biopsy

Patient survives stage IV, inoperable throat cancer in clinical trial

Source: medicalxpress.com
Author: staff

It took a white lie to get David Polisini, 79, to a doctor in 2004, after months of being unable to swallow.

“Two of my daughters, Toni and Susie, showed up on my back porch and told me to put my jacket on,” he says. “They told me we were just going for a ride, but the next thing I knew, we were pulling into the Clermont Mercy Hospital.”

Polisini says tests ordered in the emergency room uncovered a tumor in his throat.

“It was the size of a golf ball,” he says, adding that he then scheduled an appointment with his primary care physician, Francis Dumont, MD. “I was then referred to an ear, nose and throat physician within his group who said I needed to see someone at the University of Cincinnati (UC) Cancer Institute.”

A biopsy was performed, and a diagnosis was confirmed—it was Stage IV cancer.

“I began seeing Dr. (Bill) Barrett who explained that I would need to go through very aggressive radiation along with chemotherapy five days a week for three months,” he says. “I’d drive myself every day to every visit in my little Miata. The therapy really zapped my strength, but I’m here because of it.

“I really don’t think I realized how much trouble I was in with Stage IV inoperable cancer, but I knew I had to do what I had to do to get through it.”

The radiation and chemo regimen was a Phase III clinical trial at UC, studying the effects of the use of both radiation and chemotherapy for advanced head and neck cancers.

Besides his family, Polisini credits Barrett, chair and professor of the UC Department of Radiation Oncology and director of the UC Cancer Institute, as well as the staff and care providers at the Barrett Center, where he received treatment, with being a tremendous support.

“Dr. Barrett was there with me every step of the way,” he says. “He was so dedicated to helping me, as were the other nurses and staff at UC. I’m just so impressed with everyone who works there. They stood by me the whole time, and more than 10 years later, I’m doing fine, and the cancer hasn’t come back. To me, Dr. Barrett is an angel come to Earth.”
The clinical trial seems to have worked, and Polisini, who lives in Clermont County, says that while he has a primarily liquid diet, he doesn’t regret a thing.

“By golly, I’ll trade the ability to eat with the ability to get up every morning,” he says. “I have the energy to do the things I want and have to do. I go to the ‘Y’ every other day to exercise. I do my own house and lawn work. I just put a new floor on my front porch. I can only do these things because of the outstanding treatment I received at the UC Cancer Institute and the Barrett Center.”

And he warns others to not ignore symptoms, like he did.

“If you have something wrong, see a doctor right away, unlike I did,” he says. “I’m just thankful for my daughters and Dr. Barrett for helping me.”

March, 2016|Oral Cancer News|

Hopkins team shows methylation-specific ddPCR may help predict head and neck cancer recurrence

Source: www.genomeweb.com
Author: Madeleine Johnson

Oncologists probe the margins of surgical sites to detect epigenetic indicators that can anticipate cancer recurrence. But deep surgical margin analysis with biopsy can alter the site making it challenging to return to the exact spot if there is a problem. It also takes only a few rogue cancer cells to cause a recurrence and these may be missed by histological techniques.

Researchers at Johns Hopkins University School of Medicine have now developed a method using Bio-Rad’s Droplet Digital PCR platform that is amenable to molecular methods and only requires a tiny sample from the surgical margin.

Specifically, in a study published this week in Cancer Prevention Research, scientists examined an epigenetic signature of PAX5 gene methlyation previously determined to be specific to cancer, and found that it could be used to predict local cancer recurrence after tumor removal for head and neck squamous cell carcinoma, or HNSCC.

In a prospective study of 82 patients, if the tumors had methylated PAX5 then the presence of residual methylated cells in the surgical margins was a predictor of poor locoregional recurrence-free survival. And among patients on subgroup of patients who did not receive radiation treatment after surgery, the ddPCR method increased detection of the PAX5 maker from 29 percent to 71 percent.

Compared to conventional methylation analysis, the ddPCR method also reduced the number of false negatives. Importantly, the authors noted in the study that the method can be performed within three hours by one person. Thus, it might be completed before the reconstruction phase of a typical operation, allowing surgeons to resect the margin of the surgical site if methylated cells are detected.

The authors concluded that future personalized oncology workflows could also employ methylation arrays or methylation sequencing to pre-operatively define a patient’s methylome and design a panel of primers and probes that could be used in intraoperative surgical margin assays.

A spokesperson at Bio-Rad noted that an increasing number of researchers are using the firm’s digital PCR platform for methylation studies.

“There seems to be increasing success in applying ddPCR to measurements of methylation, as judged from an uptick in recent publications,” George Karlin-Neumann, the director of scientific affairs at Bio-Rad’s Digital Biology Center, told GenomeWeb in an email.

He cited another recent study that examined so-called “field cancerization,” or the presence of clonally-related cells in the mucosal area surrounding a tumor that have malignant potential and carry cancer-associated genetic or epigenetic alterations.

That work, published in Epigenetics in July, looked at colorectal cancer and showed MethyLight ddPCR was able to achieve a significantly lower limit of detection than the same technique using standard PCR. The author of that study told GenomeWeb that ddPCR could help detect the one or two cells with cancerous epigenetic changes out of a field of thousands.

