Monthly Archives: March 2012

Nanoparticles kill head/neck cancer cells in mice

Author: DrBicuspid Staff

Using nanoparticles and alternating magnetic fields, University of Georgia scientists have found that head and neck cancerous tumor cells in mice can be killed in half an hour without harming healthy cells.

The findings, published in Theranostics, mark the first time to the researchers’ knowledge that this cancer type has been treated using magnetic iron oxide nanoparticle-induced hyperthermia in laboratory mice.

The researchers successfully used small concentrations of nanoparticles to kill the cancer cells, noted Qun Zhao, lead author and assistant professor of physics, in a press release. They found that the treatment easily destroyed the cells of cancerous tumors that were composed entirely of epithelium (Theranostics, 2012, Vol. 2:1, pp. 113-121).

Other research groups are exploring the use of heated nanoparticles as a potential cancer treatment, and previous studies have shown that high temperatures created by combining magnetic iron oxide nanoparticles with strong alternating magnetic currents can create enough heat to kill tumor cells. Zhao said he is optimistic about his findings, but explained that future studies will need to include larger animals before a human clinical trial could be considered.

For the experiment, researchers injected 0.5 milliliter of nanoparticle solution directly into the tumor site. With the mouse relaxed under anesthesia, they placed the animal in a plastic tube wrapped with a wire coil that generated magnetic fields that alternated directions 100,000 times each second. The magnetic fields produced by the wire coil heated only the concentrated nanoparticles within the cancerous tumor and left the surrounding healthy cells and tissue unharmed.

Zhao said the study paves the way for additional research that might investigate how to use a biodegradable nanoparticle material similar to magnetic iron oxide for other roles in fighting cancer.

March, 2012|Oral Cancer News|

Mouthing off against oral cancer

Author: staff

April Is Oral Cancer Awareness Month

According to the Centers for Disease Control and Prevention (CDC), more than 30,000 new cases of oral cancer are diagnosed each year, and more than 8,000 deaths occur annually. The five-year survival rate for oral cancers is roughly 50 percent.

In observance of Oral Cancer Awareness Month, the Academy of General Dentistry (AGD) recommends that patients receive a dental exam from a general dentist every six months. Dental exams not only help to decrease a patient’s risk of oral diseases, such as cavities and periodontal (gum) disease, but they also may help to diagnose other, sometimes life-threatening, medical conditions, such as oral cancer.

“The next time you visit your dentist, ask about an oral cancer screening,” says AGD spokesperson Seung-Hee Rhee, DDS, FAGD. “Your dentist will feel for lumps or irregular tissue changes in your neck, head, cheeks, and oral cavity and thoroughly examine the soft tissues in your mouth, specifically looking for any sores or discolored tissues. Although you may have already been receiving this screening from your dentist, it’s a good idea to confirm that this screening is a part, and will remain a part, of your regular exam.”

Although oral cancer is sometimes difficult to self-diagnose, warning signs may include bleeding sores; sores that do not heal; lumps; thick, hard spots; soreness or feeling that something is caught in the throat; difficulty chewing or swallowing; ear pain; difficulty moving the jaw or tongue; hoarseness; and numbness of the tongue, as well as changes in the way teeth fit together.

“If it is not diagnosed and treated in its early stages, oral cancer can be deadly. Treatment for advanced stage oral cancer may lead to chronic pain, loss of function, permanent facial and oral disfigurement following surgery,” says Dr. Rhee. “The earlier the cancer is detected and treated, the better the outcome.”

Scientists are not sure of the exact cause of oral cancer. However, risk factors include tobacco use, excessive alcohol use, age, gender (oral cancer strikes men twice as often as it does women), and race (oral cancer occurs more frequently in African Americans than it does in Caucasians). New research has uncovered a connection between the human papillomavirus (HPV), the most common sexually transmitted infection in the United States, and oral cancer.

“Early detection is key to increasing the survival rate for cancers of the oral cavity,” says Dr. Rhee. “In addition to brushing and flossing your teeth twice daily, scheduling two visits with your general dentist each year helps to ensure that any concerns are caught early on.”

