9/28/2006 New York, NY Alejandro Garcia et al. Ann Thorac Surg 2006;82:1240-1243 Backgoround: Completely occlusive esophageal strictures may develop after head and neck radiotherapy or esophagectomy with gastric or colonic interposition. Major surgical intervention may be required to restore alimentary tract patency when endoscopic lumen reconstitution is not feasible by routine antegrade endoscopy. Retrograde endoscopic lumen identification and dilation is a useful method to reestablish alimentary tract patency, thereby avoiding surgical intervention. Methods: Patients requiring endoscopic dilation for completely occlusive esophageal strictures were identified by the gastroenterology, thoracic, and head and neck services. Retrograde access was obtained by balloon dilation of either a jejunostomy or gastrostomy tract, and an endoscope was passed to the area of stricture. Antegrade and retrograde endoscopy were performed simultaneously. A guidewire was passed either retrograde or antegrade under direct endoscopic visualization, followed by antegrade Savary dilation under fluoroscopic guidance. Results: From 2003 to 2006, 9 patients were identified with completely occlusive esophageal strictures requiring retrograde lumen identification and dilation. Stricture developed in 6 patients after radiotherapy for head and neck cancer and in 3 after esophagectomy with either gastric or colonic interposition for esophageal cancer. Endoscopic dilation was successful in all patients, without perforation. Conclusions: Retrograde endoscopic lumen identification and dilation is an option to reestablish lumen patency of completely occlusive esophageal strictures after esophagectomy with gastric or colonic interposition or after head and neck chemoradiotherapy. Authors: Alejandro Garcia, BA1, Raja M. Flores, MD1, Mark Schattner, MD2, Dennis Kraus, MD3, Manjit S. Bains, MD1, Richard [...]

9/28/2006 Zurich, Switzerland Nadja E. Tobler and Michael Detmar Journal of Leukocyte Biology. 2006;80:691-696 The extent of lymph node (LN) metastasis is a major determinant for the staging and the prognosis of most human malignancies and often guides therapeutic decisions. Although the clinical significance of LN involvement is well documented, little has been known about the molecular mechanisms that promote tumor spread via lymphatic vessels to sentinel and distal LN and beyond. However, recent discoveries have identified novel lymphatic-specific markers, and the newly discovered lymphangiogenesis factors vascular endothelial growth factor-C (VEGF-C) and VEGF-D were found to promote tumor-associated lymphatic vessel growth in mouse tumor models, leading to enhanced tumor spread to sentinel LN. Our recent findings indicate that VEGF-A also acts as a potent tumor lymphangiogenesis factor that promotes lymphatic tumor spread. VEGF-A overexpressing primary tumors induced sentinel LN lymphangiogenesis even before metastasizing and maintained their lymphangiogenic activity after metastasis to draining LN. Our recent studies showed that primary human melanomas that later metastasized were characterized by increased lymphangiogenesis and that the degree of tumor lymphangiogenesis can serve as a novel predictor of LN metastasis and overall patient survival, independently of tumor thickness. Tumor lymphangiogenesis also significantly predicted the presence of sentinel LN metastases at the time of surgical excision of the primary melanoma. Together, these findings suggest that tumor lymphangiogenesis actively contributes to cancer dissemination, that blockade of lymphatic vessel growth might inhibit tumor metastasis to LN, and that the extent of tumor-associated lymphangiogenesis could serve as a novel, [...]

9/28/2006 Frazer, PA staff Chron.com Drug maker Cephalon Inc. has received Food and Drug Administration approval to market its cancer pain treatment Fentora. The company expects to launch the drug in October. Cephalon said late Monday the drug is the first oral cancer-pain reliever that is absorbed directly into the blood stream via the cheek lining. Conventional short-acting oral opioids are swallowed and absorbed in the gastrointestinal tract, which can take up to 30 to 45 minutes to take effect. Fentora is currently indicated for those cancer patients who are already receiving and are tolerant to opioid therapy for breakthrough pain, a common component of chronic pain characterized by its rapid onset, intensity and relatively short duration. An estimated 800,000 cancer patients will experience breakthrough pain this year, based on data reported by the American Cancer Society. "Our longer-term clinical strategy is focused on developing Fentora for patients with breakthrough pain associated with other conditions, including neuropathic pain and back pain," said Frank Baldino, Cephalon chairman and chief executive, in a statement. Cephalon will manufacture Fentora in five dosage strengths _ 100, 200, 400, 600 and 800 micrograms. Under an agreement, the FDA approval allows Barr Laboratories to launch a generic version of Actiq, the painkiller Fentora is meant to replace.

