When a virus causes cancer, surgical robot can help

Source: www.bizjournals.com Author: James Ritchie Dr. Keith Wilson finds robotic surgery to be a good approach for removing tumors growing deep in the throat, as I recently reported. As it turns out, such tumors are often part of an alarming trend. They’re often caused by the sexually transmitted human papillomavirus, also known as HPV. In decades gone by, oral cancer was almost always associated with tobacco and alcohol use. It was typically a disease of old men. No more. Many of Wilson’s patients are nonsmokers and very light drinkers. “I can’t tell you how surprised people get,” said Wilson, who is chief of staff at University of Cincinnati Medical Center. “We’re seeing younger, more affluent and more highly educated patients.” High-risk HPVs cause virtually all cervical cancers. They have in recent years been implicated in oropharyngeal cancers. The oropharynx is the middle part of the throat, including the soft palate, the base of the tongue and the tonsils. About 63 percent of oropharyngeal cancers, or 11,000 cases per year, are associated with HPV infection, according to the American Dental Association. They’re frequently under age 50. Fortunately for such patients, HPV-associated oropharyngeal cancers have a better prognosis than those with other causes. Wilson said that cure rates can approach 90 percent. The da Vinci surgical robot is an effective tool for removing them, he said, because its long, joined arms can go where a surgeon’s hands can’t. But the machines, made by Sunnyvale, Calif.-based Intuitive Surgical Inc., are gaining some criticism. [...]

April: Oral Cancer Awareness Month

Source: Aspen Dental April is Oral Cancer Awareness Month. According to Brian Hill, founder and executive director of the Oral Cancer Foundation, as many as 40,000 people in the United States will be told they have oral or pharyngeal cancer in 2012. Some of them may be sitting in your dental chair today. With one person dying of oral cancer every hour of every day, and more than 50% of those diagnosed not living more than 5 years, this is a reminder to screen every patient yourself, and encourage your dental hygiene staff to do the same. The Statistics About 100 people are diagnosed with oral cancer every day in the United States. Few people are aware that the death rate for oral cancer is higher than for many other types of cancers, which is because oral cancer often is not discovered until it has reached later stages. This is particularly true for human papilloma virus number 16 (HPV16)-related oral cancer, which occurs most frequently in the posterior areas of the mouth—at the base of the tongue, around the tonsils, and in the oropharynx—where it’s harder to spot without a very thorough exam. To further complicate things, HPV16-related cancer does not always present the tell-tale physical characteristics, including lesions, that are easily distinguished from healthy oral tissues. This is not good news, because HPV16 has reached epidemic levels in the United States: of the 37,000 incidences of oral cancer, about 20,000 (up to 60%) can be linked to HPV, according [...]

2012-04-02T09:47:20-07:00April, 2012|OCF In The News, Oral Cancer News|

Epidermal Growth Factor Receptor and the Changing Face of Oropharyngeal Cancer

Source: Journal of Clinical Oncology To the Editor: In their article, Chaturvedi et al1 document the rise in human papillomavirus (HPV) –associated cancers as a proportion of squamous cell carcinomas of the oropharynx over the last 25 years. The contemporary figures are mirrored by two recent British studies2,3 demonstrating that the majority of oropharyngeal cancers are now HPV related. In the accompanying editorial,4 Mroz et al rightly highlight the importance of evaluating HPV vaccination for both men and women in the light of these data and lament the lack of significant improvement in the outcomes for non–HPV-associated head and neck cancers. However, they also suggest that the benefit of targeting epidermal growth factor receptor (EGFR) through concurrent cetuximab may be confined to HPV-associated tumors. Although EGFR expression per se does not correlate closely with response to cetuximab, there is increasing evidence of an inverse correlation between p16INK4A expression (as a marker of HPV association) and EGFR expression shown by immunohistochemistry.5,6 Though suppressed by viral oncogenes, HPV-associated tumors retain wild-type P53,7 and patients with this tumor type have demonstrated excellent survival with existing protocols such as concurrent chemoradiotherapy or surgery with postoperative radiotherapy. Conversely, non-HPV tumors, harboring a range of mutations,8 may respond less well to DNA-damaging agents, but patients with these tumors might benefit from the addition of concurrent EGFR blockade to radiotherapy. Data from the recent SPECTRUM (Study of Panitumumab Efficacy in Patients With Recurrent and/or Metastatic Head and Neck Cancer) study of adding another EGFR-targeting monoclonal antibody, panitumumab,9 [...]

