Head and neck cancer guidelines ‘streamlined’

Source: www.medscape.com Author: Fran Lowry Modest changes in the 2011 National Comprehensive Cancer Network (NCCN) Head and Neck Cancers Guidelines will refine and improve the treatment of these complex, challenging, and relatively rare cancers, according to the panel chief reporting here at the NCCN 16th Annual Conference. One of the main changes is a new "suggestion" that the workup for cancer of the oropharynx include testing of the tumor for human papillomavirus (HPV). "Immunohistochemical testing for HPV p16 is recommended," said David G. Pfister, MD, from Memorial Sloan-Kettering Cancer Center in New York City, and chair of the NCCN Head and Neck Cancers Guidelines Committee. "Although not used to guide treatment, HPV testing is valuable prognostically. The results should not change management decisions," he emphasized. HPV-related oropharyngeal cancer appears to be a new and distinct disease entity, and is associated with better survival than non-HPV head and neck cancers, Dr. Pfister noted. HPV Has a Clear Impact on Prognosis "Our understanding of the human papillomavirus as a risk factor for head and neck cancer has evolved. Now we see that it has a clear impact on prognosis," Dr. Pfister said in an interview with Medscape Medical News. Because of their improved prognosis, these patients might require different treatment, he said. "There is a great interest in better understanding HPV-related cancers and how we treat the disease down the road. Right now we have insufficient data to change how we treat these patients, but clinical trials are being designed to assess the optimal treatment [...]

US cancer survivors grows to nearly 12 million

Source: www.cancer.gov Author: staff The number of cancer survivors in the United States increased to 11.7 million in 2007, according to a report released by the Centers for Disease Control and Prevention and the National Cancer Institute (NCI), part of the National Institutes of Health. There were 3 million cancer survivors in 1971 and 9.8 million in 2001. The study, “Cancer Survivors in the United States, 2007,” is published today in the CDC’s Morbidity and Mortality Weekly Report. A cancer survivor is defined as anyone who has been diagnosed with cancer, from the time of diagnosis through the balance of his or her life. "It's good news that so many are surviving cancer and leading long, productive, and healthy lives," said CDC Director Thomas R. Frieden, M.D., M.P.H. "Preventing cancer and detecting it early remain critically important as some cancers can be prevented or detected early enough to be effectively treated. Not smoking, getting regular physical activity, eating healthy foods, and limiting alcohol use can reduce the risk of many cancers." To determine the number of survivors, the authors analyzed the number of new cases and follow-up data from NCI’s Surveillance, Epidemiology and End Results Program between 1971 and 2007. Population data from the 2006 and 2007 United States Census were also included. The researchers estimated the number of persons ever diagnosed with cancer who were alive on Jan. 1, 2007 (except non-melanoma skin cancers, which are fairly common and rarely fatal). Study findings indicate: Of the 11.7 million people [...]

Assessment of human papillomavirus in lung tumor tissue

Source: Journal of the National Cancer Institute Abstract Background Lung cancer kills more than 1 million people worldwide each year. Whereas several human papillomavirus (HPV)–associated cancers have been identified, the role of HPV in lung carcinogenesis remains controversial. Methods We selected 450 lung cancer patients from an Italian population–based case–control study, the Environment and Genetics in Lung Cancer Etiology. These patients were selected from those with an adequate number of unstained tissue sections and included all those who had never smoked and a random sample of the remaining patients. We used real-time polymerase chain reaction (PCR) to test specimens from these patients for HPV DNA, specifically for E6 gene sequences from HPV16 and E7 gene sequences from HPV18. We also tested a subset of 92 specimens from all never-smokers and a random selection of smokers for additional HPV types by a PCR-based test for at least 54 mucosal HPV genotypes. DNA was extracted from ethanol- or formalin-fixed paraffin-embedded tumor tissue under strict PCR clean conditions. The prevalence of HPV in tumor tissue was investigated. Results Specimens from 399 of 450 patients had adequate DNA for analysis. Most patients were current (220 patients or 48.9%) smokers, and 92 patients (20.4%) were women. When HPV16 and HPV18 type–specific primers were used, two specimens were positive for HPV16 at low copy number but were negative on additional type-specific HPV16 testing. Neither these specimens nor the others examined for a broad range of HPV types were positive for any HPV type. Conclusions When DNA [...]

