chemotherapy

Young men should be required to get the HPV vaccine. It would have saved me from cancer.

Source: www.thedailybeast.com
Author: Michael Becker

In December 2015, at the age of 47, I was diagnosed with Stage IV oral squamous cell carcinoma.

More simply, I have advanced cancer of the head and neck. While initial treatment with grueling chemo-radiation appeared successful, the cancer returned one year later in both of my lungs. My prognosis shifted from potentially curable to terminal disease. The news was shocking and devastating—not just for me, but for my wife, two teenage daughters, and the rest of our family and friends.

Suddenly, my life revolved around regular appointments for chemotherapy, radiation therapy, imaging procedures, and frequent checkups. I made seemingly endless, unscheduled hospital emergency room visits—including one trip to the intensive care unit—to address some of the more severe toxicities from treatment.

All told, I suffered from more than a dozen side effects related to treatment and/or cancer progression. Some are temporary; others permanent. These include anxiety, depression, distorted sense of taste, clots forming in my blood vessels, dry mouth, weight loss, and many more.

My cancer started with a human papillomavirus (HPV) infection, a virus that is preventable with vaccines available for adolescent girls since 2006 and boys starting in 2011. The Food and Drug Administration (FDA) has approved three vaccines to prevent HPV infection: Gardasil®, Gardasil® 9, and Cervarix®. These vaccines provide strong protection against new HPV infections for young women through age 26, and young men through age 21, but they are not effective at treating established HPV infections. It was too late for me in 2011 when the HPV vaccine was made available to young men, and I was 43 years old.

According to the Centers for Disease Control and Prevention (CDC), more than 30,000 new cancers attributable to HPV are diagnosed each year. Unlike human immunodeficiency virus (HIV), which is spread by blood and semen, HPV is spread in the fluids of the mucosal membranes that line the mouth, throat, and genital tracts, and can be passed from one person to another simply via skin-to-skin contact.

While most HPV cases clear up on their own, infection with certain high-risk strains of HPV can cause changes in the body that lead to six different types of cancer, including cancers of the penis, cervix, vulva, vagina, anus, and head and neck (the last of which is what I have). Two of these, HPV strains 16 and 18, are responsible for most HPV-caused cancers.

Researchers believe that it can take between 10 and 30 years from the time of an initial HPV infection until a tumor forms. That’s why preventing HPV in the first place is so important and the HPV vaccine is so essential.

However, only 49.5 percent of girls and 37.5 percent of boys in the United States were up to date with this potentially lifesaving vaccination series, according to a 2017 CDC report. In sharp contrast, around 80 percent of adolescents receive two other recommended vaccines—a vaccine to prevent meningococcus (PDF), which causes bloodstream infections and meningitis, and the Tdap vaccine to prevent tetanus, diphtheria, and pertussis.

Even if you don’t think your child is at risk for HPV now, they almost certainly will be. HPV is extremely common. Nearly everyone gets it at some point; in fact, the CDC estimates that more than 90 percent and 80 percent of sexually active men and women, respectively, will be infected with at least one strain of HPV at some point in their lives. Around one-half of these infections are with a high-risk HPV strain.

As a cancer patient with a terminal prognosis, I find it infuriating that the HPV vaccine is tragically underutilized more than a decade since its introduction. Two simple shots administered in early adolescence can reduce a child’s risk of receiving a cancer diagnosis much later in life.

Parents who oppose the use of vaccines cite popular misconceptions that they are unsafe, ineffective, and that immunity is short-lived. Others argue that receiving the HPV vaccine may increase sexual promiscuity. Films like Vaxxed based on research that has been discredited, and directed by a researcher who fled the United Kingdom due to the misleading uproar he created, are still quoted as science.

Regardless, the fact remains that millions of adolescents aren’t getting a vaccine to prevent a virus known to cause cancer. We must counter untrue, exposed, and discredited research that keeps some parents from having their children vaccinated and put an end to the campaign of misinformation.

Viruses that are preventable, such as HPV, should be eradicated just like previous success with polio and smallpox. Cancers that are preventable through HPV vaccination should be prevented. The safety and efficacy of these vaccines are no longer subject to serious debate (PDF). Research has shown that vaccinations work; they keep children healthy, save lives, and protect future generations of Americans—but only when they are utilized.

The lesson: Don’t wait. Talk to your pediatrician about vaccinating your 11-year-old boys and girls against HPV today to eradicate this cancer-causing virus.

I only wish my parents had that opportunity when I was young, as it could have prevented the cancer that’s killing me.

December, 2017|Oral Cancer News|

Source: www.self.com
Author: Katherine Pett, R.D.N.

If you’re dealing with cancer, eating is probably the last thing on your mind, between doctor’s appointments, your treatment schedule, getting enough rest, and focusing your energy on getting better. Not to mention that “normal” life doesn’t stop because of cancer—there’s still work and family and errands and everything in between. But getting proper nutrition during cancer treatment is important for maintaining your energy and strength, and preventing weight loss that can lead to delays in medical treatment. So instead of thinking of food as a chore, try thinking of it as a vital part of your treatment plan.

As you well know if you’re going through treatment, chemotherapy and radiation often cause side effects that make it difficult to eat, like low appetite, nausea, taste changes, or difficulty chewing and swallowing. A key step is being prepared to combat these potential symptoms, and you can do that by arming yourself with evidence-based nutrition info, a strong support system, a well-rounded health care team, and some tips and tricks for making food easier to get (and stay) down.

