2/7/2005 Rustburg, VA Cynthia T. Pegram The Lynchburg News and Advance Stephen L. Thompson, M.D., looked relaxed and healthy sitting in his office this week. The husky timbre of his voice might have been the aftermath of a cold. But it was throat cancer, not a seasonal microbe, that added the bit of hoarseness to his voice and kept him away from the office from October to January. On Jan. 5, Thompson began working a half-a-day a week in his family practice group, on his way back to full time. Nowadays patients will see him sip a glass of water he keeps nearby to combat the dry mouth after-effects of radiation treatment. Although not seen as frequently as other cancers, cancers of the head and neck are not rare. The most recent data from the Virginia Cancer Registry reported 715 patients in 1999. During 2005 nationwide, nearly 10,000 new cancers in and around the vocal cords are likely to occur, according to the American Cancer Society. Tobacco use is a factor in about 80 percent of head and neck cancers. Thompson, like most doctors, is part health educator - he wants people to be aware of throat cancer potential, so he gave permission for his doctors to talk about his treatment. Thompson, who has practiced in Campbell County for more than 30 years, was lucky. The cancer was found early, in part because of the odd way it turned up last spring. It was Mother’s Day, he recalled. “I had [...]

2/6/2005 Carlo La Vecchia et al. Journal of Thrombosis and Haemostasis as reported by www.medicalnewstoday.com Consumption of alcohol, including wine, increases the risk of several common cancers, even though many studies confirm a reduced risk of cardiovascular disease from alcohol intake. An article appearing in the Journal of Thrombosis and Haemostasis presents definite evidence of these findings amongst other papers as part of an open forum discussion on wine, alcohol, and cardiovascular risk. "Moderate alcohol drinking, less than 25 grams per day, has a favorable role on cardiovascular disease risk," states Professor , co-author of the article. "[However] it is associated with increased risk of cancers of the upper digestive tract and larynx, and also of the intestines, liver, and breast." The article lists primary liver cancer, cancers of the female breast and of the large bowel in both sexes, as being associated with alcohol drinking. Further death from diseases including cirrhosis, chronic pancreatitis, hypertension and stroke are strongly related to alcohol drinking. The analysis was based on a quantitative review, or meta-analysis, of 156 different studies, and heavy alcohol drinking was strongly linked to the diseases noted. The risks are shown to increase with the amount of alcohol consumed yet the overall evidence does not determine "whether there is any threshold, below which no effect is evident." About the Author Carlo La Vecchia, MD, MSc, is Head of the Laboratory of Epidemiology at the Mario Negri Institute for Pharmacological Research in Milan, Italy. His main fields of interest include [...]

2/5/2005 Kunihiro Nakada et al. Journal of Nuclear Medicine Vol. 46 No. 2 261-266 Salivary gland dysfunction is one of the common side effects of high-dose radioiodine therapy for thyroid cancer. The purpose of this study was to determine whether an early start of sucking lemon candy decreases salivary gland injury after radioiodine therapy. Methods: The incidence of the side effects of radioiodine therapy on the salivary glands was prospectively and longitudinally investigated in 2 groups of patients with postsurgical differentiated thyroid cancer with varying regimens for sucking lemon candy. From August 1999 to October 2000, 116 consecutive patients were asked to suck 1 or 2 lemon candies every 2–3 h in the daytime of the first 5 d after radioiodine therapy (group A). Lemon candy sucking was started within 1 h after radioiodine ingestion. From November 2000 to June 2002, 139 consecutive patients (group B) were asked to suck lemon candies in a manner similar to that of group A. In the group B, lemon candies were withheld until 24 h after the ingestion of radioiodine. Patients with salivary gland disorders, diabetes, collagen tissue diseases, or a previous history of radioiodine therapy or external irradiation to the neck were excluded. Thus, 105 patients in group A and 125 patients in group B were available for analysis. There were no statistical differences in the mean age (55.2 y vs. 58.5 y), average levels of serum free thyroxine (L-3,5,3',5'-tetraiodothyronine) (0.40 ng/dL vs. 0.47 ng/dL), and the mean dose of 131I administered [...]

