubation period for the cancer, as you may call it, takes 20, 30 years, so we don’t really know. Fortunately, even though HPV is very common, the occurrence of HPV-related cancer is very, very rare.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Correct. In terms of the vaccination for the HPV virus, I agree, the proof certainly isn’t definitively out there yet, but the vaccine protects against the strain of virus that ultimately can lead to head and neck cancer. So the thought is that by preventing the contraction of the virus, hopefully we can also prevent these head and neck cancers, which is why the American Academy of Pediatrics and the CDC (Centers for Disease Control and Prevention) recommend that children between the ages of 11 and 12, female and males, are vaccinated prior to sexual debut in the hopes of preventing these cancers down the road, certainly. So yes, head and neck cancer does account for about 6 percent of all cancers worldwide, with about 500,000 cases worldwide. And in the United States, we anticipate about 65,000 a year, I believe, and they do occur more frequently in men, almost twice as often in men than in women and typically in people over the age of 50 in the traditional head and neck cancers. But certainly, there is a change in that with the introduction of the HPV-related cancers. Can you talk a little bit about prevention in terms of things that we can do to prevent the risky behaviors?

Itzhak Brook, M.D., M.Sc.: Of course, with the traditional cancers, it can be prevented by not smoking or drinking alcohol in high quantities. But there’s the behavioral changes that men and women can change that can reduce the risk of acquiring it. It’s a sexually transmitted disease. Oral sex has been the No. 1 cause, so you think of condoms or men using them also when having oral sex may prevent it.

September, 2018|Oral Cancer News|

Head and neck cancer: Novel treatment approaches

Source: www.curetoday.com
Author: staff

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, share insight into the role of novel treatment approaches like immunotherapy, robotic surgery and de-escalation in the management of cancers of the head and neck.

Transcript:
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Dr. Brook, traditionally the treatment for head and neck cancer has been surgery, radiation, chemotherapy or some combination of those three. But there are some new and emerging treatment approaches to head and neck cancer along with many other cancers. Can you tell us a little bit about immunology? What is immunotherapy in the care of the head and neck cancer patient?

Itzhak Brook, M.D., M.Sc.: Most days, we don’t get cancer because our immune system is like the police department of our body. They detect cancer early and eliminate it. Unfortunately, in the case of cancer, the cancer cells can fool the immune system, and they go undetected and cause the disease. The main advantage of immunotherapy is that we are using the body’s defenses, the immune system, to kill the cancer in a much better way than the chemotherapy. Chemotherapy destroys the cancer cells, but it also affects the body cells. Immunotherapy is more precise. It is directed only to the cancer cells, so the rest of the body stays unscathed. That’s the beauty of immunotherapy. So, immunotherapy is an evolving field in cancer. They have many, many new drugs in the pipeline, and many studies are being done. But right now, there are several drugs that are good and seem to help in a patient with cancer, cancer that has already spread or that surgery cannot reach. The body’s own immunity would reach it.

One of them is monoclonal antibodies that were developed specifically for the cancer cells, and the other one is checkpoint inhibitors, which overcome the attempt by the cancer cells to fool the immune system and protect the cancer cells from their own immunity. So, by blocking those checkpoints, the body’s own immunity comes in and destroys the cancer cells. Those drugs are very promising because first of all, they are more effective in getting only the cancer cells. They do cause fewer side effects, and we are hopeful that they would be the new armamentarium that we will have for head and neck cancer.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: So, would you say that’s something you should ask your physician about to find out what clinical trials and what types of medications are offered for your specific type of cancer at the time of diagnosis?

Itzhak Brook, M.D., M.Sc.: Absolutely, and that is depending on your own illness, on the seriousness or stage of the illness. And your physician would be able to consult the right specialist to tailor the specific treatment for you, and that’s very important because now we have a new tool that can augment the chemotherapy. And many of those treatments are given in combination. Conventional treatment with chemotherapy plus immunotherapy seems to work very well in many patients.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Yes. The future is exciting in that regard. In the case of the HPV-positive oropharyngeal cancers, there has also been a lot of interest and push toward robotic surgery in caring for that patient population. I know that that’s not for everybody, and it’s more suited for some of the smaller tumors because of the side effects that might go along with it. What is your understanding of the role of robotic surgery in the care of head and neck cancer patients?

