Management strategies for oral potentially malignant disorders

Source: www.medscape.com Author: Joel M. Laudenbach, DMD Oral potentially malignant disorders (OPMDs) include oral leukoplakia (OL), oral erythroplakia, oral submucous fibrosis, oral lichen planus, proliferative verrucous leukoplakia, and actinic keratosis. Once an OPMD has been clinically diagnosed, execution of management strategy is critical. When formulating the strategy, healthcare providers should consider histopathology, lesion characteristics (ie, surface texture, unifocal, multifocal), lesion location in the mouth (ie, tongue, floor of mouth), patient risk factor assessment, and a detailed medical/cancer history. In this newly published article, Nadeau and Kerr[1] detail various parameters surrounding evaluation and management of OPMDs. The authors make it clear that OPMDs are challenging, each with their own nuances regarding risk for malignant transformation. For example, when OL is unifocal, nonhomogeneous, nodular, or verrucous, there is a much higher chance of the OL becoming dysplastic (12.63-fold) or demonstrating a focus of carcinoma (8.9-fold) when compared with homogeneous types of OLs.[1] Provider knowledge of these variables is critical when counseling patients about their diagnosis and management options and when selecting interventions along with follow-up care. Although progression to malignancy is difficult to predict with OPMDs, clinicians can account for multiple risk factors such as smoking/alcohol status, high-risk location in the oral cavity, and size of lesion (>200 mm2) to help formulate a tailored management plan for each patient. Consultation with an oral pathologist to discuss the histologic appearance in the context of specific patient history and lesion characteristics can provide additional perspective and/or recommendations. Modifiable oral cavity cancer risks related to [...]

HPV leads to increase In head and neck cancer In men

Source: www.nbcdfw.com Author: Bianca Castro The number of men diagnosed with head and neck cancer caused by human papillomavirus has skyrocketed. This report found that 11 million men and 3.2 million women in the United States are infected with some type of oral HPV and oncologists say it's leading to more head and neck cancer in men. "From the 1970's to today, the prevalence of this HPV-related head and neck cancer has increased by three to five percent per year from then until now, and it is continuing that same rate," said Oncologist Jerry Barker, Jr., M.D. at Texas Oncology. "This is a silent epidemic. Most patients who are exposed to this virus, they don't know it. They'll never have symptoms from it, but some of those patients will move on to develop a cancer," said Dr. Barker. Jeff Busby, of Weatherford, is one of those patients. The aerospace engineer and owner of Busby Quarter Horses says he was diagnosed with throat cancer in February of 2016. His wife Andrea, who documented their journey here, says they were both shocked. "We were just busy living life. You don't ever think that shoe is going to drop," said Andrea. Jeff says the symptoms began as pain in his ear which lead to pain in his throat. Nine months later, he had a biopsy done on what was a mass in his neck. "I had just been toughing it out and my partner said, 'hey, you can't just tough these kinds of [...]

Blood-borne HPV antibodies indicate head, neck cancer prognosis

Source: medicalxpress.com Author: provided by Brown University People with head and neck cancers with evidence of human papillomavirus (HPV) infection generally have a better prognosis than people without evidence of infection. A new study in JAMA Oncology suggests that to produce a strong, reliable prognostic signal, all that's needed is a blood serum test for two specific HPV antibodies, rather than lab work on a biopsy. Further, the researchers said, the study shows that this blood-based biomarker is predictive of outcome for all types of head and neck cancer. The human papillomavirus causes not only cervical cancer but also cancers of the head and neck. Credit: National Cancer Institute "What this adds is that it helps us know how best to measure clinically the HPV contribution to this disease," said study senior author Karl Kelsey, a professor of epidemiology and of pathology and laboratory medicine at Brown University. Kelsey collaborated with lead author Heather Nelson of the University of Minnesota Masonic Cancer Center in making the findings. Moreover, Nelson, Kelsey and their colleagues wrote, referring to the common HPV16 strain of the virus: "These data are among the first to demonstrate a convincing relationship between HPV16 and improved patient survival for tumors of the larynx and oral cavity." Appraising antibodies The study examined blood serum samples and five-year survival rates among more than 1,000 Boston-area head and neck cancer patients diagnosed between 1999 and 2011. Overall, those who tested positive for antibodies to the oncogenic HPV proteins E6 [...]

2016-12-11T09:48:32-07:00December, 2016|Oral Cancer News|

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 [...]

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, [...]

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. 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% [...]

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 [...]

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 [...]

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

2014-02-11T13:33:25-07:00February, 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 [...]

Go to Top