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New app gives throat cancer patients their voice back

Source: www.straitstimes.com
Author: staff

Throat cancer patient Vlastimil Gular can say what he wants in his own voice thanks to technology that uses past recordings of his voice to create synthetic speech that can be played on his mobile phone via an app. Photo: AFP

Vlastimil Gular’s life took an unwelcome turn a year ago: minor surgery on his vocal cords revealed throat cancer, which led to the loss of his larynx and with it, his voice.

But the 51-year-old father of four is still chatting away using his own voice rather than the tinny timbre of a robot, thanks to an innovative app developed by two Czech universities.

“I find this very useful,” Mr Gular told AFP, using the app to type in what he wanted to say, in his own voice, via a mobile phone.

“I’m not very good at using the voice prosthesis,” he added, pointing at the hole the size of a large coin in his throat.

This small silicon device implanted in the throat allows people to speak by pressing the hole with their fingers to regulate airflow through the prosthesis and so create sound.

But Mr Gular prefers the new hi-tech voice app.

It was developed for patients set to lose their voice due to a laryngectomy, or removal of the larynx, a typical procedure for advanced stages of throat cancer.

The joint project of the University of West Bohemia in Pilsen, Prague’s Charles University and two private companies – CertiCon and SpeechTech – kicked off nearly two years ago.

The technology uses recordings of a patient’s voice to create synthetic speech that can be played on their mobile phones, tablets or laptops via the app.

Ideally, patients need to record more than 10,000 sentences to provide scientists with enough material to produce their synthetic voice.

“We edit together individual sounds of speech so we need a lot of sentences,” said Dr Jindrich Matousek, an expert on text-to-speech synthesis, speech modelling and acoustics who heads the project at the Pilsen university.

A Matter of Weeks
But there are drawbacks: Patients facing laryngectomies usually have little time or energy to do the recordings in the wake of a diagnosis that requires swift treatment.

“It’s usually a matter of weeks,” said Dr Barbora Repova, a doctor at the Motol University Hospital, working on the project for Charles University.

“The patients also have to tackle issues like their economic situation, their lives are turned upside down, and the last thing they want to do is to make the recording,” she told AFP.

To address these difficulties, scientists came up with a more streamlined method for the app, which is supported by the Technology Agency of the Czech Republic.

Working with fewer sentences – ideally 3,500 but as few as 300 – this method uses advanced statistical models such as artificial neural networks.

“You use speech models with certain parameters to generate synthesised speech,” said Dr Matousek.

“Having more data is still better, but you can achieve decent quality with less data of a given voice.”

The sentences are carefully selected and individual sounds have to be recorded several times, as they are pronounced differently next to different sounds or at the beginning and end of a word or sentence, he added.

So far, the Pilsen university has recorded 10 to 15 patients, according to Dr Matousek.

Besides Czech, the Pilsen scientists have also created synthesised speech samples in English, Russian and Slovak.

Baby Dinosaurs
Mr Gular – an upholsterer who lost his job due to his handicap – managed to record 477 sentences over the three weeks between his diagnosis and the operation.

But he was stressed and less than satisfied with the quality of his voice.

“Throat cancer patients often suffer from some form of dysphonia (hoarseness) before the surgery, so in combination with a limited speech sample, it makes the voice sound unnatural,” said Dr Repova.

In a studio at the Pilsen university meanwhile, entrepreneur Jana Huttova is recording outlandish phrases.

The 34-year-old mother of three faces the risk of losing her voice to minor throat surgery – an operation on her parathyroid gland.

“The Chechens have always preferred a dagger-like Kalashnikov,” she says, reading from the text before her.

“I have small kids and I want them to hear my own voice, not a robot,” Ms Huttova said.

Then she moved on to her next sentence: “We were attacked by a tyrannosaur’s baby dinosaurs.”

Connected to the Brain
Dr Matousek believes that in the future, patients will be able to use the app to record their voice at home using a specialised website to guide them through the process.

And he hopes that one day it will go even further.

“The ultimate vision is a miniature device connected to the brain, to the nerves linked to speech – then patients could control the device with their thoughts,” he said.

This kind of advanced solution is a very long way off, said Dr Repova.

“But look at cochlear implants – 40 years ago when they started, we had no idea how it would develop, how widely they would end up being used,” she said, referring to the inner-ear implants used to tackle severe deafness.

“A happy end would be a device implanted in the throat that could talk with the patient’s own voice,” she told AFP.

“It’s realistic: it may not come in a year or even in 10 years, but it’s realistic and we’re on the way.”

January, 2019|Oral Cancer News|

Living well with a feeding tube

Source: health.usnews.com
Author: Lisa Esposito, Staff Writer

Nearyly 450,000 Americans with swallowing or digestive problems manage tube feedings – also called home enteral nutrition – on their own. Some have temporary feeding tubes, while others leave the hospital with feeding tubes surgically placed for the foreseeable future.

Veteran users or “tubies” accept long-term feeding tubes as the best or only way to nourish themselves. Many resume school, work and social lives that were once threatened by severe weight loss and malnutrition. For them, getting a feeding tube means getting their active lives back.