“Based on data and personal experience, patients unable to stay nourished tend to do worse and are less likely to tolerate the full therapy,” says Fasyal Haroun, M.D., assistant professor in hematology and oncology at George Washington University. But there’s also not one right way to get that nourishment during cancer treatment, so “an assessment by a dietitian is a good start,” Dr. Haroun says.

As a registered dietitian, I often work with patients admitted to the hospital who have trouble maintaining sufficient energy and protein intake. They want to maintain a good intake, but they’re dealing with low appetite, nausea, or trouble with chewing and swallowing due to dry mouth or mouth sores. During their stay, I help make sure their trays are full of foods they can easily eat despite their symptoms, or I add snacks between meals. (Of course, my recommendations will vary for each patient.)

I wanted to put together a guide to make eating more enjoyable—or at least less nausea-inducing—while you’re working hard on getting better, so I pulled together some of my own tips and also spoke with Danielle Penick, R.D., a long-time oncology dietitian and blogger at Survivor’s Table, a website for evidence-based nutrition advice for cancer.

1. First of all, be prepared to temporarily hate some (or all) of your favorite foods.
One common side effect of cancer treatment is changes in taste and smell. If you usually love the smell of a BLT, you might find that it makes you gag during treatment.

One way to deal with this is by changing up flavors and avoiding foods with strong smells. Chemo and radiation can sometimes cause metallic or bitter tastes, and tart or citrus flavors can work to cover these tastes. Try adding lemon to protein dishes like chicken and fish, or marinating proteins in vinegar-based dressings. Adding fresh, pungent herbs (that don’t smell bad to you) can help make foods more palatable. (Check out one of my favorite recipes for dill-marinated blue fish featuring a lemon marinade). It might sound counterintuitive, but try foods you don’t typically care for—you might find them newly tolerable.

2. Even silverware might start tasting disgusting. If so, swap it out for plastic cutlery.
As certain medications are infused, they can cause you to experience a “metallic” or bitter taste in your mouth, which certainly does not help with appetite. One common solution to help deal with this side effect is to switch out metal knives and forks for plastic. You can also try to cover up metallic tastes by sucking on mints or chewing gum.

3. If basically all food smells are too much, eat foods chilled.
Hot food is more aromatic (think about the time someone reheated fish in the office microwave, ew) and can make smell aversions worse. So if this is happening to you, put drinks on ice, make frozen smoothies, or just stick your plate in the fridge or freezer to cool it down before you eat it. The chill can also help numb your taste buds which helps if you’re experiencing taste changes.

4. If you’re dealing with painful mouth sores or cuts, stay away from acidic foods.
Since chemotherapy and radiation target rapidly dividing cells to fight cancer, it can wind up affecting normal cells that also divide rapidly, like the ones lining your mouth. This can lead to painful cuts or mouth sores that make it difficult to eat. If a sore mouth is your problem, avoid foods like citrus and tomato as well as crunchy, potentially painful foods like tortilla chips or crackers.

For mouth sores, Penick recommends ice and frozen treats. “I would encourage people to suck on ice or frozen fruit, because that can be really helpful to sooth the mouth,” Penick tells SELF. She also says that eating a frozen food first may numb up your mouth so you can tolerate a few bites of an energy dense food, like a protein bar. Frozen bananas are great, since they are sweet and starchy, as well as a bit higher in calories than other, less dense fruits.

5. Smoothies are a great way to combat dry mouth while also getting in calories and nutrients.
A dry, cottony mouth is another common symptom of both chemotherapy and radiation. For this symptom, it’s good to work with liquidy foods and mix up textures. Penick recommends custards, bananas, applesauce, cottage cheese, and oatmeal—wetter foods that are easy to get down.

To meet energy needs, “smoothies tend to be really well tolerated, too. I like those because you can add a lot of [protein-rich] foods like peanut butter, yogurt, or milk,” she says. Peanut butter and yogurt are also energy-dense options which make them optimal if you’re having trouble getting enough calories. Again, bananas are beneficial since they are high in potassium which can help with electrolyte disturbances (which can happen as a result of chemotherapy). Avocados, ever popular on toast, are a good addition, too. “They make a smoothie creamier, add calories, and taste mild,” Penick says. One of her preferred combinations is to blend ½ cup milk, an avocado, a banana, and ½ cup pineapple chunks with about five ice cubes.

6. If you’ve got zero appetite, try adding some walking into your day if you can.
One way to combat a lost appetite is to work it back up. “I actually encourage a lot of walking,” if you’re feeling up to it, “because walking can help increase appetite,” Penick says. It can also help prevent constipation, which can be a side effect of chemotherapy or certain pain medications. As with any intervention, make sure you ask your doctor if exercise is appropriate for you. If your appetite remains low over the long term, your doctor may prescribe medication to stimulate your appetite.

7. Arm yourself with lots of high-calorie snacks if eating full meals is too intimidating.
Some people describe a sense of early satiety, or “feeling full” after just a few bites of food. Others simply feel nauseous. If you’re dealing with a low appetite, Penick points out that it might be easier to eat small amounts frequently, rather than full meals. “Sometimes larger meals can be overwhelming.”

The solution: ABS (Always Be Snacking). Keep high-calorie snacks like protein bars or packets of nut butter in a backpack or purse so you always have one handy. If just being around food seems overwhelming, keep small bottles of nutritional supplement drinks around and sip them when you can. And remember, put it on ice if you just can’t with the flavor.