Itzhak Brook, M.D., M.Sc.: Robotic therapy is an amazing new procedure. It’s being done using the robotic tools that are able to do the surgery in a much less invasive way without traumatizing many of the normal tissues of the body. They cause less damage. The recovery period is shorter, and patients benefit from it tremendously. In that procedure, there is a robotic machine that the surgeon operates, and it allows very, very precise ability to cut the cancer out, and it does cause less long-term damage to the tissues and less deformity, you may say. And that’s a wonderful tool. But unfortunately, as you said, it is limited to areas of the body that the robot can reach. And when the cancer is in places that are not reachable by the robotic approach, one needs to use the conventional approach. But even in that area, there is a development of using endoscopic surgery where one can use a laser and the endoscopic approach, or the laser can kill or burn out the cancers that are more deeply located in the throat, again saving major surgery and even saving removal of the larynx from patients.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: That’s right. And also, there’s a push toward de-escalation of the radiation and the chemotherapy in some of these HPV-positive patients, as well, because the tumors are more responsive to the treatment. So, there are many studies going on looking at whether we can do less treatment for the different types of diseases. As you spoke earlier, I think finding the right specialists is important; not everybody is a specialist in all these new and advanced technologies. If you’re looking for robotic surgery, find that specialist that really does a lot of robotic surgery and is an expert in that field. The same is true for the immunotherapy and other treatment approaches as well. So, I think being your own advocate, again, to find these different alternative options and these new treatments in clinical trials becomes exceedingly important in the age of all these new discoveries.

Itzhak Brook, M.D., M.Sc.: Fortunately, the knowledge of experience in those procedures, the laser and the robotic surgery, is becoming more prevalent in the United States. And when I had my cancer, when I needed to make choices 10 years ago, there were only a handful of experts. But right now, almost every major medical center has an expert in those fields, so it’s more available for people.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Absolutely. So, even if you have to travel a distance to get to those major medical centers, it’s worth the effort and travel and time to be able to seek these other opinions and see what your other options are before pursuing your treatment.

Itzhak Brook, M.D., M.Sc.: Absolutely.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Yes, I agree.

September, 2018|Oral Cancer News|

Head and neck cancer: Getting a diagnosis of head and neck cancer

Source: www.curetoday.com
Author: staff

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, discuss which symptoms should lead one to seek a diagnosis of head and neck cancer and which tests are available to aid in evaluation.

Transcript:
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: When we talk about the HPV-related cancers, those are primarily in the oropharynx, which is the tongue base and the tonsil. But the traditional cancers typically can also involve the tongue, the lips, the floor of the mouth, the jaw, the gums and the hard palate. And the pharynx; that includes the nasopharynx behind the nose. We’ve addressed the oropharynx but also the hypopharynx, near the larynx. And in your case, laryngeal cancer that involves the larynx, the voice box, and the epiglottis. So, head and neck cancers can occur in any of those places. Can you talk about some of the signs and symptoms people can look out for in those areas?

Itzhak Brook, M.D., M.Sc.: Well, the important signs that are common to oral cancers are having a sore throat, a feeling that you cannot swallow and difficulty in swallowing. In advanced stages, it can interfere with breathing. If you have increased lymph glands in the neck and are also feeling like a lump or something is stuck in your mouth, those could be a sign. Sometimes they have symptoms such as pain in the ear or pain in the throat. And there are specific cancers such as sinuses and lips. If there is an area of the mouth where there’s a red or ulcerating lesion in the oropharynx, this can indicate that there is a cancer risk.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Exactly. Can you talk about your initial presentation? What symptoms did you experience?

