radiation

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|

The iPhone ultrasound device that can spot cancer

Source: www.dailymail.co.uk
Author: Maggie O’Neill for dailymail.com

Dr John Martin diagnosed his own stage four cancer last summer – using only his iPhone.

The 59-year-old doctor is a vascular surgeon and the chief medical officer at Butterfly Network, a company that has invented a handheld ultrasound machine that can connect to an iPhone called the Butterfly iQ. While the product was being tested for FDA clearance in July, Dr Martin decided to scan his own neck using the device because he felt a mass in his throat.

The results that popped up on his phone screen revealed he had metastatic cancer. It had started in his tongue and throat and spread to his neck. After surgery, it was downgraded to stage three and now, coming to the end of six weeks of radiation, doctors say he looks set to be cured.

Dr Martin used a device called the Butterfly iQ, which can connect to an iPhone, to perform an ultrasound.

Dr Martin said that the opportunity to try the technology on himself arose when the product was being tested in Denver, Colorado, earlier this year.

‘I noticed this mass in my neck,’ he said. He tested himself by performing an ultrasound with the Butterfly iQ and looking at the instant results on his iPhone.

‘I realized I was holding the diagnostic study I needed in my hand,’ he said.

Dr Martin, who has been a physician for 40 years, said he suspected the results were not good, but he consulted with a nearby technician to make sure that was the case.

‘I walked across to a technician, and we looked at each other, and I flew home the next morning.’ But the first thing he thought when he saw the image was that he was thankful his team had invented the ultrasound technology.

‘There’s a million things that go through your mind,’ Dr Martin said. But one unexpected thought he had when he realized he had cancer was: ‘I’m glad I’ve got this picture.’

Butterfly Network founder Jonathan Rothberg said that the speed of his employee’s diagnosis was the goal he had in mind when designing the iQ technology.

The revolutionary aspect of the Butterfly iQ is that the results of an ultrasound appear immediately on an iPhone screen. The product will be used in clinical trials in 2018, and during the studies doctors will send the devices home with high-risk patients who could benefit from an immediate ultrasound.

Rothberg and Dr Martin said that their technology could help patients with diabetes, lung problems and other ailments.

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|

Halving radiation therapy for HPV-related throat cancer offers fewer side effects, similar outcomes

Source: www.eurekalert.org
Author: Mayo Clinic press release

Mayo Clinic researchers have found that a 50 percent reduction in the intensity and dose of radiation therapy for patients with HPV-related throat cancer reduced side effects with no loss in survival and no decrease in cure rates. Results of a phase II study were presented today at the 59th Annual Meeting of the American Society for Radiation Oncology in San Diego by Daniel Ma, M.D. a radiation oncologist at Mayo Clinic.

“A common approach for treating HPV-related throat cancer is a combination of surgery followed by daily radiation therapy for six to 6½ weeks,” says Dr. Ma. “However, the radiation treatment can cause a high degree of side effects, including altered taste, difficulty swallowing, dry mouth, stiff neck and damage to the jaw bone.” Dr. Ma says that patients with HPV-related throat cancer tend to be young and, once treated, are likely to live a long time with possibly life-altering side effects from the standard treatment. “The goal of our trial was to see if an aggressive reduction of radiation therapy (two weeks of radiation twice daily) could maintain excellent cure rates, while significantly reducing posttreatment side effects, improving quality of life and lowering treatment costs.”

Researchers followed 80 patients with HPV-related oropharyngeal squamous cell cancer with no evidence of residual disease following surgery and a smoking history of 10 or fewer pack years. That’s the number of years smoking multiplied by the average packs of cigarettes smoked per day.

At two years following the aggressively de-escalated treatment, the rate of tumor control in the oropharynx (throat) and surrounding region was 95 percent. Of the 80 patients in the trial, only three experienced a local cancer recurrence. One patient experienced a regional cancer recurrence. Patient quality of life largely improved or did not change following treatment, except for some dry mouth.

“Patients in our trial had a very dramatic reduction in side effects, compared with standard treatment,” says Dr. Ma. “For example, no patient in our trial needed a feeding tube placed during dose-reduced treatment; whereas, close to a third of patients had feeding tubes placed with traditional radiation therapy doses on other recent clinical trials.” Dr. Ma says the reduction in side effects did not lead to any reduction in cure rate, as survival rates were similar to traditional survival rates for HPV-related throat cancer.

September, 2017|Oral Cancer News|

Mayo Clinic Q and A: Throat cancer symptoms

Source: newsnetwork.mayoclinic.org
Author: Dr. Eric Moore, Otorhinolaryngology, Mayo Clinic

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 in causing some of these tumors. Cancer that occurs in this area, particularly when caused by HPV, grows slowly ─ usually over a number of months. It often does not cause pain, interfere with swallowing or speaking, or have many other symptoms.

