Robot that can cut out hard-to-reach throat tumours through patients’ mouths: Pioneering operation reduces need for chemo and radiotherapy

Source: www.dailymail.co.uk
Author: Fiona McCrae, Roger Dobson

British surgeons are using a cutting-edge robot to remove difficult-to-reach throat tumours – through the mouths of patients.

The pioneering operation is designed to dramatically reduce the need for gruelling radiotherapy and chemotherapy, which can leave patients unable to swallow and dependent on a feeding tube for life.

With growing numbers of people developing throat cancer, it is more important than ever to have a range of effective treatments that lessen the impact on quality of life, says Asit Arora, consultant head and neck surgeon at Guy’s & St Thomas’ NHS Trust in London.

Once most common in elderly people with a history of drinking and smoking, rates of head and neck cancers have soared by 31 per cent in the past 25 years and are now as common in people in their 50s as in those in their 80s.

The 90 minute operation is designed to dramatically reduce the need for gruelling radiotherapy and chemotherapy, which can leave patients unable to swallow and dependent on a feeding tube for life

Much of the rise is attributed to HPV – a range of viruses that can be passed on during intimate and sexual contact. At least 80 per cent of the adult population carries some kinds of HPV on their skin, although most will never know it. In some cases, HPV can cause skin or genital warts, and other types are a known cause of cervical and anal cancers.

HPV can also infect the mouth and throat and is now to blame for at least half of throat cancers in the UK. Until a tumour occurs, the infection is typically symptomless.

Conventional treatment for early-stage throat cancer involves either powerful radiotherapy and chemotherapy to destroy the tumour, or laser surgery to cut it out.

Courses of radiotherapy and chemotherapy are time-consuming – some patients make up to 30 trips to hospital over a few months. The treatment can also damage the jaw and the swallowing muscles, meaning patients cannot eat without the help of a feeding tube.

Laser treatment is more gentle on the body but it can be difficult to cut out a hard-to-reach cancer completely and most patients need radiotherapy afterwards. Some also need chemotherapy.

Using the robot, the surgeon can zero in on the tumour and cut it away precisely. With the patient under general anaesthetic, the surgeon controls the robot with his hands and feet. One of the robot arms holds a 3D camera, while two others wield tiny instruments that can be passed through the mouth and into the throat, and turned and twisted in ways impossible with the human hand alone.

Surgery in the mouth and throat can be challenging because you are working in very small areas, manipulating surgical instruments in a tight space where there are important nerves and blood vessels to be avoided,’ says Mr Arora, who has pioneered robotic surgery for throat cancer in the UK.

‘With the latest robotic systems, we can be more targeted than ever before in how we treat these throat conditions in order to reduce unwanted side effects, particularly related to swallowing.’

Studies suggest that trans-oral robotic surgery (TORS) is at least as good as conventional surgery, although a definitive comparison has yet to be carried out, says Mr Arora. But importantly, by cutting out the tumour so precisely, it may reduce the amount of chemotherapy and radiotherapy patients need.

A £4.5 million Cancer Research UK trial into the procedure is now being carried out at Guy’s and hospitals around the country.

Mr Arora has used the method to remove about 30 throat tumours in the year since setting up the service with Jean-Pierre Jeannon, Guy’s clinical director for cancer.

The operation takes 90 minutes and patients are usually discharged after two days. They then undertake rehab, including speech therapy.

Retired policeman David Wonfor, 60, chose to take part in the trial after being diagnosed with early-stage throat cancer last summer. After his operation, David, 60, of Petts Wood, Kent, started on five weeks of low-dose radiotherapy. Although he lost weight and his sense of taste at first, he has now largely recovered, and says he is convinced that his recovery would have been very different if he had had chemotherapy.

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March, 2019|Oral Cancer News|

HPV infection may be behind rise in vocal-cord cancers among young nonsmokers

Source: www.eurekalert.org
Author: Public Release Massachusetts General Hospital

A remarkable recent increase in the diagnosis of vocal-cord cancer in young adults appears to be the result of infection with strains of human papilloma virus (HPV) that also cause cervical cancer and other malignancies. Investigators from Massachusetts General Hospital (MGH) describe finding HPV infection in all tested samples of vocal-cord cancer from 10 patients diagnosed at age 30 or under, most of whom were non-smokers. Their report appears in a special supplement on innovations in laryngeal surgery that accompanies the March 2019 issue of Annals of Otology, Rhinology and Laryngology.