2/4/2005 Toronto, Ontario, Canada pharmalive.com Viventia Biotech Inc. announced today that its lead drug candidate Proxinium(tm) has been granted orphan drug designation from the U.S. Food and Drug Administration (FDA) for the treatment of advanced, recurrent head and neck cancer. The US Orphan Drug Act provides financial, regulatory and marketing incentives to companies to help facilitate the development and marketing of drugs for the treatment of rare diseases or conditions that affect fewer than 200,000 patients in the United States. Orphan drug designation entitles Viventia to various incentives, including seven years of exclusive marketing rights if Proxinium(tm) receives marketing approval by the FDA. Historically, many orphan drugs have received expedited regulatory review because they have been developed to treat serious or life-threatening illnesses, leading to more rapid approval times. About head and neck cancer: Head and neck cancer, comprising cancers of the larynx, tongue, mouth, oral cavity, and pharynx, is the sixth most common form of cancer globally. In the United States alone over 50,000 new cases of head and neck cancer are diagnosed annually. Despite aggressive measures, such as radical surgery, radiation and/or chemotherapy, as well as concerted efforts from clinicians to eradicate these tumors, long-term survival rates have not improved in the last 30 years and the five year survival rate remains less than 40%. As more than two-thirds of patients will present with advanced disease, curative treatments are often not possible. Compounding the poor prognosis for survival are the often devastating effects these tumors and their treatment [...]

2/4/2005 John McKenzie New England Journal of Medicine as reported by abcnews.go.com A study published in today's New England Journal of Medicine offers encouraging news about a novel way to fight cancer. It finds that injecting a type of liquid radiation, called Bexxar, into patients with lymphoma — a cancer of the immune system — can fight the disease more quickly and with fewer side effects that existing treatments. The approach might eventually be used on a variety of cancers. "This is the first time we're using injectable radiation to treat cancer," said Dr. Andrew Zelenetz, a hematologic oncologist at Memorial Sloan-Kettering Cancer Center in New York. The radioactive drug is delivered intravenously and works like a guided missile. It travels throughout the body, homing in on a specific protein found on the cancer cells. "And when it latches on to it, it now has radiation attached to it and the radiation is essentially there at the site where you want it, radiating the tumor and not radiating other tissues," said Dr. Mark Kaminski, director of the Multidisciplinary Lymphoma Clinic at the University of Michigan Cancer Center. When Bexxar was used to combat non-Hodgkin's lymphoma, 59 percent of patients remained cancer-free during the five years of study. "These results are very similar to the results we're getting with state-of-the-art chemotherapy," said Zelenetz. "However, the distinct advantage here is that it is much more user-friendly for the patient." Few Side Effects The liquid radiation treatment is completed in just one week, [...]

3/2/2005 Syed S.A. Qadri et al. Ann Thorac Surg 2005;79:990-995 Background: Even after apparently curative resection, lung cancer recurrence continues to lead to high mortality levels. The aim of this study was to assess the effects of cyclooxygenase-2 (COX-2) inhibitor on local and systemic recurrent tumor growth. Methods: C57BL/6 mice underwent mammary fat pad inoculation with 3LL cells. After two weeks growth, flank tumors were resected completely and followed for recurrent tumor growth. Postresection mice were randomized to receive placebo alone (group 1) or the selective COX-2 inhibitor, rofecoxib (group 2), daily for two weeks by tube feeding. Recurrent tumor growth kinetics were compared for both groups. Two weeks following primary tumor excision animals were sacrificed, after which lungs were resected and pulmonary metastatic burden was assessed using the lung-body weight ratio. Apoptotic and mitotic indices were established for recurrent tumors and lungs, using hematoxylin and eosin histology. Results: Two weeks postexcision of the primary tumor, recurrent tumors in the placebo group were significantly greater than the treatment group (p = 0.002). While primary tumors were typically encapsulated and not adherent, recurrent tumors in the placebo group were invasive, adherent to the chest wall and the overlying wound. In contrast, recurrent tumors in the treatment group were nonadherent to the chest wall. Moreover, postoperative pulmonary metastatic burden was significantly reduced in treated animals. Histologic examination revealed increased apoptosis as well as an increase in the apoptosis-mitosis ratio in treated animals. Conclusions: Primary tumor excision was associated with accelerated local and [...]

