Symptoms of throat cancer depend on which throat structures are affected

Source: tribunecontentagency.com Author: Eric Moore, M.D. Dear Mayo Clinic: Are there early signs of throat cancer, or is it typically not found until its late stages? How is it treated? Answer: The throat includes several important structures that are relied on every minute of the day and night to breathe, swallow and speak. Unfortunately, cancer can involve any, and sometimes all, of these structures. The symptoms of cancer, how early these symptoms are recognized and how the cancer is treated depend on which structures are involved. All of the passageway between your tongue and your esophagus can be considered the throat. It includes three main areas. The first is the base of your tongue and tonsils. These, along with the soft palate and upper side walls of the pharynx, are called the oropharynx. Second is the voice box, or larynx. It consists of the epiglottis — a cartilage flap that helps to close your windpipe, or trachea, when you swallow — and the vocal cords. Third is the hypopharynx. That includes the bottom sidewalls and the back of the throat before the opening of the esophagus. Tumors that occur in these three areas have different symptoms, behave differently and often are treated differently. That’s why the areas of the throat are subdivided into separate sections by the head and neck surgeons who diagnose and treat them. For example, in the oropharynx, most tumors are squamous cell carcinoma. Most are caused by HPV, although smoking and alcohol can play a role [...]

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 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 [...]

Bioscientists help throat cancer patients speak again

Source: medicalxpress.com Author: staff, provided by the University of Kent Voice Prosthesis Biofilm. Credit: Dr Campbell W. Gourlay, University of Kent Through the work of the School of Biosciences team, in collaboration with East Kent Hospitals University NHS Foundation Trust, Kent has developed a new method of care for patients who have to have their larynx removed. The Biosciences team found that the replacement voice boxes would last much longer if they dealt with the fungal infection Candida albicans that was causing the silicone versions to fail. For the first time, scientists were able to extend the life of the replacement voicebox by dealing with the fungal infection. The team has developed clinical care for patients that has now been taken up by many NHS Trusts in the UK and which is anticipated could be used worldwide for throat cancer patients. It means patients may be able to carry on using silicone voice prosthesis for much longer, enabling them to still speak and reducing the risk of dangerous secondary chest infections. Dr Campbell Gourlay, Senior Lecturer in Cell Biology at Kent, said the University's work, funded by the NHS and Kent Cancer Trust, will enable people who lose their larynx to maintain speech and enjoy a better quality of life.

2016-12-01T14:49:14-07:00December, 2016|Oral Cancer News|

Immunotherapy Continues to Advance in Head and Neck Cancer

Source: www.onclive.comAuthor: Megan Garlapow, PhD   Concomitant administration of motolimod with cetuximab (Erbitux) increases the innate and adaptive immune response in the blood and the tumor microenvironment in head and neck squamous cell carcinoma (HNSCC), overcoming negative prognostic biomarkers of cetuximab therapy alone, according to the biomarker data from a recent phase Ib clinical trial that was presented at the 2016 Head and Neck Cancer Symposium. The trial was recently amended to add nivolumab to the combination of cetuximab and motolimod. Dr. Robert Ferris, MD PhD   “We know that PD-1 and PD-L1 are overexpressed in head and neck cancer, and so it was somewhat irresistible to combine our baseline treatment of cetuximab and motolimod with the PD-L1 inhibition pathway. EGFR itself drives PD-L1, so combining cetuximab with anti-PD-1 inhibitor makes sense. So, we’ve amended this trial. We’re now accruing to treatment with cetuximab, motolimod, and the anti–PD-L1 nivolumab in this trial,” said lead author Robert Ferris, MD, PhD, professor, Departments of Otolaryngology, Radiation Oncology, and Immunology, Cancer Immunology Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania. According to the authors of the phase Ib data presented at the symposium, the rationale for combining cetuximab with motolimod (VTX2337) as neoadjuvant therapy was that cetuximab induces cellular immunity that correlates with neoadjuvant clinical response. The phase I dose-escalation and safety of the combination had been established (NCT 01334177). This study of neoadjuvant cetuximab and motolimod had accrued 14 patients with HNSCC that was stage II-IV, resectable, and located in the oropharynx, [...]