“Over the past 150 years, vocal-cord or glottic cancer has been almost exclusively a disease associated with smoking and almost entirely seen in patients over 40 years old,” says Steven Zeitels, MD, director of the MGH Division of Laryngeal Surgery, senior author of the report. “Today nonsmokers are approaching 50 percent of glottic cancer patients, and it is common for them to be diagnosed under the age of 40. This epidemiologic transformation of vocal-cord cancer is a significant public health issue, due to the diagnostic confusion it can create.”

The researchers note that the increase in vocal-cord cancer diagnosis appears to mimic an earlier increase in the diagnosis of throat cancer, which has been associated with infections by high-risk strains of HPV. After initially attributing incidents of vocal-cord cancer in nonsmokers, which they began to see about 15 years ago, to increased travel and exposure to infectious diseases, Zeitels and his colleagues decided to investigate whether HPV infection might explain the diagnosis in younger nonsmokers.

To do so they examined the records of patients treated by Zeitels either from July 1990 to June 2004 at Massachusetts Eye and Ear Infirmary or between July 2004 and June 2018 at MGH. Of 353 patients treated for vocal-cord cancer during the entire period, none of the 112 treated from 1990 to mid-2004 were age 30 or younger. But 11 of the 241 patients treated from 2004 to 2018 were 30 or younger – 3 were age 10 to 19 – and only 3 of the 11 were smokers. Analysis of tissue samples from the tumors of 10 of the 11 younger patients revealed high-risk strains of HPV in all of them.

The authors note that these high-risk-HPV-associated vocal-cord cancers greatly resemble recurrent respiratory papillomatosis (RRP), a benign condition caused by common, low-risk strains of HPV. One of the 11 patients treated by Zeitels had previously been diagnosed at another center with vocal-cord cancer, and when it recurred after being surgically removed, she was misdiagnosed with RRP and treated with a medication that made the cancer worse, leading to the need for a partial laryngectomy.

“Benign RRP of the vocal cords has been a well-known HPV disease for more than a century, and it is very remarkable that there is now an HPV malignancy that looks so similar, creating diagnostic and therapeutic confusion,” says Zeitels, the Eugene B. Casey Professor of Laryngeal Surgery at Harvard Medical School. “It should be noted that these HPV-associated vocal-cord carcinomas are not a malignant degeneration of the benign disease.”

Zeitels adds that HPV vocal-cord cancers are amenable to endoscopic treatment with the angiolytic KTP laser that he developed. “Large-scale studies are now needed to determine the pace of the increase in glottic cancer among nonsmokers, the incidence of high-risk HPV in these cancers and changes in the age and genders of those affected,” he says.

Note:
The lead author of the Annals of Otology, Rhinology and Laryngology paper is Semirra Bayan, MD, previously a fellow in laryngeal surgery at MGH and now at University of Chicago Medicine; William Faquin, MD, PhD, MGH Pathology, is a co-author. The study was supported by the Voice Health Institute, the National Philanthropic Trust, and the Eugene B. Casey Foundation.

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March, 2019|Oral Cancer News|

Suspect laryngeal cancer in patients with sore throat and hoarseness, GPs urged

Source: www.pulsetoday.co.uk
Author: Isobel Sims

GPs should suspect laryngeal cancer and consider urgent referral in patients who present with a persistent sore throat and hoarseness, according to a new study.

A recurrent sore throat in combination with symptoms such as hoarseness, difficulty swallowing or ear pain increases the likelihood that a patient has laryngeal cancer and may warrant urgent referral, the authors said.

The study, published in the British Journal of General Practice, was carried out by researchers at the University of Exeter and looked at primary care data for just over 800 patients diagnosed with laryngeal cancer, as well as just over 3,500 controls.

The researchers found hoarseness carried the greatest individual risk, with those presenting with the symptom having a 2.7% likelihood of having laryngeal cancer – just under the NICE (National Institue for Health & Care Excellene) threshold of 3% for urgent referral.