This increased sensitivity over conventional qPCR is “translating into better clinical sensitivity and specificity with methylation biomarkers, bringing us closer to the possibility of their clinical implementation,” Karlin-Neumann said.

He further noted another recent study, published in Diabetes, which showed absolute measurements of methylated and non-methylated preproinsulin cell-free DNA in blood could provide a better association with Type 1 diabetes than ratio measures.

This result “plays to the strengths of ddPCR’s ability to make absolute measurements, rather than just relative ones.”

Raleigh, North Carolina-based biopharmaceutical company Islet Sciences is also using the methylation status of cell-free DNA to track pancreatic beta cell death. That firm licensed a ddPCR-based epigenetic method from a lab at Yale University, and representatives told GenomeWeb last year that Islet is working to commercialize the assay.

Viresh Patel, global marketing director at Bio-Rad’s Digital Biology Center, told GenomeWeb in an email that the firm is not currently marketing methylation applications specifically, but Bio-Rad continues to work with customers on assay design, sample compatibility, and data analysis.

“This is an emerging application for ddPCR which we expect to gain momentum as researchers continue to publish their breakthrough research,” Patel said.

August, 2015|Oral Cancer News|

For the war against oral cancer, what’s in your arsenal?

Source: www.dentistryiq.com
Author: Dennis M. Abbott, DDS

The face of oral cancer has changed: No longer is oral cancer a disease isolated to men over 60 years of age with a long history of smoking and alcohol consumption. Today, the demographic for the disease includes younger people of both sexes with no history of deleterious social habits who are otherwise healthy and active. It spans all socioeconomic, racial, religious, and societal lines. In other words, oral and oropharyngeal cancer is an equal opportunity killer. Today, as you read this article, 24 people in the US will lose their battles with oral cancer. That is one person for each hour of the day, every day of the year. Each of those lost is someone’s sister, a father’s son, a small child’s mommy, or maybe even a person you hold dear to your heart. The truth is, oral and oropharyngeal cancer has several faces . . . and each of those faces is a human being, just like you and me. So how can we, as dental professionals, be instrumental in the war against oral and head and neck cancer?

Views of the oropharynx, the base of the tongue, and the epiglottis, taken with the Iris HD USB 3.0 intraoral camera using different points of focus. Photos courtesy of the author.

Views of the oropharynx, the base of the tongue, and the epiglottis, taken with the Iris HD USB 3.0 intraoral camera using different points of focus.
Photos courtesy of the author.

The answer, as with most other cancers, lies in early detection. When oral and oropharyngeal cancer is detected early, the five-year survival rate can be as high as 80% to 90%. The harsh reality is that most oral and head and neck cancers are only found at late stages after the cancer has advanced—often to the lymph system. As a result, the chance of the person living for five years after diagnosis falls to approximately 55%.

As dentists and dental hygienists, we—like it or not—are on the front line of this war. We often have the opportunity to see potential cancer patients more frequently than our medical colleagues do, and we are trained to see abnormalities inside the mouth and in the head and neck region. (This is a huge part of the solution!) Many of my medical colleagues tell me that they do not have the training to see what I can see in the mouth. But I do not have the training to practice oncological medicine like they do. The truth is, it takes all of us doing our jobs to care and manage the individual person—not just the teeth, not just the liver, not just the breast, but the whole patient.

Years ago, we could almost profile who would or would not be likely to present with oral cancer. It was always the “Marlboro man”—that guy who was older, drank alcohol frequently, and had a smoking pack-year history that was two or three times his age. But those days are long gone. With the recent understanding that the human papillomavirus (HPV), the most common sexually transmitted infection in the United States, is an etiological factor for oral and oropharyngeal cancer, virtually everyone is a potential cancer patient. As such, everyone should be screened. While the individual with classic risk factors still remains at risk for developing oral cancer, many who present with HPV-related oral and head and neck cancers have no other discovered risk factors, other than exposure to HPV and an immune system that, for reasons still unknown, will not adequately clear the virus without repercussions.

It is believed that 80% to 90% of all Americans have been exposed to HPV at least once in their lifetimes. Most people manage to clear the virus through the immune system’s normal defense function within six to seven months; in some patients, however, damage takes place at the cellular level that may take months, years, or even decades to manifest as cancer. The majority of HPV-related oral and head and neck cancers present in areas that are difficult for us as dental professionals to visualize, such as the tonsils, the base of the tongue, the oropharynx, the posterior pharyngeal wall, and the larynx. That, however, does not give us an excuse not to screen in these areas . . . we just have to think outside of the box and get creative about how we screen.

Visual inspection combined with palpation remains the essential foundation of screening for oral and oropharyngeal cancers, but where visualization is difficult—such as with the base of the tongue and the lower oropharynx—knowing and asking the right questions can become critically important for identifying potential concerns:
“Are you noticing any unusual hoarseness?”
“Are you having any difficulty swallowing?”
“Do you ever have a sensation as though something is caught in your throat?”
“How long has that tonsil been inflamed?”
“Have you noticed any sinus or allergy issues since that tonsil has been enlarged?”
While these questions may seem unrelated to teeth, they are not unrelated to oral health. Simply asking the right questions can open a dialogue of discovery that may lead to the detection of an oropharyngeal cancer early. And early detection is the key to beating the disease and maintaining a good quality of life during the survivorship years.