8. If anyone wants to help, give them really explicit instructions on the kinds of foods you can currently stomach and how to make them freezer-friendly.
Cancer treatments are exhausting, and it’s not reasonable to expect that you’ll feel like cooking for yourself. So Penick recommends anything that’s grab-and-go, like meals from a family member that you can save, freeze, and reheat when needed. In addition to pre-prepared meals (think casseroles, soups, or even starchy foods like pancakes and waffles that freeze well), she recommends “things that are prepackaged that you can easily open, and nutrition supplements,” like the nutritional drinks Ensure, Boost, or Orgain.

For supportive friends and family, be clear about what foods you are tolerating well at the moment, and keep lines of communication open. Definitely accept help, but realize that now is a time when friends might start making “helpful” recommendations that are anything but. If someone in your circle tries to nudge you towards trying a “diet that’s great for cancer,” know that you can just politely ignore that. You don’t need the added stress, and if your friend/yoga teacher/lifestyle guru is not also an oncologist, their advice is likely not evidence-based.

9. Bookmark a few friendly resources with helpful tips.
If you or a loved one will be starting chemo or radiation soon, it’s not too early to stock up on good online resources with helpful food prep and nutrition suggestions. The American Cancer Society has clear, helpful instructions for troubleshooting eating-related side effects of cancer treatment; so does the Eating Hints guide from the National Cancer Institute. Penick also recommends Cook for Your Life, a website dedicated to recipes for people with cancer. They’re indexed by cancer-specific priority such as “easy to swallow,” “high calorie,” or “nausea” to help you find foods that can fit your needs.

Reputable sources like Cleveland Clinic’s Chemocare, the American Cancer Society, and the National Cancer Institute can help you find answers to common questions about nutrition and cancer. However, be wary of advice provided on online forums or social media, especially if it conflicts with your physician or dietitian’s advice. While seeking support is good, Penick warns that “most online forums where anyone can post are filled with an abundance of misinformation,” and while participants may mean well, they can make unsubstantiated claims that promote anxiety around eating. An oncology dietitian can work to fine-tune your eating plan if you have additional dietary needs (like those that come with diabetes or celiac disease), which brings me to the next tip…

10. Get personalized advice from an oncology dietitian.
If there’s one thing Penick always wants her patients to know, it’s this: “What works for one person may not work for another person.” Because energy and nutrient needs can vary before and during your treatment, a dietitian can follow your progress, calculate your nutrition needs, and help you troubleshoot any food-based challenges that may arise.

So much of cancer treatment can feel like it’s being done to you: chemo, surgery, radiation, etc. Nutrition can be an empowering part of your care, since you have control over your food choices. A dietitian can help by bringing subject-matter expertise to visits designed to meet your needs and preferences. They can provide meal plans, give you ideas for food replacements that fit your changing tastes, and they have a strong background knowledge of potentially helpful medical foods and supplements. As licensed clinicians, dietitians focus on evidence-based practice and will guide you to practical advice (and away from unproven or potentially harmful diet plans and practices).

While many oncologists and medical practices have dietitians on staff, not all do. If your doctor doesn’t offer nutrition support within his or her office, ask for a referral to a dietitian who specializes in oncology. To determine whether an outpatient or even home-based visit with a dietitian is covered by your healthcare, call your insurance provider.

11. Don’t worry about “optimizing” your diet—just get down what you can.
Often when I see cancer patients concerned with nutrition, they want to know exactly how much protein to get, or what foods are good sources of antioxidants, or whether they should invest in “superfoods” or other (sometimes gimmicky) supplements. While trying to get enough protein is a noble intention, our primary goal is for you to get enough to eat. Unless you have another illness that requires a specific diet, now is probably not the time to “optimize” aspects of your diet (by going all organic, for example).

These restrictions are going to make it harder for you to meet your energy needs and are unlikely to have a major effect on your outcome. And, they might cause additional weight loss, something we try to avoid as much as possible while a patient is in treatment. Definitely focus on eating mostly healthy foods, but if all you can tolerate is chocolate pudding? Add chocolate pudding to the menu! While food can seem like a minor player in the battle against cancer, it’s crucial for maintaining energy and can help you tolerate and complete treatments.

Author:
Katherine Pett is a registered dietitian with an MS in Nutrition Biochemistry and Epidemiology. She runs the website Nutrition Wonk, where the goal is to provide high-quality nutrition science news, opinions, and interactive content.

November, 2017|Oral Cancer News|

Complex cancer decisions, no easy answers

Source: blogs.biomedcentral.com
Author: Jeffrey Liu

With the many different options now available for the treatment of cancer, it can be very difficult for both clinicians and patients to decide on the best possible treatment strategy, particularly when faced with a complicated cancer. In this blog, Dr Jeffrey C. Liu reflects on the challenges encountered in cancer decision making, particularly when presented with difficult cases.

When treating cancer, sometimes the treatment decisions are straightforward and unambiguous. For example, surgery is the treatment of choice for an early, uncomplicated tongue cancer. However, many times, the recommendation for cancer treatment is not straightforward and requires combination treatment – one or more of surgery, radiation or chemotherapy.

As a head and neck cancer surgeon, I work with a team to make these treatment decisions, and usually team consensus is achieved. However, when we are faced with the choice of multiple treatments that all have the same chance of cure available, it seems to result in a never ending discussion amongst our team.