Patients presenting with a recurrent sore throat in combination with hoarseness had a 12% likelihood of having laryngeal cancer.

The likelihood of cancer was also increased above the NICE threshold when recurrent sore throat presented with dysphagia, recurrent dyspnoea, ear pain and raised inflammatory markers, the researchers said.

They found that, ‘unexpectedly’, neck lumps were not associated with laryngeal cancer.

The authors said the findings back up the NICE recommendation to consider referring patients with persistent unexplained hoarseness, but that GPs should also be vigilant about symptoms not currently listed in the NICE guidance.

The paper said: ‘This evidence supports some of the recommendations in current NICE guidance, particularly relating to hoarseness.It refutes the recommendation for neck lumps, though the clinician must still consider lymphoma.

‘It adds some new symptom combinations: sore throat supplemented by otalgia, dyspnoea, or dysphagia.

‘However, selection of patients for investigation is not simply a matter of totting up symptoms and positive predictive values. Clinical experience — although almost impossible to measure — adds to skilful decision making.’

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March, 2019|Oral Cancer News|

How regular use of painkillers could boost survival rates from cancer

Source: www.mirror.co.uk
Author: Miriam Stoppard

In recent research, aspirin or ibuprofen were found to treble the chance of beating head and neck cancer.
Could regular use of aspirin or ibuprofen boost survival rates from head and neck cancer? It seems it’s possible.

In recent research, the common painkillers were found to treble the chance of survival (from 25% to 78%) for patients with a specific kind of cancer which contains an altered gene, known as PIK3CA. Around a third of head and neck cancers carry this mutation and it’s also found in other types of cancer.

Head and neck cancer is newly ­diagnosed in more than 12,000 people in the UK each year, and in 65,000 in the US. It kills just over 4,000 people here and 14,000 in America. There are more than 30 areas in the head and neck where cancer can develop, such as the mouth and throat.

Researchers at the University of ­California, San Francisco, looked at five-year survival rates for people ­diagnosed with the disease and found the regular use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, significantly improved survival for a third or more of patients with the disease.

All the patients had the mutated gene. NSAIDs, however, had no effect on tumours without PIK3CA mutation. The study included 266 patients from the University of Pittsburgh Medical Center whose tumours were surgically removed. Altogether, 75 tumours (28%) in the study had a change in the PIK3CA gene. Among the patients who regularly used NSAIDs, 93% used aspirin at some point, and 73% only took aspirin.

Dr Jennifer Grandis, a professor of head and neck surgery and senior author of the paper, said: “Our results suggest that the use of NSAIDs could significantly improve outcomes for not only head and neck cancer patients, but also patients with other cancers that contained the PIK3CA mutation.

“The magnitude of the apparent advantage is strong, and could potentially have a positive impact on human health.”

The researchers said the regular use of NSAIDs for at least six months provided “markedly prolonged” improved survival compared to patients whose PIK3CA gene was mutated and didn’t use NSAIDs.

They suggest that NSAIDs possibly block tumour growth by reducing the production of an inflammatory ­molecule called prostaglandin E2.

For something so simple, it seems too good to be true.

It would be very easy and cheap to try in patients but there’s a little way to go yet.

First, we need much larger trials as proof that what is only a theory actually works.

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March, 2019|Oral Cancer News|

Woman gets new tongue made from her arm after cancer battle

Source: www.mirror.co.uk
Author: Laura Elvin

A woman who lost her tongue while fighting cancer has had a new one made from her arm. Despite being a non-smoker Joanna Smith, 58, was diagnosed with tongue cancer after she found a tiny ‘ulcer’ in her mouth. The grandmother-of-four was given eight months to live unless she had it removed, so went through with a 15-hour surgery. Doctors removed her tongue via a hole in her neck and made a new one using skin, muscle and a long vein from her left arm .

The cleaner, from Bedfordshire, was able to talk as soon as she woke up and can now eat and drink on her own. However, she has no taste buds on the new organ and has to eat slowly to avoid biting it – but is cancer free and expected to make a full recovery.