Feeding Tube Benefits
Feeding tubes can prevent weight loss, boost energy and bolster your immune system. They also offer important health benefits for people coping with the following health issues:

Tube feeding for chronic swallowing challenges. For people with chronic health conditions that can cause swallowing difficulties, it helps keep them well-nourished. Neurologic conditions such as Parkinson’s disease, stroke or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) can impair nerves, affecting swallowing ability.

Tube feeding for oral and throat cancer. Inability to swallow food because of cancer of the mouth or throat is a major contributor to people receiving one, says Lisa Epp, a registered dietitian nutritionist with Mayo Clinic in Rochester, Minnesota.

Tube feeding for nutrition during recovery. A patient who has a short-term eating problem likely to eventually resolve, such as someone recovering from a surgery, brain injury or stroke, may benefit from having one.

Tube feeding for gastric problems. Gastric problems in which the stomach doesn’t empty well or a part of the intestine doesn’t work are the third major cause for feeding tubes, Epp says. Less commonly, trauma and paralysis impair the ability to swallow.

Tube feeding for kids with impaired eating ability. In kids, genetic and other disorders that affect their development can compromise their ability to swallow and eat. Premature infants, toddlers diagnosed with failure to thrive and kids with congenital heart defects, cerebral palsy, cystic fibrosis, GI tract malformations or gastroesophageal reflux disease (GERD) may be candidates for feeding tubes.

When children are barely able to eat because of chronic illness, feeding tubes must be considered, Epp says. If children can’t have needed surgery or chemotherapy because their bodies are weakened by malnutrition, parents have to make that difficult choice.

“Getting better nutrition is going to help them be stronger, increase their immune system and help children grow to their potential, whatever that potential can be,” Epp says. As for adult patients, she adds, “The No. 1 thing I hear when people come back at six-week and three-month visits is, ‘Why didn’t I do this sooner?'”

Maintaining a healthy body weight while tube feeding. Even though they can eat a certain amount of food, some people with gastric conditions can’t take in enough to maintain their health.

“An important consideration is if a patient is continuing to lose weight,” says Arlene Escuro, a dietitian and nutrition therapy specialist at the Center for Human Nutrition in the Digestive Disease and Surgery Institute at Cleveland Clinic. “The key is if they have a functional GI tract. We do have patients with a GI dysfunction (who are) able to take some food by mouth, but it’s not sufficient to sustain their nutrition, so they will need to continue on with the home tube-feeding regimen.”

Types of feeding tubes
Feeding tubes can be temporary or longstanding. Nasal tubes and gastric tubes are the two main types.

A nasal tube, which is usually temporary, is nonsurgical. Nasogastric tubes enter the body through one nostril and run down into the stomach. Another nasal tube, called a nasoduodenal tube, goes into the small intestine, or duodenum. A nasojejunal feeding tube goes into a farther part of the small intestine, the jejunum.

A gastrostomy tube, or G-tube, is often the choice for people who need longer-term feeding tubes. Surgeons use an endoscope to place the G-tube directly into the stomach. The surgery creates a stoma, a visible opening that connects to the feeding tube outside the body. The feeding tube allows people to take specialized liquid nutrition directly into their stomach.

Gastrostomy tubes are often referred to simply as PEGs. Specifically, PEG means percutaneous endoscopic gastrostomy. The visible portion of the feeding tube is permanently attached. However, people can transition to other options.

With buttons or low-profile feeding tubes, there’s no long outer tube attached to the stomach. Instead, users attach extension sets only when needed for feedings, water or medication. The button closure lies nearly flat against the stomach.

However, buttons aren’t the best option for everyone, Epp says. For instance, people who stay on a pump with continuous feeding throughout the day often prefer a tube, which can feel more secure.

Patients and families need to be fully informed of risks as well as benefits before a feeding tube is placed. Doctors evaluate a patient’s medical history to assess his or her individual risk and determine if there are any contraindications, or reasons against, having this procedure.

A variety of intestinal and esophageal conditions, a history of gastric bleeding, previous abdominal surgery and intractable diabetes are among the possible contraindications for G-tube feedings, according to comprehensive, evidence-based guidelines developed by the Cystic Fibrosis Foundation.

Mechanical risks involve tube malfunctions. For example, the tube can get blocked so feeding can’t get through, or it may become dislodged or fall out. It must then be replaced in a hospital.

Skin problems include redness and irritation around a patient’s stoma because of moisture build-up from the stomach or feeding leakage. “There’s also a risk of infection through the stoma site where (users) had a gastrostomy tube, a PEG tube, placed,” Escuro says.

Gastric side effects can develop as well. “GI complications could be diarrhea, constipation or under-hydration,” Escuro says. “Our goal when we have these patients, as we transition them from hospital to home, is to prevent readmissions and tube-feeding related complications.”

Tube Feeding Schedules
Feeding schedules range from episodic feedings at standard mealtimes to continuous feeding regimens.

