9/27/2004 UK MICHAEL N PEMBERTON MBCHB, FDSRCS(EDIN) & RIGEL B ALLAN MBCHB, FDSRCS The Practitioner ·What are the common benign anatomical variations of the tongue? ·What investigations should be considered in burning tongue? ·When should the GP suspect the presence of oral cancer? The tongue is an accessible organ that has been used for millennia as an indicator of health in both Western and Eastern medical philosophies. This article outlines the most common conditions affecting the tongue, from variations of normal to conditions affecting quality of life and potentially life-threatening lesions. ·Variations of normal Patients are often concerned when a self- examination of the mouth, perhaps prompted by minor injury, irritation or cancer concern, reveals a variety of seemingly pathological lesions. Once noted by patients these variations of normal' can cause psychological distress out of all proportion to their seriousness. It is therefore important to be able to diagnose' anatomical variations and differentiate these from more serious underlying pathologies. Normally, posterior tongue anatomy is difficult to visualize by oneself; however, edentulous patients can often extend the tongue further than when dentate. ·Foliate papilla and lingual tonsils Foliate papillae are slit-like structures found at the extreme posterior aspect of the lateral borders of the tongue. They are associated with lymphoid aggregates (lingual tonsils), which are components of the upper respiratory tract lymphoid ring (Waldeyer's ring). Hyperplasia secondary to upper respiratory tract infection or irritation from teeth makes these areas hyperplastic and uncomfortable and liable to further trauma. ·Circumvallate papillae are the [...]

9/23/2004 no attribution wsoctv.com - Medstar American men have about a one in two risk of developing cancer during their lifetime. For women, the risk is about one in three. This year alone the American Cancer Society estimates 1,368,030 cases will be diagnosed in the U.S. Cancer is the second leading cause of death in this country (after heart disease). About 563,700 Americans will die of cancer in 2004. Although cancer can occur at any age, it is rare in children (about 9,200 cases of childhood cancer will be diagnosed this year). More than three-quarters of all cancers are diagnosed in people 55 and older. The most common cancers in men are: prostate, lung and colon/rectum. In women, the leading cancers are breast, lung and colon/rectum. The leading causes of cancer death for men are lung, prostate and colon/rectum. For women, the top cancer killers are: lung, breast and colon/rectum. More cancers are being detected in early, more treatable stages. In addition, researchers have developed better treatment methods. Nearly 10 million Americans are surviving with a diagnosis of cancer (some are cancer-free while others are still undergoing treatment). Overall, the five-year survival rate for all cancers is about 63 percent. The four main types of cancer treatment are surgery, chemotherapy, radiation therapy and biologic therapy. Traveling for Cancer Treatment Many patients must travel some distance for their treatments. In some cases, local hospitals don't offer treatments for a particular kind of cancer. In other instances, specialized treatment is only available [...]

9/22/2004 E. Cheong, K. Ivory, J. Doleman, M.L. Parker, M. Rhodes and I.T. Johnson Carcinogenesis vol.25 no.10 © Oxford University Press 2004 Epidemiological studies suggest that the use of NSAIDs and/or a high intake of fruit and vegetables reduce the risk of oesophageal adenocarcinoma. Since COX-2 is up-regulated in Barrett's oesophageal carcinogenesis, the protective effect of NSAIDs and natural food components might reflect COX-2 inhibition. We explored the effects of quercetin, a natural flavonoid with a potent COX-2 inhibitory activity, and two commercially available selective COX-2 inhibitors (NS-398 and nimesulide) on cell proliferation, apoptosis, PGE2 production and COX-2 mRNA expression in a human oesophageal adenocarcinoma cell line (OE33). Changes in the relative numbers of adherent and floating cells were quantified and apoptotic cells were identified using ethidium bromide and acridine orange staining under fluorescence microscopy. Flow cytometric analysis of adherent and floating cells was used to quantify apoptosis and to examine the effects of the agents on the cell cycle. After 48 h exposure at concentrations of 1 µM both COX-2 inhibitors and quercetin suppressed cell proliferation (P < 0.01) and increased the fraction of floating apoptotic cells. At higher concentrations (50 µM) and longer exposure (48 h) the effects of quercetin were significantly greater than those of the selective COX-2 inhibitors (P < 0.01). Cell cycle analyses showed that quercetin blocked cells in S phase, while the selective COX-2 inhibitors blocked cells in G1/S interphase. COX-2 mRNA expression was suppressed by quercetin and the synthetic COX-2 inhibitors in a [...]

