3/14/2006 Ottawa, Ontario, Canada Olli-Pekka Alho et al. Canadian Medicl Association Journal • March 14, 2006; 174 (6). doi:10.1503/cmaj.050623 Background: Little is known about the diagnosis of head and neck carcinoma in primary care. We sought to estimate the general prevalence of symptoms reported by patients with head and neck carcinomas and to determine the association between detection patterns of head and neck cancer cases in primary care and survival. Methods: In a cross-sectional survey, we used a questionnaire to estimate the general prevalence of symptoms associated with head and neck cancer from a sample of 5646 primary care visits in 25 randomly selected health centres over 4 weeks throughout Finland. A population-based retrospective cohort study involved the 221 patients resident in one primary health care district (population about 700 000) in whom head and neck carcinoma was diagnosed between Jan. 1, 1986, and Dec. 31, 1996. Data on the initial primary care visit, clinical characteristics and survival were obtained from patient charts. Results: Of 5646 visits to a primary care practitioner, 11% (617) were made because of the same symptoms as those initially reported by patients later found to have head and neck cancer. According to the cohort data, the detection rate of these carcinomas in primary care was 1 per 63 000 visits. At the initial visit of 221 patients later found to have cancer, 56% (123) received referrals, 24% (53) follow-up appointments and 20% (45) neither ("overlooked"). At 3 years, the risk of death was significantly higher [...]

3/10/2006 Baltimore, MD Judy Foreman Baltimore Sun (www.baltimoresun.com) A year ago, when Gayle Driscoll's cancer recurred on her skin, the 63-year-old retired teacher from Barnstable, Mass., tried an experimental treatment that gave her radiation therapy some extra oomph. Every time she lay down for radiation treatment on her chest, her tumors were also heated with a device that emitted radio frequency waves. After six weeks, the skin tumors were gone. The heat therapy called hyperthermia was meant only as a local treatment - and the cancer ultimately spread to her bones - but it was "psychologically important" to her to see the tumors in her skin disappear, she said. Hyperthermia, in which microwaves are used to raise the temperature of a tumor - or the patient's whole body - to 104 to 106 degrees Fahrenheit, is a new twist on an old treatment idea that has gained new currency recently, thanks to some successful studies. Hyperthermia significantly boosts the killing power of chemotherapy and radiation. It is generally used to help prevent local recurrences, but some doctors speculate that it may improve overall survival as well. At least eight studies in recent years have shown that adding hyperthermia to chemotherapy or radiation can improve local control of cancers of the esophagus, cervix, head and neck, brain, melanoma and breast cancers that have spread to the chest wall, said Dr. Mark Dewhirst, director of the hyperthermia program at Duke University Medical Center in Durham, N.C. Scientists who have observed first hand [...]

3/10/2006 Zurich, Switzerland Sandro J. Stoeckli, MD et al. Annals of Surgical Oncology 12:919-924 (2005) Background: The Second International Conference on Sentinel Node Biopsy in Mucosal Head and Neck Cancer was hosted by the Department of Otorhinolaryngology, Head and Neck Surgery of the University Hospital in Zurich, Switzerland, from September 12 to 13, 2003. The aims of this conference were to present the results of validation studies and to achieve a consensus on methodological requirements. Methods: More than 80 delegates from 20 countries attended the conference. The presented validation studies were summarized and compared with the literature. Consensus was achieved concerning requirements for lymphatic mapping and histopathologic work-up. Results: Twenty centers presented results on 379 patients with cN0 disease. Sentinel nodes were identified in 366 (97%) of 379. Of these 366, 103 (29%) were positive for occult metastasis, and 263 (71%) were negative. Of those 263 patients, 11 patients (4%) showed nodal disease not revealed by the sentinel lymph node biopsy (SNB). The negative predictive value of a negative sentinel node for the remaining neck was 96%. The consensus conference resulted in the use of a radiotracer, lymphoscintigraphy, and a handheld gamma probe for lymphatic mapping as minimal requirements. The use of conventional hematoxylin and eosin staining and immunohistochemistry for cytokeratin is mandatory. Step-sectioning of the entire node at intervals of 150 µm is recommended. Conclusions: The conference attracted delegates from all over the world, thus underscoring the high interest in the topic. With regard to the presented data and [...]