“We make the regimen very individualized, as much as possible, so it will not interfere with patients’ lives,” Escuro says. Bolus or syringe feedings are larger feedings spread throughout the day like regular meals. It takes about 15 to 20 minutes to administer the formula, Escuro says, usually taken three to four times a day. “Basically, it’s like eating breakfast, lunch, dinner and a snack.”

Other patients go home with a pump for 24-hour feedings. “The reason for the pump feeding is that the feeding tube is placed in their small bowel,” Escuro says. “We don’t really recommend doing bolus feedings in the small intestine, just because it’s such a small reservoir, where most people will not tolerate bolus feedings.”

Pump feedings can be gradually spaced out for some people. “If they go home on continuous feeding when they’re hooked up to a feeding pump, we try to cycle their feedings, eventually.” Escuro says. “So from 24 hours we will gradually cycle them to 20 hours to 18, 16 and to 12 hours or so. If it’s in the stomach, we can transition a patient to bolus feedings.”

Eventually, some patients are weaned off feeding tubes altogether.

Managing a Feeding Tube
Learning how to manage and become comfortable with home tube feeding ideally starts before patients leave the hospital.

At Cleveland Clinic, patients and family caregivers start home enteral feeding education, which includes hands-on practice, before discharge. After discharge, Escuro says, patients with PEGs receive care from a home health nurse to check the stoma site and make sure it’s healing properly. In addition, a home care dietitian follows up to make sure patients are doing well.

Still, for a patient coming home with a tube placed in his or her stomach, the responsibility can seem overwhelming. Through practice, they master the following steps to successfully manage the feeding tube:

  • Prepare the tube feeding
  • Gather supplies
  • Position for feeding
  • Check residual contents
  • Run continuous/cyclic tube feeding
  • Infuse a bolus tube feeding
  • Clean skin around tube site
  • Clean tube feeding equipment
  • Troubleshoot or report problems

Not Best for Everyone
A feeding tube is not always the right choice. For example, people with severe Alzheimer’s disease in later stages often have trouble eating and drinking. However, a feeding tube might not be for the best, according to Choosing Wisely, an initiative focused on avoiding unnecessary medical tests, treatments and procedures.

A frail older adult with Alzheimer’s could be at greater risk of complications such as pneumonia or pressure sores on the skin. They may lose the human contact of being fed by hand as well as the sensation of tasting food.

“Don’t recommend percutaneous feeding tubes (PEGs) in patients with advanced dementia – instead, offer oral assisted feeding,” tops a list of recommendations for physicians regarding quality of life for older adults from the American Geriatrics Society.

<u>Feeding Tube Food</u>
Commercial tube-feeding formulas are available to meet users’ individual nutritional needs. However, just as consumers of traditional food want more natural, less-processed options including plenty of fruits and vegetables, a similar movement is afoot among feeding tube users.

Blenderized whole foods, either made at home or commercially, are choices for patients who feel they can tolerate them better or who simply want to eat what others do. “It’s basically joining the family during mealtime and getting the same food, but it’s just blenderized,” Escuro says.

Expense is an issue. Users must work with insurers to cover ongoing costs of feeding supplies, particularly the food itself. While insurance usually covers the surgical placement, people pay at least a portion for tube-feeding formulas out of pocket.

<u>Resources for People With Feeding Tubes</u>
In addition to turning to their health care teams, people on home enteral nutritional can go online for expertise, advice and peer support.

The Feeding Tube Awareness Foundation is a nonprofit group whose mission is to support parents of children who are tube-fed.

January, 2019|Oral Cancer News|

HPV discovery raises hope for new cervical cancer treatments

Source: www.eurekalert.org
Author: press release – University of Virginia Health Syste

Researchers at the University of Virginia School of Medicine have made a discovery about human papillomavirus (HPV) that could lead to new treatments for cervical cancer and other cancers caused by the virus.

HPV is responsible for nearly all cases of cervical cancer and 95 percent of anal cancers. It is the most common sexually transmitted disease, infecting more than 79 million Americans. Most have no idea that are infected or that they could be spreading it.

“Human papillomavirus causes a lot of cancers. Literally thousands upon thousands of people get cervical cancer and die from it all over the world. Cancers of the mouth and anal cancers are also caused by human papillomaviruses,” said UVA researcher Anindya Dutta, PhD, of the UVA Cancer Center. “Now there’s a vaccine for HPV, so we’re hopeful the incidences will decrease. But that vaccine is not available all around the world, and because of religious sensitivity, not everybody is taking it. The vaccine is expensive, so I think the human papillomavirus cancers are here to stay. They’re not going to disappear. So we need new therapies.”

HPV and Cancer
HPV has been a stubborn foe for scientists, even though researchers have a solid grasp of how it causes cancer: by producing proteins that shut down healthy cells’ natural ability to prevent tumors. Blocking one of those proteins, called oncoprotein E6, seemed like an obvious solution, but decades of attempts to do so have proved unsuccessful.

Dutta and his colleagues, however, have found a new way forward. They have determined that the virus takes the help of a protein present in our cells, an enzyme called USP46, which becomes essential for HPV-induced tumor formation and growth. And USP46 enzyme promises to be very susceptible to drugs. Dutta calls it “eminently druggable.”