Technology-based adjunctive devices to assist the dental professional in the early detection of oral cancer have existed in the market for the past 10 to 15 years. Much has been written about fluorescence and reflective technologies, which help the examiner to detect subtle changes in tissue through the usage of light in the violet and yellow ranges of visible light, respectively. Examination with these wavelength-specific devices enhances visualization by highlighting changes in the oral mucosa and vasculature. Usage of these adjuncts has also demonstrated value in enabling clinicians to better understand the size of affected tissue surrounding suspected lesions. As such, these may be useful in selecting a field for biopsy that may produce clear, or noncancerous, margins.

Since the completion of the Human Genome Project (HGP) in 2003, there exists a more clearly defined understanding of how diseases such as cancer affect our cells at the nucleic acid level and how genetic mutations can serve as risk factors or catalysts for cancerous changes in cells. Technology used in the HGP has also provided insight into the genotyping of viruses, leading to a sharper picture of how viral interaction with our genetic code can lead to disease. Today, the dentist and dental hygienist have this technology readily available to move their practice into the era of personalized health.

Salivary tests, such as the MOP (Molecular Oral Testing) by PCG Molecular, take advantage of innovative, advanced genetic testing to establish the risk or presence of oral or oropharyngeal squamous cell carcinoma. MOP does this by evaluating cellular abnormalities in the oral cavity and oropharynx, DNA damage associated with oral and oropharyngeal cancer, and the presence of HPV. With this information, the clinician can better determine the appropriate course of action for the patient.

Sometimes striving to provide the best possible patient care means thinking outside of the box to use technology designed for one purpose and discovering a new application to meet an unanswered need. Most of us are at least familiar with intraoral cameras, and many of us have them in our offices. Using the magnified imagery of a quality intraoral camera and a high-resolution monitor, this tool is a favorite device for illustrating the need for proposed treatment and for establishing patient trust. But what if we could use those images to possibly save a life?

The Iris HD USB 3.0 intraoral camera by Digital Doc LLC has catapulted intraoral photography into the high-definition age. Using the Iris HD precision optical lens array and an advanced HD sensor from Sony, the Iris HD USB 3.0 provides unmatched 720p-resolution clarity that is perfect for the magnification and photographic capture of suspicious areas discovered during a thorough head and neck examination/oral cancer screening. Because of the size of the camera head, the device even makes it possible to examine areas of the oropharynx that were previously difficult for dentists and hygienists to visualize.

Of course, the camera cannot substitute for laryngeal endoscopy, especially if cancer inferior to the epiglottis is suspected, but the camera’s ability to see beyond the palatopharyngeal arch is an improvement over an angled dental mirror. Most patients can tolerate the necessary posterior placement of the camera to capture an oropharyngeal image either by breathing through the nose or with placement of a topical anesthetic on the posterior soft palate and uvula to suppress the gag reflex.

Regardless of the power of the technology, the ultimate skill in detecting early-stage oral and oropharyngeal cancer lies in the eyes, hands, and brain of the examiner. Careful inspection, knowledge, discernment, and experience are the real tools of the professional for acquiring and processing all of the available data and for correctly fitting the puzzle pieces into a picture that illustrates either health, concern with reason for reevaluation, or the need to biopsy the area in question. When reevaluation is required, no more than two weeks should elapse between the initial examination and follow-up, as time is of the essence in proceeding to treatment should the suspicious area indeed be cancerous.

Responsibility to the patient does not end with an abnormal screening result. The dental professional should have a plan in place to either biopsy or refer. The dental professional should biopsy only if he or she is well-experienced in the removal of suspected cancerous lesions. Otherwise, the patient should be referred to an oral/maxillofacial surgeon, periodontist, otolaryngologist, or head and neck surgeon who is comfortable with and experienced in the safe and effective biopsy of a potentially cancerous area. It is most often the case that only one opportunity to obtain a diagnostic tissue sample exists, so the skills of the doctor performing the biopsy should be without question. Every effort should be made to ensure that the patient is seen promptly for biopsy and that the pathology results are returned and shared with the patient expeditiously. Delay can be detrimental to the survival of a patient with oral or oropharyngeal cancer.

Should a screening result from your office lead to a diagnosis of oral or oropharyngeal cancer, be prepared to counsel and educate your patient about what to expect in his or her cancer journey. Learn about and be prepared to meet the unique dental and oral health needs of patients with oral and head and neck cancers, and become equipped to continue care for your patients throughout their treatment and into survivorship. For all of the destruction and hardship that cancer brings, it can form unbreakable bonds, between doctor and patient and between dentist and physician.

Don’t be afraid to reach out to your counterparts in the medical community and bridge the gap between medicine and dentistry in your area. Form alliances with head and neck surgeons, radiation oncologists, medical oncologists, and oncology nurses. Let them know about your skills and the services and technology available in your office that place you on the front line of this war on oral cancer. Take time to understand your medical colleagues’ role in treating the disease and become familiar with the technology they are using to save lives and diminish the long-term effects of oral cancer treatment. We are, after all, fighting the same war, and we’re all on the same side. It is all of us against oral and oropharyngeal cancer, with the needs and health of that one patient we’re fighting for leading us in the battle.