2012-03-09T10:34:29-07:00March, 2012|Oral Cancer News|

Evaluation of a combined triple method to detect causative HPV in oral and oropharyngeal squamous cell carcinomas: p16 Immunohistochemistry, Consensus PCR HPV-DNA, and In Situ Hybridization

Source: 7thspace.com Recent emerging evidences identify Human Papillomavirus (HPV) related Head and Neck squamous cell carcinomas (HN-SCCs) as a separate subgroup among Head and Neck Cancers with different epidemiology, histopathological characteristics, therapeutic response to chemo-radiation treatment and clinical outcome. However, there is not a worldwide consensus on the methods to be used in clinical practice. The endpoint of this study was to demonstrate the reliability of a triple method which combines evaluation of: 1. p16 protein expression by immunohistochemistry (p16-IHC); 2. HPV-DNA genotyping by consensus HPV-DNA PCR methods (Consensus PCR); and 3 viral integration into the host by in situ hybridization method (ISH). This triple method has been applied to HN-SCC originated from oral cavity (OSCC) and oropharynx (OPSCC), the two anatomical sites in which high risk (HR) HPVs have been clearly implicated as etiologic factors. Methylation-Specific PCR (MSP) was performed to study inactivation of p16-CDKN2a locus by epigenetic events. Reliability of multiple methods was measured by Kappa statistics. Results: All the HN-SCCs confirmed HPV positive by PCR and/or ISH were also p16 positive by IHC, with the latter showing a very high level of sensitivity as single test (100% in both OSCC and OPSCC) but lower specificity level (74% in OSCC and 93% in OPSCC).Concordance analysis between ISH and Consensus PCR showed a faint agreement in OPSCC (kappa = 0.38) and a moderate agreement in OSCC (kappa = 0.44). Furthermore, the addition of double positive score (ISHpositive and Consensus PCR positive) increased significantly the specificity of HR-HPV detection on [...]

2012-02-29T17:24:29-07:00February, 2012|Oral Cancer News|

Adaptive radiotherapy may benefit patients with head and neck cancer

Source: News-Medical.net Researchers led by a senior investigator at Hofstra-North Shore LIJ School of Medicine and The Feinstein Institute for Medical Research have released initial findings from a first-of-a-kind clinical trial in adaptive radiotherapy (ART) for head and neck cancer. The trial, sponsored by the National Cancer Institute, provides evidence that ART may benefit patients with less technical difficulty than previously believed. The findings of this trial were released online in advance of publication in the International Journal of Radiation Oncology Biology Physics. Physicians commonly use radiotherapy to treat squamous cell carcinoma of the oropharynx (back of throat). Current standard-of-care treatment is called intensity-modulated radiotherapy, or IMRT. IMRT allows physicians to "sculpt" radiation to fit the anatomy of individual patients. Although appealing, this technique has a crucial Achilles' heel - it is based entirely on a CT or MRI scan taken before actual treatment begins. Since a typical course of radiation treatment for oropharynx cancer lasts 6-7 weeks, standard IMRT cannot compensate for common changes that take place in a patient's body during this time, such as weight loss, shrinkage of tumor, or gradual movement of normal tissues. Recent work suggests that the inability of standard IMRT to keep up with these changes may lead to unanticipated toxicity, or potentially worse, missing of tumor. For this new trial, which was conducted at the University of Texas M.D. Anderson Cancer Center, investigators started patients on standard IMRT. They then took CT scans while patients were lying in the radiation treatment room [...]

2012-02-10T10:40:11-07:00February, 2012|Oral Cancer News|

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 [...]

Cellular p16 localization and survival outcomes in head and neck cancer.