Source: Academy of General Dentistry

March, 2012|Oral Cancer News|

HPV-related head and neck cancer on the rise among middle-aged white men

Author: staff

Research led by Lauren Cole, a public health graduate student, and Dr. Edward Peters, Associate Professor of Public Health and Director of the Epidemiology Program at LSU Health Sciences Center New Orleans, reports that the incidence of head and neck cancer has risen at sites associated with Human Papilloma Virus (HPV) infection, with the greatest increase among middle-aged white men. At the same time, younger, Non-Hispanic blacks experienced a substantial decrease in these cancers. They also found that the disease process for tumors associated with HPV is different from those caused by exposure to tobacco and alcohol, with implications for treatment. The findings are published this month in the PLoS ONE journal.

Tobacco and alcohol are the most common risk factors for cancers of the head and neck, but HPV infection is emerging as an important risk factor as well. The objectives of this study were to assess the recent incidence of head and neck cancer in the United States and to investigate the trends of these cancers associated with HPV infection.

Using incidence data for 1995-2005 from 40 US population-based cancer registries, the researchers described the epidemiology of head and neck cancer (HNC) in the US and examined the variation in cancer rates by age, sex, race/ethnicity, stage and cancer location. As some HNC sites are strongly associated with a tendency for HPV infection, they also examined if rates varied by those sites associated with HPV.

“During 1995-2005, we observed a significant overall increase in head and neck cancer incidence among HPV-associated sites, while in the same time period, non HPV-associated sites underwent a significant decline in incidence,” notes Lauren Cole, an Epidemiology PhD student at LSU Health Sciences Center New Orleans School of Public Health.

The researchers found overall, younger age groups, Non-Hispanic Whites and Hispanics experienced greater increases in incidence for HPV-associated sites, while incidence declined for Non-Hispanic Blacks independent of HPV-association of site. The evidence from this large population-based study suggests that since the disease process for HPV-associated tumors is different, HPV tumor status should be incorporated into treatment decisions for head and neck cancer patients to improve prognosis and survival.

“With the introduction of the HPV vaccine, this study suggests that the vaccine can not only be used to help prevent cervical cancer, but head and neck cancer as well,” adds Dr. Edward Peters, Associate Professor and Director of the Epidemiology Program at the LSU Health Sciences Center New Orleans School of Public Health.

Source: Louisiana State University Health Sciences Center

March, 2012|Oral Cancer News|

Prevalidation of Salivary Biomarkers for Oral Cancer Detection



Background: Oral cancer is the sixth most common cancer with a 5-year survival rate of approximately 60%. Presently, there are no scientifically credible early detection techniques beyond conventional clinical oral examination. The goal of this study is to validate whether the seven mRNAs and three proteins previously reported as biomarkers are capable of discriminating patients with oral squamous cell carcinomas (OSCC) from healthy subjects in independent cohorts and by a National Cancer Institute (NCI)-Early Detection Research Network (EDRN)-Biomarker Reference Laboratory (BRL).

Methods: Three hundred and ninety-five subjects from five independent cohorts based on case controlled design were investigated by two independent laboratories, University of California, Los Angeles (Los Angeles, CA) discovery laboratory and NCI-EDRN-BRL.

Results: Expression of all seven mRNA and three protein markers was increased in OSCC versus controls in all five cohorts. With respect to individual marker performance across the five cohorts, the increase in interleukin (IL)-8 and subcutaneous adipose tissue (SAT) was statistically significant and they remained top performers across different cohorts in terms of sensitivity and specificity. A previously identified multiple marker model showed an area under the receiver operating characteristic (ROC) curve for prediction of OSCC status ranging from 0.74 to 0.86 across the cohorts.

Conclusions: The validation of these biomarkers showed their feasibility in the discrimination of OSCCs from healthy controls. Established assay technologies are robust enough to perform independently. Individual cutoff values for each of these markers and for the combined predictive model need to be further defined in large clinical studies.

