Monthly Archives: March 2019

How do speech-language pathologists support cancer patients?

Source: syvnews.com
Author: Aundie Werner

Question: What are speech-language pathologists and how do they support cancer patients?

It is estimated that about 100,000 people will be diagnosed with a head, neck or thyroid cancer this year.

Although this does not grab headlines as often as many other cancers, for those affected the disease and treatment can have a significant impact on their lives. In general, most people survive head and neck cancer; however, side effects of treatment can sometimes be a long-term problem.

The support and guidance of a speech-language pathologist (SLP) can do much to help promote recovery and cope with the difficult symptoms of treatment. Ideally, the SLP becomes involved when the patient has been identified as having head and neck cancer before their surgery or before their chemotherapy/radiation protocol. Counseling and education are provided as to the functions of voice, speech and swallowing. Assessment is made to determine the patient’s baseline and to provide guidance as to the patient’s role in their rehabilitation.

Frequently, the SLP works with patients who have difficulty eating and drinking. Treatment is based on the cause of the problem: anatomical changes from surgery, decreased saliva, changes in taste, difficulty opening the mouth due to trismus, and problems protecting the airway, which can result in coughing and choking during meals.

Maintaining nutrition after surgery and during treatment is necessary to help the body heal. At times, the patient may need to have a feeding tube to help with nutrition when it becomes too difficult to swallow. The SLP assesses the patient’s current needs, instructs the patient in specific swallowing exercises, compensatory swallowing strategies or diet modification recommendations. The goal is for patients to continue to eat and drink during and after treatment.

Following radiation therapy, patients may experience lymphedema and/or fibrosis of the radiated tissue. These effects can persist long after the treatment concludes. Difficulties can include problems opening the mouth to eat from a spoon or fork, or decreased ability of the throat muscles to protect the airway while eating or drinking. In these cases, specific testing and exercises are instructed by the SLP.

Voice changes may also occur after surgery or radiation. The SLP instructs patients how to use their voice efficiently so as not to strain the muscles. Patients who have had their voice box removed are instructed in alternative methods to produce voicing to communicate.

Additionally, articulation and resonance changes can occur from surgery and/or radiation. Patients who have had sinus, palatal, jaw or tongue cancer are instructed how to articulate more clearly through customized treatment or prosthetic devices, if needed.

Each patient’s cancer is unique, as is the plan of care developed by the SLP. The Central Coast has excellent speech-language pathologists who are trained to provide their expertise to facilitate your road to recovery.

March, 2019|Oral Cancer News|

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.

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.

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.’

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.

March, 2019|Oral Cancer News|