The mum-of-two said: “It’s a bit weird. I look at my arm and I can see where my tongue has come from.

“I think ‘that’s in my mouth now but yet I can talk’ and that’s really weird. I can’t stick my tongue out and I can’t say it really feels like a tongue. It feels a bit surreal. Before I had it done I was thinking to myself ‘how it that going to work’ but now I’ve had it I’m like ‘wow’.”

“It’s really weird but it shows what they can do now.”

Joanna noticed a tiny dot on the side of her tongue in October last year and thought it was an ulcer. She went to her GP when it started to hurt and grew bigger. Her GP initially gave her tablets and mouth ulcer gel, but when it didn’t get any better she returned and was referred to Bedford Hospital for a biopsy. Medics said she had tongue cancer and the lump grew to the “size of a Malteaser” before the operation on January 10 at Luton and Dunstable Hospital.

“He said if I didn’t have the operation I wouldn’t see next Christmas,” said Joanna

“He said I would be lucky if I got six to eight more months. That was a bit of a shock.”

In a painstaking 10-hour operation, surgeons removed all but a “tiny sliver” of her real tongue, which they left so she would retain movement. They removed all the glands in her neck, the rest of her tongue, and all but 10 teeth before cutting a section of skin and muscle – as well as a vein – from her right leg. But after it was reattached it “turned black” so surgeons sought permission from her family to take her back into surgery and try again – using flesh from her left arm.

“I didn’t know anything about it,” she said.

“But they asked my daughter and she said ‘anything to save my mum’s life’.

“They always said that they would be able to replace my tongue with a new one, but it was nervewracking. There was 29 people involved in the operation.”

It took medics five more hours to replace her tongue with a circle of skin and a vein from her left arm, and she had to have a third operation to repair it further.

She added: “When I woke up I was a bit disorientated but I could talk straight away.

“It felt like I has something strange in my mouth.

“I have to think before I eat now, and have to wash my mouth out. I can’t just do or eat what I used to. I have to think about talking. I have to make sure I don’t bite my tongue, because I can’t feel bits of it.”

“It makes me feel like I have something in my mouth I want to take out, but I know I can’t because it’s my tongue. I don’t sound exactly like I used to. I find myself sucking my mouth a lot because I don’t want to dribble. I can taste everything I used to, but just on the roof of my mouth, not my tongue.”

Joanna was allowed home after 11 days in hospital.

She’s currently avoiding food that’s too hot – for fear of burning herself – because she has no feeling in her tongue yet. She initially stuck to liquid meals like milkshakes, but has moved onto solids like salmon and potatoes. She had already had quite a few of her back teeth removed – and replaced with a plate – when she was younger, but not only has ten left. Doctors hope to be able to replace the missing ones once her mouth has healed.

Last week she was told her body was cancer free so she won’t need chemotherapy or radiotherapy.

“You can see where they took my tongue from and the vein they took to make my tongue work,” she said.

“I can’t fault the hospital in any way. They were fantastic.”

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February, 2019|Oral Cancer News|

E-cig users develop some of the same cancer-related molecular changes as cigarette smokers

Source: EurekAlert!
Date: February 14, 2019

If you think vaping is benign, think again.

A small USC study shows that e-cig users develop some of the same cancer-related molecular changes in oral tissue as cigarette smokers, adding to the growing concern that e-cigs aren’t a harmless alternative to smoking.

The research, published this week in the International Journal of Molecular Sciences, comes amid a mushrooming e-cig market and mounting public health worries. On a positive note, recent research found vaping is almost twice as effective as other nicotine replacement therapies in helping smokers quit.

But among adolescents, vaping now surpasses smoking, and there’s evidence that e-cig use leads to nicotine addiction and future smoking in teens.

“The existing data show that e-cig vapor is not merely ‘water vapor’ as some people believe,” said Ahmad Besaratinia, an associate professor at Keck School of Medicine of USC and the study’s senior author. “Although the concentrations of most carcinogenic compounds in e-cig products are much lower than those in cigarette smoke, there is no safe level of exposure to carcinogens.”

Besaratinia emphasized that the molecular changes seen in the study aren’t cancer, or even pre-cancer, but rather an early warning of a process that could potentially lead to cancer if unchecked.