Impact: Salivary proteomic and transcriptomic biomarkers can discriminate oral cancer from control subjects. Cancer Epidemiol Biomarkers Prev; 21(4); 664–72. ©2012 AACR.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

March, 2012|Oral Cancer News|

Nobel Laureate Makes Strong Case for Vaccinating Young Males Against HPV to Prevent Cervical Cancer in Females

Source: Therapeutics Daily

AUSTIN, Texas, March 26, 2012 /PRNewswire-USNewswire/ — Nobel Prize winner Harald zur Hausen called for vaccinating both young males and females for human papilloma virus (HPV) in an achievable quest to eradicate cervical cancer, which is the second leading type of women’s cancer worldwide. Zur Hausen made his remarks at a gathering of more than 1,600 members of the Society of Gynecologic Oncology during its 43rd Annual Meeting on Women’s Cancer® in Austin.

“If we wish to eradicate these types of infections – then theoretically we can do it,” zur Hausen said. “And if we wish to achieve this (eradication of HPV) in a foreseeable period of time, then we should vaccinate both genders globally.”

He pointed out that educational, cultural and religious barriers contribute to the lack of knowledge or willingness to address or discuss the subject by public health officials, teachers, parents and even some physicians. Zur Hausen also said that if society were to vaccinate just one gender to prevent the spread of cervical-cancer causing HPV, it would be more effective to vaccinate just males, highlighting the potential medical value of male HPV vaccinations. Zur Hausen also noted that research shows that early fears of the side effects of the HPV vaccine were overblown, and Australian research shows that there is about one adverse reaction in 100,000 vaccinations, which confirms the safe nature of the vaccine.

Keynote speaker for this year’s Annual Meeting on Women’s Cancer, Harald zur Hausen was awarded the Nobel Prize in Medicine in 2008 for his pioneering discovery of the role of human papilloma virus (HPV) in the development of cancer of the cervix. He currently is professor emeritus, after having served as Chairman of the Management Board and Scientific Director of the German Cancer Research Center, Heidelberg, Germany.

Zur Hausen said approximately 275,000 women die each year of cervical cancer, some 85 percent in economic-constrained countries, with more than 500,000 new cases appearing in women globally each year.

About the SGO
The Society of Gynecologic Oncology (SGO) is a national medical specialty organization of physicians and allied healthcare professionals who are trained in the comprehensive management of women with malignancies of the reproductive tract. Its purpose is to improve the care of women with gynecologic cancer by encouraging research, disseminating knowledge that will raise the standards of practice in the prevention and treatment of gynecologic malignancies, and cooperating with other organizations interested in women’s health care, oncology and related fields. The Society’s membership, totaling more than 1,600, is primarily comprised of gynecologic oncologists, as well as other related medical specialists including medical oncologists, radiation oncologists, nurses, social workers and pathologists. SGO members provide multidisciplinary cancer treatment including chemotherapy, radiation therapy, surgery and supportive care. More information on the SGO can be found at

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

March, 2012|Oral Cancer News|

Oral Complications After Head/Neck Radiation ‘Underreported’

Source: Elsevier Global Medical News

Late oral effects of head and neck cancer therapy are “multiple, underreported, and under-appreciated. “That is the perspective of Joel Epstein, D.M.D., who has worked extensively with head and neck cancer patients experiencing severe dental and other oral problems following radiation therapy.

“The acute complications of head and neck cancer therapy are pretty well known, but the late complications are underappreciated,” Dr.  Epstein, director of oral medicine at City of Hope National Medical Center, Duarte, Calif., told attendees at the symposium. As head and neck cancer treatments have advanced and patients are living longer, the spectrum of treatment complications has shifted, he explained. In a 5-year, prospective longitudinal study of 122 patients with oral carcinoma, dry mouth, sticky saliva, speech changes, dental problems, and sleep disturbance were reported by all patients except those treated only with surgery. These complications persisted at 1 and 5 years and affected quality of life (Head Neck 2008;30:461-70).

According to Dr. Epstein, the data illustrate the need for better collaboration between oncologists and dentists. “While people discuss  the concept of multidisciplinary [and] interdisciplinary teams for the benefit of our patients, it is unfortunate that dentistry developed  separately from physicians and surgeons. So while we need to interact, we’re not really well prepared to do so, particularly in the  community,” he said.