Take for example an advanced tonsil cancer. These cancers can sometimes be removed first with surgery, a process which removes both the primary cancer and the lymph nodes in the neck. Then, depending on the pathology results, patients may need radiation treatment, chemoradiation or sometimes no further treatment at all. Meanwhile, chemoradiation alone, and no surgery, is an excellent option. Whether the patient receives surgery or no surgery, the chance of cure is pretty much the same. However, based on the need for additional treatment after surgery, the patient may have better, equivalent, or worse function than chemoradiation alone.

How then can a patient make a decision with imperfect data? I wish I could help my patients better with these complex decisions. Most patients will make this decision only once in their lives. With the increased emphasis on patient autonomy, there is sometimes a feeling to just “present the options and let the patient decide.”

However, when a group of smart experienced doctors who all treat the same cancer, cannot reach an agreement, how is a patient with no experience expected to make the right decision? There is not enough time to explain to patients the observations of hundreds of such decisions and their thousands of outcomes. Some patients are so overwhelmed by the decision, that they just want someone to tell them what to do. Others have so many questions and concerns that they get lost in the details and paralyzed by the process. I don’t know the right answer for such patients.

Unfortunately, there is no option but to choose a treatment strategy and move forward. We all carry the hope that one day, with more research and better understanding, such complex decisions for the treatment of cancer, will become the easy ones.

October, 2017|Oral Cancer News|

Penn surgeons become world’s first to test glowing dye for cancerous lymph nodes

Source: www.phillyvoice.com
Author: Michael Tanenbaum, PhillyVoice Staff

Surgeons at the University of Pennsylvania have achieved a global first with the use of a fluorescent dye that identifies cancerous cells in lymph nodes during head and neck cancer procedures.

The study, led by otorhinolaryngologist Jason G. Newman, seeks to test the effectiveness of intraoperative molecular imaging (IMI), a technique that illuminates tumors to provide real-time surgical guidance.

More than 65,000 Americans will be diagnosed with head and neck cancers in 2017, accounting for approximately 4 percent of all cancers in the United States, according to the National Cancer Institute. About 75 percent of these cancers are caused by tobacco and alcohol use, followed by human papillomavirus (HPV) as a growing source for their development.

Common areas affected by these cancers include the mouth, throat, voice box, sinuses and salivary glands, with typical treatments including a combination of surgery, radiation and chemotherapy.

Lymph nodes, which act as filters for the immune system, are often among the first organs affected by head and neck cancers as they spread or resurface. Initial surgeries may leave microscopic cancerous cells undetected in the lymphoid tissue, heightening the risk that a patient’s condition will return after the procedure.

“By using a dye that makes cancerous cells glow, we get real-time information about which lymph nodes are potentially dangerous and which ones we can leave alone,” Newman said. “That not only helps us remove more cancer from our patients during surgery, it also improves our ability to spare healthy tissue.”

With the aid of a fluorescent dye, surgeons are able to key in on suspicious tissue without removing or damaging otherwise healthy areas. Previously adopted for other disease sites in the lungs and brain, the practice now allows Newman’s team to experiment with indocyanine green (ICG), an FDA-approved contrast agent that responds to blood flow.

Newman explained that since tumor cells retain the dye longer than most other tissues, administering the dye prior to surgery singles out the areas where cancer cells are present.

The current trial at Penn will enable researchers to determine whether ICG is the most suitable dye for head and neck cancers and provide oncologists with a deeper understanding of how cancer spreads in the lymph nodes.

October, 2017|Oral Cancer News|

Blood test for HPV may help predict risk in cancer patients

Source: www.newswise.com
Author: University of North Carolina Health Care System

A blood test for the human papillomavirus, or HPV, may help researchers forecast whether patients with throat cancer linked to the sexually transmitted virus will respond to treatment, according to preliminary findings from the University of North Carolina Lineberger Comprehensive Cancer Center.

HPV can cause oropharyngeal cancer, which is a cancer of the throat behind the mouth, including the base of the tongue and tonsils. Studies have shown that patients with HPV-positive oropharyngeal cancer have better outcomes than patients whose cancer is not linked to the virus.

Preliminary findings presented at this year’s American Society for Radiation Oncology Annual Meeting suggest a genetic test for HPV16 in the blood could be useful to help assess risk for patients, and could help identify patients suitable for lower treatment doses.

“Our work on this blood test is ongoing, but we are optimistic that ‘liquid biopsy’ tests such as ours may be useful in the personalization of therapy for many patients with HPV-associated oropharyngeal cancer,” said the study’s senior author Gaorav P. Gupta, MD, PhD, UNC Lineberger member and assistant professor in the UNC School of Medicine Department of Radiation Oncology.

To avoid over-treating patients and to spare them from toxic treatment side effects, UNC Lineberger’s Bhisham Chera, MD, an associate professor in the radiation oncology department, led studies testing whether favorable-risk patients with HPV-positive oropharyngeal cancer can be treated successfully with lower doses of radiation and chemotherapy. A phase II clinical trial using this de-intensified regimen have shown “excellent” cancer control, Chera said.

The researchers used a number of selection criteria to identify patients who can benefit from lower-doses: patients had to be positive for HPV, and they had to have smoked fewer than 10 pack years. Chera said this system is not perfect, however. The researchers have seen cancer recur in non-smoking patients as well as “excellent” cancer control in longtime smokers.