Source: ASCO.org Background: Head and neck squamous cell carcinoma (HNSCC) constitutes approximately 3-5 percent of all cancers. Recent data suggest an increasing incidence rate among younger people who are often non-smokers and non-drinkers, which are believed to be caused by human papillomavirus (HPV) infection. HPV positive tumors are typically found in the oropharynx and have better response to treatment and better disease outcome despite more advanced nodal stages. Therefore, HPV-positive HNSCCs represent a unique clinical subgroup with a separate tumor entity. Methods: Patients treated for HNSCC from 2002 to 2006 at UNC hospitals and had banked tissue available were eligible for this study. Tissue microarrays (TMA) were generated in triplicate. Immunohistochemical (IHC) staining for p16 was performed and scored separately for nuclear staining and cytoplasmic staining. Human papilloma virus (HPV) staining was also carried out using monoclonal antibody E6H4. P16 expression, HPV status and other clinical features were correlated with progression-free (PFS) and overall survival (OS). Results: 135 patients had sufficient sample for this analysis. Median age of diagnosis was 57 years (range 20-82), with 68.9% males, 8.9% never smokers and 32.6 % never drinkers. 3 year OS rate and PFS rate was 63.0% and 54.1% respectively. Based on the p16 staining score, patients were divided into three groups: high nuclear any cytoplasmic staining group (HNAC), low nuclear low cytoplasmic staining group (LNLC) and low nuclear high cytoplasmic staining group (LNHC). HNAC and LNLC groups had significantly better overall survival than LNHC groups with hazard ratios of 0.01 and 0.37 [...]

Another call to extend HPV vaccine to boys. Is anyone listening?

Source: www.abc.net.au Author: Lindy Kerin Australian researchers say the human papillomavirus (HPV), which can cause cervical cancer in women, is now a leading cause of oral cancer in men in the Western world. The news has reignited debate over whether the HPV vaccine, which is free for young women, should also be offered to men. A University of Sydney study shows that 60 per cent of throat and tonsil cancers are caused by the virus. "We've tested just over 300 cancers of the oropharynx, and the oropharynx includes the tonsil and the base of tongue and part of the pharangyl wall," said Barbara Rose, an Associate Professor in research at the University of Sydney. "We've tested those for the human papillomavirus type-16 and type-18, which are the major cause of cervical cancer in women. "And we found a sizeable proportion are associated with those types. In fact, probably in excess of 50 per cent now." Those figures from 2001 to 2005 increased to almost 60 per cent in 2006 and 2007. Associate Professor Rose says head and neck cancers have traditionally been associated with older men and related to alcohol and smoking. She says these findings show that has now changed and most are due to the increasing practise of oral sex. "We now know that there's another subset, which is quite distinct biologically, which tends to affect younger people who don't smoke and don't drink, caused by human papillomavirus probably by sexual transmission," she said. "And the types of [...]

Speaking and swallowing seems to be possible post tonsil cancer surgery

Source: www.healthjockey.com Author: staff Cancer of the tonsil is said to be one among the head and neck cancers. It apparently develops in the part of the throat just behind your mouth, called the oropharynx. Smoking and consuming alcohol may increase the risk for tonsil cancer. After a tonsil cancer surgery, it is believed that patients cannot speak or eat properly. But a new method for reconstructing the palate post surgery for tonsil cancer apparently preserved the capability of the patients to speak clearly and devour majority of the foods. This technique was developed at the University of Michigan Comprehensive Cancer Center. Tonsil cancer apparently develops in the back of the throat, which could mean that surgery could contain parts of the palate, the tongue and the jaw. In conventional reconstruction efforts, a huge round piece of tissue was apparently taken to plug the hole left when the tumor is supposedly detached. But this apparently damages the way the palate and tongue function, and may not reinstate the intricate mechanism of the throat that may enable an individual to speak and swallow. Study author Douglas Chepeha, M.D., M.S.P.H., associate professor of otolaryngology head and neck surgery and director of the microvascular program at the University of Michigan Health System, commented, “This is the area that triggers swallowing, that separates the mouth from the nasal cavity. It affects speech and eating – typically, patients have difficulty eating when they have this kind of tumor and undergo surgery. We can remove the [...]

2009-09-27T18:21:04-07:00September, 2009|Oral Cancer News|
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