Clinically, it’s important to evaluate oral care, including brushing, flossing, fluoride, and tobacco abstinence, at all head and neck cancer treatment follow-up visits. Patients should be assessed for xerostomia, speech, swallowing, mucosal sensitivity, and taste. Head and neck and oral exams should include assessments for saliva (wet mucosa), exposed bone, infection, and new lesions or recurrent cancer, and a dental exam (for plaque, caries, and periodontal health), Dr. Epstein recommended.

Dry mouth, in particular, can lead to a host of other chronic problems related to swallowing, eating, sleeping, and dental health. When the 50-item Vanderbilt Head and Neck Symptom Survey was administered to a total of 70 patients, 67 reported having dry mouth at more than 6 months’ follow up (Head Neck 2011 Aug. 24 [doi:10.1002/hed.21816]).

The majority reported that dry mouth makes chewing/swallowing difficult (65) and that it affects their ability to sleep (67) and  talk (64). With regard to eating and swallowing, similar majorities reported trouble eating solids (67) and drinking liquids (68), with food getting stuck in their mouth (66) and throat (67).

And, of concern, the same numbers of patients reported the sensation of choking or strangling on solids (66) and liquids (68). “The impact on function from the lack of saliva and the change in quality of saliva are issues we need to be more ready and willing to address,”  Dr. Epstein commented.

Taste and smell may also be profoundly altered. In the Vanderbilt survey, most patients reported altered taste (68), a decreased desire to eat (68), altered food choices (66), and a decrease in food eaten (66). A change in sense of smell was reported by 69 patients.

Such alterations often result in changes in diet, including decreased consumption of high-fiber food and of vitamins and other nutrients,  along with increased consumption of fats, caffeine, and sugar. All of these factors increase the risk for dietary deficiencies, as well as  dental caries.

Yet, altered taste sensation is not something patients might think to mention. “Half of patients experience altered taste sensation. But if  they think you’re not interested or you don’t ask, you may not know,”  Dr. Epstein commented.

Periodontal health is often compromised by hyposalivation, which can lead to inflammation, bone/attachment loss, oral infection, and necrosis. Dental demineralization and cavitation may develop as early as 2-3 months after cancer treatment and progress rapidly, leading to fractures of the gum line, tooth loss, and necrosis.

Demineralization appears as a change to white, which may not be recognized as a problem because of the belief that white teeth are  healthy. However, recognition at this stage is critical in order to prevent further dental damage, he said.

“The white change near the gum line and the tips of the teeth represent demineralization, and [in] time reversal can be accomplished  prior to structural breakdown. Once cavitation has occurred, fillings are needed and prevention must be instituted or the cavities will  recur and progress,” Dr. Epstein said in an interview.

In the Vanderbilt survey, reported dental problems included difficulty chewing because of teeth/dentures (54 of the 70 patients); tooth  sensitivity to hot, cold, or sweet foods (52); teeth feeling looser (51); teeth cracking/chipping (50); and trouble with dentures (24).

Oral candidiasis is another common problem, affecting approximately 39% of head and neck cancer patients during treatment and 33% afterward. One common clinical mistake is prescribing these patients antifungals that contain sugar, such as nystatin. “Nystatin is very high in sugar, and one of the [most commonly] used antifungals. The message is to avoid sugar-sweetened products in dry mouth patients and utilize alternatives,” Dr. Epstein said in the interview.

Mucosal sensitivity and pain is also frequent. In a meta-analysis of 22 studies published between 1990 and 2008, the prevalence of trismus was 25.4% in patients who received conventional radiotherapy and 5% for the few intensity-modulated radiation therapy studies that were included, suggesting that the newer radiation modality might diminish the problem (Support. Care Cancer 2010;18:1033-8).

Data suggest that the radiation effect on mandibular movement correlates with the radiation dose to the mastication muscles, with a  steep dose-response curve. Onset is typically 2-6 months post treatment and is ongoing. Concurrent chemotherapy may increase the  incidence and/or severity of mandibular immobility (Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 1999;88:365-73).