“This has led us to question whether we can get better prognostication with other biomarkers,” Chera said.

They developed a test that can detect HPV16 circulating in the blood, and found that circulating HPV16 DNA was detectable using the test in the majority of a group of 47 favorable-risk oropharyngeal cancer patients.

In a finding that seems counterintuitive, they discovered that very low or undetectable HPV16 pretreatment levels in their blood actually had higher risk of persistent or recurrent disease for chemotherapy and radiation treatment. In contrast, patients with high pretreatment levels of HPV16 in their blood had 100 percent disease control.

They hypothesized that, potentially, the patients with undetectable/low pre-treatment HPV16 levels in the blood may have different, more radiation/chemotherapy resistant cancers.

“Our current theory is that these patients with low or undetectable levels of HPV16 have a different genetic makeup—one that is perhaps less driven purely by HPV, and thus potentially less sensitive to chemotherapy and radiation,” Gupta said. “We are performing next generation sequencing on these patients to search for additional genetic markers that may give us a clue regarding why they have a worse prognosis.”

They also identified a subset of patients who rapidly cleared the HPV16 from their blood. Researchers hypothesize that they could use their findings to further stratify patients who may be eligible for lower intensity treatment.

“A tantalizing – and yet currently untested – hypothesis is whether this subset of ultra-low risk patients may be treated with even lower doses of chemoradiotherapy,” Gupta said.

October, 2017|Oral Cancer News|

Head and neck cancer is more common than you think

Source: www.irishtimes.com
Author: Jamie Ball

Well over 1,000 people in Ireland are diagnosed each year with cancers of the head and neck, with almost three-quarters of cases being attributed to smoking and alcohol. Yet this pernicious form of cancer very often goes under-reported, or sufficient heed isn’t paid to the warning signs that, if caught early, may be the difference between life and death.

This is why July 27th will mark the third World Head & Neck Cancer day, taking place across 53 countries. The 2017 National Cancer Strategy highlights the importance of prevention, detection and diagnosis, and education and awareness is key for early recognition of the disease.

According to James Paul O’Neill, Prof of Otolaryngology, Head and Neck Surgery in Beaumont Hospital, Dublin and the Royal College of Surgeons in Ireland, there can be many different types of cancers within the head and neck, each with their own tissue characteristics and biological behaviour.

“Cancers may develop in several areas of this region, including the mouth, throat, larynx (voice box), glandular tissue (thyroid), salivary tissue (parotid gland), lymphatic tissue, nose, sinuses and skin. Patients have a large variety of symptoms and signs according to the subsite of the disease,” says O’Neill.

He says surgery incorporates many different techniques and skills, as the region has essential functional roles, such as talking, breathing, smelling, hearing, chewing and swallowing.

“We are now in the age of highly-specialised technological innovations. There is a drive towards minimally invasive surgery because we can perform the same surgery except with reduced morbidity to surrounding structures.

“Chemotherapy overall offers little in head and neck oncology, with an overall survival difference of approximately 6.5 per cent, but a hike in morbidity of nearly 50 per cent.

“Overall, some head and neck cancers have an excellent prognosis, but unfortunately two-thirds of all our patients present with advanced disease at the time of diagnosis. If these patients fail our first line of therapy, their prognosis is often very challenging. Head and neck cancers often advance quickly and given the anatomical complexity of the region, frequently impinge on or directly invade the patient’s airway,” says O’Neill.

Following a diagnosis of Laryngeal cancer in 2014, Sligoman Donal Connor had his larynx removed in Beaumont Hospital, under the care of Prof O’Neill and plastic surgeon Barry O’Sullivan. Despite his diagnosis, Connor had never smoked, and remained fit and active all his life.

“This was life-changing surgery, but it gave me a chance to have a life and get rid of this tumour, which was making me hoarse and very unwell,” says Connor. “I now have a little prosthesis, or speaking valve, in my neck, which helps to project my voice. I have to put my finger in the hole in my neck, which is called a stoma, every time I want to speak, which can be very tiring. Conversation for me is the biggest challenge, as I cannot raise my voice if I need to call someone, and I cannot speak over the radio, television or in a crowded situation,” says Connor.

“I now breathe through the stoma, which must be cleaned and cared for on a daily basis, and so it’s much easier for me to get chest infections. I understand my neck looks different and people stare at it, but by now I’m used to this type of attention.”

Connor says his sense of smell has been impacted hugely, while going for a swim is no longer an option either. “If water enters my stoma it would flood my lungs. I have to take great care in the shower. My stoma needs to be covered at all times around water. I am very lucky I can eat and drink most things, but I have to relax after my meals or my food will repeat on me. I cannot speak during mealtimes as I need to focus on swallowing.

“Regardless of all these negatives, I am thankful to God every day to be cancer free and given this second chance. I could go around all day depressed, and some days I do, but I try my best to make the most out of the life I have been left with,” says Connor.

“I know I had different treatments and surgeries that weren’t successful for me, but what didn’t work for me may be very successful for other cancer patients, as everyone’s cancer is different. I know now that anyone who is hoarse for more than six weeks should have it investigated. Please go to your GP, or further if needs be, and have it checked out. It may be nothing to worry about, but if it is detected early, its half the battle.”