About the author:
Dennis M. Abbott, DDS, is the founder and CEO of Dental Oncology Professionals, an oral medicine-based practice dedicated to meeting the unique dental and oral health needs of patients battling cancer. In addition to private practice, he is a member of the dental oncology medical staff at Charles A. Sammons Cancer Center at Baylor University Medical Center in Dallas. Dr. Abbott is also the founder of the American Academy of Dental Oncology and serves as a consultant to the national American Cancer Society in the development of oral monitoring guidelines for post-treatment cancer survivors. Dr. Abbott lectures internationally on the topics of dental oncology and oral cancer.

Mouth cancer survivor: Dental check ups saved my life

Source: www.express.co.uk
Author: Elaine McLaren

“Nobody particularly enjoys visits to the dentist and I’m no exception, but I’ve always looked after my teeth and have never missed a six-month check. So that day back in May 2009, I wasn’t expecting there to be any problems. I hadn’t been in any pain or discomfort, so I was surprised when the dentist voiced his concern.

‘There’s a white patch on the side of your tongue,’ he told me through his mask. ‘It’s probably nothing but you should get it checked out by your GP, just to be on the safe side.’

Examination over, I sat up in the chair as he explained what he thought it could be – a condition called leukoplakia, which was harmless in its mild form and often disappeared without the need for treatment.

So when, a few days later, I was sitting opposite my GP, I was shocked to hear the condition was closely linked to mouth cancer.

My heart sank at the mere mention of the word. Just seven years earlier, I’d lost my dad to lung cancer.

My thoughts immediately turned to my own children, Grace, who was then only eight, and Daniel, five, and whether they’d have to go through the same trauma as I had with Dad.

As quickly as the notion had entered my head, I brushed it aside. I was only 38 then, I didn’t smoke or drink heavily and I ate healthily. Nothing made me a high risk.

But that still didn’t stop my heart pounding as I sat in the hospital waiting to see the consultant a few weeks later. Opening my mouth wide once again, I steeled myself for the worst possible news.

When he told me I had nothing to worry about, I could have cried with relief.

But its habit of developing into something far more sinister meant that wasn’t the end. I was sent for a biopsy to check for irregular cells and continued to see the consultant for check-ups, then discharged 18 months later. I could finally start to relax and believe it was over.

My dentist wasn’t quite so laid-back. As an expert in mouth cancer, he kept a close eye on it, taking photographs every time I saw him to make sure he could track the changes. It became a routine part of my visits and something I barely even thought about, until five years later I started to notice a difference myself.

All of a sudden, the patch started to rub against my teeth, whereas I’d never noticed it before. It started to get red and aggravated and every time I ate spicy foods, an agonising, searing pain would shoot through my tongue.

As luck would have it, I already had an appointment with my dentist booked, so I decided to see him before doing anything else. I was hoping he would tell me it was nothing, but in my heart I knew that wasn’t the case. Sure enough, he took one look at it and recommended I went back to see the GP.

Just weeks later, I was once again sitting in the familiar surroundings of the consultant’s office. I knew from his straight-faced, stilted reaction – so different to the casual reassurance I’d had before – that it was much more serious.

His voice was calm and steady as he told me I would need another biopsy, but I could tell he thought the worst. I had the procedure two days before Christmas 2013 and though I tried to think positively, telling myself that I’d been worried before and it had turned out to be nothing, the truth was I was terrified.

I spent the entire festive season putting on a happy face and trying to make everything as normal as possible for the children when, inside, all I could think about were the impending results. Every waking moment, I worried about the outcome.

When I returned to the consultant early in the new year, I thought I’d prepared myself for what he was about to say. When I eventually heard the words, ‘You have mouth cancer,’ it turns out I wasn’t prepared at all.

Though I’d known deep down that it was coming, it hit me like a bolt out of the blue as if I’d never expected it at all. As the words began to sink in, it came as such a huge shock that he was talking about me.

I’d always assumed it was a disease that only affected older men who smoked heavily. How wrong I’d been. Mercifully, and thanks to the diligence of my dentist, mine had been caught early enough to give me a great chance. I felt incredibly lucky. I was going to beat this.

But just as I was counting my lucky stars, fate dealt me another blow. A routine MRI scan revealed a mass on my right lung. It couldn’t be diagnosed with a biopsy because of its position, so I had no choice but to leave it there until they’d dealt with the cancer in my mouth.

I was determined to get through it and get back to being a mum again.

In January last year, I had a 10-hour operation to remove the cancer in my tongue and have it rebuilt with tissue and a vein from my arm, which was then grafted with skin from my tummy.

As soon as I recovered, in March last year, I was back in theatre again for a four-hour operation to remove the mass on my lung, which did turn out to be cancerous.

Both of the operations were a success and I’m finally getting my life back on track. I know I’ve got the vigilance of my dentist and the fact that I visited him regularly for the fact that it was caught early enough and I can put it all behind me. If it wasn’t for him, I could still be living with a cancer I didn’t even know was there.”

