February 2014 – Oral Cancer News

Improving QOL in head and neck cancer as survival improves

Source: www.medscape.com Author: Zosia Chustecka In patients undergoing radiation treatment for head and neck cancer, reducing the radiation to organs not affected by cancer is key to improving quality of life post-treatment. Several studies presented here at the 2014 Multidisciplinary Head and Neck Cancer Symposium described new approaches to sparing radiation delivered to the salivary glands and to the voice box, without any loss of cancer control, but with a reported reduction in adverse effects, such as xerostomia (dry mouth), and an anticipated reduction in loss of voice and speech quality. Improvements in such outcomes are becoming increasingly important as the epidemiology of head and neck cancer is changing, and the increase in human papillomavirus-positive disease means that patients are being diagnosed their 50s and will, in many cases, go on to live for decades after their definitive cancer treatment, researchers commented at a press briefing. Xerostomia can make it difficult to speak, as well as chew and swallow, and can lead to dental problems. "Dry mouth might seem trivial, but it actually has a significant effect on quality of life," commented Tyler Robin, PhD, an MD candidate in his final year at the University of Colorado Medical School in Denver. To reduce this adverse effect, intensity-modulated radiation techniques are already directing the beam away from the parotid gland, which is responsible for stimulated saliva production, for example during eating. But for the rest of the time, saliva is produced unstimulated from the submandibular gland. "This gland actually produces the [...]

Oral Cancer Foundation News Team - A2014-02-28T14:23:04-07:00February, 2014|Oral Cancer News|

Mouth bacteria trigger oral cancer

Source: www.digitaljournal.com Author: Tim Sandle Chemicals released from two bacteria that cause gum disease can incite the growth of deadly lesions and tumors in the mouth, trigger oral cancer. This is according to a new study carried out by Case Western Reserve University. High levels of certain bacteria found in the saliva of people are associated with the risk of oral cancer. The researchers were keen to understand why most people never develop oral cancer and what it is that protects them. Their answer related to most people not carrying a certain type of bacteria in their mouths. The cancer of concern is Kaposi's sarcoma-related (KS) lesions and tumors in the mouth. The bacteria associated with this are the species Porphyromonas gingivalis and Fusobacterium nucleatum. These species are associated with gum disease. For the research, scientists recruited 21 patients, dividing them into two groups. All participants were given standard gum-disease tests. The first group of 11 participants had an average age of 50 and had severe chronic gum disease. The second group of 10 participants, whose average age was about 26, had healthy gums. The bacteria were common to those with gum disease. By carrying out further tests, the researchers found that the bacteria produce fatty acids and these fatty acids then allowed oral cancer causing viruses to grow. The discovery could lead to early saliva testing for the bacteria. When such bacteria are found the mouth of a patient could be treated and monitored for signs of cancer and [...]

Oral Cancer Foundation News Team - A2014-03-09T21:58:39-07:00February, 2014|Oral Cancer News|

Contralateral submandibular gland-sparing radiation safe, effective in head, neck cancers

Source: helio.comPublished: February 24, 2014 Sparing the contralateral submandibular gland with low doses of radiation therapy appeared safe and effective among patients with locally advanced head and neck cancers, according to study results presented at the Multidisciplinary Head and Neck Cancer Symposium. “Historically ... there has been hesitation to spare the submandibular gland from radiation because there are lymph nodes near the gland that also end up not getting treated,” researcher Tyler Robin, PhD, an MD candidate at the University of Colorado School of Medicine, said in a press release. “While this seems worrisome because head and neck cancer spreads through the lymph nodes, it is well established that the risk of cancer involvement in the lymph nodes near the submandibular gland is exceedingly low, yet the benefit of sparing the gland for a patient’s quality of life is high.” Robin and colleagues evaluated data from 71 patients who underwent contralateral submandibular gland-sparing radiation therapy at the University of Colorado Cancer Center or Memorial Sloan-Kettering Cancer Center. The median age of patients was 55 years. About half of patients were current or former smokers, and half were never smokers. Nearly 50% of patients had lesions involving the base of the tongue. About 80% of patients had N2b or greater disease, and 90% of patients had overall stage IV disease. Researchers classified contralateral submandibular gland sparing as mean radiation doses to the contralateral submandibular gland of ≤39 Gy. The mean radiation dose to the contralateral submandibular gland of all patients in [...]