Woman awarded $15 million for misdiagnosed lesion

Source: DrBicuspid.com September 11, 2011 -- A Michigan jury awarded a 61-year-old woman $15 million after her oral surgeon failed to diagnose an oral lesion that eventually progressed into stage IV cancer, according to a story in the Detroit News. Because of a state law capping malpractice awards, however, the woman will receive only about $600,000, the story noted. Herta Hopton first complained of pain in her lower right jaw in 2005. Her dentist, R. Peter Maly, D.D.S., referred her to a periodontist, John Sivertson, D.D.S., who detected a white lesion in the bottom of her mouth but diagnosed it as "aspirin burn." She was referred to Warren Vallerand, D.D.S., an oral and maxillofacial surgeon, in May 2006 and saw him four times about the lesion, but he never called for a biopsy. Hopton was finally diagnosed with stage IV skin cancer in November 2006. She has since had more than 20 surgeries to remove part of her jaw and reconstruct it with other bone tissue, according to the Detroit News. Hopton sued all three doctors and the case went to trial, but ended with a hung jury. She settled out of court with Dr. Maly for an undisclosed amount. In a second trial, Dr. Sivertson was exonerated, while the jury found against Dr. Vallerand.

Oral cancer screenings a must, say malpractice attorneys

Source: Dr.Bicuspid.com By: Donna Domino March 10, 2011 -- The patient was insistent: All she wanted was to get her teeth whitened for an upcoming high school reunion. She came in for the $99 Internet special the dentist had run and mentioned a sore on her tongue, but she said it was recent, attributing it to a tongue-biting habit. The dentist did the procedure but advised the patient that she needed a follow-up oral exam. The patient eventually went to an oral surgeon who diagnosed the young mother with terminal tongue cancer. She sued the dentist who did the teeth whitening for malpractice, for missing her oral cancer. That case, Tale of the Tainted Tongue, was dramatized at the recent Chicago Dental Society Midwinter Meeting in a session highlighting the growing number of malpractice suits over missed oral cancer screenings. Anne Oldenburg, an attorney with Alholm, Monahan, Klauke, Hay & Oldenburg, which specializes in dental malpractice cases, participated in the mock trial. Ten years ago she didn't have many such cases, she told DrBicuspid.com. But that scenario has changed dramatically in recent years, she said, noting that she is currently involved in three dental malpractice cases. The mock trial was similar to a previous lawsuit she handled, in which a young man in his 40s died. "It was oral cancer that was clearly missed," Oldenburg recalled. The family settled for $750,000 because the children didn't want to go through the litigation process, but many death cases can reach $1 million [...]

Increasing incidence of oral tongue squamous cell carcinoma in young white women, age 18 to 44 years

Source: jco.ascopubs.org Authors: Sagar C. Patel et al. Purpose: To evaluate the incidence of oral cavity squamous cell carcinoma (OCSCC) and oral tongue squamous cell carcinoma (OTSCC) in young white women, age 18 to 44 years. Patients and Methods: We analyzed incidence and survival data from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute from 1975 to 2007 for OCSCC and OTSCC. Three cohorts were examined: all ages, age 18 to 44 years (ie, “young”), and age > 44 years. Individuals were stratified by sex and/or race. Percentage change (PC) and annual percentage change (APC) were calculated. Joinpoint regression analyses were performed to examine trend differences. Results: Overall, incidence of OCSCC was decreasing for all ages. However, incidence was increasing for young white women (PC, 34.8; APC, 2.2; P

HPV prevalence in men

Source: The Lancet, Volume 377, Issue 9769, Pages 881 - 883, 12 March 2011 Authors: Anna Giuliano et al. In The Lancet, Anna Giuliano and colleagues1 present a prospective study (HPV in Men [HIM]) of the incidence and clearance of human papillomavirus (HPV) infections in men. They also report on male sexual behavior, which determines HPV incidence and clearance. The epidemiology of HPV infections in men is not well understood and thus the results are of substantial interest. The results bring to light important new information, and draw attention to differences between the natural histories of male and female HPV infections, and the need for further studies to better define HPV transmission, progression to disease, and epithelial sites in men. Because HPV infection in men greatly affects disease risk in women,2 transmission and protection are important topics. However, circumcision and condom use have not been clearly shown to fully protect against either HPV acquisition or clearance in male genital sites,3, 4 which questions their value in preventing infection in men and transmission to female partners. Understanding male HPV infection is important to minimize anxiety and the health-care costs associated with genital warts, penile cancer treatment, and morbidity in men, in addition to addressing the acknowledged public health concern created by HPV infection in women. The HIM data on HPV incidence and clearance should be exploited to elaborate prevention guidance, and to minimize transmission and to aid management and associated concerns for couples. Because most HPV infections in men are asymptomatic, [...]