9/21/2004 Columbus, Ohio Larry Gierer Ledger Inquirer Still, many survivors and doctors shy away from the word 'cure'. Mary Starke Harper, 85, knows something about cancer. The Columbus resident has doctorate degrees in clinical psychology and medical sociology and a master's in nursing. She's been an adviser on health issues to four Presidents of the United States. And she's had the disease. In 1968, she had her left breast removed. In January, more than 35 years later, cancer was found in her other breast. "I don't think you can use the word 'cured,' " Harper said, "because there is always a chance of recurrence. People who have had cancer are always haunted by it. Every time something goes wrong with their body, they think it has returned." Nearly 10 million Americans have battled cancer, including 1.4 million who had it more than 20 years ago and are called "long-term survivors" by those afraid to call them cured. At a time when more people are cured of cancer than ever before, fewer doctors seem willing to say so. "The medical community has backed off the term 'cured,"' said Julia Rowland, a psychologist who directs the federal Office of Cancer Survivorship, which was started in 1996, the year Lance Armstrong began treatment for testicular cancer that had spread to his lungs and brain. The cyclist has since boasted of beating the disease, and this summer he won his sixth Tour de France. Some cancers -- certain lymphomas and leukemias in particular -- [...]

9/20/2004 S. K. Jain, A. Kumar and J. K. Singh Journal of Clinical Oncology, Annual Proceedings Vol 22, No 14S Background: Since inception goal of radiotherapy is to deliver high dose to tumor with maximum sparing of normal tissue with brachytherpy there is rapid fall of dose beyond implanted area, thus delivering high dose to target with sparing of surrounding normal tissue. In early stage node negative oral cavity cancer surgery and radiotherapy produces equal result but radiotherapy is considered superior as it causes less functional and cosmetic deficit. Method: We present 25 patient of oral cavity cancer treated with HDR brachytherapy alone or in combination with external beam radiotherapy (EBRT). Interstitial implant was done using flexible plastic tubing or rigid stainless steel needles under local or general anesthesia. A dose of 45 to 51 Gy in 15 to 17 fractions, 3 Gy per fraction, two fractions per day with a gap of 6hr in-between, was delivered with HDR brachytherpy alone. When combine with EBRT 24 to 30 Gy was delivered with HDR bracytherapy, and 36 to 40 Gy by EBRT. Result: Complete clinical response was noted, in all the patients at six weeks of completion of RT. Two out of twenty five patients have local recurrence and were salvaged by surgery. Nodal failure was observed in two patients and was managed by radical neck dissection. With mean follow-up of fourteen months, all patients are alive disease free. Localize grade III mucositice was observed in all the patients, no grade [...]

9/20/2004 Bruce H. Campbell et al. Arch Otolaryngol Head Neck Surg. 2004;130:1100-1103 Objective To determine associations between objective assessments (swallowing function and weight change) and subjective quality-of-life (QOL) measures. Design Observational case series using clinical testing and questionnaires. Setting University hospital-based tertiary clinical practice. Patients Convenience sample of 5-year survivors of head and neck cancer (62 nonlaryngectomy survivors were studied). Interventions Objective testing included examination, weight history, videofluoroscopic swallow studies (VFSS), and oropharyngeal swallowing efficiency (OPSE). Subjective testing included QOL questionnaires (University of Washington Quality-of-Life [UWQOL] Scale, Performance Status Scale for Head and Neck Cancer Patients [PSS-HN], Functional Assessment of Cancer Treatment–General [FACT-G] Scales, and Functional Assessment of Cancer Therapy–Head and Neck [FACT-H&N] Scale). Main Outcome Measures Aspiration (identified by VFSS), weight change, and QOL measures. Results Aspiration was associated with the decreased QOL scores in chewing, swallowing, normalcy of diet, and additional concerns of the FACT-H&N Scale. No association was found between aspiration and willingness to eat in public, subjective understandability, or any of the FACT-G scales. Of the nonlaryngectomy survivors, 27 (44%) demonstrated some degree of aspiration during VFSS. Associations were found between aspiration, primary tumor T stage, weight change, and OPSE. Aspirators lost a mean of 10.0 kg from precancer treatment weight, while nonaspirators gained a mean of 2.3 kg (P<.001). Mean OPSE scores were 69 for nonaspirators and 53 for aspirators (P = .01). Conclusions Almost half of long-term nonlaryngectomy head and neck cancer survivors demonstrated at least some degree of aspiration. The presence of aspiration [...]