9/28/2006 Reading, United Kingdom Riina Rautemaa et al. J. Med Microbiol 55 (2006), 1447-1451 Traditional sampling methods for the diagnosis of oral candidosis in head and neck cancer patients, i.e. saliva collection or tongue scrapings, are often impossible to perform. The aim was to determine the optimal sampling method. Eighteen oral cancer patients and five control subjects were sampled semi-quantitatively from the labial sulcus, dorsum of the tongue, dental plaque and saliva for cultivation of yeasts. The patients were examined prior to all cancer treatment (n=5), or 2–4 weeks (n=5) or 8–12 weeks (n=8) post-operatively. The incidence of Candida was found to increase from 40 % at the control and pre-operative level up to 73 % 8–12 weeks post-operatively. Candida albicans was found to be the only species until 4 weeks post-operatively. Thereafter, the incidence of species other than C. albicans was 38 %. The most sensitive sampling site was found to be the vestibular sulcus, from which all culture-positive cases could be confirmed. Tongue surface scraping was found to be more sensitive than saliva collection in detecting Candida. All sampling methods and sites were equally sensitive in detecting the different Candida species. Dental plaque was found to have the highest density of Candida colonization, and was thus found to be the most significant source of Candida infection, which emphasizes the role of dental care in these patients. Authors: Riina Rautemaa1,2,3, Peter Rusanen1,4, Malcolm Richardson1,3 and Jukka H. Meurman2,4 Authors' affiliations: 1 Department of Bacteriology and Immunology, Haartman Institute, University [...]

9/27/2006 Scottsdale, AZ Richard Johnson www.market-day.net There are two types of smokeless tobacco--snuff and chewing tobacco. Snuff,a finely ground or shredded tobacco, is packaged as dry, moist, or insachets (tea bag-like pouches). Typically, the user places a pinch or dipbetween the cheek and gum. Chewing tobacco is available in loose leaf, plug(plug-firm and plug-moist), or twist forms, with the user putting a wad oftobacco inside the cheek. Smokeless tobacco is sometimes called "spit" or"spitting" tobacco because people spit out the tobacco juices and saliva that build up in the mouth. Chewing tobacco and snuff contain 28 carcinogens (cancer-causing agents).The most harmful carcinogens in smokeless tobacco are the tobacco-specific nitrosamines (TSNAs). They are formed during the growing, curing, fermenting, and aging of tobacco. TSNAs have been detected in some smokeless tobacco products at levels many times higher than levels of other types of nitrosamines that are allowed in foods, such as bacon and beer. Other cancer-causing substances in smokeless tobacco include N-nitrosaminoacids, volatile N-nitrosamines, benzo(a)pyrene, volatile aldehydes,formaldehyde, acetaldehyde, crotonaldehyde, hydrazine, arsenic, nickel,cadmium, benzopyrene, and polonium-210. All tobacco, including smokeless tobacco, contains nicotine, which is addictive. The amount of nicotine absorbed from smokeless tobacco is 3 to 4 times the amount delivered by a cigarette. Nicotine is absorbed more slowly from smokeless tobacco than from cigarettes, but more nicotine per dose is absorbed from smokeless tobacco than from cigarettes. Also, the nicotine stays in the bloodstream for a longer time. Smokeless tobacco users increase their risk for cancer of the oral cavity. [...]

9/26/2006 Toronto, Ontario, Canada Benjamin S. Bleir, MD et al. MedicalNewsToday.com Over the past twenty years there has been a significant shift from surgery towards chemoradiation therapy as primary treatment for certain head and neck cancers. While primary chemoradiation allows many patients to avoid surgery and its concurring postoperative complications, it may be associated with significant post-treatment dysphagia, or difficulty in swallowing, which can be debilitating and potentially lethal. During treatment, radiation is typically given over a wide field which encompasses both the primary tumor and its associated lymphatic drainage. As a consequence, structures vital to swallowing are subjected to high doses of radiation which may result in complications such as silent aspiration and feeding tube dependence. The addition of chemotherapy to radiation provides a synergistic effect which has been shown to further improve locoregional control. While chemotherapeutic agents act as radiosensitizers and thereby increasing tumor control rates, they also result in increased acute toxicity as well as late complications secondary to collateral injury to surrounding healthy tissue. A team of scientists from Philadelphia, PA have conducted a study to identify which stages of swallow function are differentially affected by chemoradiation treatment for head and neck cancer, to describe the incidence of long term complications including clinical pneumonia and prolonged feeding tube dependence, and to correlate the clinical variables to the modified barium swallow findings. The authors of the study, “Post Chemoradiation Dysphagia” are Benjamin S. Bleier MD, Marc S. Levine MD, Rosemarie Mick PhD, Stephen E. Rubesin MD, Stephen [...]