In the Vanderbilt survey, most patients reported burning in the throat or mouth (69); sensitivity to hot, spicy, or acid food (67);  sensitivity to dryness (69); and changes in food intake because of mucosal sensitivity (67); most patients also reported that mucosal  sensitivity prevents tooth brushing (63). “Mucosal sensitivity is a quality of life issue,” Dr. Epstein said.

The Vanderbilt survey was particularly illuminating, Dr. Epstein commented. Studies that utilize claims data probably underrepresent  the problem of long-term oral complications because dental and medical insurance are separate and the data are not easily combined, he added.

“Late oral effects are best diagnosed [and] managed in a multidisciplinary team with close communication between medical and  dental providers. … We really need to come together.”

The Multinational Association of Supportive Care in Cancer is developing tools to improve communication between dentistry and  medicine. These could be available for beta testing as early as this fall.

Dr. Epstein said he had no relevant financial disclosures.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.


March, 2012|Oral Cancer News|

Maura L. Gillison, M.D., Ph.D., Receives AACR’s Richard and Hinda Rosenthal Memorial Award

Source: AACR News

CHICAGO — The American Association for Cancer Research will award Maura L. Gillison, M.D., Ph.D., with the 36th Annual AACR Richard and Hinda Rosenthal Memorial Award during the AACR Annual Meeting 2012, held here March 31 – April 4. Gillison is receiving this award in recognition of her significant contributions to the understanding of the role of human papillomavirus (HPV) in head and neck cancers.

Gillison’s award lecture, “Clinical implications of HPV in head and neck cancers,” will take place at 10 a.m. CT on Wednesday, April 4 in room S100 of the McCormick Place Convention Center.

“It is an honor to be the recipient of this award,” said Gillison. “Our team strives to generate data that will improve the lives of individuals affected by head and neck cancers, and this is a wonderful validation that we are on the right track.”

This award is designed to provide incentive to young investigators early in their careers. It was established in 1977 by the AACR and the Rosenthal Family Foundation to recognize research that has made, or promises to make, a notable contribution to improved clinical care in the field of cancer.

Gillison is a professor of medicine, epidemiology and otolaryngology and the Jeg Coughlin Chair of Cancer Research at Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus, Ohio. She is also adjunct faculty at The Johns Hopkins University School of Medicine, in Baltimore, Md. Her seminal research on the role of HPV in head and neck cancers revolutionized the specialty. Her research has demonstrated that HPV infection causes a distinct molecular, clinical and pathological subset of head and neck squamous cell carcinomas.

In a landmark case-control study, Gillison identified oral sexual behavior and HPV infection as risk factors for oropharyngeal cancer, findings that led the International Agency for Research on Cancer to formally recognize HPV-16 as a significant cause of oropharyngeal cancers.

Results of other key studies conducted by Gillison and her colleagues showed that tumor HPV status is one of the single greatest predictors of survival in head and neck cancer. As a result, multiple organizations now advocate routine HPV testing of oropharyngeal cancer patients. Clinical trial designs have also been amended to adopt HPV testing as a means by which to stratify various cancer subsets, allowing for better targeted therapies and treatment regimens. Additionally, Gillison established the gold standard of HPV diagnostic tests, currently in use within clinics nationwide. Currently, she is the principal investigator of the first phase III trial focused on HPV-positive head and neck cancers, which began enrolling patients in 2011.

Gillison has led several studies in collaboration with the National Cancer Institute and the Centers for Disease Control and Prevention that have examined the effects of HPV infection on head and neck cancer at the population level. She has also been the leader in development of methods for oral HPV detection, which will facilitate the development of primary and secondary prevention strategies for the cancer she characterized.

Gillison’s work has had, and will continue to have, significant public health implications. Her group’s recent research established that HPV has been the cause of a dramatic increase in the incidence of oropharyngeal cancer in the United States during the last 20 years.

Currently, the burden of HPV-caused cancers is shifting from women to men, a trend that is anticipated to continue throughout the next decade. In 2011, such data were presented to the Advisory Committee on Immunization Practices, which now recommends that all preteen boys aged 11 to 12 be vaccinated against HPV.