2016-02-29T10:49:56-07:00February, 2016|Oral Cancer News|

Head, Neck Cancer Patients May Be at Higher Risk for Suicide: Study

Source: www.health.usnews.comAuthor: Robert Preidt THURSDAY, Nov. 12, 2015 (HealthDay News) -- Head and neck cancer patients may be at raised risk for suicide, new research suggests. However, the overall risk is still small, the findings showed. The study included over 350,000 patients in the United States diagnosed with head and neck cancer between 1973 and 2011. Of those patients, 857 died by suicide. The investigators found that the suicide rate among head and neck cancer patients was three times higher than in the general population. And suicide rates were higher among patients treated with radiation alone compared to surgery alone. Suicide rates were highest among those with cancers of the lower part of the throat, including the larynx ("voice box") and hypopharynx, at five times and 12 times higher, respectively, than in the general population. "This may be linked to these anatomic sites' intimate relationship with the ability to speak and/or swallow. Loss of these functions can dramatically lower patients' quality of life," Dr. Richard Chan Woo Park, of Rutgers New Jersey Medical School, and colleagues wrote. "It is possible that the increased rates of tracheostomy [breathing tube] dependence and dysphagia [difficulty swallowing] and/or gastrostomy [feeding] tube dependence in these patients are . . . factors in the increased rate of suicide observed," the authors added. The study was published online Nov. 12 in the journal JAMA Otolaryngology--Head & Neck Surgery. "While there is a considerable body of research that examines survival outcomes for patients with head and neck cancer, additional [...]

2015-11-13T15:34:55-07:00November, 2015|Oral Cancer News|

Nutritional and Zinc Status of Head and Neck Cancer Patients: An Interpretive Review

Source: Journal of the American College of NutritionAuthors: Ananda S. Prasad, MD, PhD, MACN, Frances W.J. Beck, PhD, Timothy D. Doerr, MD, Falah H. Shamsa, PhD, Hayward S. Penny, MS, RD, Steven C. Marks, MD, Joseph Kaplan, MD, Omer Kucuk, MD and Robert H. Mathog, MD  Abstract In this review, we provide evidence based on our studies, for zinc deficiency and cell mediated immune disorders, and the effects of protein and zinc status on clinical morbidities in patients with head and neck cancer. We investigated subjects with newly diagnosed squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx. Patients with metastatic disease and with severe co-morbidity were excluded. Nutritional assessment included dietary history, body composition, and prognostic nutritional index (PNI) determination. Zinc status was determined by zinc assay in plasma, lymphocytes, and granulocytes. Pretreatment zinc status and nutritional status were correlated with clinical outcomes in 47 patients. Assessment of immune functions included production of TH1 and TH2 cytokines, T cell subpopulations and cutaneous delayed hypersensitivity reaction to common antigens. At baseline approximately 50% of our subjects were zinc-deficient based on cellular zinc criteria and had decreased production of TH1 cytokines but not TH2 cytokines, decreased NK cell lytic activity and decreased proportion of CD4+ CD45RA+ cells in the peripheral blood. The tumor size and overall stage of the disease correlated with baseline zinc status but not with PNI, alcohol intake, or smoking. Zinc deficiency was associated with increased unplanned hospitalizations. The disease-free interval was highest for the group which had both zinc sufficient and nutrition sufficient [...]

2013-07-03T17:11:10-07:00July, 2013|Oral Cancer News|

Ten year results of landmark neck cancer trial published

Source: www.modernmedicine.com Author: Gabriel Miller The latest data from a trial that opened in 1992 confirm that for locally advanced laryngeal cancer, sequential and concomitant chemoradiotherapy each produce similar survival rates, but the concomitant approach more often allows the larynx to be preserved. When the results of RTOG 91-11 were first published in 2003. "they changed the standard of care treatment for preserving the larynx from the sequential use of chemotherapy then radiotherapy to giving both together," said lead investigator Dr. Arlene Forastiere of Johns Hopkins University in an email to Reuters Health. "The results have held up over the last decade," she said, "...and this exact treatment remains the standard of care today because on average, 15% will ultimately require laryngectomy with the concomitant approach, compared to double that, or 30%, with either giving chemotherapy and radiation in sequence or giving radiotherapy alone." "There's no question that this study has changed the way we approach and treat this disease, so it is truly a landmark study," said Dr. Chris Holsinger, a head and neck cancer surgeon at MD Anderson Cancer Center in Houston, Texas who wasn't involved in the research. Between 1992 and 2000, 547 patients were randomly assigned to three treatment groups: induction chemotherapy followed by radiation; concomitant chemoradiotherapy; and radiotherapy alone. The induction group received up to three cycles of cisplatin 100 mg/m2 on day one and fluorouracil 1,000 mg/m2 per day for five days, every three weeks. Responders then received up to 70 Gy of radiotherapy [...]