“It’s an enzyme, and because it’s an enzyme, it has a small pocket essential for its activity, and because drug companies are very good at producing small chemicals that will jam that pocket and make enzymes like USP46 inactive,” said Dutta, chairman of UVA’s Department of Biochemistry and Molecular Genetics. “So we are very excited by this possibility that by inactivating USP46 we’ll have a way to treat HPV-caused cancers.”

Curiously, HPV uses USP46 for an activity that is opposite to what the oncoprotein E6 was known to do. E6 has been known for more than two decades to recruit another cellular enzyme to degrade the cell’s tumor suppressor, while Dutta’s new finding shows that E6 uses USP46 to stabilize other cellular proteins and prevent them from being degraded. Both activities of E6 are critical to the growth of cancer.

The researchers note that enzyme USP46 is specific to HPV strains that cause cancer. It is not used by other strains of HPV that do not cause cancer, they report.

Notes:
(1) The researchers have published their findings in the scientific journal Molecular Cell. The team included Shashi Kiran, Ashraf Dar, Samarendra K. Singh, Kyung Yong Lee and Dutta. All are from UVA’s Department of Biochemistry and Molecular Genetics.

(2)The work was supported by the National Institutes of Health, grant R01 GM084465.

December, 2018|Oral Cancer News|

Tobacco 21 — its time has come

Source: vtdigger.org
Author: Nevin Zablotsky, DMD

As we approach the holiday season I am reminded of the gifts of love we share with our families, as well as the New Year’s resolutions we make and try to keep after Jan. 1 history.

I am a periodontist having practiced in Burlington and South Burlington for the past 40 years. In that time I have treated patients that have been severely compromised by tobacco. Some have lost teeth from advanced periodontal disease and some have lost parts of their tongue and jaw due to oral cancer, leaving them significantly compromised functionally as well as well as emotionally. I have had to advise teenagers and their families that their tobacco chewing habit had caused significant enough changes in their mouth to warrant a biopsy of the involved area. This caused great stress to them as they waited a week to find out the results. Some may think that it takes many years for tobacco use to compromise one’s health, but teenagers can die a horrible death from tobacco use if they are one of the unlucky ones who is genetically predisposed to oral cancer.

Over the years, I have traveled throughout Vermont teaching about tobacco and nicotine addiction to elementary, junior and senior high school students. I feel that I have a good sense of what kids are thinking about these subjects. The elementary school students seem to understand that cigarettes are bad for them. When one talks to the middle school kids, there are some that are beginning to think that cigarettes and smokeless tobacco use is cool, and when speaking to high school students, there is a larger percentage of them that have begun to use a variety of these products, ranging from cigarettes and cigars, to hookahs, to a variety of e-cigarettes, with the newest product, Juul, going viral. This product has become so much of a problem local schools have sent letters to parents warning them of its sudden increase in usage .

It is legal for anyone over 18 to purchase all of these tobacco and nicotine products. Here are some facts to chew on.

About 95 percent of adult smokers begin smoking before they turn 21. Two-thirds of 10th grade students and nearly half of eighth grade students say it is easy to get cigarettes. More 18- and 19-year-olds using in high school means younger kids have daily contact with students who can legally purchase tobacco products.

I am often told that when one reaches the age of 18 they are mature enough to vote, or join the military, so therefore they are mature enough to decide on using tobacco products.

Tobacco use costs the military about $1.6 billion annually in lost productivity and health care expenses tied to respiratory problems, cardiovascular disease and slower healing, according to the Department of Defense data. That’s expected to climb to $19 billion during the next 10 years and result in 175,000 premature deaths. The Air Force bans tobacco in recreation facilities, and the Navy banned tobacco on all submarines. The Vermont National Guard also stated that they would abide by Tobacco 21 legislation if it passed, again citing readiness and fitness.

An argument has been made that tobacco retailers’ businesses will be irreparably harmed if tobacco 21 is implemented. Studies show that its impact over the first 5-8 years will be between one quarter and one half of a percent.

Vermont law does not allow the sale of alcohol to anyone under 21, and the new marijuana law passed last year also restricts its usage to those over 21. Given the proven health risks of tobacco use, why does the present law allow tobacco usage at age 18?

It has been calculated that 10,000 kids now under 18 and alive in Vermont will ultimately die prematurely from the smoking habit they began in their teenage years.

Six states have passed tobacco 21 legislation. This includes Massachusetts and Maine, with New York likely to join this group. Do we really want kids coming from our surrounding states coming here to get their cigarettes or e-cigarettes?

Even Altria and R.J. Reynolds, two of the largest tobacco companies in the world have stated that the age of sale should be 21.

So as we approach the new year I want to appeal to our representatives, to resolve to pass tobacco 21 in the 2019 legislative session, and remind them about how much suffering they can prevent. The decisions they make will have major consequences for generations to come. What a great resolution to keep. What a great holiday gift for us all.

Note: This commentary is by Nevin Zablotsky, DMD, a retired periodontist who practiced in South Burlington and the Coalition for a Tobacco Free Vermont.