About the AACR

Founded in 1907, the American Association for Cancer Research (AACR) is the world’s first and largest professional organization dedicated to advancing cancer research and its mission to prevent and cure cancer. AACR’s membership includes 34,000 laboratory, translational and clinical researchers; population scientists; other health care professionals; and cancer advocates residing in more than 90 countries. The AACR marshals the full spectrum of expertise of the cancer community to accelerate progress in the prevention, biology, diagnosis and treatment of cancer by annually convening more than 20 conferences and educational workshops, the largest of which is the AACR Annual Meeting with more than 18,000 attendees. In addition, the AACR publishes seven peer-reviewed scientific journals and a magazine for cancer survivors, patients and their caregivers. The AACR funds meritorious research directly as well as in cooperation with numerous cancer organizations. As the Scientific Partner of Stand Up To Cancer, the AACR provides expert peer review, grants administration and scientific oversight of individual and team science grants in cancer research that have the potential for patient benefit. The AACR actively communicates with legislators and policymakers about the value of cancer research and related biomedical science in saving lives from cancer.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

March, 2012|Oral Cancer News|

Grant Achatz Drops Malpractice Suits After Four-Year Battle

Source: Crain’s Chicago Business

Renowned chef Grant Achatz, whose successful battle with tongue cancer added an unusual twist to his story, has dropped his medical malpractice lawsuits filed against Chicago dentists.

Mr. Achatz sued two dentists and their practices in April 2008 in Cook County Circuit Court for negligence. He claimed neither took the steps necessary to diagnose his cancer. He sought damages in excess of $50,000 plus court costs.

The last of the suits, one filed against Dr. Loveline Dulay and her Wilmette practice, was dismissed Wednesday, according to another defendant’s attorney. The medical malpractice trial had already started with jury selection under way, the attorney said.

Mr. Achatz’s attorney, Chuck Hornewer of Phillips Law Offices of Chicago, declined to comment.

Mr. Achatz and his business partner Nick Kokonas opened Alinea in 2005. While it was accumulating accolades from around the country (and eventually from around the world), Mr. Achatz noticed a painful lesion on his tongue. In November 2005 he visited Dr. Dulay, who did not order a biopsy, a decision that Mr. Achatz said was negligent, according to his original complaint. In July 2006, he visited Dr. Michelle Schwartz at Bucktown Wicker Park Dental Associates, who also did not order a biopsy. Mr. Achatz believed she was also negligent, according to the original complaint.

By 2007, he was diagnosed with stage 4 tongue cancer, and doctors found the cancer metastasized to his neck. He took part in a University of Chicago clinical trial that used radiation and chemotherapy, rather than the typical method of removing parts of his tongue. His cancer is now in remission.

The chef is also a co-owner with Mr. Kokonas of Next, another eatery that has received much buzz.

The suit against Dr. Schwartz was dismissed with prejudice on Friday, said Roger Littman, her attorney at Hughes Socol Piers Resnick & Dym Ltd. He said the complaint against Dr. Schwartz was “dismissed voluntarily by the plaintiff after ascertaining her level of liability.”

The case against Bucktown Wicker Park Dental Associates was dismissed with prejudice after both parties reach an undisclosed settlement, according to a court document. Attorneys for the dental practice were not available for immediate comment.

Claims against Otolaryngology Group Ltd. of Glenview, which was not part of the original complaint, were dismissed a “matter of weeks ago,” Mr. Littman said.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

March, 2012|Oral Cancer News|

Wider Surgical Margins Better for Early Tongue Cancer


Wider surgical margins for early tongue tumors may reduce local recurrence and improve survival for most early-stage (T1 or T2) oral tongue squamous cell carcinoma (SCC) tumors, according to a new study in the Journal of Laryngology & Otology.

Oral tongue SCC is usually treated with initial surgical resection with or without post-operative chemo- and radiotherapy. Regional recurrences occur in approximately one in four patients with T1 or T2 oral tongue SCC, justifying aggressive treatment, according to the study authors from the University of Melbourne (JLO, March 2012, Vol. 126:3, pp. 289-294).

“We feel that wider surgical margins may be justified, being the only prognostic factor that surgeons have the ability to improve.”