3/9/2006 New York, NY staff Forbes.com Researchers may be within spitting distance of a reliable, saliva-based early detection test for oral cancer. "It's nothing more than having someone spit. And 24 hours after the sample is mailed in, that information could be known to the individual -- whether you're at risk of having oral cancer," said study senior researcher Dr. David T. Wong, director of the Dental Research Institute at the University of California, Los Angeles. His team presented its findings Thursday at the American Association for Dental Research annual meeting, in Orlando, Fla. According to the American Cancer Society, each year more than 31,000 Americans are diagnosed with some form of oral cancer, and more than 7,000 people die from the disease. Smoking and the use of smokeless tobacco products, as well as excessive drinking, are both risk factors for oral malignancies. According to Wong, early detection is key to beating oral cancer. "The later you detect it, the more dreadful the outcome," he said. "For example, someone who has what we call stage 3 disease -- there are stages one through four -- has only a 20 percent chance of survival. But if you detect that person's disease at stage one, he'll have a 90 percent chance of survival over five years." Regular, thorough oral exams by a trained professional can spot lesions early on, but "not every dentist or health-care provider does a full oral heath exam," Wong said. That's why he and other researchers are working [...]

3/8/2006 England A M Kirby et al. British Journal of Cancer (2006) 94, 631-636 Head and neck cancer is the sixth most common malignant tumour diagnosed in Europe. More than 100 000 cases were diagnosed in Europe in 2000 with more than 50 000 deaths occurring in the same year. Many patients present with locally advanced, unresectable (stages III and IV) disease in which the standard treatment is a combination of platinum-based chemotherapy and radiotherapy. For patients who relapse after such treatment, the only curative treatment option is surgical. If this is not possible, as is often the case, platinum-based chemotherapy is frequently used as palliative therapy (Forastiere et al, 1992; Jacobs et al, 1992) Other drugs that have some activity in this tumour type include bleomycin, methotrexate, taxanes, gemcitabine and vinorelbine (Clark et al, 2001; Basaran et al, 2002). However, tumour response rates rarely exceed 30-35% (Liggett and Forastiere, 1995) and responses are usually of short duration such that the outlook in the setting of recurrent/metastatic disease is poor, with 1-year survival below 30% and median survival only 4 months. Treatment options for patients with progressive disease (PD) are limited and, therefore, this is an area of high unmet need. The epidermal growth factor receptor (EGFR), a member of the erbB family of receptors, is a transmembrane glycoprotein whose intracellular domain has tyrosine kinase activity. Activation of the EGFR increases the proliferation, differentiation and survival of cancer cells via multiple phosphorylation-dependent signalling cascades down to transcription factors in the [...]

3/8/2006 Memphis, TN staff CancerConsultants.com According to an early online article published in the Journal of Clinical Oncology, circulating ribonuclease acids (RNAs) present in a blood sample may help detect oral cancer. Oral cancer, or cancer of the mouth, is considered a type of head and neck cancer. Approximately 40,000 people in the US are diagnosed with head and neck cancer every year. In 2005 the American Cancer Society estimated that 11,000 people would die from head and neck cancer. The earlier that oral cancer is detected, the greater the cure rate with standard therapy. Therefore, “markers” that accurately detect early oral cancers may help improve survival among patients with this disease. Research continues into early detection of head and neck cancers since a significant portion of patients has advanced disease upon diagnosis. Researchers from the University of California, Los Angeles (UCLA), recently conducted a clinical study to evaluate the accuracy of the presence of RNA (a type of genetic protein) in circulating blood in detecting oral cancer. This trial included 32 patients with early oral squamous cell carcinoma (the most common type of oral cancer; designated by the type of cell where the cancer originated), and 35 healthy patients. All patients had their blood drawn and tested for the presence of specific mRNAs. A combination of markers (specific RNAs) detected 91% of the cancers. The same combination of markers accurately distinguished 71% of cancers from non-cancerous conditions. The researchers concluded that, although these findings need further confirmation, results from [...]

3/8/2006 Iowa City, IA staff CancerConsultants.com Among selected patients with head and neck cancer that has not yet spread to distant sites in the body, combination chemotherapy and radiation therapy appears to cure many patients without the need for surgical removal of the affected area. These results were published in the Journal of Clinical Oncology. Approximately 40,000 people in the US are diagnosed with head and neck cancer every year. Cancers of the head and neck comprise several types of cancers affecting the nasal cavity and sinuses, oral cavity, nasopharynx (upper part of throat, behind ear), oropharynx (middle part of throat, including soft palate, base of tongue, and tonsils), and other sites throughout the head and neck. In 2005 the American Cancer Society estimated that 11,000 people would die from head and neck cancer. To describe patient outcomes after treatment of head and neck cancer with radiation therapy and combination chemotherapy delivered at the same time (concurrent), researchers at the Cleveland Clinic Foundation assessed 222 patients who were treated between 1989 and 2002. All patients had squamous cell cancer of the head or neck that had not yet spread to distant sites in the body. A majority of the patients had stage III or stage IV cancer, and a small number had stage II cancer. Patients received radiation therapy once or twice daily. During the first and fourth weeks of radiation therapy, patients also received chemotherapy with fluorouracil and cisplatin. Patients underwent surgery to remove the cancer only if there [...]