The researchers looked at gene expression in oral cells collected from 42 e-cig users, 24 cigarette smokers and 27 people who didn’t smoke or vape. Gene expression is the process by which instructions in our DNA are converted into a functional product, such as a protein. Certain alterations in gene expression can lead to cancer.

They focused on oral epithelial cells, which line the mouth, because over 90 percent of smoking-related cancers originate in epithelial tissue, and oral cancer is associated with tobacco use.

Both smokers and vapers showed abnormal expression, or deregulation, in a large number of genes linked to cancer development. Twenty-six percent of the deregulated genes in e-cig users were identical to those found in smokers. Some deregulated genes found in e-cig users, but not in smokers, are nevertheless implicated in lung cancer, esophageal cancer, bladder cancer, ovarian cancer and leukemia.

Besaratinia and his team plan to replicate his findings in a larger group of subjects and explore the mechanisms that cause gene deregulation. He’s also launching another experiment in which smokers switch to e-cigs; he wants to see whether any changes in gene regulation occur after the switch.

“For the most part, the participants are as curious as we are to know whether these products are safe,” he said.

In addition to Besaratinia, the study’s other authors are first author Stella Tommasi, Andrew Caliri, Amanda Caceres, Debra Moreno, Meng Li, Yibu Chen and Kimberly Siegmund, all of USC.

The research was supported by grants from the National Institute of Dental and Craniofacial Research of the National Institutes of Health (1R01DE026043) and the University of California Tobacco-Related Disease Research Program (TRDRP-25IP-0001 and TRDRP-26IR-0015).

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February, 2019|Oral Cancer News|

Pioneering surgery to regrow woman’s jaw hailed a ‘success’

Source: www.breakingnews.ie
Author: staff

A pioneering operation to regrow a woman’s jaw from her own skin and bone after she lost it from cancer has been branded a “significant success”.

Val had her entire lower jaw removed including her glands, chin, lower lip and part of her tongue after being diagnosed with cancer in 2015, leaving her unable to eat, drink or talk.

The 55-year-old from Wolverhampton eventually under went a pioneering surgical technique – known as distraction osteogenesis – to encourage her jaw to grow back after two previous attempts to reconstruct it failed.

This involved surgeons at trust’s maxillofacial service at Nottingham University Hospitals NHS Trust’s Queen’s Medical Centre (QMC) fitting her with a facial frame to act as “scaffolding” around which her own bone and tissue can grow back.

Val has had two further operations including one last month to remove the frame, and was discharged on Thursday.

Doctors said 90mm of bone had grown since the operation in January 2018 – and branded the procedure a “significant success”.

Val after the pioneering operation to regrow her jaw (Nottingham University Hospital)

Val said it had been a “leap of faith” to undergo the surgery – which was the first time it had been carried out in the UK.

She added: “Just over a year ago I was resigned to the fact I would have to wear a prosthetic chin for the rest of my life, but after one of our brainstorming sessions at my local hospital, when we joked about growing a new jawbone, it sparked an idea.

“It was a leap of faith as there were no guarantees it would work at all, but I had everything to gain and nothing to lose.

“It’s been a bumpy road, often painful and frustrating but throughout the maxillofacial team at QMC have given me their upmost support.

“Now there is an end in sight and although there is still a little way to go the results are more positive than I ever could have hoped for.”

Val hopes that following the success of her treatment, the procedure can be used for others with similar difficulties with confidence that it will change their lives for the better.

Dilip Srinvasin, clinical director for the Maxillofacial Service and Val’s surgeon, said: “The surgery was the first of its kind used in this way in the UK.

“Using pioneering techniques and specialist knowledge from both surgeons and the laboratory in Nottingham, we have managed to use a frame to reconstruct the lower jaw.

“Remarkably, 90mm of bone has grown back following Val’s surgery.”

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February, 2019|Oral Cancer News|

Scientists to test light therapy as relief from side effects of cancer treatment

Source: www.photonics.com
Author: staff

University at Buffalo (UB) researchers have received part of a $1.5 million grant to investigate light therapy as a replacement for prescription opioids in treating oral mucositis, painful ulcers, and swelling in the mouth that result from chemotherapy and radiation treatment for cancer.