Throat cancer survivor celebrates life after trans-oral robotic surgery

Source: www.newswise.com
Author: staff

When Charlie Guinn sits down to eat with his lovely wife of 39 years, he thoroughly enjoys each bite. It’s not just the food; the entire experience is a celebration. Just over a year ago, Mr. Guinn learned that he had stage IV throat cancer. For him, just surviving would have been an accomplishment — so swallowing again at a meal with a loved one is truly something special.

The American Cancer Society estimates that in 2013 over 41,000 people in the U.S. were diagnosed with cancer of the oral cavity and pharynx and almost 8,000 died from the disease. But Mr. Guinn would be the first to say that he is one of the lucky ones. He is one of the first patients to undergo trans-oral robotic surgery (TORS) at the University of New Mexico Hospital. And the results have been stunning.

Mr. Guinn first discovered the lump in his throat while shaving. When it was still there a week later, he went to an urgent care center where he was immediately referred to an Ear, Nose and Throat physician. The physician ran a number of tests including a biopsy. When the results came back, the physician referred Mr. Guinn to Nathan Boyd, MD, at the University of New Mexico Cancer Center. It had been only a week and a half from that fateful visit to urgent care.

Mr. Guinn recalls, “When I first got there to see Dr. Boyd, one of the nurses told me, ‘You really hit the lottery because you have some of the finest doctors working on you.’ And I agree. Dr. Boyd is one of the most fantastic people I’ve ever met.” Dr. Boyd, an Assistant Professor in the Department of Surgery, Division of Otolaryngology at the UNM School of Medicine, is one of the first two physicians in New Mexico to offer TORS. The other physician, Andrew Cowan, MD, PhD, is also an Assistant Professor in the Department of Surgery, Division of Otolaryngology at the UNM School of Medicine and initiated and launched the surgical program in early 2013.

After his initial consultation with Dr. Boyd, in which he learned about his surgical options, Mr. Guinn consulted with two other physicians at the UNM Cancer Center that same day. He met with his oncologist, Elizabeth McGuire, MD, an Associate Professor in the Department of Internal Medicine, Division of Hematology/Oncology; and with his radiation therapy physician, William Thompson, MD, a Staff Physician in the Department of Internal Medicine, Division of Hematology/Oncology.

The physician team took Mr. Guinn’s preferences into account and agreed to offer him the TORS procedure. Dr. Boyd explained to Mr. Guinn that they would need to complete at least one exploratory surgery first. Mr. Guinn agreed. He recalls that meeting with a laugh and says, “Dr. Boyd told me, ‘My goal for you is, in one year, to have a [Blake’s] Lotaburger with cheese and green chile.’”

Three weeks later, Dr. Boyd completed three TORS procedures on Mr. Guinn and the tumor was out. But because the tumor cells had spread to the lymph nodes, even bursting one of them, Mr. Guinn’s UNM Cancer Center physician team decided to recommend chemotherapy and radiation as a preventive measure to make sure no cancer cells were lurking. Mr. Guinn did not like the additional treatments but knew they were necessary. “The worst experience for me was the radiation,” he says. He experienced some third-degree burning during his course of treatment, but has healed now. He shrugs off the experience saying it’s nothing compared to what burn victims go through.

His chemotherapy experience was a little better. Mr. Guinn didn’t feel like eating very much and he lost weight. “That was the positive of all this,” he laughs. “I do not recommend the diet, but it was the greatest thing.” Another side effect was his hair changing color. “I didn’t lose my hair. I’ve been silver and grey since my late 20s and now my hair is black. At first, I was mad.” But, he’s now accustomed to the darker hair.

Mr. Guinn reflects on what the experience of the past year has brought him. “It’s made me understand what other people go through and what their families go through,” he says. “And I realize that it’s not talking about it but just asking: How are you feeling? What can I do for you?”

Additionally, he and wife have gotten closer. “We’ve been married for 39 years. And we never thought we could get closer.” They are planning a celebratory vacation together.
Finally, Mr. Guinn credits his recovery to his faith, positive attitude, and the people around him who helped him keep that positive attitude. His family was with him at every single appointment. His family and friends sent their prayers and cards, meals, and other helpful items. And his entire treatment team at the UNM Hospital and the UNM Cancer Center gave him the confidence that he would pull through. “Ever since I met Dr. Boyd, not once did I think I was going to die,” he says. “I tell people, you don’t need to go anywhere. These people will take good care of you.”

At his latest visit recently, Mr. Guinn gave Dr. Boyd a gift card to Blake’s Lotaburger. He laughs as he recalls the look on his surgeon’s face. “I told him, ‘Have one on me!’

March, 2014|Oral Cancer News|

Shedding light on oral cancer

Source: www.laboratorytalk.com
Author: staff

A team of Indian cancer researchers led by Dr Narayanan Subhash has developed a simple, non-invasive spectral imaging system that holds the possibility of rapid, inexpensive mass screening. Even in the hands of non-clinical staff, it is capable of real-time discrimination of healthy oral tissue from pre-malignant and malignant tissues with accuracy comparable to the gold standard histopathology of a biopsy sample.

The core of the novel Diffuse Reflectance Imaging System (DRIS) is an Andor Luca-R EMCCD camera, which captures monochrome images of the patient’s mouth at 545 and 575 nm.