Itzhak Brook, M.D., M.Sc.: I experienced something stuck in my mouth, and when it didn’t go away after a week or so, I went to see my doctors, and they discovered it very early. And I was fortunate that it was possible to remove it by a simple biopsy. And then, unfortunately for me, even though I got radiation, the cancer came back about a year and a half later, and I required a laryngectomy to remove the cancer because it had moved to other places, the throat. And that was a way to treat it initially, but being vigilant and recognizing early that there’s something wrong, something is happening, can definitely save many lives.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Exactly. And quality of life, right?

Itzhak Brook, M.D., M.Sc.: Right.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: What were some of the tests exactly that you underwent in trying to find this cancer and making a diagnosis?

Itzhak Brook, M.D., M.Sc.: Well, I got obviously the most important thing, which was to have a good otolaryngological examination with endoscopy, where they put the tube into your throat or through the nose to try to detect and see what’s going on through direct examination. The other tests that I am aware of are MRI and then CT. But the most important thing in my case was a good physical examination because in my case, the MRI and CT didn’t show anything wrong because you need the cancer to be larger than about a half an inch, and mine wasn’t yet. So, seeing your doctor is the most important thing a person can do to catch the cancer early.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Absolutely. And one of the things the Head and Neck Cancer Alliance does and promotes is free screenings throughout the country and throughout the world. And traditionally, the Head and Neck Cancer Alliance has done that during oral head and neck cancer awareness week, which occurs in April every year. But there has been a push in the past couple of years to really spread that out throughout the year and help raise awareness to these signs and symptoms that you addressed, as well as direct patients to facilities that can provide a screening. And a screening is simple and easy, and it does involve a physical examination—feeling the neck, looking for signs and symptoms and talking about signs and symptoms. So. certainly, if any listeners were to identify any of these risk factors that you address, such as a change in swallowing, a change in voice, a lump in the neck, pain in the ear or difficulty breathing, then certainly looking to some of these screening sites or reaching out to your doctor is a good way to really find those cancers early and help minimize the intensity of the treatment that might result.

Itzhak Brook, M.D., M.Sc.: Absolutely.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Yes. And in terms of staging head and neck cancers, one of the important pieces of that work-up when you had the endoscopy and the scans was to come up with a TNM stage for that head and neck cancer that really kind of directs the treatment. Part of that also is being evaluated by a multidisciplinary team, and I think it’s really important in the management of head and neck cancer that there are multiple specialists, including the otolaryngologist, who’s often the first person to make the diagnosis. But a team of specialists, including radiation oncologists, hematology, oncology, speech pathology, nutrition, social work and pathology—there are so many professionals involved. Was there a multidisciplinary team involved in your care?

Itzhak Brook, M.D., M.Sc.: Yes. Fortunately, I had been examined by all those experts. In addition to it, I also, when I finally had the laryngectomy, met and represented several patients who wanted and got that procedure, and meeting them prepared me more than anything else in our life for what a laryngectomy would be.

September, 2018|Oral Cancer News|

Cancer biology graduate student travels ‘ROCKy’ road toward a cure for post-radiation dry mouth

Source: medicalxpress.com
Author: staff, University of Arizona

The United States is in the midst of a head-and-neck cancer epidemic. Although survival rates are relatively high—after treatment with chemotherapy and radiation—survivors can suffer permanent loss of salivary function, potentially leading to decades of health problems and difficulties eating.

It is unknown why the salivary gland sometimes cannot heal after radiation damage, but Wen Yu “Amy” Wong, BS, a University of Arizona cancer biology graduate student, may have taken a step toward solving that riddle.

Radiation often comes with long-term or even permanent side effects. With a head-and-neck tumor in radiation’s crosshairs, the salivary gland might suffer collateral damage.