Funded by the National Institutes of Dental and Craniofacial Research Small Business Innovation Research program, the grant will help the researchers determine the effectiveness of photobiomodulation in prevention and treatment of oral mucositis after cancer treatment.

At a high power, light, often in the form of a laser, is used in medicine to cut or destroy tissue. But at a low level, it has the ability to relieve pain and promote healing. Courtesy of Douglas Levere, University at Buffalo

The grant was awarded to Cleveland-based MuReva Phototherapy, a spin-off company of lighting solutions manufacturer Lumitex, to further develop the light technology. UB received $511,000 of the award to test the technology.

The research, led by Praveen Arany, DDS, assistant professor in the UB School of Dental Medicine, will be performed in collaboration with faculty from the Departments of Radiation Medicine and Oral Oncology at Roswell Park Comprehensive Cancer Center.

“The current epidemic of opioids has impacted cancer care, especially for cancer pain relief,” Arany said. “This treatment offers a simple, nondrug, noninvasive treatment approach to relieve pain and improve quality of life for cancer patients. The striking lab and clinical evidence for photobiomodulation treatments in supportive cancer care has demonstrated tremendous promise.”

Arany, who is president of the World Association for Photobiomodulation Therapy and co-chair of the committee on light therapy for supportive oncology care of the Multinational Association of Supportive Care in Cancer, is an advocate for wider use of photobiomodulation in the United States. He recently took part in the first congressional briefing on photobiomodulation before the House Science, Space, and Technology Committee in Washington, D.C. The briefing, held Oct. 11, 2018, invited a panel of international experts on the therapy to discuss the potential of photobiomodulation to improve health care and lower dependence on opioids.

“The ability of low-dose light therapy to promote healing has been established since the 1960s,” Arany said. “A major obstacle with its widespread use has been a lack of understanding of its precise biological mechanism. Recent work from our group has outlined both therapeutic and dose-limiting molecular pathways that are aiding development of safe and efficacious clinical protocols.”

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February, 2019|Oral Cancer News|

E-cigarette users show cancer-linked genetic changes

Source:news.usc.edu
Author: Leigh Hopper

If you think vaping is benign, think again.

While studies have indicated that vaping can help smokers quit, USC researchers say the health consequences of using a e-cigarettes may be worse than widely believed. (Photo/Pixabay)

A USC study in 93 people shows that e-cigarette users develop some of the same cancer-related molecular changes in oral tissue as cigarette smokers, adding to the growing concern that e-cigarettes aren’t a harmless alternative to smoking.

The research, published this week in the International Journal of Molecular Sciences, comes amid a mushrooming e-cigarette market and mounting public health worries. On a positive note, recent research found vaping is almost twice as effective as other nicotine replacement therapies in helping smokers quit. But among adolescents, vaping now surpasses smoking, and there’s evidence that e-cigarette use leads to nicotine addiction and future smoking in teens.

“The existing data show that e-cig vapor is not merely ‘water vapor’ as some people believe,” said Ahmad Besaratinia, an associate professor at Keck School of Medicine of USC and the study’s senior author. “Although the concentrations of most carcinogenic compounds in e-cig products are much lower than those in cigarette smoke, there is no safe level of exposure to carcinogens.”

E-cigs and cancer: Early warning in oral cells
Besaratinia emphasized that the molecular changes seen in the study aren’t cancer, or even pre-cancer, but rather an early warning of a process that could potentially lead to cancer if unchecked.

The researchers looked at gene expression in oral cells collected from 42 e-cigarette users, 24 cigarette smokers and 27 people who didn’t smoke or vape. Gene expression is the process by which instructions in our DNA are converted into a functional product, such as a protein. Certain alterations in gene expression can lead to cancer.

They focused on oral epithelial cells, which line the mouth. More than 90 percent of smoking-related cancers originate in epithelial tissue, and oral cancer is associated with tobacco use.