Andor’s SOLIS software computes a ratio image (R545/R575) of the area under investigation and generates a Pseudo Colour Map (PCM) where blue designates healthy tissue, red denotes dysplastic/pre-malignant tissue and yellow identifies malignant tissue.

Fig-1a

This allows rapid visual differentiation of oral lesions and identification of regions with pre-malignant characteristics.

Fig-1b

“Since mortality from oral cancer is particularly high, early detection, diagnosis and treatment is vital in increasing the survival rate of those with the disease,” says Dr Subhash. “Our imaging method has the great advantage of non-invasively scanning entire lesions and their surrounding areas and automatically categorising these oral lesions into normal/clinically healthy, pre-malignant, and malignant tissue in real-time.

“It also delineates the boundaries of neoplastic changes and locates sites with the most malignant potential for biopsy, thereby avoiding unnecessary repeated biopsies and delay in diagnosis. What’s more, imaging the entire region may also help the surgeons to identify the margins of the lesion that cannot be easily visualised by the naked eye during surgical interventions.”

Orla Hanrahan of Andor added: “The Luca-R EMCCD camera is well-equipped to handle this demanding role. It is built around a monochrome, megapixel frame transfer EMCCD sensor to deliver single photon detection sensitivity and unrestrained QE (65% max) in a TE cooled, USB 2.0 camera platform.”

February, 2014|Oral Cancer News|

Noninvasive oral cancer test eases patient fears

Source: www.drbicuspid.com
Author: Donna Domino, Features Editor

A new, noninvasive cytology test for oral cancer, ClearPrep OC, is being offered free to dentists. The test, aimed at “watch and wait” lesions, is less expensive than biopsies and less frightening for patients, according to Resolution Biomedical, the company that is commercializing it.

The chairside oral cancer test — which can be ordered directly from the company — is designed to be a diagnostic option for assessing lesions when a biopsy is not warranted or the patient fears getting a biopsy, according to Donald Williams, MD, chief medical officer of Resolution Biomedical.

The test involves a cyto-brush sampling method that measures gross changes in the nuclear DNA content of oral epithelial cells, providing information about the precancerous or cancerous state of a lesion, the company explained. The samples are sent to medical testing labs, and the report is sent to the dentist within four to five days, the same time frame as biopsies. Dentists send the samples to the company, which prepares the slides and sends them to labs, which prepare a diagnostic report for the dentists.

“It’s a way to triage patients where something may be suspicious but the patient is balking about getting a biopsy,” Dr. Williams told DrBicuspid.com. “It could be leukoplakia lesions or thrush instead of an indication of a neoplasm. It rules out biopsies without an invasive process.”

When dentists refer patients to periodontists to get biopsies of suspicious lesions, many patients don’t follow through on the recommendation because they find it a daunting procedure, Dr. Williams noted.

“Some patients think, ‘I’ve had this for years and it hasn’t killed me, so I don’t want to be biopsied,’ ” he said. “It’s kind of frightening to say you’re going to have a piece of meat cut out of your mouth.”

The most logical application is for worrisome lesions that are likely benign, Dr. Williams said.

Ongoing clinical trial
Resolution Biomedical conducted about five validation studies of the ClearPrep OC test in general practices over six months, Dr. Williams said. It is now being tested with Southern California dentists.

In addition, the test is in the second phase of a trial study with cancer patients in the City of Hope cancer research hospital in Duarte, CA. ClearPrep OC and saliva samples will be taken, and p16 stains will be done on the biopsy specimens. All the modalities then will be combined before a blind match is done. The company plans to do a joint publication based on the results with the University of California, Los Angeles, Dr. Williams said. The test was primarily designed for gynecologic cytology pap tests, but Resolution Biomedical realized it also had potential to detect oral cancer.

The company does not plan on doing an official launch of the product, which has no marketing restrictions since nongynecologic cytology tests are an established medical practice, according to Dr. Williams. As a result, the test does not require U.S. Food and Drug Administration clearance or need to be Clinical Laboratory Improvement Amendments (CLIA)-certified, he said.

While the test is being provided for free to dentists, patients and labs pay $60 to $125 — much less than biopsies, which range from $400 to $500, according to Dr. Williams. It is usually covered by insurance, and dentists can charge a collection fee for the process, including interpreting the final report, according to Dr. Williams. Company revenues will be derived from the testing labs it uses for analysis.

“Biopsies are invasive, expensive, and painful,” said company CEO Mike Friedl. “This is an intermediate way to rule out stuff while you’re still at the dentist rather than going to a specialist.”

The test is especially suitable if the condition is simply a treatable condition, such as a fungal change, and doesn’t require a trip to see a specialist, Friedl noted. Since the human papillomavirus (HPV) is now associated with many oral cancers, the company tests for it if the sample shows any degree of atypism.

Sol Silverman Jr., DDS, a professor of oral medicine in the University of California, San Francisco (UCSF) School of Dentistry and head of one of the oral medicine clinics at UCSF, called the ClearPrep test a good adjunctive diagnostic technique.

“Cytology has been around a long time, and it’s very high-quality,” Dr. Silverman told DrBicuspid.com. “Any technique that will accelerate the recognition of dysplasia is important. Early detection is still our best approach to good survival results.”