9/19/2004 J. Sudbø et al Journal of Clinical Oncology, 2004 ASCO Annual Meeting Proceedings Abstract: Background: Oral cancer is a tobacco-related cancer, with high morbidity and mortality. Although there is evidence of a possible protective effect of aspirin on oesophageal cancer, only scattered data exist on its role on cancer of the oral cavity or larynx. Methods: We performed a population-based nested case-control study by combining data from the Norwegian Institute of Public Health and the Norwegian Cancer Registry. Among persons accrued to the health survey in the period 1975-1990, 3275 persons at high risk for oral cancer, as judged by their tobacco habits, were identified through the databases of a population based national health survey, and the occurrence of carcinomas in this group was assessed through cross-linking with the database of the Norwegian cancer Registry. Additional information regarding smoking habits, medication, age, sex and comorbidity was entered in the database of the Norwegian Institute of Public Health. Results: Among the 3275 persons identified to be at risk of oral cancer, 496 were identified with a squamous cell carcinoma of the oral cavity. 454 matches controls were identified among the other 2779 person identified to be at risk of oral cancer. The hazard ration for developing oral cancer was. Among the 992 person included in the analysis (454 person from the case group and 454 person from the matched control group), 690 did not have a history of long-term NSAID use, while 302 did. The hazard ratio for developing oral [...]

9/19/2004 By Christopher Cundy Plastics & Rubber Weekly New research by scientists has concluded that formaldehyde, a chemical used in thermoset plastics and rubber manufacture, does pose a cancer risk to humans. An international study by the International Agency for Research on Cancer, part of the World Health Organisation, concluded that formaldehyde causes nasopharyngeal cancer, a relatively rare form of cancer in developed countries that occurs in the upper throat behind the nose. It had earlier stated that formaldehyde was a probable carcinogen. The group also found limited evidence that the chemical causes cancer of the nasal cavity and paranasal sinuses, and “strong but not sufficient” evidence for leukaemia. More than one million workers in the EU are exposed to some degree. “A very wide range of exposure levels has been observed in the production of resins and plastic products. The development of resins that release less formaldehyde and improved ventilation has resulted in decreased exposure levels in many industrial settings in recent decades,” the agency said.

9/19/2004 By DARLA CARTER The Marion Star, Gannett News Service It's a habit that can leave you with bad breath, mouth lesions and a disfigured face, yet an estimated 7.8 million Americans use smokeless tobacco. Tobacco use carries a risk of oral cancer, but users sometimes avoid seeing a dentist, who can detect early signs, says dentist Dr. Lee Mayer. "A lot of times they don't appear in a dentist's office about anything in their mouth until they either have a toothache, or they have some type of growth or something's going on, and they realize that there's a problem and they get scared," says Mayer, director of community dental health at the University of Louisville School of Dentistry. "This is especially true with the younger crowd." Nationally, 18- to 25-year-olds make up the largest percentage of people who use smokeless tobacco, according to the federal government's 2002 National Survey on Drug Use and Health. Smokeless tobacco includes snuff, finely ground tobacco that's held between the cheek and gum, and chewing tobacco, which is bulkier and comes in leaf and plug form, according to the National Cancer Institute. "It's one of those types of things you can do in secret, you know, and once you're hooked, you're hooked," Mayer says. "There's no telltale smoke from it, and like any tobacco product, it's highly addictive." Smokeless tobacco has been acceptable and common among certain populations, such as rural people, for a long time, Mayer says. It's also popular among some athletes, [...]

9/19/2004 American Society for Therapeutic Radiology and Oncology To help patients understand the importance of radiation therapy in the treatment of head and neck cancer, the American Society for Therapeutic Radiology and Oncology has published the new patient information brochure Radiation Therapy for Head and Neck Cancer: A Patient's Guide to Understanding Treatment. "As a head and neck cancer specialist, I know how a cancer diagnosis can be overwhelming for patients and their families," said Louis Harrison, M.D., Co-chair of the ASTRO Communications Committee and a radiation oncologist at Beth Israel Medical Center in New York. "There have been many advances in radiation therapy to treat head and neck cancer in recent years. The patient literature available hasn't been able to keep up. We hope this brochure will help patients better understand the importance of radiation therapy in the treatment of their cancer." This year, about 62,000 Americans will be diagnosed with cancer of the oral cavity, pharynx, larynx and thyroid. Rates of head and neck cancer are nearly twice as high in men and are greatest in men over age 50. Many of these patients are not aware that radiation therapy is often combined with surgery and/or chemotherapy to treat cancers of the face, mouth and throat. To help patients understand their treatment options, ASTRO has taken the initiative in developing an up-to-date brochure that patients can use to talk with their healthcare providers when contemplating radiation therapy. The brochure also helps patients find support groups and information on [...]