Most people discover cancer in the oropharynx when they notice a mass in their neck that’s a result of the cancer spreading to a lymph node. Eighty percent of people with cancer that affects the tonsils and base of tongue are not diagnosed until the cancer moves into the lymph nodes.

This type of cancer responds well to therapy, however, and is highly treatable even in an advanced stage. At Mayo Clinic, most tonsil and base of tongue cancers are treated by removing the cancer and affected lymph nodes with robotic surgery, followed by radiation therapy. This treatment attains excellent outcomes without sacrificing a person’s ability to swallow.

When cancer affects the voice box, it often affects speech. People usually notice hoarseness in their voice soon after the cancer starts. Because of that, many cases of this cancer are detected at an early stage. People with hoarseness that lasts for six weeks should get an exam by an otolaryngologist who specializes in head and neck cancer treatment, as early treatment of voice box cancer is much more effective than treatment in the later stages.

Early voice box cancer is treated with surgery — often laser surgery — or radiation therapy. Both are highly effective. If left untreated, voice box cancer can grow and destroy more of the larynx. At that point, treatment usually includes major surgery, along with radiation and chemotherapy ─ often at great cost to speech and swallowing function.

Finally, cancer of the hypopharynx usually involves symptoms such as pain when swallowing and difficulty swallowing solid food. It is most common in people with a long history of tobacco smoking and daily alcohol consumption. This cancer almost always presents in an advanced stage. Treatment is usually a combination of surgery, chemotherapy and radiation therapy.

If you are concerned about the possibility of any of these cancers, or if you notice symptoms that affect your speech or swallowing, make an appointment for an evaluation. The earlier cancer is diagnosed, the better the chances for successful treatment. — Dr. Eric Moore, Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota

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 in causing some of these tumors. Cancer that occurs in this area, particularly when caused by HPV, grows slowly usually over a number of months. It often does not cause pain, interfere with swallowing or speaking, or have many other symptoms.

Most people discover cancer in the oropharynx when they notice a mass in their neck that’s a result of the cancer spreading to a lymph node. Eighty percent of people with cancer that affects the tonsils and base of tongue are not diagnosed until the cancer moves into the lymph nodes.

This type of cancer responds well to therapy, however, and is highly treatable even in an advanced stage. At Mayo Clinic, most tonsil and base of tongue cancers are treated by removing the cancer and affected lymph nodes with robotic surgery, followed by radiation therapy. This treatment attains excellent outcomes without sacrificing a person’s ability to swallow.

When cancer affects the voice box, it often affects speech. People usually notice hoarseness in their voice soon after the cancer starts. Because of that, many cases of this cancer are detected at an early stage. People with hoarseness that lasts for six weeks should get an exam by an otolaryngologist who specializes in head and neck cancer treatment, as early treatment of voice box cancer is much more effective than treatment in the later stages.

Early voice box cancer is treated with surgery — often laser surgery — or radiation therapy. Both are highly effective. If left untreated, voice box cancer can grow and destroy more of the larynx. At that point, treatment usually includes major surgery, along with radiation and chemotherapy — often at great cost to speech and swallowing function.

Finally, cancer of the hypopharynx usually involves symptoms such as pain when swallowing and difficulty swallowing solid food. It is most common in people with a long history of tobacco smoking and daily alcohol consumption. This cancer almost always presents in an advanced stage. Treatment is usually a combination of surgery, chemotherapy and radiation therapy.

If you are concerned about the possibility of any of these cancers, or if you notice symptoms that affect your speech or swallowing, make an appointment for an evaluation. The earlier cancer is diagnosed, the better the chances for successful treatment. — Eric Moore, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.

Note: For information, visit www.mayoclinic.org

Changing definition of margin status for oral cancer

Source: www.medpagetoday.com
Author: staff

Data cast doubt on 5-mm standard, use of frozen sections

A commonly used metric for defining a close surgical margin for resected oral-cavity tumors failed to identify adequately the patients at increased risk of recurrence, a retrospective review of 432 cases showed.

The analysis showed an inverse relationship with increasing distance between invasive tumor and inked main specimen margin on the main specimen, but results of a receiver operating characteristic curve analysis identified a cutoff of < 1 mm as most appropriate for classifying patients as having a high risk of local recurrence, as opposed to the more commonly used cutoff of 5 mm.

The analysis also showed that resection of tissue beyond 1 mm on intraoperative frozen section did not improve local disease control, as reported online in JAMA Otolaryngology-Head and Neck Cancer.