Among the most important histological factors that impact the prognosis for early oral cancer are lymph node metastases, extracapsular extension, and close or involved surgical margins, they noted.

“Although other factors have an impact on adjuvant treatment, surgical margins is the only factor that may be improved by the surgeon,” they wrote.

Traditionally, a 1-cm margin is taken in all planes around a macroscopic or palpable oral tongue SCC, the study authors noted. Pathologists and clinicians have agreed to define involved margins as less than 1 mm and close margins as 5 mm or less, while margins greater than 5 mm are designated as clear.

However, mucosal margins shrink by approximately 30% to 50% with formalin fixation and slide preparation. This results in a final pathological margin of approximately 5 mm where the surgeon measured 1 cm, leaving little room for error.

Statistically significant findings

For this study, the research team set out to determine the site of closest margins for previously untreated early oral SCC cases from 2000 to 2009 at Royal Melbourne Hospital. The median age at diagnosis was 63.

Through a retrospective chart review, the researchers identified 68 T1 tumors and 13 T2 tumors, with a median follow up of 38 months. Sites of close and involved margins were reviewed histologically.

Slides were categorized as clear if the margin was more than 5 mm (n = 24), close if the margin was 1.1 to 5 mm (n = 44), and involved if the margin was less than 1 mm (n = 10).

The site of close and involved margins was classified according to its quadrant, i.e. medial, lateral, anterior or posterior. Close and involved margins were also designated as deep (more than 3 mm from the cut mucosal edge) or mucosal (less than 3 mm from the mucosal edge or on the actual mucosa).

Other prognostic variables included depth of invasion, tumor differentiation, maximum diameter, lymphovascular invasion, perineural invasion, pathological cervical nodes, and extracapsular extension.

The researchers found clear margins in 24 patients (30.8%), close margins in 44 patients (56.4%), and involved margins in 10 patients (12.8%). There was a non-significant trend toward deeper tumors having more involved margins (p = 0.18). Clear or close margins were just as likely to be achieved in T1 cases (90%) as in T2 cases (82%) and node-negative (100%) and node-positive cases (82%).

Perineural or lymphovascular invasion was seen equally in cases with involved margins (20%) and cases with clear or close margins (21%).

Patients with deeper tumors were more likely to undergo neck dissection for the N0 neck than patients with thin tumors (p = 0.02). Four patients (22%) with a tumor depth of 2.1 to 4 mm had a prophylactic neck dissection, as did 15 patients (58%) with a tumor depth of 4.1 to 7 mm.

A majority of the tumors had the closest margin at or near the mucosal edge (59%) rather than on the deep surface (41%, p = 0.22), the study found.

1-cm margins ‘inadequate’

Local recurrence occurred in 22 patients (28%) at a median of 12 months. Five of the 10 patients (50%) with involved margins developed local recurrence, the study found. Nine (21%) of the 43 patients with close margins had local recurrence, compared with eight (33%) of the 24 patients with clear margins (p = 0.10).

The study found that involved surgical margins had a trend to worse local recurrence (p = 0.10) and significantly worse survival (p = 0.002). Over the last 10 years at the hospital, 14% of patients had involved margins and 55% had close margins, the researchers noted.

“Consequently, we feel that wider surgical margins may be justified, being the only prognostic factor that surgeons have the ability to improve,” the researchers wrote.

Histological clear margins may be one of the few prognostic factors on which good surgery can have an impact, they added. Wider margins, however, may have an impact on functional outcomes and significantly affect quality of life.

“This study’s findings support the hypothesis that wider surgical margins may be appropriate for most T1and T2 oral tongue SCC tumors, with the aim of reducing local recurrence and thereby improving survival,” the study authors concluded. “The historically accepted 1-cm margin around macroscopic and palpable oral tumors seems to provide inadequate pathological results.”

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

March, 2012|Oral Cancer News|

Court: Tobacco Health Labels Constitutional


Combination picture of new graphic cigarette packages, released by the U.S. Food and Drug Administration June 21, 2011, shows a varied collection of a man on a ventilator, diseased lungs and dead bodies were among the graphic images for revamped U.S. tobacco labels, unveiled by health officials who hope the warnings will help smokers quit. REUTERS/U.S. Food and Drug Administration/Handout

Combination picture of new graphic cigarette packages, released by the U.S. Food and Drug Administration June 21, 2011, shows a varied collection of a man on a ventilator, diseased lungs and dead bodies were among the graphic images for revamped U.S. tobacco labels, unveiled by health officials who hope the warnings will help smokers quit.