“When you get radiation therapy, you end up targeting your salivary glands as well,” Wong said. Losing the ability to salivate predisposes patients to oral complications and an overall decrease in their quality of life. “Salivary glands help you digest food, lubricate your mouth and fight against bacteria. After radiation, patients could choke on their food because they can’t swallow. They wake up in the middle of the night because their mouth is so dry. They often get cavities.”

Favorite foods may lose their flavor. “Saliva produces certain ions that help you taste,” she said. “Patients lose the ability to enjoy food. The best steak is very bland to them.”

The quest to restore salivary function in post-radiation head-and-neck cancer patients starts with learning why the salivary gland is unable to heal itself after radiation damage.

Wong’s study may have helped to unravel this mystery. Her team looked closely at two proteins, E-cadherin and β-catenin, which allow communication between cells. Normally, these proteins bind cells together, but after radiation damage, these connections are severed. “Think of them as telephone wires,” Wong said. “Radiation is like lightening hitting a telephone pole. That breaks the ability of one friend to talk to another on the other side of the city.”

Just as a maintenance crew can repair downed telephone poles after a storm, the body is able to heal itself after injury. Unfortunately, in post-radiation dry mouth, salivary glands’ ability to regenerate might be blocked.

In the lab, Wong was able to artificially force the regeneration of salivary glands, allowing her to learn where there are obstructions in the regeneration process. Wong particularly was interested in something called the ROCK pathway, which might go awry in the wake of radiation, blocking E-cadherin and β-catenin from reuniting.

“If I use an inhibitor to prevent this ROCK signaling pathway, these two proteins come back together,” Wong said.

The next step is to learn more about how a defective ROCK pathway blocks salivary glands’ natural ability to regenerate following radiation damage. Unlocking this secret could uncover novel ways to treat or cure post-radiation dry mouth.

Earlier this month, Wong and her co-authors were recognized by the American Physiological Society for their investigation, which was published in June by the American Journal of Physiology—Regulatory, Integrative and Comparative Physiology. Wong, along with Maricela Pier, BS, a research specialist with the UA College of Medicine—Tucson Department of Cellular and Molecular Medicine, and Kirsten Limesand, Ph.D., of the UA Cancer Center and professor of nutritional sciences with the UA College of Agriculture and Life Sciences, was selected for the APSselect award, given to the best articles in physiological research.

Wong selected Dr. Limesand’s lab as her “home base” throughout her graduate studies because “I wanted to connect with a woman in science who understands the difficulties. She was very easy to talk to, and the people in the lab provide a very nurturing environment. She is a great mentor.”

Dr. Limesand takes her role as a mentor seriously, and finds it deeply satisfying.

“Hands down, the most rewarding aspect of my career is training students,” Dr. Limesand said. “They’re our next generation of scientists, tackling the big questions that need to be solved.”

Dr. Limesand is a professor with the UA Cancer Biology Graduate Interdisciplinary Program, which emphasizes translational research to address significant problems relating to cancer development and treatment. Students are prepared for careers in cancer research through an interdisciplinary approach involving faculty members from a wide range of disciplines.

“I have students from cancer biology and physiological sciences, and I’ve been on committees of genetics students and immunobiology students,” said Dr. Limesand. “These diverse perspectives add to the research we’re doing.”

August, 2018|Oral Cancer News|

How early do the effects of smoking start? Earlier than you think

Source:
Author: Julia Mullaney

Smoking’s destructive nature has been known for quite a while. But many people think that a cigarette here and there is okay, or smoking is fine as long as you quit while you’re young. But what’s the truth? How much — and for how long — do you need to smoke before it does irreversible damage to your health? We broke down all the facts.

Put out the cigarette and prolong your life. BrianAJackson/Getty Images

Smoking’s negative effects start with the first puff
The moment you inhale a cigarette, there are instant effects — even if it’s only your first time. The tar in cigarette smoke instantly hits your teeth and starts damaging your enamel. It also hits the gums and starts to do damage. Over time, the gums turn black.

