1/1/2008 web-based article Leslie DeLong RDH Magazine (www.rdhmag.com) Educators view dental hygiene students with enthusiasm, and students have the sincere hope that they can change the lives of patients by providing excellent care. Students are educated in an ideal environment and required to practice under the scrutiny of professionals who demand the highest standards in treatment. It is hoped that students who are taught these high standards will practice them after graduation. However, once students graduate and enter private practice, they often enter less than perfect environments and develop poor work habits and short cuts that alter the valued priorities of the academic setting. Many hygienists and even dentists admit they no longer spend time performing the thorough oral screening exam they learned in school. The purpose of this article is to encourage clinicians who are providing this service to (1) continue to do so, (2) motivate other clinicians to provide this service, and (3) review appropriate technique, documentation and referral protocols. The American Cancer Society estimates that 34,360 new cases of oral cavity and pharyngeal cancer will be diagnosed in 2007, and that 7,550 deaths from oral and pharyngeal cancer will occur in 2007.1 The five-year and 10-year survival rates for oral and pharyngeal cancers are 60 percent and 48 percent respectively.1 This five-year survival rate is one of the lowest of all major cancers because a majority of the lesions are not diagnosed until they are more advanced. Early detection increases the chances of survival. However, between 1990 [...]

1/1/2008 Baltimore, MD press release www.newswise.com A morning gargle could someday be more than a breath freshener – it could spot head and neck cancer, say scientists at the Johns Hopkins Kimmel Cancer Center. Their new study of a mouth rinse that captures genetic signatures common to the disease holds promise for screening those at high risk, including heavy smokers and alcohol drinkers. Lead investigator Joseph Califano, M.D., says his group at Johns Hopkins asked 211 head and neck cancer patients and 527 individuals without cancers of the mouth, larynx or pharynx to brush the inside of their mouths, then rinse and gargle with a salt solution. The researchers collected the rinsed saliva and filtered out cells thought to contain one or more of 21 bits of chemically altered genes common only to head and neck cancers. Tumor and blood samples also were collected. The cellular mishaps occur when small molecules called methyl groups clamp on to the DNA ladder structure of a gene. In the grip of too many methyl groups, these genes can incorrectly switch on or off in a process called hypermethylation. “Mass-methylation” of particular genes can lead to cancer, the researchers say. Methylation mistakes in other genes could be triggered simply by aging and amount to no more than fine lines and wrinkles. “The challenge is to predict which hypermethylated genes are most specific to cancer,” says Califano, an associate professor of otolaryngology – head and neck cancer and oncology at Johns Hopkins. And because every [...]

12/31/2007 web-based article Lisa Martin TopCancerNews.com A multidisciplinary team of UCLA scientists were able to differentiate metastatic cancer cells from normal cells in patient samples using leading-edge nanotechnology that measures the softness of the cells. The study represents one of the first times researchers have been able to take living cells from cancer patients and apply nanotechnology to analyze them and determine which were cancerous and which were not. The nano science measurements may provide a potential new method for detecting cancer, especially in cells from body cavity fluids where diagnosis using current methods is typically very challenging. The method also may aid in personalizing treatments for patients. When cancer is becoming metastatic, or invading other organs, the diseased cells must travel throughout the body. Because the cells need to enter the bloodstream and maneuver through tight anatomical spaces, cancer cells are much more flexible, or softer, than normal cells. These spreading, invading cancer cells can cause a build-up of fluids in body cavities such as the chest and abdomen. But fluid build-up in patients does not always mean cancer cells are present. If the fluid could be quickly and accurately tested for the presence of cancer, oncologists could make better decisions about how aggressive a treatment should be administered or if any treatment is necessary at all. In this study, researchers collected fluid from the chest cavities of patients with lung, breast and pancreatic cancers, a relatively non-invasive procedure. One problem with diagnosing metastatic disease in this setting is [...]

12/31/2007 Aurora, CO Kyle Rusthoven et al. Int J Radiat Oncol Biol Phys, December 8, 2007 Purpose: Patients with head and neck cancer have a significant risk of developing a second primary cancer of the head and neck. We hypothesized that treatment with external beam radiotherapy (RT) might reduce this risk, because RT can eradicate occult foci of second head and neck cancer (HNCA). Methods and Materials: The data of patients with Surveillance, Epidemiology, and End Results Historic Stage A localized squamous cell carcinoma of the oral cavity, larynx, and pharynx were queried using the Surveillance, Epidemiology, and End Results database. For patients treated with or without RT, the incidence of second HNCA was determined and compared using the log-rank method. Cox proportional hazards analysis was performed for each site, evaluating the influence of covariates on the risk of second HNCA. Results: Between 1973 and 1997, 27,985 patients were entered with localized HNCA. Of these patients, 44% had received RT and 56% had not. The 15-year incidence of second HNCA was 7.7% with RT vs. 10.5% without RT (hazard ratio 0.71, p <0.0001). The effect of RT was more profound in patients diagnosed between 1988 and 1997 (hazard ratio 0.53, p <0.0001) and those with pharynx primaries (hazard ratio 0.47, p <0.0001). On multivariate analysis, RT was associated with a reduced risk of second HNCA for pharynx (p <0.0001) and larynx (p = 0.04) tumors. For oral cavity primaries, RT was associated with an increased risk of second HNCA in [...]