9/26/2006 New York, NY Lauren Foster msnbc.msn.com Big Tobacco had more bad press this week after a US federal judge ruled people who smoked "light" cigarettes in the belief they were safer than higher-tar alternatives could proceed with a nationwide class action. The news follows a recent study that found the amount of nicotine in US cigarettes rose about 10 per cent between 1998 and 2004, potentially making it harder to quit and easier to become addicted. The message was clear: smokers are getting more nicotine than in the past and may need additional help in trying to break their powerful nicotine addiction. In the US, home to 44.5m adult smokers, 70 per cent want to quit and 40 per cent make a serious attempt each year, but fewer than 5 per cent succeed in any given year, according to the National Institutes of Health. Worldwide, an estimated 5m people die every year from tobacco-related diseases, and health officials predict the annual death toll will double by 2020 if current smoking trends continue. Faced with these figures, some public health experts are looking more closely at smokeless products, such as Swedish "snus" and traditional moist snuff, as a way to reduce tobacco-related deaths and diseases. They suggest these products are a potentially less harmful way of delivering nicotine. "Five million deaths worldwide is unconscionable when some of those could be prevented by offering some safer alternatives to smoking, which we know is very dangerous," said Philip Alcabes, associate professor of [...]

9/25/2006 Memphis, TN staff CancerConsultants.com In patients with squamous cell cancer of the mouth, imaging with fluorodeoxyglucose positron emission tomography (FDG-PET) detected more hidden lymph node metastases in the neck than computed tomography (CT) or magnetic resonance imaging (MRI). These results were published in the Journal of Clinical Oncology. Oral cancer refers to cancer that involves the mouth, lips, or tongue. A majority of cases of oral cancer are linked with tobacco use. High alcohol intake also increases the risk of oral cancer. Because oral cancer can spread to lymph nodes in the neck, treatment of oral cancer may involve surgical removal or irradiation of these lymph nodes. While it would be optimal to reserve lymph node treatment for those patients with lymph node metastases, it can be difficult to determine in advance whether lymph node metastases are present. Some lymph node metastases are too small to be felt. They may also be missed by conventional imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI). To determine whether an alternative imaging technique—FDG-PET—can be used to identify hidden lymph node metastases in the neck, researchers in Taiwan conducted a study among 134 patients with oral cancer. None of the patients had lymph node metastases that could be felt by palpating the neck. Before surgical removal of the lymph nodes of the neck, patients underwent imaging with FDG-PET and CT or MRI. - Surgery detected lymph node metastases in 26% of the patients. - FDG-PET detected more lymph node [...]

9/25/2006 Scottsdale, AZ Richard Johnson MarketDay.net Scientific evidence has shown that cancers of the oral cavity (lip, tongue,mouth, and throat), larynx, lung, and esophagus are associated with cigarsmoking. Furthermore, evidence strongly suggests a link between cigar smoking and cancer of the pancreas. In addition, daily cigar smokers,particularly those who inhale, are at increased risk for developing heartand lung disease. Like cigarette smoking, the risks from cigar smoking increase withincreased exposure. For example, compared with someone who has neversmoked, smoking only one to two cigars per day doubles the risk for oraland esophageal cancers. Smoking three to four cigars daily can increase therisk of oral cancers to more than eight times the risk for a nonsmoker,while the chance of esophageal cancer is increased to four times the riskfor someone who has never smoked. Both cigar and cigarette smokers havesimilar levels of risk for oral, throat, and esophageal cancers. The health risks associated with occasional cigar smoking (less than daily)are not known. About three-quarters of cigar smokers are occasional smokers. One of the major differences between cigar and cigarette smoking is the degree of inhalation. Almost all cigarette smokers report inhaling while the majority of cigar smokers do not because cigar smoke is generally more irritating. However, cigar smokers who have a history of cigarette smoking are more likely to inhale cigar smoke. Cigar smokers experience higher rates of lung cancer, coronary heart disease, and chronic obstructive lung disease than nonsmokers, but not as high as the rates for cigarette smokers. These [...]

9/24/2006 Montreal, Quebec, Canada Alison Palkhivala www.docguide.com Overexpression of the cyclooxygenase-2 (COX-2) and Ki-67 proteins is a marker of poor outcome in patients with stage I or II glottic cancer and can be used to help tailor therapy, researchers reported here at the 26th International Congress of the International Academy of Pathology (IAP). Involvement of COX-2 in glottic cancer suggests that currently available COX-2 inhibitors may play a role in the treatment of this disease, the researchers said. Finding molecular markers that predict disease course and/or response to therapy is an important goal in the management of all cancers. The researchers say they looked at cyclooxygenase-2, Ki-67, and p53 expression in glottic cancer to see if they had any prognostic value, said Melanie K. Sackett, MD, pathologist, Centre hospitalier universitaire, L'Hôtel-Dieu de Quebec Hospital, Quebec, Canada. The researchers performed immunohistochemical analyses on preradiation biopsies taken from 301 patients with stage I or II glottic squamous cell carcinoma who were participating in a clinical trial evaluating the effect of vitamin E on rate of secondary recurrences of head and neck cancers. "We found a correlation between COX-2 overexpression and increased overall mortality, with a hazard ratio [HR] of 1.68 when we adjusted for age and trial arm," she said during a poster presentation on September 19th. Overexpression of Ki-67 was associated with all cause mortality, with an HR of 1.59 and with the development of a secondary primary cancer, with an HR of 2.34. There was no relationship between p53 overexpression [...]