December, 2018|Oral Cancer News|

Oral cancer prognostic signature identified

Source: www.eurekalert.org
Author: press release

Researchers in Brazil have identified a correlation between oral cancer progression and the abundance of certain proteins present in tumor tissue and saliva. The discovery offers a parameter for predicting progression of the disease – whether cervical lymph node metastasis is present, for example – and points to a strategy for overcoming the limitations of clinical and imaging exams. It could also help guide the choice of an ideal treatment for each patient.

The study began in the discovery phase with a proteomic analysis of tissue from different tumor areas using 120 microdissected samples. In the verification phase, prognostic signatures were confirmed in approximately 800 tissue samples by immunohistochemistry and in 120 samples by targeted proteomics.

The study was supported by São Paulo Research Foundation – FAPESP and conducted at the National Energy and Materials Research Center (CNPEM) in partnership with the São Paulo State Cancer Institute (ICESP), the University of Campinas’s Piracicaba Dental School (FOP-UNICAMP), the Institute of Computing from the same university, the University of São Paulo’s Mathematics and Computer Science Institute (ICMC) in São Carlos, and the Dental School of the West Paraná University (UNIOESTE), in addition to other institutions in Brazil and abroad.

“The data led to robust results that are highly promising as guides to defining the severity of the disease. We suggested potential markers of the disease in the first phase of the study and verified these markers in the second phase, enhancing the reliability of the findings and showing that these markers are effective in classifying patients with cervical lymph node metastasis,” said Adriana Franco Paes Leme, a researcher at CNPEM’s National Bioscience Laboratory (LNBio) and the corresponding author of the article published in Nature Communications.

Mouth cancer, also known as oral squamous cell carcinoma (OSCC), is the most common type of malignant head and neck tumor. Prevalence and mortality are high, with some 300,000 new cases diagnosed per year worldwide and 145,000 deaths. Although it is relatively easy to detect, typically when a dentist notices an oral lesion, the disease is usually diagnosed when it is already at an advanced stage.

“We worked on the study for five years until we achieved this breakthrough,” Paes Leme told. “It was divided into two phases. In the first, we used discovery proteomics to identify and quantify tumor tissue proteins. The second phase of the study consisted of analyses using immunohistochemistry and targeted proteomics, for when you know precisely which proteins you want to quantify.”

Proteomics focuses on the identification, localization and functional analysis of the proteins in a sample, which may consist of tissue or cells, for example. The proteins are quantified, post-translational modifications are detected, and their activity and interactions are assessed.

Bioinformatics and machine learning
The study funded by FAPESP had two phases. In the first phase, the researchers used laser microdissection and proteomics to map the proteins in mouth cancer tissue and correlate them with the clinical characteristics of patients. This analysis permitted the identification of several proteins, such as CSTB, NDRG1, LTA4H, PGK1, COL6A1, ITGAV, and MB, with differing levels of abundance depending on tumor area and links to key clinical outcomes.

In the second phase, after identifying and quantifying proteins in the 120-odd tumor tissue samples, the researchers deployed two protein verification strategies.

“One strategy consisted of gauging the abundance of the selected proteins in independent tissue samples using immunohistochemistry with antibodies. The other consisted of monitoring the same preselected targets in patients’ saliva,” Paes Leme said.

Saliva was chosen because this cancer is located in the mouth, where proteins could be secreted by neoplastic cells. “Saliva is a promising source of markers, as well as being a fluid obtained by noninvasive collection,” she explained. “We verified the proteins in saliva from 40 patients. Technical triplicates were analyzed to achieve the highest possible confidence level for the results in this phase of the study.”

After analyzing the saliva samples, the researchers used bioinformatics and machine learning techniques to arrive at prognostic signatures, verifying which of the proteins or peptides selected in the first phase could distinguish between patients with and without cervical lymph node metastasis.

“In addition, we had valuable information about the clinical evolution of the patients who took part in the study as volunteers by donating samples of their saliva,” Paes Leme said.

From this result, it was possible to identify three specific peptides – LTA4H, COL6A1, and CSTB – that can be used as a signature to classify patients with and without cervical lymph node metastasis, offering the potential to help doctors overcome the limitations of clinical exams and guide personalized treatment strategies.

Affordable biosensors
The scientists are now working on a new study designed to use translational techniques to build affordable biosensors capable of detecting prognostic signatures in patients’ saliva.

Peptides currently have to be identified and quantified by mass spectrometry and proteomics, which are costly techniques and not often available in clinics and hospitals.

“We want to develop a simpler and cheaper method that can easily be used by health professionals to assess the progression of the disease on the basis of tests that can be performed in a dentist’s or doctor’s office, or in clinical labs. In the study we’ve just published, we were able to identify this prognostic signature by mass spectrometry. We now plan to develop a biosensor with a focus on the use of this signature so that it can be adopted for clinical use and help guide treatment decisions”, Paes Leme said.