12/31/2007 Baltimore, MD SK Mithani et al. Clin. Cancer Res., December 15, 2007; 13(24): 7335-40 Purpose: Alterations of the mitochondrial genome have been identified in multiple solid tumors and in many head and neck squamous cell carcinomas (HNSCC). Identification of mitochondrial mutations in the salivary rinses of patients with HNSCC has potential application in disease detection. In this study, we used the MitoChip v2.0 mitochondrial genome resequencing array to detect minor populations of mitochondrial DNA in salivary rinses of patients with HNSCC. Experimental Design: Salivary rinses from 13 patients with HNSCC, whose tumors carried mitochondrial mutations, were collected before surgical resection. DNA isolated from salivary rinses and serial dilutions of DNA derived from HNSCC-derived cell lines with known mitochondrial mutations were sequenced using the MitoChip, and analyzed using a quantitative algorithm which we developed to detect minor populations of mitochondrial DNA from MitoChip probe intensity data. Results: We detected heteroplasmic populations of mitochondrial DNA up to a 1:200 dilution using MitoChip v2.0 and our analysis algorithm. A logarithmic relationship between the magnitude of assay intensity and concentration of minor mitochondrial populations was shown. This technique was able to identify tumor-specific mitochondrial mutations in salivary rinses from 10 of 13 (76.9%) patients with head and neck cancer. CONCLUSIONS: Minor populations of mitochondrial DNA and disease-specific mitochondrial mutations in salivary rinses of patients with HNSCC can be successfully identified using the MitoChip resequencing array and the algorithm which we have developed. This technique has potential application in the surveillance of patients after [...]

12/31/2007 Chicago, IL A Langerman et al. Arch Otolaryngol Head Neck Surg, December 1, 2007; 133(12): 1289-95 Objective: To review the incidence of aspiration after chemoradiation therapy in patients with head and neck cancer (HNC). Design: Retrospective review. Setting: Academic institution. Patients: One hundred thirty patients with advanced HNC underwent chemoradiation therapy at our institution between 1998 and 2002 as part of a larger, multi-institutional, prospective study of induction chemotherapy followed by chemoradiation therapy; the 118 patients (91%) for whom oropharyngeal motility (OPM) study data were available are discussed in this article. Main Outcome Measures: Incidence of trace ( 5%) aspiration (deep laryngeal or tracheal penetration) as determined by pretreatment and posttreatment OPM studies and correlation of the findings with the patients' reported symptoms. Results: Eighty-one patients (69%) underwent at least 1 OPM study demonstrating aspiration within the first year after chemoradiation therapy, with 30 (25%) demonstrating frank aspiration. Of the patients who aspirated, 61 (75%) reported no symptoms of coughing or choking (80% of trace and 67% of frank aspirators). The patients with cancer of the larynx and hypopharynx were more likely to be aspirators (P = .007 and P = .004, respectively). Of the 62 patients with available pretreatment OPM data, 33 (53%) demonstrated aspiration at baseline. Conclusions: Aspiration is highly prevalent among patients with advanced HNC at baseline and is worse in the posttreatment period after chemoradiation therapy. The majority of these patients report no symptoms. All patients with advanced HNC should undergo instrumental swallow assessment, even [...]