Both smokers and vapers showed abnormal expression, or deregulation, in a large number of genes linked to cancer development. Twenty-six percent of the deregulated genes in e-cig users were identical to those found in smokers. Some deregulated genes found in e-cig users, but not in smokers, are nevertheless implicated in lung cancer, esophageal cancer, bladder cancer, ovarian cancer and leukemia.

E-cigs and cancer: What’s next?
Besaratinia and his team plan to replicate his findings in a larger group of subjects and explore the mechanisms that cause gene deregulation. He’s also launching another experiment in which smokers switch to e-cigs; he wants to see whether any changes in gene regulation occur after the switch.

“For the most part, the participants are as curious as we are to know whether these products are safe,” he said.

In addition to Besaratinia, the study’s other authors are first author Stella Tommasi, Andrew Caliri, Amanda Caceres, Debra Moreno, Meng Li, Yibu Chen and Kimberly Siegmund, all of USC.

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February, 2019|Oral Cancer News|

The epidemic of throat cancer sweeping the industrialized world

Source: www.mercurynews.com
Author: Dr. Bryan Fong

Tonsils – Angina Pectoris

Over the past three decades, a dramatic increase in a new form of throat cancer has been observed throughout the industrialized world. The good news is that it’s potentially preventable — if parents get their children vaccinated.

The disease shows up primarily in men, typically between the ages of 45 and 70. Those who are affected often lead healthy lifestyles. They do not have extensive histories of smoking tobacco or consuming alcohol, which are risk factors for traditional throat cancers.

The rate of this new cancer has been increasing 5 percent per year and today, it is more than three times as common as in the mid-1980s. If you think this scenario sounds like a slow-moving infectious medical drama (think Contagion or World War Z), you would be right.

The source of this cancer is a virus, the human papillomavirus (HPV) — the same virus that causes most cervical cancer in women. It’s widely known that parents should get their girls vaccinated. Now, with the surge in oral HPV cancers, especially in men, parents should get their boys vaccinated too.

Currently, vaccination against HPV is recommended by the Centers for Disease Control for children and young adults ages 9-26. The vaccination includes a series of two or three injections; the side effects are mild.

Ideally, the vaccinations should be administered before someone becomes sexually active. That’s because HPV is spread via sexual activity. Risk of HPV infection and throat cancer increases with the number of lifetime partners.

Men have a lower immune response to the virus than women, which explains the predilection of this disease for men. It’s difficult to know if someone has an active oral HPV infection because there are no symptoms. Currently, there is no widely accepted test for HPV in men.

Chronic infection leads to cellular changes within the lymphatic tissues in the throat, specifically the tonsils and base of tongue. Over the course of 20-30 years, these changes can result in the formation of cancer.

Throat cancer caused by HPV is insidious. The primary tumor in the tonsil or base of tongue often causes little to no symptoms. Early signs of this cancer may be a mild sore throat, occasional blood-tinged oral saliva, or increased or new snoring.

Often, the first sign of the cancer is a lump in the neck after the cancer has spread into the lymphatic system. The lump may arise quickly and then shrink to varying degrees, lulling one into complacency.

Early stage cancer can be treated with surgery or radiation. More advanced cancers are treated with combined therapy such as surgery followed by radiation therapy, or chemotherapy in conjunction with radiation therapy.

Finally, some good news. Treatment for HPV-related throat cancer is successful in about 90 percent of cases and is significantly more successful than treatment of non-HPV related throat cancer.

But, as successful as medicine has been in treating this cancer, an even better alternative is prevention via vaccination. Initial studies have shown that vaccination produces an immune response to HPV and reduces the rate of HPV infection. Given time and good vaccination coverage, a decline in throat cancer is expected.

In summary, here are a few simple take-home messages: If you have a lump in the neck or a chronic sore throat, don’t procrastinate. Have your doctor check it out. If you are a partner of someone with these symptoms, strongly encourage your partner to see his or her doctor.

If you have children ages 9-17, talk to your pediatrician about HPV vaccination. If you are 18-26 years old, talk to your primary care doctor about vaccination. These simple steps may save your life or the life of your loved one.

Note: Dr. Bryan Fong is the senior practicing head and neck surgical oncologist for Northern California Kaiser Permanente.

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February, 2019|Oral Cancer News|