Charlotte Parker2014-02-26T15:59:38-07:00February, 2014|Oral Cancer News|

HPV-Positive Oropharyngeal Patients Show Overall Higher Survival Rate Compared to HPV-Negative Patients

Source: eurekalert.orgPublished: February 20, 2014By: Michelle Kirkwood Scottsdale, Ariz., February 20, 2014—A retrospective analysis of oropharyngeal patients with recurrence of disease after primary therapy in the Radiation Therapy Oncology Group (RTOG) studies 0129 or 0522 found that HPV-positive patients had a higher overall survival (OS) rate than HPV-negative patients (at two years post-treatment, 54.6 percent vs. 27.6 percent, respectively), according to research presented today at the 2014 Multidisciplinary Head and Neck Cancer Symposium. The analysis included 181 patients with stage III-IV oropharyngeal squamous cell carcinoma (OPSCC) with known HPV status (HPV-positive = 105; HPV-negative = 76), and cancer progression that was local, regional and/or distant after completion of primary cisplatin-based chemotherapy and radiation therapy (standard vs. accelerated fractionation (AFX)) in RTOG 0129 or cisplatin-AFX with or without cetuximab in RTOG 0522. Tumor status was determined by a surrogate, p16 immunohistochemistry. Median time to progression was virtually the same for HPV-positive and HPV-negative patients (8.2 months vs. 7.3 months, respectively). Increased risk of death in univariate analysis was associated with high tumor stage at diagnosis (T4 vs. T2-T3), fewer on-protocol cisplatin cycles (≤1 vs. 2-3) and distant vs. local/regional recurrent (for all, hazard ratios (HRs) >2.0 and p<0.05). Risk of death after disease progression increased by 1 percent per cigarette pack-year at diagnosis. Rates were estimated by Kaplan-Meier method and compared by log-rank. HRs were estimated by Cox proportional hazards models and stratified by treatment protocol. In addition, HPV-positive and HPV-negative patients who underwent surgery after cancer recurrence also experienced improved OS [...]

Charlotte Parker2014-02-25T18:01:44-07:00February, 2014|Oral Cancer News|

Gland-sparing technique safe in tonsillar, tongue cancers

Source: oncologypractice.com/The Oncology ReportPublished: February 24, 2014By: Neil Osterweil SCOTTSDALE, ARIZ. – Although radiation oncologists have typically worried that, in patients with oral cancers, leaving contralateral submandibular glands untreated could lead to tumor involvement of nearby lymph nodes, those worries may soon be put to rest, suggest results of a small retrospective study. Among 71 patients with locally advanced cancers of the tongue base or tonsils who underwent radiation therapy that avoided targeting the contralateral submandibular glands, there were no cancer recurrences in contralateral level 1B nodes after a median 27.3 months of follow-up, reported Dr. Tyler Robin of the University of Colorado at Denver, Aurora. "We’re interested in sparing the contralateral submandibular gland because we’re interested in minimizing xerostomia. Xerostomia is a significant morbidity of head and neck cancer radiotherapy, and it has substantial impact on patient quality of life," Dr. Robin said at the Multidisciplinary Head and Neck Cancer Symposium. Intensity-modulated radiation therapy (IMRT) allows treatment beams to be shaped to avoid the parotid glands with no subsequent increase in regional lymph node failures and preservation of parotid salivary flow. But patient-reported xerostomia and quality-of-life outcomes with parotid-sparing techniques have been mixed, Dr. Robin said. "Interestingly, an earlier study looking at predictors of xerostomia found that dose to the submandibular gland was a stronger predictor of xerostomia than dose to the parotids, and this may be because of the role of the submandibular gland in unstimulated salivary flow," he said. The submandibular gland is located near level IB [...]

