staging

Calls grow for treatment deintensification of HPV-positive OPC

Source: ww.pharmacytimes.com Author: Bryan Fitzgerald, PharmD, BCOP Health-System Edition, July 2021, Volume 10, Issue 4 Oropharyngeal cancer (OPC) is a type of head and neck cancer that affects structures in the back of the throat, including the base of the tongue, the posterior pharynx, the soft palate, and the tonsils.1 In the United States, rates of OPC are increasing each year, with an estimated 54,010 new cases in 2021.2 Well-established risk factors include alcohol abuse; exposure to tobacco, including chewing tobacco, cigarettes, and pipes; and infection with human papillomavirus (HPV). With an estimated 43 million infections in 2018, HPV is the most common sexually transmitted infection in the United States.3 HPV infection is causally linked with cancers of the anogenital region, including anal, cervical, penile, vaginal, and vulvar cancers. When HPV is spread orally, infections can also lead to the development of OPC. In the United States, more than 70% of OPC cases are caused by HPV.4 HPV is a group of more than 100 viruses, including certain high-risk strains associated with the development of cancer. The HPV-16 strain is responsible for causing the majority of HPV-positive (HPV+) OPC cases, with HPV-18, HPV-33, and HPV-35 also contributing, albeit significantly less than HPV-16.1 In these high-risk HPV strains, the viral genome encodes several oncogenic proteins that inhibit tumor suppressor proteins, leading to chromosomal instability and malignancy in infected cells. HPV+ OPC is considered a genetically distinct form of OPC. Compared with HPV-negative (HPC–) OPC cases, HPV+ OPC is associated with a [...]

Oral Cancer Foundation News Team - A2021-07-21T10:05:34-07:00July, 2021|Oral Cancer News|

Changes in cancer staging: what you should know

Source: health.clevelandclinic.org Author: staff When you learn you have cancer, you want to know what to expect: How will doctors treat your illness? How effective is treatment likely to be? Much depends on the way doctors first classify, or “stage,” your cancer, using the official staging manual from the American Joint Committee on Cancer. Staging guidelines continue to evolve as knowledge about individual tumor growth and innovative technologies come into play. An ever-evolving system “Historically, we staged cancers according to tumor size, lymph node involvement and the presence of metastases,” says oncologist Dale Shepard, MD, PhD. “The latest staging manual incorporates new findings on the importance of changes in molecular DNA and tumor genomic profiling. This will affect many patients going forward.” Among those most impacted by changes in staging are people newly diagnosed with breast cancer; head and neck cancer caused by human papillomavirus (HPV); or sarcoma. How staging works “Staging allows us to stratify patients into groups based on anatomic and other criteria. It gives us a framework for understanding the extent of disease,” Dr. Shepard explains. Cancers are staged clinically and pathologically: The clinical stage is determined during the initial workup for cancer. The pathologic stage is determined by studying a surgically removed tumor sample under the microscope. Adds Tumor Registry Manager Kate Tullio, MPH, MS, “Staging helps physicians and other researchers to compare patients with the same types of cancer to each other in a consistent way — so that we might learn more about these cancers and [...]

Oral Cancer Foundation News Team - A2018-07-05T07:45:14-07:00July, 2018|Oral Cancer News|

Study provides new guidelines for assessing severity of head and neck cancers

Source: eurekalert.org Author: press release Cedars-Sinai Medical Center Cedars-Sinai investigators have developed a new, more accurate set of guidelines for assessing the severity of head and neck cancers and predicting patient survival. The new guidelines, outlined in a study recently published in the Journal of Clinical Oncology, center around counting the number of malignant lymph nodes found in each patient. "The greater the number of malignant lymph nodes, the less favorable the patients' chances of survival," said Allen S. Ho, MD. Ho is director of the Head and Neck Program at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai and lead author of the study. "This new approach could dramatically simplify staging systems." For decades, doctors have determined the stage and predicted the progression of head and neck cancers based primarily on nodal size, location and how far the cancer has spread beyond the lymph nodes, but they have given less importance to the number of cancerous nodes. As a result, staging and treatment recommendations, based on current national guidelines, "are the same whether a patient has two or 20 positive lymph nodes," said Zachary S. Zumsteg, MD, assistant professor of Radiation Oncology at Cedars-Sinai and the study's senior author. With the new system, based on the number of cancerous lymph nodes, patients are separated into similarly sized groups with distinct outcomes, Zumsteg said. "Our study demonstrated a better way to assess cancer severity, which will improve our ability to predict outcomes and give patients more personalized treatment." The Cedars-Sinai [...]