12/28/2007 web-based article Zosia Chustecka Medscape.com This past year had 6 major clinical cancer advances and a further 18 that are considered "notable," according to the American Society of Clinical Oncology (ASCO) in its independent annual review. The report, Clinical Cancer Advances 2007, has been published online December 17 in the Journal of Clinical Oncology. In the report, ASCO officials review what they consider to be the most significant cancer research presented or published over the past year, much of which has already been reported in news articles on Medscape Oncology. Together, these advances demonstrate "the important progress being made on the front lines of clinical cancer research today," says ASCO president Nancy Davidson, MD. ASCO lists the following as major advances: = Magnetic resonance imaging for breast cancer screening. - The role of human papilloma virus in head and neck cancers. - Decreasing use of hormone replacement therapy linked to declines in breast cancer cases. - Preventive radiation therapy improves survival and decreases brain metastases in patients with advanced small-cell lung cancer. - Sorafenib (Nexavar, Onyx/Bayer) improves survival in liver cancer. = Bevacizumab (Avastin, Genentech/Roche) improves treatment of advanced kidney cancer. The report notes that in recent years, 3 new agents have been approved for kidney cancer — sorafenib, sunitinib (Sutent, Pfizer), and temsirolimus (Torisel, Wyeth) — and future trials will need to compare bevacizumab with these agents and explore combinations. The following are considered to be "notable" advances: - Arsenic trioxide (Trisenox, Cell Therapeutics Inc) improves leukemia survival. [...]

12/28/2007 San Francisco, CA staff medGadget.com Radiation-induced oral mucositis is the most common complication observed in patients with head and neck cancer who underwent radiation therapy. Thanks to a newly developed supersensitive infrared camera from Argonne National Laboratory, early diagnosis and possible prevention and/or treatment of oral mucositis could be possible: While buccal and other head-and-neck cancers are treatable and frequently curable, patients who undergo the necessary treatment regimen -- a combination of radiation and chemotherapy -- frequently develop unpleasant side effects. One of the most common and painful of these, oral mucositis, involves the inflammation and ulceration of the mucous membranes of the mouth and soft palate. These sores can make speaking, eating or even opening the mouth extraordinarily painful. If patients experience especially severe toxicity, they may temporarily lose the ability to taste or may even need to be fed through a tube... As part of the ongoing National Cancer Initiative, researchers at the U.S. Department of Energy's Argonne National Laboratory have teamed up with oncologists at the University of Chicago to use infrared imaging of the head and neck to predict which patients have the highest risk for severe mucositis. Patients who show local increases in temperature around the tumor site in the immediate wake of the initial round of treatment may be more likely to suffer later side effects, said Ezra Cohen, a University of Chicago oncologist who will head up the clinical side of the project. Cohen, in collaboration with Valentyn Novosad, a principal investigator [...]

12/25/2007 web-based article Nicholas Choong, MD and Everett Vokes, MD CA Cancer J Clin 2007 The multidisciplinary approach to treating squamous cell carcinoma of the head and neck is complex and evolving. This article aims to review some recent developments in squamous cell carcinoma of the head and neck, in particular the expanding role of chemotherapy in its management. Surgery and radiotherapy have remained the mainstay of therapy. Chemotherapy is increasingly being incorporated into the treatment of squamous cell carcinoma of the head and neck. Previously, radiotherapy following surgery was the standard approach to the treatment of locoregionally advanced resectable disease. Data from randomized trials have confirmed the benefits of concurrent chemoradiotherapy in the adjuvant setting. Chemoradiotherapy is also the recommended approach for unresectable disease. Induction chemotherapy has been useful in resectable disease where organ preservation is desirable, but this approach was inferior for the goal of larynx preservation, while leading to similar survival when compared with concomitant chemoradiotherapy. There is recent evidence that taxanes added to induction chemotherapy with cisplatin and fluorouracil result in improved survival outcomes. Novel targeted agents, such as epidermal growth factor receptor antagonists, are showing promise in the treatment of patients with both locoregionally advanced and recurrent/metastatic squamous cell carcinoma of the head and neck.

12/25/2007 London, England staff inthenews.co.uk Cancerous tumours can be detected under the skin by using tiny gold particles embedded with dyes, a new study claims. Scientists at Emory University and the Georgia Institute of Technology said the new technique could one day help doctors to detect and diagnose cancer earlier and less invasively. The researchers injected mice with gold particles studded with antibody fragments called ScFv peptides that bind cancer cells. They found that the particles grab on to tumours, and when illuminated with a laser beam they send back a signal that is specific to the dye. Writing in the journal Nature Biotechnology, the scientists say the cancer cells were detected at a depth of 1cm to 2cm, making the gold particles an especially appropriate tool for head and neck tumours that tend to be more accessible. They argue that the treatment will need further adaptation before it can be used for lung or abdominal cancers deep within the body. The gold particles are extremely bright and are about 60 to 80 nanometres in diameter – thousands of times smaller than a human hair. "I expect that with these probes it will be possible to detect cancer much earlier, at the microscopic level," said Dr Dong Moon Shin, associate director of Emory's Winship Cancer Institute. "Even a half-centimetre-wide nodule contains millions of cancer cells, but with this technology we can detect many fewer cells at a time." The researchers now plan to modify the coatings of the nanoparticles to [...]