Charlotte Parker2014-02-25T17:53:10-07:00February, 2014|Oral Cancer News|

Effects of Chemoradiation on Voice and Speech Quality of H&N Cancer Patients

Source: Med Page TodayPublished: February 23, 2014By: Charles Bankhead SCOTTSDALE, Ariz. -- Patients with oropharyngeal cancer reported significant voice and speech impairment for up to 2 years after chemoradiation therapy, but most of their doctors saw no evidence of it, data from a prospective study showed. Two years after treatment, a fourth of patients said their voice and speech remained below baseline levels, whereas none of their clinicians noted any impairment. At no time did as many as 10% of clinicians report patients with speech and voice issues, whereas the proportion of patients reporting problems ranged as high as 56%. The likelihood of patient-reported difficulties with oral communication increased with the radiation dose to the glottic larynx, reported Jeffrey M. Vainshtein, MD, and colleagues at the Multidisciplinary Head and Neck Cancer Symposium. "Our findings highlight the critical role of patient-reported outcomes in identifying areas of improvement of our current therapies, which may ultimately translate into improvements in quality of life for our patients," Vainshtein, of the University of Michigan in Ann Arbor, said during a press briefing. Dysphagia and xerostomia are recognized adverse effects of chemoradiation for head and neck cancer and have been studied extensively in recent years. In contrast, a paucity of information exists relative to the effects of chemoradiation on voice and speech quality, Vainshtein said. To examine the issue, investigators assessed voice and speech outcomes in 93 patients who underwent chemoradiation for oropharyngeal cancer, using intensity-modulated radiation therapy (IMRT). At baseline, and then every 3 to [...]

Charlotte Parker2014-02-24T17:36:33-07:00February, 2014|Oral Cancer News|

Study: Recurrence of SCCOP may differ in HPV-positive and HPV-negative patients

Source: News MedicalPublished: February 21, 2014 Patients with HPV-positive squamous cell carcinoma of the oropharynx (SCCOP) had a longer time to development of distant metastasis (DM) after initial treatment, and had more metastatic sites in more atypical locations compared to HPV-negative patients, according to research presented today at the 2014 Multidisciplinary Head and Neck Cancer Symposium. Culled from records of an IRB-approved registry, the study reviewed 285 patients with stage III-IV SCCOP (originally thought to be a smoking-related head and neck cancer) treated with chemotherapy and radiation from 2002 to 2013. HPV status was determined by in situ hybridization for HPV DNA and/or by strong and diffuse (>75 percent) staining for p16 immunohistochemistry. There were 245 HPV-positive and 40 HPV-negative patients. Twenty-seven HPV-positive and eight HPV-negative patients failed with DM and were the subjects for more detailed evaluation. Radiation therapy (RT) was either 3-D RT (HPV-positive = 15/27; HPV-negative = 4/8) or intensity modulated radiation therapy (IMRT) (HPV-positive = 12/27; HPV-negative = 4/8) with doses from 66-79 Gy. Patients received concurrent chemotherapy of cisplatin (HPV-positive = 9/27; HPV-negative = 2/8), cisplatin/5 fluorouracil (FU) (HPV-positive = 10/27; HPV-negative = 3/8) or cetuximab (HPV-positive = 8/27; HPV-negative = 2/8). One HPV-negative patient received cisplatin/paclitaxel chemotherapy. One patient in each group was treated with adjuvant chemoradiotherapy after initial resection. Student t-tests were used to compare the difference between the means of the samples. Both HPV-positive and HPV-negative patients were found to have similar rates of DM, however the mean time to develop DM [...]

Charlotte Parker2014-02-24T17:27:06-07:00February, 2014|Oral Cancer News|

New study claims children who use snus before age 16 are more likely to become cigarette smokers