December, 2018|Oral Cancer News|

Australian doctor helps restore cancer patient’s jaw using 3D printed mandible

Source: neoskosmos.com
Author: staff

Anelia Myburgh, a 31-year-old woman from Melbourne who lost most over her upper jaw and teeth to cancer has been offered a second chance in life thanks to Maxillofacial Surgeon George Dimitroulis, who customised a 3D printed jaw.

The fitted 3D mandible featuring a titanium frame, has changed Ms Myburgh’s life who had been left embarrassed and self-conscious, let alone unable to experience basic functions like eating or talking normally.

It all starter in April 2017, when she was diagnosed with jaw cancer after she noticed a small bump above her teeth, which was causing them to move and decided to have it checked with the dentist.

While a team of specialists reassured her it was fine, the test results that came a week later proved it was cancer which resulted in Ms Myburgh undergoing immediate lie-saving surgery to remove most of her upper jaw and part of her lips.

The patient was then left with only two teeth at the back of each side of her mouth and a deformed face.

People’s reactions – who sometimes stopped to take photos of her – made her avoid leaving her home and covering her face with a surgical mask if she had to.

“We communicate with our mouths, we eat with our mouths, if you don’t have a mouth we can’t really live in a way a person takes for granted,” Ms Myburgh told Nine News.

It wasn’t until she started researching possible treatment online that she stumbled upon Dr Dimitroulis’ work and previous successful procedures he had performed on patients using 3D technology.

Dr Dimitroulis assessed the case and decided to move forward with creating a 3D mandible for Ms Myburgh that would also allow teeth to be implanted.

The surgery only lasted a few hours and as seen on Nine News, Ms Myburgh’s new teeth look and feel like normal.

The doctors also took skin from the her forearm to recreate her lip.

“I can now enjoy life and meals with my friends,” the finance worker told Nine News.

“I’m slowly gonna get that burger!”

December, 2018|Oral Cancer News|

Israeli company set to begin testing new radiation cancer therapy

Source: www.forbes.com
Author: Robin Seaton Jefferson

An Israeli medical technology company is set to begin testing its new radiation cancer therapy in leading medical centers in Italy. The Alpha DaRT (Dіffusіng Alpha-emіtters Radіatіon Therapy) device delivers high-precision alpha radiation that is released when radioactive substances decay inside the tumor and kills cancer cells while sparing the surrounding healthy tissue, the company says.

The company hopes to get approval from the European Commission by next year for the therapy.

Early results from an ongoing pre-clinical trial on patients with squamous cell carcinoma (SCC) tumors at the Rabin Medical Center in Israel and the IRST (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori) in Italy showed a reduction in all tumor sizes and more than 70 percent of the tumors completely disappearing within a few weeks after treatment, NoCamels reported.

The therapy has already been tested on more than 6,000 animals and has been found “to be effective and safe for various indications, including tumors considered to be resistant to standard radiotherapy.” according to the breakthrough innovation news site NoCamels.

Alpha Tau Medical was founded in 2016 to focus on research and development as well as commercialization of its Alpha DaRT cancer treatment. The therapy was initially developed in 2003 by Professors Itzhak Kelson and Yona Keisari at Tel Aviv University.

According to the National Cancer Institute (NCI), cancers that are known collectively as head and neck cancers, or squamous cell carcinomas of the head and neck, usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (for example, inside the mouth, the nose, and the throat).

Head and neck cancers account for about 4% of all cancers in the United States, are more than twice as common among men as they are among women, and are more often diagnosed among people over age 50.

Cancers of the head and neck are further categorized by the area of the head or neck in which they begin including the oral cavity, pharynx (throat), larynx, paranasal sinuses and nasal cavity, and salivary glands. They can include hypopharyngeal cancer, laryngeal cancer, lip and oral, cavity cancer, metastatic squamous neck cancer with occult primary, nasopharyngeal cancer, oropharyngeal cancer, paranasal sinus and nasal cavity cancer, salivary gland cancer.

The Alpha DaRT treatment can be applied under local anesthesia in a short single session and can be combined with chemotherapy and immunotherapy to increase effectiveness, according to Alpha Tau Medical. The company reports Alpha DaRT can even trigger anti-tumor immunity for the elimination of distant metastases, NoCamels reported.

Clinical trials for Alpha DaRT will be conducted at the Sapienza University of Rome, which is initiating Alpha Tau’s clinical trial protocol for squamous cell carcinomas of the skin and oral cavity, and the IFO (Istituti Fisioterapici Ospitalieri), which is conducting its first study of Alpha DaRT for the treatment of cutaneous and mucosal malignant neoplasia (CMN).

Alpha Tau is also collaborating with key cancer physicians worldwide to investigate the Alpha DaRT as a treatment for other cancers, including pancreatic, breast and prostate, NoCamels reported.