Oral Cancer Foundation News Team - A2018-01-24T09:24:42-07:00January, 2018|Oral Cancer News|

MRI shows promise for oral cancer staging

Source: www.drbicuspid.com Author: DrBicuspid Staff Magnetic resonance imaging (MRI) could play an important role in the diagnosis of oral cancer, according to a study in Brazilian Oral Researcher (December 2011, Vol. 25:6, pp. 512-518). Researchers from the University Center of Anapolis School of Dentistry compared clinical staging and MRI staging for oral cancer in 10 patients diagnosed with oral cancer. A head and neck surgeon performed standard TNM staging, while two medical radiologists and two oral radiologists performed a new staging assessment by interpreting MRI studies, without prior knowledge of the clinical staging. Each evaluated the extent of the primary tumor (T), metastasis to regional lymph nodes (N), and grouping by stages. There was significant agreement (p

Oral Cancer Foundation News Team - A2011-12-09T06:53:40-07:00December, 2011|Oral Cancer News|

MRI can show jaw invasion of oral cancer

Source: www.medpagetoday.com Author: Charles Bankhead, Staff Writer Oral cancer's spread to the mandible could not hide from a type of MRI that may facilitate more accurate staging and surgical planning, data from laboratory studies suggest. Sweep imaging with Fourier transform (SWIFT) provided fine-detail views of cortical and medullary bone specimens, and the images exhibited good correlation with histopathologic findings. The in-vitro studies did not specifically examine SWIFT's ability to identify early cortical bone invasion by oral cancer. However, the high-quality images obtained from the investigation provide reason for optimism, the researchers reported in the September issue of Archives of Otolaryngology Head and Neck Surgery. "Our study is very promising in that it offers a SWIFT-based MRI technique for accurate assessment of minute changes of cortical and medullary bone in three dimensions without any ionizing radiation," Ayse Tuba Karagulle Kendi, MD, of the University of Minnesota in Minneapolis, and co-authors wrote. "It has the potential to precisely determine the extent of mandibular bone invasion associated with oral carcinoma. This study is a crucial step toward the goal of developing a robust and noninvasive approach for preoperative imaging of mandibular invasion," they added. Carcinoma of the oral cavity often spreads to the mandible, but in many instances does not cross the periosteal layer, obviating the need for mandibulectomy. Limitations of current imaging techniques often preclude determination of bone invasion prior to surgery, the authors noted. MRI and CT have been used most often to evaluate mandibular invasion of oral cancer, but conventional [...]

Oral Cancer Foundation News Team - A2011-09-23T16:35:59-07:00September, 2011|Oral Cancer News|

FDG-PET staging and importance of lymph node SUV in head and neck cancer

Source: 7thspace.com Author: staff Objectives: The role of positron emission tomography (PET) with fluoro-deoxy-glucose (FDG) in the staging of head and neck cancer (HNC) is unclear. The NCCN guidelines do not recommend FDG-PET as a part of standard workup. The purpose of this report is to examine the role of FDG-PET imaging in altering management and providing prognostic information for HNC. Methods: Retrospective review of HNC patients who had a staging FDG-PET scan performed at either Thomas Jefferson University or University of Kansas Medical Center between the years 2001 and 2007. A total of 212 PET scans were performed in patients who went on to receive radiotherapy. Results: The median follow-up time for all patients was 469 days. The PPV and NPV of PET imaging to correctly identify lymph node status was 94% and 89% respectively. Lymph nodes with extracapsular extension (ECE) had higher SUVs than nodes without ECE, 11.0 vs. 5.0 (p <0.0007). Maximum SUV for the primary tumor >8.0 was predictive of worse overall survival (p <0.045), while the SUV of the lymph nodes was predictive for distant recurrence at one year--with a mean SUV value of 10.4 for patients with distant failure vs. 7.0 without (p <0.05). Conclusions: FDG-PET staging in head and neck cancer has good positive and negative predictive values in determining lymph node status. The maximum SUV of the primary tumor is predictive of overall survival. This is the first report to find that the SUV of a lymph node is predictive for ECE [...]