Credit: Reuters/U.S. Food and Drug Administration/Handout

By Terry Baynes

(Reuters) – A U.S. law requiring large graphic health warnings on cigarette packaging and advertising does not violate the free speech rights of tobacco companies, a federal appeals court ruled on Monday.

Cigarette makers had sued to stop the U.S. Food and Drug Administration’s new labeling and advertising requirements on grounds the rules violated their First Amendment right to communicate with adult tobacco consumers.

But the Cincinnati-based U.S. Court of Appeals for the 6th Circuit upheld the bulk of the FDA’s new regulatory framework, including the requirement that tobacco companies include large warning images on cigarette packs.

The decision comes on the heels of a Washington, D.C., judge’s ruling in a different, but related, case that rejected the FDA requirements and seems to set up a clash over the constitutionality of the FDA rules.

Floyd Abrams, a lawyer for Lorillard, noted the difference in tone in the two rulings and said the 6th Circuit case, the Washington case, or both, would likely end up in the U.S. Supreme Court.

The difference in the two cases is that the FDA had not introduced the specific images when the companies filed the 6th Circuit suit. While the Washington suit focused on the images, the appeals court addressed the larger issue of the FDA’s regulatory power.

“There can be no doubt that the government has a significant interest in preventing juvenile smoking and in warning the general public about the harms associated with the use of tobacco products,” Judge Eric Clay wrote for the three-judge 6th Circuit panel.

Congress passed the law in 2009 and ordered the FDA to adopt specific warning-label regulations. The labels must be in color, must cover the top 50 percent of a cigarette pack’s front and back panels, and must cover the top 20 percent of print advertisements.

After tobacco companies, including R.J. Reynolds Tobacco Co and Lorillard Inc’s Lorillard Tobacco Co, sued to block the law, the FDA unveiled nine images to go on cigarette packs, including graphic pictures of dead bodies, diseased lungs and rotting teeth. The companies accused the government of forcing them to disseminate an anti-smoking message in order to stigmatize and embarrass already-informed consumers.

The appeals court panel’s two-judge majority disagreed with the companies on the label requirement, finding that the fact that the specific images might trigger disgust does not make the requirement unconstitutional. The majority did note that it was only addressing the constitutionality of the statute on its face, and not the specific images that the FDA introduced after the suit was filed.


Judge Clay, who wrote the main opinion upholding most of the FDA regulations, dissented, however, on the graphic label ruling. He called the rule “simply unprecedented.” While the government can require a product manufacturer to provide truthful information, “it is less clearly permissible for the government to simply frighten consumers or to otherwise attempt to flagrantly manipulate the emotions of consumers as it seeks to do here,” Clay wrote.

On February 29, D.C. district judge Richard Leon ruled that the FDA’s images violated the tobacco companies’ free-speech rights. He found that the warning labels were too big and that the government has numerous other tools at its disposal to deter smoking, such as raising cigarette taxes or including simple factual information on the labels rather than gruesome images.

The Obama administration appealed that ruling to the U.S. Court of Appeals for the District of Columbia Circuit on March 5.

Lorillard lawyer Abrams says Monday’s appeals court decision does not necessarily conflict with the Leon’s decision.

“The court made clear it was focusing on the statute as written, as opposed to the implementation of it,” Abrams said.

The Department of Justice did not immediately provide comment.

The 6th Circuit also upheld other FDA regulations, including restrictions on the marketing of “light” cigarettes, on the distribution of free tobacco samples, and event sponsorship. The court struck down a rule barring the use of color and graphics in tobacco advertising.

“We are pleased the 6th Circuit Court of Appeal upheld the continued use of colors and imagery in our advertisements,” said R.J. Reynolds spokesman Bryan Hatchell.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

March, 2012|Oral Cancer News|