Source: Reuters Health Author: Shereen Jegtvig Norwegians who started using snus before age 16 were more likely to become cigarette smokers than those who started using snus later in life, according to a new study. Snus is moist smokeless tobacco developed in Sweden. It's contained in a small pouch, and unlike regular chewing tobacco, it doesn't make the user spit. Research suggests snus has lower levels of chemicals called nitrosamines than cigarettes and may be less harmful. In Norway, snus has become a smoking cessation aid and most older snus users are former smokers. But snus is also becoming increasingly popular among young Norwegian adults, many of whom have not smoked cigarettes. And although research is divided, the current thinking is that snus use reduces the likelihood of taking up smoking. The authors of the new study wanted to know more about when people start using snus, to see if that ties into whether they also begin smoking cigarettes. "I already knew about the research investigating associations between snus use and later smoking, but discovered that snus debut age had not been mentioned in that research," Ingeborg Lund told Reuters Health in an email. Lund is a researcher with the Norwegian Institute for Alcohol and Drug Research - SIRUS, in Oslo. She and her colleague Janne Scheffels published their study in Nicotine and Tobacco Research. The researchers analyzed surveys of Norwegian teenagers and adults conducted from 2005 to 2011. Out of 8,313 people, 409 were long-term snus users who had started using snus before [...]

Charlotte Parker2014-02-18T17:17:10-07:00February, 2014|Oral Cancer News|

Support HPV Vaccination to protect children in the US

Source: www.usatoday.com Author: Liz Sbazo The USA is failing to protect children from preventable cancers that afflict 22,000 Americans a year by not vaccinating enough of them against HPV, a new report says. Although a safe and effective HPV vaccine has been available for eight years, only one-third of girls have been fully immunized with all three recommended doses, according to a report from the President's Cancer Panel, which has advised the White House on cancer since 1971. HPV, or human papillomavirus, is a family of viruses that causes cancer throughout the body, including cancers that predominantly affect men, such as a type of throat cancer. Only 7% of boys are fully vaccinated, although the Centers for Disease Control and Prevention has recommended the shots for them since 2011. Raising vaccination rates to at least 80% of teen girls could prevent 53,000 future cases of cervical cancer in girls alive today, according to the CDC. "Our children deserve this protection," says panel chairperson Barbara Rimer, a professor at the University of North Carolina at Chapel Hill. Administering the HPV shot poses practical difficulties not faced by other adolescent vaccines, because it currently requires three doses, at least two months apart, beginning when kids are 11 or 12, says pediatrician Mary Anne Jackson, director of infectious diseases at Children's Mercy Hospital & Clinics in Kansas City, Mo., who wasn't involved in the new report. Although emerging research suggest that two doses could be equally effective, experts have not yet changed their [...]

Charlotte Parker2014-02-11T15:59:23-07:00February, 2014|Oral Cancer News|

Shedding light on oral cancer

Source: www.laboratorytalk.com Author: staff A team of Indian cancer researchers led by Dr Narayanan Subhash has developed a simple, non-invasive spectral imaging system that holds the possibility of rapid, inexpensive mass screening. Even in the hands of non-clinical staff, it is capable of real-time discrimination of healthy oral tissue from pre-malignant and malignant tissues with accuracy comparable to the gold standard histopathology of a biopsy sample. The core of the novel Diffuse Reflectance Imaging System (DRIS) is an Andor Luca-R EMCCD camera, which captures monochrome images of the patient’s mouth at 545 and 575 nm. Andor’s SOLIS software computes a ratio image (R545/R575) of the area under investigation and generates a Pseudo Colour Map (PCM) where blue designates healthy tissue, red denotes dysplastic/pre-malignant tissue and yellow identifies malignant tissue. This allows rapid visual differentiation of oral lesions and identification of regions with pre-malignant characteristics. “Since mortality from oral cancer is particularly high, early detection, diagnosis and treatment is vital in increasing the survival rate of those with the disease,” says Dr Subhash. “Our imaging method has the great advantage of non-invasively scanning entire lesions and their surrounding areas and automatically categorising these oral lesions into normal/clinically healthy, pre-malignant, and malignant tissue in real-time. “It also delineates the boundaries of neoplastic changes and locates sites with the most malignant potential for biopsy, thereby avoiding unnecessary repeated biopsies and delay in diagnosis. What’s more, imaging the entire region may also help the surgeons to identify the margins of the lesion that cannot be [...]

Oral Cancer Foundation News Team - A2014-02-11T13:33:25-07:00February, 2014|Oral Cancer News|