November, 2018|Oral Cancer News|

New guidelines from NCCN help people with mouth cancers understand treatment options

Source: www.heraldmailmedia.com
Author: press release

The National Comprehensive Cancer Network® ( NCCN ®) has published the first of three guidelines for patients with head and neck cancers, focused on oral cavity (mouth and lip) cancers. The guidebook offers treatment explanations based on the recommendations from the NCCN Clinical Practice Guidelines in Oncology ( NCCN Guidelines ®) used by clinicians, put into plain language with accompanying glossary and background. This free online resource is also available in print through Amazon.com for a nominal fee. The publication was made possible thanks to funding through the NCCN Foundation ®, and sponsorship from the Head and Neck Cancer Alliance ( HNCA ) and Support for People with Oral and Head and Neck Cancer ( SPOHNC ).

“These guidelines will help to decrease the anxieties associated with a cancer diagnosis,” explained Mary Ann Caputo, Executive Director, SPOHNC. “You will learn and empower yourself with the necessary knowledge of the disease and its treatment. These tools will enable one to go forward with a strong conviction of moving on and living a full life.”

“When I was first diagnosed, I was surprised, overwhelmed and scared. I was completely focused on the treatment for my cancer, and so initially I was less aware of all the information shared with me during my medical appointments about my particular diagnosis,” said Jason Mendelsohn, HNCA Board Member and Survivor. “These guidelines are a great resource that patients, their caregivers, and families can read when they’re ready and able to focus on everything they need to know. We believe they will be a great resource for head and neck cancer patients everywhere.”

Ellie Maghami, MD, FACS, Chief and Professor, Division of Otolaryngology/Head and Neck Surgery, City of Hope National Medical Center, and Member, NCCN Guidelines Panel for Head and Neck Cancers says Mendelsohn’s experience is one she’s seen again and again. She emphasized that while smoking and other tobacco use is by far the most common cause of mouth cancer, it can happen to anybody.

“It’s not just an old person’s disease or just a smoker’s disease,” said Dr. Maghami. “For instance, incidences of tongue cancer — which is a type of oral cancer — are on the rise in non-smoking young people.” She also explained that HPV, despite its common link to throat cancer, is actually responsible for fewer than five percent of tongue cancer occurrences.

The NCCN Guidelines for Patients explain that there are several different types of cancers that can originate in all different parts of the mouth. They are generally treated first by surgery, including immediate reconstruction as needed and followed by rehabilitation of speech and swallow functions. It can be beneficial to receive treatment at a high-volume cancer center with highly-experienced specialists who frequently treat these rarer types of cancers. The NCCN Guidelines® also recommend enrollment in clinical trials whenever possible, and advocate for asking questions and seeking second opinions.

As with most cancers, early detection can make a huge difference. According to Dr. Maghami, these cancers are often caught early, thanks to the high visibility of the mouth location.

“It’s relatively easy to do a self-exam for oral cavity cancers. If you see something in your mouth that looks abnormal or feels strange for more than a few days, talk to a doctor about it.”

NCCN Guidelines for Patients currently cover disease types that account for approximately 90% of all cancer diagnoses. Patient guidelines for both Non-Invasive and Metastatic Breast Cancer have been recently updated, along with those for Colon and Prostate Cancer. The next two books in the Head and Neck series will cover oropharynx and nasopharynx cancers. The NCCN Guidelines for Patients: Thyroid Cancer already exists as a separate publication. All patient guidelines are available for free online at NCCN.org/patients or by app.

“Patients need reliable, accurate, up-to-date information presented in an easy to understand fashion,” said Dr. Maghami. “And that’s exactly what NCCN provides.”

NCCN Guidelines for Patients and NCCN Quick Guide™ sheets DO NOT replace the expertise and clinical judgment of the clinician.

November, 2018|Oral Cancer News|

Call for closer links between GPs and dentists

Source: www.onmedica.com
Author: Adrian O’Dowd

GPs must work more closely and liaise better with dentists if the rising number of patients with oral cancer are to be helped properly, according to a new action plan.

The action plan launched by trade union the British Dental Association (BDA) calls for better coordination between health professionals, checks to ensure patients have regular dental check-ups, and better detection and prevention of the disease.

The document Oral Cancer: A Plan for Action was launched in Edinburgh by BDA Scotland at a Stand Up to Oral Cancer event held to coincide with Mouth Cancer Action Month in November.

New cases of oral cancer in the UK have reached 8,302 per year and this has increased by 49% in the last decade. Cancer Research UK estimates that incidence rates for oral cancers will rise by a further 33% in the UK by 2035.

In the UK last year, 2,722 people died after developing oral cancer. The 10-year survival rate is between 19% and 58%, depending on where the cancer strikes and how early it is diagnosed.

The plan focuses on prevention, early detection and having better referral pathways to ensure good links between dentists, GPs and pharmacists.

It follows the publication of the Scottish Government’s Oral Health Improvement Plan (OHIP) earlier this year, which proposed extending the dental recall interval for some patients to 24 months – a move strongly opposed by the BDA.

Anas Sarwar MSP (member of the Scottish Parliament) has tabled a motion in the Scottish Parliament calling for sustainable and innovative approaches to oral cancer treatment, and expressing concern over the potential impact of the OHIP.

BDA Scotland said it wanted a strategic focus on early detection, prevention and joining-up services, with measures including sufficient resources for alcohol treatment and smoking cessation programmes, and a catch-up programme to offer 140,000 older school-aged boys access to the vaccination programme for the cancer-causing Human Papillomavirus (HPV).