Beating HPV-positive throat cancer

Source: www.huffingtonpost.com
Author: Pamela Tom, Contributor

National Oral, Head, and Neck Cancer Awareness Week is April 12-18, 2017

For at least two years, 47 year-old Rob Clinton of Rochester, NY, would choke on post nasal drip in the shower. He knew something was wrong in his throat but he didn’t feel any pain.

Did he have cancer? Clinton smoked cigarettes for 30 years and worked in an auto body shop where he was regularly exposed to carcinogens, but he wasn’t experiencing the typical symptoms of throat cancer. These include hoarseness or a change in the voice, difficulty swallowing, a persistent sore throat, ear pain, a lump in the neck, cough, breathing problems, and unexplained weight loss.

In November 2015, Clinton went to the dentist to have his teeth cleaned. His dentist felt Clinton’s swollen neck and recommended that he visit a medical doctor. Clinton heeded the advice and sought the opinion of an ear, nose, and throat specialist at Strong Memorial Hospital in Rochester, NY.

The ENT doctor sent Clinton to have a CAT scan and when he scoped Clinton’s throat, the doctor said, “I see something in there.”

What he saw was a tumor and there were a few other things going on too.

The Diagnosis
The biopsy showed that Clinton had Stage IVa oral squamous cell carcinoma (OSCC) at the base of his tongue—and the cancer was HPV positive. HPV stands for the human papillomavirus and a recent survey found that more than 42% of Americans are infected with HPV. While most people’s bodies naturally clear HPV after two years, some people’s immune systems do not recognize the virus and consequently, HPV can harbor in the body for decades. HPV-related throat cancer has been linked to oral sex.

The Treatment
On December 4, 2015, Clinton underwent neck dissection surgery at Roswell Park Cancer Institute in Buffalo, NY. Dr. Hassan Arshad, a head and neck cancer surgeon, removed 30 lymph nodes; two had cancer and one tumor was the size of a golf ball. One lymph node on the other side of neck and a tongue tumor would be treated with radiation.

The first of 35 radiation treatments began one month later in conjunction with Cisplatin chemotherapy infusions. That’s seven weeks of simultaneous radiation and chemo.

“I drove myself to treatment for the first five weeks. Up until the last week of treatment, it wasn’t too terrible,” Clinton says. “But then I started getting tired and my mother took me to the cancer center.”

Clinton had decided not to get a feeding tube prior to or during treatment and as the radiation and chemo attacked his cancer, he began to lose weight. The treatment reduced Clinton’s appetite because foods began to taste different. For two weeks, he also felt a burning sensation in his mouth and says his saliva tasted like hot sauce.

“It was excruciating and the worst thing I dealt with during treatment.”

Furthermore when radiation makes the throat feel tender and raw, it becomes nearly impossible to eat normally through the mouth.

Clinton was 215 pounds before treatment. After treatment, he weighed in at a mere 165 pounds. A loss of 50 pounds. In hindsight, Clinton wishes he had the feeding tube inserted while he was still strong.

“Don’t be afraid of the treatment. It’s manageable and you can get through it. I recommend a feeding tube because it’s a comfort knowing you have an option,” says Clinton.

The Recovery
While it took a month for Clinton to recover from the initial surgery, doctors say it takes at least a year for HPV+ throat cancer patients to find their “new normal”—regaining strength, adapting to lingering side effects.

Following chemo, Clinton experienced “chemo brain” or “chemo fog,” known as a cognitive impairment that can occur after chemotherapy. The patient may experience memory loss or dysfunction, and have difficulty concentrating or multi-tasking.

The radiation also took its toll on Clinton. He researched and found a salve made of calendula flowers, olive oil, beeswax, and Vitamin E oil to soothe his parched skin. Trying to gain weight was a bigger challenge. First, his taste went “totally upside down” and spicy foods were intolerable.

“A vanilla cookie tasted like black pepper,” Clinton says. “Only frozen peas and parsley tasted normal.”

And dry mouth is a common result of the radiation treatment. While both sides of Clinton’s neck received radiation, he had less saliva production on his left side. At night he would have to wake up every 40 minutes to drink water. Clinton must make certain not to become dehydrated because it causes the dry mouth to worsen. Now he chews gum almost non-stop.

In his search to combat dry mouth, Clinton says he researched solutions online and found ALTENS, or acupuncture-like transcutaneous electrical nerve stimulation. A study led by Dr. Raimond Wong, an associate professor of oncology at McMaster University in Ontario, Canada, found evidence that ALTENS may reduce patient-reported xerostomia, the medical term for dry mouth.

Clinton joined Dr. Wong’s clinical trial to determine whether ALTENS for six weeks/four days a week would be as effective as treatment for 12 weeks/two times a week.

“Four days a week, the researchers put pads on the inside of my ankles, the outside of my knee, back of my hands, between my thumb and forefingers, and between my chin and bottom lip,” says Clinton.

Clinton says ALTENS felt like little shocks and the acupuncture-like stimulation improved his saliva production by 80 percent. “Even after I stopped ALTENS, my saliva kept improving,” says Clinton.

The Survivor
Two years after cancer treatment, regular PET scans show that Rob Clinton has no evidence of cancer. In fact, the prognosis for HPV-related throat cancer is 85 to 90 percent positive if caught early. In contrast, patients who battle advanced throat cancer caused by excessive smoking and alcohol have a five-year survival rate of 25 to 40 percent.

Dr. Arshad, Clinton’s surgeon at the Roswell Park Cancer Institute, explained why.