The smoke then hits the throat, where it damages the esophagus lining. In time, this is what leads to throat cancer. It also damages the cilia in your trachea, preventing them from being able to clean away the tar. The smoke then travels to the lungs, where the tar builds up and stays. The tar damages the lungs’ natural cleaning process, which hurts lungs’ ability to work and makes them more susceptible to serious infections.

Finally, inhaling that puff of smoke also means inhaling carbon monoxide, which gets absorbed in the blood stream instantly. You might feel tired and out of breath, and over time this leads to heart disease because it takes away the oxygen that is supposed to travel through your cells and replaces it with carbon monoxide. The nicotine in the cigarette also travels to your brain, which releases “feel good” dopamine and makes you want more. And so the smoking addiction begins.

Smoking’s lasting effects can begin as early as your teen years
In a 2018 study, it was found that teens who smoke and drink alcohol already showed signs of stiffening arteries — something that can lead to serious heart trouble down the road. If you begin smoking as a teen, you don’t even make it out of your teen years before the body starts to be seriously damaged. Smoking and drinking at a young age leads to the progression of atherosclerosis, which occurs when plaque forms on the inner walls of the arteries. Eventually, you might suffer a heart attack, heart disease, and heart failure.

If you start smoking before 25, your lungs will never fully develop
The lungs don’t fully develop until around age 25. If you start smoking as a teen, they never get the chance to reach full size because of the damage caused by cigarettes. Even if you quit, your lungs won’t magically get bigger. However, if you don’t begin smoking until your lungs are fully developed, you can at least reverse most of the damage done to the lungs — but that also depends at what age you quit. According to Thrillist, in order to cut your risk of smoking-related death by 90%, you need to stop smoking before you turn 40. However, the sooner the better.

Smoking for less than one week can inhibit your lungs’ performance
It doesn’t take long for smoking’s effects to damage the body. Actually, it only takes about five to seven days. Since a cigarette fills your lungs with dangerous chemicals, the lungs can’t make a full recovery. And if you keep smoking — say, a few times per day — the lungs never have a chance to get rid of the gunk that filled them. After just a little while, those chemicals will harbor in the lungs and cause lasting damage. Plus, they can lead to various cancers.

But quitting still outweighs not quitting, despite the lasting effects
While the lungs of a smoker will never as healthy as smokeless lungs, the benefits of quitting greatly outweigh not quitting. Your body does have the ability to bounce back. After being smoke-free for just six hours, the carbon monoxide levels in your body decline and the heart starts to function more normally. After a couple of months, your lung function can improve by up to 30%, and you won’t have the horrid cough you’ve had for years. After nine months, your heart is almost totally out of the danger zone (this does depend on age, though). Over time, the body rebuilds itself and heals the damage.

August, 2018|Oral Cancer News|

E-cigarettes ‘could give you mouth cancer by damaging your DNA’

Source: metro.co.uk
Author: Zoe Drewett

Researchers say vaping could lead to an increased risk of developing mouth cancer. A study carried out by the American Chemical Society found evidence to suggest using e-cigarettes raises the level of DNA-damaging compounds in the mouth. If cells in the body are unable to repair the DNA damage after vaping, the risk of cancer can increase, the study claims.

The long-term effects of e-cigarettes are not yet known but researchers say they should be investigated further (Picture: PA)

The researchers admit the long-term health effects of using electronic cigarettes are still unknown. Researcher Dr Romel Dator said: ‘We want to characterize the chemicals that vapers are exposed to, as well as any DNA damage they may cause.’

Since they were introduced in 2004, e-cigarettes have been marketed as a safer alternative to smoking. But the team carrying out the study claim genetic material in the oral cells of people who vape could be altered by toxic chemicals. E-cigarettes work by heating a liquid – which usually contains nicotine – into an aerosol that the user inhales. It is often flavoured to taste like fruit, chocolate or bubblegum.