Oral Cancer Foundation News Team - A2010-07-18T06:52:58-07:00July, 2010|Oral Cancer News|

PET-FDG improves staging, management of head, neck cancer

Source: helathimaging.com Author: staff Adding whole-body PET-FDG to the pre-therapeutic conventional staging of head and neck squamous cell carcinoma improved the TNM [tumor, node and metastasis] classification of the disease and altered the management of 13.7 percent of patients, according to a study published in the February issue of the Journal of Clinical Oncology. Max Lonneux, MD, from the departments of nuclear medicine, head and neck surgery, radiation oncology and maxillofacial surgery, Cliniques Universitaires Saint-Luc in Brussels, and colleagues included his 233 patients in this multicenter, prospective study with newly diagnosed and untreated head and neck squamous cell carcinoma. Researchers first determined the TNM stage and therapeutic decision based on the conventional work-up (including physical exam, CT/MRI of the head and neck region, and thoracic CT) and sealed in envelope. They then performed whole-body PET-FDG, and subsequently wrote TNM stage and therapeutic decision in a sealed envelope. The investigators also recorded changes in TNM stages and in patient management as a result of PET-FDG imaging. Clinical outcome and histopathology were used as gold standards to validate the TNM stage. Conventional and PET stages were compared using the McNemar test. According to the authors, conventional and PET stages were discordant in 43 percent of the patients. PET proved to be accurate in 47 patients and inaccurate in 13 patients. TNM status was left unconfirmed in 40 patients because no therapeutic change was expected from the stage difference. The researchers found that conventional plus PET TNM classification (envelope two) was significantly more [...]

Oral Cancer Foundation News Team - A2010-02-17T08:18:31-07:00February, 2010|Oral Cancer News|

Positron Emission Tomography Offers Modest Improvement for Staging of Head and Neck Cancers: Presented at AHNS

Source: Doctor's Guide (www.docguide.com) Author: Arushi Sinha Use of positron emission tomography (PET) imaging offers modest improvement in positive predictive value, specificity, and accuracy compared with computed tomography (CT) for diagnosing head and neck cancers. Researchers at the American Head and Neck Society 7th International Conference on Head and Neck Cancer (AHNS) presented new data on the effectiveness of PET scans singly or in combination with CT compared with CT scans alone. "We used the scans in comparison to the gold standard, which was the pathology findings from neck dissections," explained study presenter Surjeet Pohar, MD, Department of Radiation Oncology, Eastern Virginia Medical School, Norfolk, Virginia. The study, presented in a poster session on July 22, used information gathered from 36 patients diagnosed with head and neck squamous cell carcinoma. All the patients underwent neck dissection as well as CT scans, PET scans, or combined PET and CT. In addition, all patients received a full medical examination, endoscopy, and X-ray imaging to help stage their disease. In addition, nodal involvement and information about the side of the neck were also documented. As a result of the full diagnostic workup, the researchers found that most patients exhibited locally advanced disease: 4 patients had stage II disease; 3 had stage III disease; and 25 had stage IV disease. Four patients had indeterminate staging at the time of the initial workup. Results showed that several parameters of the different imaging technique were comparable. CT scans exhibited sensitivity to the samples in 72% of [...]

Oral Cancer Foundation News Team - A2008-07-25T03:02:48-07:00July, 2008|Oral Cancer News|

Greater Accuracy in Staging Can Influence Long-Term Treatment Options in Oropharyngeal Cancer: Presented at AHNS

Source: Doctor's Guide (www.docguide.com) Author: Arushi Sinha Primary surgical treatment does not appear to provide benefits to patients with stage I or II oropharyngeal squamous cell carcinoma, whereas in patients with occult metastases, these procedures offer the opportunity for upstaging and intensification of therapy, according to research presented here at the American Head and Neck Society 7th International Conference on Head and Neck Cancer (AHNS). Disease staging helps to determine treatment plans and prognosis in patients with oropharyngeal squamous cell carcinoma, so accuracy in staging has definite clinical implications, the researchers noted during their presentation on July 22. To assess the accuracy of staging information, they reviewed the records of 49 patients with oropharyngeal squamous cell carcinomas, including primary carcinomas of the tonsil (53%), base of tongue (33%), or posterior pharyngeal wall (14%). "When we went back to our results on surgical staging and actually looked at the pathology, some of the tumors were upstaged and some were downstaged," explained Rohan Walvekar, MD, Department of Otolaryngology -- Head and Neck Surgery, Louisiana State University Health Sciences Center New Orleans Louisiana Dr. Walvekar conducted the study while he was at the University of Pittsburgh Clinical staging data showed that 61% of patients were either stage I or II, and 39% were stage III. With reference to nodal involvement, 58% were N0 and 42% were N1. As part of the initial workup, neck dissections were performed in 46 of the 49 patients. When compared with clinical staging, neck dissection altered nodal status [...]

Oral Cancer Foundation News Team - A2008-07-24T14:51:22-07:00July, 2008|Oral Cancer News|