Tongue cancer – experts warn against increasing incidence of tongue disease

Source: starglobaltribune.com Author: Matthew Bennett A UNC study released this week in the Journal of Clinical Oncology finds an increasing incidence of squamous cell carcinoma of the oral tongue in young white females in the United States over the last three decades. A team of researchers from UNC Lineberger Comprehensive Cancer Center analyzed data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database and found that, between 1975 and 2007, the overall incidence for all ages, genders, and races of the disease was decreasing. However, the incidence of oral tongue squamous cell carcinoma rose 28 percent among individuals ages 18 to 44. Specifically, among white individuals ages 18 to 44 the incidence increased 67 percent. The increasing incidence was most dramatic for white females ages 18 to 44. They had a percentage change of 111 percent. Interestingly, the incidence decreased for African American and other racial groups. Historically, oral tongue cancer has been strongly associated with heavy tobacco and alcohol use. Other epidemiological studies have related the decreasing incidence of oral tongue cancer in the United States to the decreased use of tobacco products. Though the UNC research team verified the known decreasing incidence of oral tongue cancer, they were surprised to observe an increasing incidence in young white individuals, specifically young white females. “Lately we have been seeing more oral tongue cancer in young white women in our clinic. So we looked at the literature, which reported an increase in oral tongue squamous cell carcinoma in [...]

Tonsillar squamous cell carcinoma- are we making a difference?

Source: SAGE Journals Online Objective. To analyze outcomes in patients with squamous cell carcinoma (SCCA) of the tonsil from the years 1998 to 2006. To assess factors that may affect disease-specific survival, such as patient characteristics and/or treatment modality. Study Design and Setting. National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program. Subjects and Methods. The SEER database was used to perform a population-based cohort analysis for patients diagnosed with SCCA of the tonsil from 1998 to 2006. Disease-specific survival was correlated with sex, age, ethnicity, year of diagnosis, and treatment modality in a univariate Cox proportional hazards analysis and a multiple Cox-regression model with and without interaction effect. Results. Applied inclusion criteria resulted in 8378 patients. Of this patient cohort, 80% were male and 85% were white. The mean patient age at diagnosis was 58.1 years. On univariate and multivariate analyses, ethnicities other than white carried a significantly higher rate of disease-specific death (hazard ratio = 1.71, P < .001). Each additional year of age at the time of diagnosis carried approximately a 4% increase in likelihood of disease-specific death. With each passing year of time at diagnosis, patients carried a decreased risk of disease-specific death (P < .001); this value was significant in all 3 statistical models. Patients who underwent external-beam radiation had a higher likelihood of disease-specific survival with each passing year at time of diagnosis. Conclusion. Population analysis based on the SEER database reveals increased disease-specific survival from tonsillar SCCA in more recent years. This [...]

Reirradiation for head-and-neck cancer: delicate balance between effectiveness and toxicity

Source: HighWire- Stanford University PURPOSE: To analyze the effectiveness and toxicity of reirradiation (re-RT) for head-and-neck cancer. METHODS AND MATERIALS: A retrospective data analysis was performed of 58 patients who underwent re-RT with curative intent. Re-RT was given as definitive treatment in 53% of patients, whereas salvage surgery preceded reirradiation in 47%. The median cumulative RT dose was 119 Gy (range, 76-140). Concurrent chemotherapy was administered with re-RT (CRT) in 57% of patients. Event-free survival was defined as survival without recurrence and without serious toxicity (?Grade 3). RESULTS: Median follow-up was 57 months (range, 9-140). Locoregional (LR) control was 50% at 2 and 5 years. The 2-year and 5-year overall survival (OS) was 42% and 34%. The following factors were associated with improved OS: postoperative re-RT (vs. primary re-RT), treatment with RT only (vs. CRT) and interval >3 years between previous RT and re-RT. For patients treated with postoperative re-RT and definitive re-RT, the 5-year OS was 49% and 20%, respectively. Patients treated with CRT had a 5-year OS of 13%. Serious (late) toxicity ?Grade 3 was observed in 20 of 47 evaluable patients (43%). Three cases of treatment-related death were recorded. The 2- and 5-year serious toxicity-free interval was 59% and 55%, respectively. Associated with increased risk of serious toxicity were CRT and higher re-RT dose. The event-free survival rates at 2 and 5 years were 34% and 31%, respectively. CONCLUSIONS: Re-RT in head-and-neck cancer is associated with poor survival rates of 13-20% in patients with inoperable disease treated [...]

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