‘It’s clear that more carcinogens arise from the combustion of tobacco in regular cigarettes than from the vapor of e-cigarettes,’ Silvia Balbo, the project’s lead investigator said. ‘However, we don’t really know the impact of inhaling the combination of compounds produced by this device. ‘Just because the threats are different doesn’t mean that e-cigarettes are completely safe.’ The latest study, due to be presented at a meeting of the American Chemical Society this week, analysed the saliva and mouth cells of five e-cigarette users before and after a 15-minute vaping session.

Researchers found levels of the toxic chemicals formaldehyde, acrolein and methylglyoxal had increased after vaping. Now they plan to follow up on the preliminary study with a larger one involving more e-cigarette users. They also want to see how the level of toxic chemicals differs between e-cigarette users and regular cigarette smokers.

According to a 2016 report by the US Surgeon General, 13.5% of middle school students, 37.7% of high school students and 35.8% of 18 to 24-year-olds have used e-cigarettes, compared with 16.4% of adults aged 25 and over. Ms Balbo, a professor at the Masonic Cancer Center at the University of Minnesota, said:

‘Comparing e-cigarettes and tobacco cigarettes is really like comparing apples and oranges.  The exposures are completely different. ‘We still don’t know exactly what these e-cigarette devices are doing and what kinds of effects they may have on health, but our findings suggest that a closer look is warranted.’

 

August, 2018|Oral Cancer News|

Smoking, cancer, heart disease, and the oral-systemic link: Where we are with research

Source: www.dentistryiq.com
Author: Richard H. Nagelberg, DDS

Dr. Richard Nagelberg examines the links between smoking, lung cancer, and heart disease, as well as the types of research and studies that established the strength of their credibility over time. Likewise, he considers where we are today with the link between oral health and overall health as he evaluates the current state of oral-systemic research.

Perhaps the most universally accepted facts in health care are the detrimental effects of tobacco, particularly cigarette smoking, for nearly every part of the body. It is safe to say that no one disputes the direct causal links between cigarette smoking, lung cancer, and heart disease. Listed below are only two statements regarding the state of this knowledge.

✔️The scientific evidence is incontrovertible: inhaling tobacco smoke, particularly from cigarettes, is deadly. Since the first Surgeon General’s Report in 1964, evidence has linked smoking to diseases of nearly all organs of the body. (surgeongeneral.gov. June 21, 2018)

✔️Smoking is by far the biggest preventable cause of cancer. Thanks to years of research, the links between smoking and cancer are now very clear. Smoking accounts for more than 1 in 4 UK cancer deaths, and 3 in 20 cancer cases. (cancerresearchuk.org)

There is a boatload of research supporting this link. However, there has never been one large-scale double-blinded interventional study demonstrating that smoking causes lung cancer and heart disease. The fact that this link exists is based on the cumulative results of numerous smaller studies over a long period of time.

The reasons are the same for the lack of large-scale interventional studies investigating the link between smoking, lung cancer, and heart disease, among others, as well as that between the mouth and the body. These studies are too costly and full of variables that are difficult to control in a study spanning 20 years or more. It is the cumulative results of research that will demonstrate the strength of the link between oral health and overall health, rather than one definitive piece of research.

While the risks of smoking were being investigated, there were naysayers who doubted the emerging results. In fact, there was substantial skepticism within the medical community about whether the apparent increase in cancer deaths was real or the result of better diagnosis. The study that is credited with the beginning of the stop-smoking movement was published in 1954 by Hammond and Horn. Their paper ended with: “[we are of the opinion that the associations found between regular cigarette smoking and death rates from diseases of the coronary arteries and between regular cigarette smoking and death rates from lung cancer reflect cause and effect relationships.]” (1)

At present, we are in the middle of the oral-systemic research, waiting until a sufficient body of research provides incontrovertible evidence one way or the other.

Reference
1. Hammond EC, Horn D, The relationship between human smoking habits and death rates: a follow-up study of 187,766 men. J Am Med Assoc. 1954;155(15):1316-1328.

August, 2018|Oral Cancer News|