3/8/2006 St. Louis, MO staff YubaNet.com Before you take that walk or ride a bike, think again - especially if you will be undergoing a positron emission tomography (PET) scan any time soon. "Any type of physical activity - from tapping your feet while in the waiting room to jogging the neighborhood the day before - can affect the results of a PET scan and lead to false-positive results," said Medhat M. Osman, M.D., ScM, Ph.D., assistant professor in the department of internal medicine's division of nuclear medicine and director of PET at St. Louis University Hospital, St. Louis, Mo. "Knowing whether a patient has participated in physical activity is relevant in interpreting a PET imaging study," added the co-author of "Prevalence and Patterns of Physiologic Muscle Uptake Detected With Whole-Body 18F-FDG PET," which appears in the March issue of the Journal of Nuclear Medicine Technology. "Individuals undergoing PET scans should take it easy - and if you do any kind of physical activity outside of the ordinary - you should let your nuclear medicine technologist know so it can be noted," said Thomas C. Schlarman, MBA, CNMT, educational coordinator with the department of nuclear medicine technology at St. Louis University. Physical activity may trigger a potential source of false-positive results on a PET scan in about one out of eight patients, he noted. In order to obtain the most accurate reading of PET scans, patients should not exercise excessively 48 hours prior to having a PET scan and should [...]

3/7/2006 Iowa City, IA staff cancerconsultants.com According to a recent article published in the International Journal of Radiation Oncology, Biology, Physics, the treatment combination of chemotherapy plus radiation therapy results in improved outcomes compared to aggressive radiation therapy for cancers of the oropharynx or hypopharynx that cannot be surgically removed. Approximately 40,000 people in the US are diagnosed with head and neck cancer every year. Cancers of the head and neck comprise several types of cancers affecting the nasal cavity and sinuses, oral cavity, nasopharynx, oropharynx, and other sites throughout the head and neck. In 2005 the American Cancer Society estimated that 11,000 people would from head and neck cancer. The oropharynx is the part of the throat that lies behind the mouth. The hypopharynx is the bottom part of the throat that leads to the esophagus (tube leading to the stomach) and the larynx (tube where air passes to the lungs). Standard treatment for cancer of the oropharynx or hypopharynx is largely determined by the stage (extent to which the cancer has spread) as well as the specific locations to which the cancer has spread. The patient’s overall medical condition is also a consideration. Treatment typically consists of radiation therapy, chemotherapy with surgery, or surgery alone. Unfortunately, a significant portion of patients are not able to undergo surgery; this condition is referred to as “unresectable”. Cancer is typically considered unresectable due to the extent of spread of the cancer, the structures to which the cancer has spread, or the [...]

3/5/2006 Chicago, IL Martin K. Bench, DDS J Am Dent Assoc, Vol 137, No 3, 294 Letters: I am writing in response to Dr. Charles Hapcook’s November JADA column, "Risk Management Considerations for Oral Cancer" ( JADA 2005;136: 1566–7[Medline] ). Dr. Hapcook writes, "For abnormalities or suspicious lesions found during the evaluation, the dentist should either schedule the patient for a reevaluation or properly refer the patient. Failure to follow these procedures on a timely basis can result in a more severe medical and dental consequence for the patient and an onerous legal consequence for the dentist, especially in the case of oral cancer." Many JADA readers, no doubt, are well aware of the value of the oral brush biopsy in the early detection of precancerous and cancerous oral lesions. The great majority of oral abnormalities are not "suspicious" and, therefore, do not warrant referral or need for biopsy. Rather, dentists are faced, almost daily, with evaluating lesions that have minimal or no suspicious features, and no obvious etiology. It is precisely these types of lesions that dentists should evaluate with the brush biopsy, since some will prove to be pre-cancerous or cancerous, despite their benign appearance. These types of lesions develop in all ages, including in young patients, in those with no risk factors for oral cancer and, increasingly, in women. Personally, I have found the brush biopsy to be an invaluable and reliable tool in my practice. The brush biopsy provides my referring dentists and, more importantly, my [...]