“The commonly used cutoff of 5 mm for a close margin lacks an evidential basis in predicting local recurrence,” Steven M. Sperry, MD, of the University of Iowa in Iowa City, and colleagues concluded. “Invasive tumor within 1 mm of the permanent specimen margin is associated with a significantly higher local recurrence risk, though there is no significant difference for greater distances.

“This study suggests that a cutoff of less than 1 mm identifies patients at increased local recurrence risk who may benefit from additional treatment. Analysis of the tumor specimen, rather than the tumor bed, is necessary for this determination.”

The results add to a growing volume of evidence that margins <5 mm can still be curative, said Michael Burkey, MD, of the Cleveland Clinic, who was not involved in the study. The data also add to evidence that the margins calculated from the main specimen are more predictive than frozen-section margins that many head and neck surgeons have used for years.

“This doesn’t change the fact that clearly getting all the tumor out and clearing margins microscopically are still critical to curative surgery,” Burkey told MedPage Today. “The study provided good data to show that when they got positive margins, even if they subsequently treated with radiation therapy, that led to no improvement in local recurrence.”

“A second key point is that the way we determine the adequacy of surgery is changing,” he added. “We used to say 5 mm, and now it’s probably 1 to 2 mm. More and more we’re finding that the best way to look at margins is off the main specimen, not by taking frozen sections from the tumor bed.”

Despite widespread use in surgical management of head and neck cancers, interpretation of margin status and associated prognostic implications remain imprecise. A survey of head and neck surgeons showed that 83% of respondents considered carcinoma in situ as a positive margin and 17% included dysplasia in the definition. Additionally, 69% of the surgeons used a cutoff of <5 mm between invasive tumor and resection margin to a close margin, consistent with multiple reports in the literature. However, other literature suggested a smaller-distance cutoff is adequate, Sperry’s group noted.

To continue an investigation of the clinical significance and impact of surgical margins in oral-cavity cancer, the authors retrospectively reviewed results in 432 consecutive patients with primary oral-cavity squamous cell carcinoma treated at the University of Iowa from 2005 to 2014. Patients with recurrent disease were excluded from the analysis. The primary outcome was local recurrence as determined by minimum distance in millimeters between invasive tumor and inked main specimen margin.

The patients had a median age of 62, and men accounted for 58% of the study population. T-stage distribution consisted of T1 disease in 45% of patients, T2 in 21%, and T3/4 in 34%. Subsite location was tongue in 45%, alveolus in 21%, floor of the mouth in 18%, and other in 15%.

Rates of local recurrence by margin status were:
44% for microscopic positive margins
28% for margins <1 mm
17% for 1-mm margins
13% for 2-mm and 3-mm margins
14% for 4-mm margins
11% for ≥5-mm margins

“These data demonstrated an exponential inverse relationship between distance and local recurrence, with no appreciable difference in local recurrence for distances greater than 1 mm,” the authors reported.

Local recurrence also was determined on the basis of intraoperative frozen section assessment from tumor bed sampling. The analysis showed similar recurrence rates for close-margin distances between patients with involved and negative frozen sections. Among patients with a positive main specimen margin, those with an involved frozen margin had the highest local recurrence rate at 54%, as compared with 36% for patients with a negative frozen margin.

The authors analyzed the results on the basis of whether additional tissue was resected to achieve a negative margin after initial frozen section indicated cancer. The analysis incorporated collapsed margins of ≥5 mm, 1 to 5 mm, <1 mm, and positive. Success was defined as a final margin uninvolved with either invasive carcinoma or carcinoma in situ after further resection. For patients with a positive main specimen margin, successful additional resection did not improve local control.

“For patients with final margin distances grater than 0 millimeter, the local recurrence rate appeared to be the same whether a successful additional resection of the margin was performed or note,” the authors reported.

Finally, Sperry’s group analyzed local recurrence according to whether patients received adjuvant radiation therapy. For patients with a positive main specimen margin, radiotherapy did not improve local control, and the recurrence rate was the same for the other main-specimen margin categories, regardless of whether radiation therapy was administered.
Study limitations included a relatively small group of surgeons performing the majority of surgical procedures, and the inability to compare results based on different methods of intraoperative margin evaluation, such as tumor bed versus main specimen sampling, the authors noted.

Reviewed by:
Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Primary Source:
JAMA Otolaryngology-Head and Neck Surgery

Source Reference: Tasche KK, et al “Definition of ‘close margin’ in oral cancer surgery and association of margin distance with local recurrence rate” JAMA Otolaryngol Head Neck Surg 2017; DOI:10.1001/jamaoto.2017.0548.