March, 2013|Oral Cancer News|

Chicago ENT head and neck surgeons using VELscope Vx to enhance oral cancer surgery success rate

Source: www.menafn.com
Author: press release

LED Medical Diagnostics Inc. subsidiary LEDDental announced today that its VELscope Vx enhanced oral assessmentdevice will now be used by Chicago Otolaryngology Associates for oralmucosal abnormality assessment and when performing surgery on oral cancer patients.

According to Chicago Otolaryngology Associates’ Howard Kotler, MD,FACS, “We pride ourselves on embracing state-of-the-art technologies that allow us to provide the best patient care possible. The VELscopeVx may significantly enhance our ability to see the entire cancerous or precancerous lesion that needs to be excised, allowing us to minimize risk of additional unnecessary surgery.”

The VELscope Vx’s fluorescence visualization technology is the first approved by the FDA and Health Canada to help surgeons determine the surgical margins when excising cancerous and precancerous tissues. The technology is also approved to help dental and medical professionals discover cancerous and precancerous tissue that might not be apparent to the unaided eye.

The vast majority of the nearly 12,000 VELscope devices in use around the world are used by dental practices. Typically, when a suspicious lesion is detected by a dentist, the patient is referred to an oral surgeon or a periodontist for a surgical biopsy, which is then evaluated by an oral pathologist. If the biopsy sample is determined to be cancerous or precancerous, the patient is usually referred to an ENT head and neck surgeon for consultation and likely excision. VELscope technology was developed to address the problem of detecting all abnormal tissue, including that beneath the surface, as well as making it possible for dentists to discover early stage oral cancer, which requires less invasive treatment and has a significantly higher chance of survival than when the disease is detected in late stages.

“We applaud Dr. Kotler and Chicago Otolaryngology Associates forbeing one of the first Otolaryngology practices in the U.S. toincorporate VELscope’s potentially life-saving technology,” saidPeter Whitehead, founder and CEO of LED Dental and its parent, LEDMedical Diagnostics Inc. .

January, 2013|Oral Cancer News|

New gene test detects early mouth cancer risk

Source: www.health.am

Researchers from Queen Mary, University of London have developed a new gene test that can detect pre-cancerous cells in patients with benign-looking mouth lesions. The test could potentially allow at-risk patients to receive earlier treatment, significantly improving their chance of survival.

The study, published online in the International Journal of Cancer, showed that the quantitative Malignancy Index Diagnostic System (qMIDS) test had a cancer detection rate of 91-94 per cent when used on more than 350 head and neck tissue specimens from 299 patients in the UK and Norway. Mouth cancer affects more than 6,200 people in the UK each year and more than half a million people worldwide, with global figures estimated to rise above one million a year by 2030*. The majority of cases are caused by either smoking or chewing tobacco and drinking alcohol.

Mouth lesions are very common and only five to 30 per cent may turn into cancers. If detected in the early stages treatment can be curative, but until now no test has been able to accurately detect which lesions will become cancerous.

The current diagnostic gold standard is histopathology – where biopsy tissue taken during an operation is examined under a microscope by a pathologist . This is a relatively invasive procedure and many mouth cancers are being diagnosed at later stages when the chances of survival are significantly reduced. For patients presenting with advanced disease, survival rates are poor (10-30 per cent at five years).

Lead investigator and inventor of the test Dr Muy-Teck Teh, from the Institute of Dentistry at Queen Mary, University of London, said: “A sensitive test capable of quantifying a patient’s cancer risk is needed to avoid the adoption of a ‘wait-and-see’ intervention. Detecting cancer early, coupled with appropriate treatment can significantly improve patient outcomes, reduce mortality and alleviate long-term public healthcare costs.”

The qMIDS test measures the levels of 16 genes which are converted, via a diagnostic algorithm, into a “malignancy index” which quantifies the risk of the lesion becoming cancerous. It is less invasive than the standard histopathology methods as it requires only a 1-2 mm piece of tissue (less than half a grain of rice), and it takes less than three hours to get the results, compared to up to a week for standard histopathology.

Consultant oral and maxillofacial surgeon, Professor Iain Hutchison, founder of Saving Faces and co-author on the study, said: “We are excited about this new test as it will allow us to release patients with harmless lesions from regular follow-up and unnecessary anxiety, whilst identifying high-risk patients at an early stage and giving them appropriate treatment. Mouth cancer, if detected early when the disease is most receptive to surgical treatment, has a very high cure rate.”

Dr Catherine Harwood, a consultant dermatologist and a co-author on the study, said: “Our preliminary studies have shown promising results indicating that the test can potentially also be used for identifying patients with suspicious skin or vulva lesions, offering the opportunity of earlier and less invasive treatments.”

Whilst this proof-of-concept study validates qMIDS as a diagnostic test for early cancer detection, further clinical trials are required to evaluate the long-term clinical benefits of the test for mouth cancers.

With further development it could potentially be applied to other cancer types as the test is based on a cancer gene – FOXM1 – which is highly expressed in many cancer types. In this study the researchers used the qMIDS test to detect early cancer cells in vulva and skin specimens with promising results.