David Cross, vice-chair of the BDA’s Scottish Council said: “Dentists are on the front line of a battle against some of the fastest rising cancers in Scotland. Early detection is key, but now risks becoming a casualty of a cost-cutting exercise.

“People in otherwise good health are succumbing to this disease. Telling our ‘lower risk’ patients to come back in two years will only handicap efforts to meet a growing threat, while putting further pressure on NHS cancer services.

“Oral cancer now claims three times as many lives in Scotland as car accidents. Rather than chasing quick savings we need to see concrete plans and real investment to help turn the tables on this devastating but preventable disease.”

The BDA is working with the BMA and Community Pharmacy Scotland on the plan and is developing partnerships and links with other organisations such as ASH (Action on Smoking and Health) Scotland.

November, 2018|Oral Cancer News|

Standard chemotherapy treatment for HPV-positive throat cancer remains the most effective, study finds

Source: www.eurekalert.org
Author: press release, University of Birmingham

A new study funded by Cancer Research UK and led by the University of Birmingham has found that the standard chemotherapy used to treat a specific type of throat cancer remains the most effective.

The findings of the trial, which aimed to compare for the first time the outcomes of using two different kinds of treatment for patients with Human papillomavirus (HPV)-positive throat cancer, are published today (November 15th) in The Lancet.

Throat cancer is one of the fastest rising cancers in Western countries. In the UK, incidence was unchanged between 1970 and 1995, then doubled between 1996 and 2006, and doubled again between 2006 and 2010. The rise has been attributed to HPV, which is often a sexually transmitted infection. Most throat cancers were previously caused by smoking and alcohol and affected 65 to 70 year old working class men. Today, HPV is the main cause of throat cancer and patients are middle class, working, have young children and are aged around 55.

HPV-positive throat cancer responds well to a combination of cisplatin chemotherapy and radiotherapy, and patients can survive for 30 to 40 years, but the treatment causes lifelong side effects including dry mouth, difficulty swallowing, and loss of taste.

The De-ESCALaTE HPV study, which was sponsored by the University of Warwick, compared the side effects and survival of 164 patients who were treated with radiotherapy and cisplatin, and 162 who were given radiotherapy and cetuximab. The patients were enrolled between 2012 and 2016 at 32 centres in the UK, Ireland, and the Netherlands. Patients were randomly allocated to be treated with radiotherapy and either cisplatin or cetuximab. Eight in ten patients were male and the average age was 57 years.

Importantly, the results found that there was very little difference between the two drugs in terms of toxicity in patients and side effects such as dry mouth, however, there was a significant difference in the survival rates and recurrences of cancer in patients taking part in the trial.

They found that the patients who received the current standard chemotherapy cisplatin had a significantly higher two-year overall survival rate (97.5%) than those on cetuximab (89.4%). During the six-year study, there were 29 recurrences and 20 deaths with cetuximab, compared to 10 recurrences of cancer and six deaths in patients who were treated with the current standard chemotherapy cisplatin.

And cancer was three times more likely to recur in two years following treatment with cetuximab compared to cisplatin, with recurrence rates of 16.1 per cent versus six per cent, respectively.

Study lead Professor Hisham Mehanna, Director of the University of Birmingham’s Institute of Head and Neck Studies and Education, said: “Many patients have been receiving cetuximab with radiotherapy on the assumption that it was as effective as cisplatin chemotherapy with radiotherapy and caused fewer side effects but there has been no head-to-head comparison of the two treatments.

“Cetuximab did not cause less toxicity and resulted in worse overall survival and more cancer recurrence than cisplatin.

“This was a surprise – we thought it would lead to the same survival rates but better toxicity. Patients with throat cancer who are HPV positive should be given cisplatin, and not cetuximab, where possible.”

Dr Emma King, Cancer Research UK Associate Professor in head and neck surgery at the University of Southampton, said: “Studies like this are essential for us to optimise treatments for patients. We now know that for HPV-positive throat cancer, the standard chemotherapy treatment remains the most effective option.

“However, we must keep testing new alternatives to ensure patients always have access to cutting-edge and kinder treatments. Chemotherapy and radiotherapy can leave head and neck cancer patients with long term pain and difficulties swallowing, so we should always strive to minimise side effects.”

Professor Janet Dunn from the University of Warwick, whose team ran the De-ESCALaTE HPV trial, said: “In the current trend for de-escalation of treatment, the results of the De-ESCALaTE HPV trial are very important as they were not as we expected. They do highlight the need for academic clinical trials and are an acknowledgement of the key role played by Warwick Clinical Trials Unit at the University of Warwick as the co-ordination and analysis centre for this important international trial.”

The patients on the De-ESCALaTE trial Steering Committee endorsed the importance of research findings.

Malcom Babb, who is also President of the National Association of Laryngectomee Clubs, said: “From a patient perspective, De-ESCALaTE has been a success by providing definitive information about the comparative effectiveness of treatment choices.”

November, 2018|Oral Cancer News|