2012-11-30T05:39:25-07:00November, 2012|Oral Cancer News|

Throat cancer survivors sing to give thanks, encourage others

Source: www.wfaa.com Author: Jim Douglas Five cancer survivors stepped up to the microphones Tuesday at Baylor All Saints Medical Center in Fort Worth. About 300 people waited to hear the North Texas Laryngectomy Choir. Video available here. It takes courage for anyone to sing in front of a crowd. Imagine doing it without vocal cords. Howard Defibaugh found his courage by first singing to his wife, Diana. He sang her the song she sang to him to soothe his recovery from throat surgery a couple of years ago: You are my sunshine, my only sunshine. You make me happy when skies are gray. It came out low and raspy... almost mechanical. Doctors removed Defibaugh's larynx to save his life. Same with John Robinson. They now have plastic implants. Both hold their hands over the valves in their necks as they talk... and sing. "I don't know how I'm going to do with a big crowd today," Robinson said with a smile. Defibaugh gave him a reassuring pat on the back. This is how the North Texas Laryngectomy Choir started: As a support group. They joke they couldn't carry a tune in bucket (even when they had their real voices). But this concert is about what they carry in their hearts. The five singers stepped to the mics, and sang, "What a Wonderful World." The occasion was the first annual banquet for cancer survivors and caregivers at Baylor All Saints. The crowd gave them a standing ovation.

Convergence in Head and Neck Cancer

Source: Eurekalert.org Powerful new technologies that zoom in on the connections between human genes and diseases have illuminated the landscape of cancer, singling out changes in tumor DNA that drive the development of certain types of malignancies such as melanoma or ovarian cancer. Now several major biomedical centers have collaborated to shine a light on head and neck squamous cell cancer. Their large-scale analysis has revealed a surprising new set of mutations involved in this understudied disease. In back-to-back papers published online July 28 in Science, researchers from the Broad Institute, Dana-Farber Cancer Institute, Johns Hopkins Kimmel Cancer Center, the University of Pittsburgh, and the University of Texas MD Anderson Cancer Center have confirmed genetic abnormalities previously suspected in head and neck cancer, including defects in the tumor suppressor gene known as p53. But the two teams also found mutations in the NOTCH family of genes, suggesting their role as regulators of an important stage in cell development may be impaired. "This adds a new dimension to head and neck cancer biology that was not on anyone's radar screen before," said Levi A. Garraway, a senior associate member of the Broad Institute, an assistant professor at Dana-Farber Cancer Institute and Harvard Medical School, and a senior author of one of the Science papers. "Head and neck cancer is complex and there are many mutations, but we can infer there is a convergence on a cellular process for which we previously did not have genetic evidence. It shows that if you [...]

Palifermin Decreases Severe Oral Mucositis of Patients Undergoing Postoperative Radiochemotherapy for Head and Neck Cancer: A Randomized, Placebo-Controlled Trial

Source: Journal of Clinical Oncology Purpose: Radiochemotherapy of head and neck cancer causes severe mucositis in most patients. We investigated whether palifermin reduces this debilitating sequela. Methods: We conducted a multicenter, double-blind, randomized, placebo-controlled trial in 186 patients with stages II to IVB carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Patients received 60 or 66 Gy after complete (R0) or incomplete resection (R1), respectively, at 2 Gy/fraction and five fractions per week. Cisplatin 100 mg/m2 was administered on days 1 and 22 (and on day 43 with R1). Patients were randomly assigned to receive weekly palifermin 120 μg/kg or placebo from 3 days before and continuing throughout radiochemotherapy. Trained evaluators performed oral assessments twice weekly. The primary end point was the incidence of severe oral mucositis (WHO grades 3 to 4). Overall survival and time to locoregional progression were also assessed. Analysis was by intention to treat. Results: Severe oral mucositis was seen in 47 (51%) of 92 patients administered palifermin and 63 (67%) of 94 administered placebo (P = .027). Palifermin decreased the duration (median, 4.5 v 22.0 days) and prolonged the time to develop (median, 45 v 32 days) severe mucositis. Neither patient-reported mouth and throat soreness scores nor treatment breaks differed between treatment arms. After median follow-up of 32.8 months, 23 deaths (25%) had occurred in both treatment arms, and disease had recurred in 25 (27%) and 22 (24%) of palifermin- and placebo-treated patients, respectively. Conclusion: Palifermin reduced the occurrence of severe oral mucositis in [...]

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