“The majority of tonsil and tongue base (“throat”) cancers are HPV-positive, but smoking is still a major risk factor. Typically, non-smoking patients with HPV-positive tonsil/tongue base cancers present with a lump in the neck, implying that the cancer has already spread to lymph nodes. This used to mean that the patient would have a reduced chance of long-term survival,” Arshad says. “We now know that for nonsmokers who have HPV-positive cancers, metastasis to lymph nodes doesn’t carry the same poor prognosis. The newest staging system reflects that change, i.e. Some of those patients who were previously classified as stage IV are now at stage II if the cancer is HPV-positive.”

Clinton is not only faring well physically, surviving cancer changed his outlook and lifestyle.

“My life is pretty much back to normal. I get a little nervous each time I get a PET scan but so far, it shows I am free of cancer,” Clinton says. “I have a better appreciation of things. I live healthy in terms of diet and recreation. I don’t smoke or drink heavily.”

The Future of HPV+ Oropharyngeal Cancer
De-stigmatizing HPV is a key component to building public awareness and acceptance of HPV infection, and the ability to recognize the early symptoms of HPV-related throat cancer. As more and more people are diagnosed with HPV-related throat cancer, the social stigma surrounding the virus is a disturbing deterrent because HPV cancer patients are often reticent to disclose the HPV connection.

In a 2015 public service announcement, actor Michael Douglas who was treated HPV+ base of tongue cancer called for oral screenings but never said “HPV” by name. “A very common virus, one responsible for the vast majority of cervical cancers is now identified as the cause of this rapid rise in oral cancers,” said Douglas.

In the early years of the AIDS crisis, people associated infection with illness, fear, and death. It took a decade to generate a movement and begin to change the public sentiment. Now after continual education, AIDS is accepted and the focus centers on hope instead of ostracization.

Clinton hopes more people will accept that HPV infection is common—the most common sexually-transmitted infection in the U.S., according to the CDC. The American Society of Clinical Oncologists also found that by 2020, the annual number of HPV-related oropharyngeal in nonsmoking, middle-aged men will surpass the number of cervical cancer cases.

“HPV is not a shameful thing. It’s very common. It’s just that some people can’t clear the virus from their bodies,” Clinton says. “This type of cancer is the next epidemic. I feel fortunate every day that I came through it as well as I did.”

April, 2017|Oral Cancer News|

UK cancer patient receives new jaw thanks to 3D printing

Source: http://www.3ders.org/
Author: staff

3D printing techniques are being adopted with increasing regularity in surgery of all kinds, and more and more patients are seeing a hugely improved quality of life thanks to the unique benefits of the technology. The most recent success story took place in the UK, where a patient’s jawbone was entirely reconstructed using bone from his leg. The pioneering surgical procedure made use of 3D printing at various different stages.

Stephen Waterhouse was diagnosed with throat cancer eight years ago, and underwent chemotherapy and radiotherapy in order to fight it. The treatments were a great success and his cancer went away, but they had an unfortunate side effect. His jawbone had started to crumble, and emergency surgery was required before it completely disintegrated. The 53-year-old was taken to Royal Stoke University Hospital, which had purchased a new 3D printer just two years previously.

Costing the hospital trust around £150,000 (about $188K), the machine is the only one of its kind in the country, and was a crucial part of the effort to save the patient’s jawbone. A 3D model was designed from a scan of his remaining intact jaw and printed out as a mold, which was then used to reconstruct the jaw using bone taken from his fibula. The operation lasted around 12 hours and was a great success.

According to Daya Gahir, consultant in maxillofacial and head and neck surgery, the hospital does “at least 40 major head and neck reconstructions per year. Around 10 to 15 cases will be done in this way using the printer.” The procedure is very intricate, and the hospital’s purchase of the 3D printer has revolutionized the way his team operates. “Some of the leg bone was taken then reshaped, as you have to replace bone with bone. We took away some of the skin from the leg as well and replanted it back into the neck. A face is not easy to reconstruct, it is intricate.”

New software for the 3D printer was developed last year, which allows the whole process to be planned and carried out within the hospital. Without this, Stephen may have had to travel to Germany for the operation to be completed, according to Gahir. Using the 3D printer in this way saves a lot of time and effort for patient and medical team alike, as well as cutting costs. Around £11,000 is saved for each case by carrying out the whole surgical process on-site.

Stephen is still in recovery and has praised the care he is receiving from staff, as well as the effectiveness of the surgery. “I am so pleased with the results,” he says, “you can’t tell the difference between the two sides of my mouth.”

March, 2017|Oral Cancer News|

Magnolia man joins exclusive trial in battle against cancer

Source: www.cantonrep.com
Author: Denise Sautters

Rich Bartlett is looking forward to getting back to his hobbies — woodworking and nature watching — and enjoying a good steak and potato dinner. Until then, though, he is in a fight for his life, one he plans to win.

Bartlett is a cancer patient and the first participant in a clinical trial at University Hospitals Seidman Cancer Center in Cleveland to test the safety of an immunotherapy drug — Pembrolizumab — when added to a regimen of surgery, chemotherapy and radiation therapy.

Back to the beginning
Bartlett went to the dentist in October for a checkup.

“He had a sore in his mouth he thought was an abscess,” explained his wife, Nancy Bartlett, who pointed out that, because radiation and chemo treatments cause the inside of the mouth to burn and blister, it is hard for Bartlett to talk.