Dr Teh’s earlier research on FOXM1 – which showed that when FOXM1 is overexpressed the protein loses its control over cell growth, allowing cells to proliferate abnormally –was awarded ‘Molecule of the Year 2010’ by the International Society for Molecular and Cell Biology and Biotechnology Protocols and Research.

Notes:
1. This study was jointly funded by the Facial Surgery Research Foundation – Saving Faces (UK), the Bergen Medical Research Foundation, Norwegian Cancer Research Association, British Skin Foundation and Cancer Research UK.

2. Teh M-T, et al. (2012) ‘Exploiting FOXM1-Orchestrated Molecular Network for Early Squamous Cell Carcinoma Diagnosis and Prognosis’ is published in the peer-reviewed journal International Journal of Cancer.

October, 2012|Oral Cancer News|

Growing ‘mini tumors’ from patient’s cancer could lead to custom treatments

Source: www.huffingtonpost.com
Author: Marilynn Marchione

It’s a medical nightmare: a 24-year-old man endures 350 surgeries since childhood to remove growths that keep coming back in his throat and have spread to his lungs, threatening his life. Now doctors have found a way to help him by way of a scientific coup that holds promise for millions of cancer patients.

The bizarre case is the first use in a patient of a new discovery: how to keep ordinary and cancerous cells alive indefinitely in the lab.

The discovery allows doctors to grow “mini tumors” from each patient’s cancer in a lab dish, then test various drugs or combinations on them to see which works best. It takes only a few cells from a biopsy and less than two weeks to do, with materials and methods common in most hospitals.

Although the approach needs much more testing against many different types of cancer, researchers think it could offer a cheap, simple way to personalize treatment without having to analyze each patient’s genes.

“We see a lot of potential for it,” said one study leader, Dr. Richard Schlegel, pathology chief at Georgetown Lombardi Comprehensive Cancer Center in Washington. “Almost everyone could do it easily.”

An independent expert agreed.

For infections, it’s routine to grow bacteria from a patient in lab dishes to see which antibiotics work best, Dr. George Q. Daley of Children’s Hospital Boston and the Harvard Stem Cell Institute said in an email. “But this has never been possible with cancer cells because they don’t easily grow in culture,” he said.

The new technique may reveal in advance whether a person would be helped by a specific chemotherapy, without risking side effects and lost time if the drug doesn’t work. “Pretty nifty,” Daley wrote.

In the case of the 24-year-old, described in Thursday’s New England Journal of Medicine, lab-dish tests suggested that a drug used to treat a type of blood cancer and some other unrelated conditions might help.

It’s not a drug that doctors would have thought to try, because the man technically does not have cancer. But his lung tumor shrank after a few months of treatment, and he has been stable for more than a year. He still has to have operations to remove throat growths that keep coming back, but only about once every five months.

The man, an information technology specialist in suburban Washington who asked to remain anonymous to protect his privacy, has recurrent respiratory papillomatosis, or RRP. It’s usually due to infection at birth with certain types of a virus, HPV, that causes genital warts.

The condition causes wartlike growths in the throat, usually around the voice box. These growths usually are noncancerous but can turn malignant, and even benign ones can prove fatal if they spread to the lungs. The main treatment is surgery, usually with lasers to vaporize the growths and keep them from choking off the airway or making it hard to talk.

About 10,000 or more people in the U.S. have the disease, said Jennifer Woo, president of the RRP Foundation. Woo, 29, is a medical student at Georgetown and one of the researchers on the study. She also has the condition but said it is confined to her throat and has required only about 20 surgeries so far.

The man in the study has a much more serious case.

“I was diagnosed when I was 3 or 4. At first, I had to have surgery every 7 to 10 days,” the man said in a phone interview. “I get short of breath and my voice will get more hoarse.”

Two years ago, the growths to his lungs became extensive and life-threatening, and his physician, Dr. Scott Myers, described the condition at a meeting of Georgetown hospital specialists. “It’s crushing the airway,” Myers said.

Doctors suggested that the new lab method pioneered by Schlegel and others might help. It borrows an idea from stem cell researchers: adding mouse cells for nourishment, plus a chemical that prevents cell death to an ordinary lab culture medium. That enabled healthy and cancerous cells to keep growing indefinitely.

Researchers grew “mini tumors” from the man’s lung mass and from healthy tissue and screened various drugs against them. One proved ineffective. Another worked against the tumor but at too high a dose to be safe. The third did the trick.

A similar approach could let doctors screen drugs for cancer patients.

“What could be more personalized than taking this person’s cell, growing it in culture, finding a drug to treat them and then treat them?” said Doug Melton, co-director of the Harvard Stem Cell Institute. The Georgetown method gives an answer quickly enough that it could save lives, he said.

Tyler Jacks, a cancer researcher at the Massachusetts Institute of Technology and former president of the American Association for Cancer Research, said the next step is to show that this could work for many different cancers and that it leads to better outcomes in patients.

“It seems to have worked in this one instance, but other tumors might prove to be more challenging,” he said.

The National Institutes of Health paid for much of this work and has already sent research teams to Georgetown to learn the method. About a dozen other universities have done the same, Schlegel said. So far, his lab has grown prostate, breast, lung and colon cancer cells. Georgetown University is seeking a patent on the method.

September, 2012|Oral Cancer News|