2/2/2005 New York, NY Journal of Clinical Oncology January 2005 as reported by Medscape (www.medscape.com) Chemotherapy combined with chemoradiotherapy allows organ preservation in patients with advanced resectable cancer of the tongue or hypopharynx, according to a report in the January 1st issue of the Journal of Clinical Oncology. The base of the tongue and hypopharynx are good candidates for organ preservation because of the potential compromise of speech and swallowing resulting from surgery, the authors explain. Dr. Susan G. Urba from University of Michigan Medical Center, Ann Arbor, and colleagues investigated the benefits of two cycles of induction chemotherapy followed by chemoradiotherapy for responders in a phase II trial of 59 patients with advanced resectable cancer of the tongue base (n=37) or hypopharynx (n=22). Fifty-eight percent had stage IV and 42% had stage III disease. Seventy-eight percent of the patients had a 50% or greater response to induction chemotherapy at their primary tumor site, the authors report. Of the 43 patients that went on to receive concurrent chemoradiotherapy, 32 (54%) achieved a documented histologic complete response, the results indicate, and 9 additional patients achieved a complete clinical response, but did not undergo the recommended biopsies. Overall, the researchers note, 44 patients (75%) were deemed organ preservation successes; they did not require salvage surgery of the primary tumor immediately following completion of the treatment because of their excellent responses to therapy. Apart from one death attributed to the induction chemotherapy, the report indicates, the treatment was well tolerated, the researchers report. [...]

2/2/2005 Richard C. Semelka, MD Medscape Radiology Medscape Radiology Editor's Note: Richard Semelka, MD, is one of the preeminent practitioners of abdominal MRI in the United States and is a frequent contributor to Medscape Radiology. The hot-button issues raised in this opinion piece call into question some of the current practices surrounding the use of CT scanning. It's the opinion of this editor that a topic of importance, such as the safety and health of patients referred for diagnostic imaging evaluation, merits a broad dialogue in an open, spontaneous, and timely forum. --------------------------- Hippocrates is credited with the expression "First, do no harm" (ca 460-ca 377 B.C.), which has become the oath of all physicians in their doctoral graduation. The radiology community adheres to the fundamental precept of ALARA (as low as reasonably achievable) in order to limit patients' exposure to harmful radiation. "First, Do No Harm": The Present-Day Fallacy In recent years, there has been an increased awareness of the rights of patients and their need for information and protection. The regulations of the recently implemented Health Insurance Portability and Accountability Act (HIPAA) is one example of efforts to protect patients. The obligation of physicians to provide information on diseases and treatment options has always been important, but has come under greater emphasis in the modern medical environment. Despite this, one egregious example in which patients are not provided sufficient information to make informed decisions on their healthcare involves the limited information provided to them on diagnostic imaging tools, [...]

2/1/2005 JB Thomsen, JA Sorensen, and A Krogdahl J Oral Pathol Med, February 1, 2005; 34(2): 65-9 Background: Sentinel lymph node biopsy, step sectioning and immunohistochemistry have changed detection of tumor deposits. Isolated tumor cells (ITC) are detected more frequently than earlier because of a changed level of detection. Methods: A total of 108 sentinel lymph nodes from 30 patients with T1/T2 cN0 oral cancer were re-classified histologically to find possible ITC and to describe technical pitfalls. Results: Primarily we found metastatic spread in 12 of 108 sentinel lymph nodes: five macrometastasis and seven micrometastasis. After re-classification, we found seven lymph nodes with macrometastasis, five with micrometastasis and two with ITC. Conclusion: The ITC are probably precursors of micrometastasis waiting to grow and should be treated as such. Benign inclusions and dendritic cells did not cause problems, but can mimic ITC.

1/30/2005 Bruce Ames and Lois Swirsky Gold "Cancer Prevention and the Environmental Chemical Distraction" This is an edited version of a chapter titled 'Cancer Prevention and the Environmental Chemical Distraction', by Bruce Ames and Lois Swirsky Gold, in Politicizing Science: the Alchemy of Policymaking, Michael Gough ed., Hoover Institute Press, Stanford, California (2003). Blaming synthetic chemicals for a 'cancer epidemic' is flawed science that makes for dubious policy. Entering a new millennium seems a good time to challenge some old ideas about cancer cause and prevention, which in our view are implausible, have little supportive evidence, and might best be left behind. In this essay, we summarise data and conclusions from 15 years of work, raising five issues that involve toxicology, nutrition, public health, and US government regulatory policy: 1. There is no cancer epidemic other than that due to smoking. 2. The dose makes the poison. Half of all chemicals tested, whether natural or synthetic, cause cancer in high-dose rodent cancer tests. Evidence suggests that this high rate is due primarily to effects that are unique to high doses. The results of these high-dose tests have been used to regulate low-dose human exposures, but are not likely to be relevant. 3. Even Rachel Carson was made of chemicals: natural v synthetic chemicals. Human exposure to naturally occurring rodent carcinogens is ubiquitous and dwarfs the exposure of the general public to synthetic rodent carcinogens. 4. Errors of omission. The major causes of cancer (other than smoking) do not involve exposures [...]