“When the dentist looked at his sore, he sent Richard to a specialist in Canton, and in early November, he had a biopsy done. It came back positive for cancer.”

From there, he was referred to Dr. Pierre Lavertu, director of head and neck surgery and oncology at University Hospitals, and Dr. Chad Zender from the otolaryngology department, who did Bartlett’s surgery.

“They let us know it was serious,” said Nancy. “It had gone into the bone and the roof of the mouth, but they were not sure if it had gone into the lymph nodes. By the time we got through that appointment, it was the first part of December and (they) scheduled him for surgery on Dec. 22.”

The cancer tripled in size by then and the surgery lasted 10 hours. Doctors had to remove the tumor, all of the lymph nodes and parts of the jaw and the roof of Bartlett’s mouth.

“They harvested skin from his hand to rebuild the inside of his mouth, and took the veins and arteries and reattached everything through his (right) cheek,” she said. “He could not even have water until February because of the patch. He uses a feeding tube to eat now.”

The tube is temporary until Bartlett heals.

Clinical trial
Just before he started chemo and radiation therapies, the hospital called him about the clinical trial.

The trial is the first to use quadra-modality therapy — or four different types of therapy — against the cancer, according to Dr. Min Yao, the principal investigator.

Yao said Bartlett has squamous cell carcinoma of the oral cavity, with only a 50 percent chance of survival.

“Patients have surgery, then followed by six weeks of radiation and chemotherapy and immunotherapy,” Yao said in an email interview. “That is followed by six more months of immunotherapy, one dose every three weeks.”

Bartlett currently is in the radiation, chemotherapy and immunotherapy part of the study.

“It is too early to tell how he is responding,” said Yao. “His tumor has been resected. After the treatment, we will see them periodically with scans. Cancer often recurs in the first two years after treatment.”

Pembrolizumab originally was developed to activate the body’s immune system in the fight against melanoma. Former president Jimmy Carter was treated with the drug for his brain metastases from melanoma in 2015.

A truck driver by trade, Bartlett will undergo daily fluoride treatments for the rest of his life to protect his teeth.

“We did not realize until we got to Cleveland just how bad this was,” said Nancy. “When you have oral cancer, and they are getting ready to do radiation and chemo, you have to go have your teeth cleaned and examined and get anything done that needs to be done because radiation tends to compromise your blood flow in your mouth. That was a step we didn’t know.”

Although he was shocked to hear the outcome of that sore in his mouth, Bartlett is grateful to be a part of the trial.

“Who wouldn’t feel good about something like this? I mean, you got something that was used on Jimmy Carter, who is recovered and is now making public appearances again,” said Bartlett, who is looking forward to June when hopefully he can start eating again and enjoying his hobbies.

“I am very hopeful about this. The whole thing has been a trial. I have a dentist in Cleveland who said I was going to be in the fight of my life, and I am. I am in a huge fight. The chemotherapy is what has knocked me down the most, but I am very positive about the outcome of this.”

March, 2017|Oral Cancer News|

Artificial larynx implant helps throat cancer patient breathe and speak

Source: www.ctvnews.ca
Author: staff

Sixteen months after receiving an artificial larynx, a 56-year-old French man suffering from throat cancer can now whisper and breathe normally. A report published this week in the New England Journal of Medicine considers this to be a significant first achievement.

Thanks to the implant, a 56-year-old throat cancer patient can now whisper and breathe normally. © ChrisChrisW / Istock.com

Thanks to the implant, a 56-year-old throat cancer patient can now whisper and breathe normally. © ChrisChrisW / Istock.com

This is the first time that doctors have observed a patient with the implant long term recover functions such as breathing and speaking after the complete removal of the larynx. Thanks to an artificial voice box, implanted in 2015 at France’s Strasbourg-Hautepierre university hospital, the 56-year-old Frenchman, who lives in Alsace, can now whisper in a comprehensible manner and breathe normally.

The patient has also recovered his sense of smell, which was damaged by the removal of the larynx. Other than the vocal cords, the larynx features an upper valve, called the epiglottis, which closes when food passes down the throat to prevent it from entering the windpipe.

The prosthetic larynx was developed by a French company called Protip Médical. It consists of a rigid titanium and silicone structure replacing the larynx and a removable titanium part that mimics the function of the epiglottis.

The only problem that remains unresolved in the implant is the function of the epiglottis. As a result, the patient coughs from time to time when eating, as food accidentally enters the windpipe. However, the surgeons still consider the functioning implant a highly satisfactory achievement.

The current procedure used to return voice function to throat cancer patients involves puncturing the throat to insert a valve allowing air to pass from the windpipe to the esophagus.

A few doubts remain about the long-term effectiveness of the implant. For example, blockages caused by dried out mucus and secretions from the lungs and nose could be a risk. Another concern is the risk of rejection, particularly in cancer patients who have undergone radiotherapy or chemotherapy treatments.

As for patient comfort, further testing will establish how the mobility of the patient’s neck is affected by the presence of a rigid tube in the throat.

“This implant is constantly evolving and the next patients will benefit from substantial improvements,” notably to improve the passage of food down the throat, said lead researcher Nihal Engin Vrana.

Each year more than 12,000 new cases of throat cancer are diagnosed in the U.S.. Larynx transplants remain extremely rare worldwide and are generally used in cases unrelated to cancer, which represent a small majority.

Source: The report is published in the New England Journal of Medicine.

January, 2017|Oral Cancer News|