Taste, smell dysfunction may persist after HNSCC treatment for longer than survivors anticipate

Source: www.oncologynurseadvisor.com
Author: Bette Weinstein Kaplan

Many people who survive squamous cell cancers of the head and neck (HNSCC) experience difficulty eating and drinking. The problem goes beyond the survivors’ active disease state and into recovery, where it continues to negatively affect their quality of life. HNSCC is the seventh most common cancer worldwide. These cancers are usually found in the oral cavity, pharynx, and larynx. Although often attributed to alcohol and tobacco use in the past, many malignancies seen today result from exposure to the human papillomavirus (HPV).

Treatment plans for HNSCC include combination regimens such as chemoradiation or single therapy such as surgery or radiation by itself. Taste dysfunction is one of the most common adverse effects patients report after treatment, and it has a significant impact on patients’ quality of life.

M. Yanina Pepino, PhD, professor of Food Science and Human Nutrition at the University of Illinois Urbana-Champaign, and her colleagues recently conducted a study on the long-term effects of HNSCC treatment. Their goal was to determine when and if senses of taste and smell fully recover after treatment is completed. Most sensory evaluation studies reported the difficulty in taste and smell should be expected to resolve within several months after cessation of treatment; however, many survivors report continued taste dysfunction more than 6 months after treatment completion.

For this study, Dr Pepino and her group recruited 40 survivors of HNSCC who had been treated with radiation therapy between 6 months and 10 years prior to recruitment. A control group of 20 healthy persons who were equivalent in age, sex, race, smoking history, and body mass index to the study group also were recruited.

Taste stimuli were solutions with strawberry extract (sweet) and lemon extract (sour), sodium chloride in a vegetable broth (salty), coffee (bitter), and deionized water as a blank. Taste quality and intensity was measured using whole mouth and regional methods. For the whole mouth method, participants were asked to swish the taste sample around in their mouths for approximately 5 seconds before spitting it out. Participants performed this without a nose clip and with one, to exclude the stimulation of smell. For the regional evaluation, a team member soaked a cotton swab with stimulus and applied it encircling the tip of the patient’s tongue.

Study results demonstrated subtle differences in taste perception over the long term in the HNSCC survivors compared with the control group. The whole mouth tests suggested that taste function was normal in the study group. However, some taste deficits became evident with the regional tests. The survivors had difficulty perceiving low concentrations of stimuli for bitter, sweet, and salty tastes in the front of the tongue. This lasted for several months after treatment was completed.

The researchers suggest that a deficit in taste on the tip of the tongue but normal in the whole mouth indicates localized damage to the chorda tympani or the taste buds in the fungiform papillae. Any part of the area tested can be damaged by chemotherapy or surgery, as well as radiation therapy.

“The concurrent presentation of smell and taste stimuli in the mouth resulted in mutual enhancements of perceived taste and smell intensity,” noted the researchers. Thus, when the participants did not use the nose clip, they perceived the sucrose solutions to be sweeter, and citric acid solutions to be more sour. The senses of smell and taste are often synergistic.

This study also evaluated sense of smell. The University of Pennsylvania Smell Identification Test (UPSIT) was used to measure smell. UPSIT utilizes 40 small boxes containing microencapsulated common odors. Participants would scratch off the box to release the odor, sniff the box, and identify the descriptor that matched the perceived smell. This enabled the researchers to evaluate survivors’ sense of smell separately from their sense of taste, demonstrating that in some patients smell was slightly impaired by the cancer and/or its treatment.

These results suggest persistent and subtle damage occurs, which may explain why survivors complain of sensory loss long after completing radiation therapy, concluded the researchers.

Reference

Alfaro R, Crowder S, Sarma KP, Arthur AE, Pepino MY. Taste and smell function in head and neck cancer survivors. Chem Senses. 2021;46:bjab026. doi:10.1093/chemse/bjab026

Head-and-neck surgeons buoyant about new, just-right robot

Source: newsroom.uw.edu
Author: Brian Donohue

You know how great it feels when someone makes a pie or cake just for you? University of Washington Medicine head and neck surgeons have been feeling that kind of love lately, and on Feb. 5 they shared the first slice, so to speak, with patient Steven Higley.

Surgical assistants work near patient Steven Higley on Feb. 5. Lead surgeon Jeff Houlton is obscured by the robotics.

The cake in this story is actually a da Vinci robotic-assist system built especially for head and neck procedures. It is easier to maneuver than the robotic device they’ve used for the past decade, which was designed for operations to the chest and abdomen.

Higley underwent surgery to have a cancerous tonsil and part of his throat removed. Sitting at a console a few feet from the patient, Dr. Jeff Houlton manipulated the miniature surgical tools emanating from the robot’s single port, positioned just outside Higley’s open mouth. It was UW Medicine’s first trans-oral surgery with the new tool.

“If you think about laparoscopic surgery in the belly area, robotics provides the advantage of multiple mechanical arms approaching from different angles,” Houlton said. “But it’s a challenge to have three robotic arms that all need to go through a patient’s mouth. With this machine, the three arms are designed to come through one garden hose-like entry port and then articulate out from there.

“Pretty interesting, though, that in the past 10 years we built a nationally recognized practice for robotic head and neck surgery with a device designed for a different part of the body,” he added, laughing.

The new robot’s single port, left, through which all surgical instruments travel. At right, Dr. Jeff Houlton manipulates the instruments from a distant console. Photos by Randy Carnell, UW Medicine

Higley’s radical tonsillectomy entailed the removal of a margin of tissue beyond the visible tonsil and tumor. Houlton’s incisions exposed cranial nerves and branches of the carotid artery. Working in tight quarters with such vital anatomy, Houlton and his head-and-neck colleagues in surgery, Brittany Barber and Neal Futran, welcome the improvement in maneuverability.

Head and neck cancers represent only 3% of all oncology cases in United States. But case numbers are rising, Houlton said, with increased incidence of throat cancer involving human papillomavirus (HPV), as was the case with Higley, 68.

“Most of these cancers are HPV-mediated rather than smoking- and drinking-related,” Houlton said. “We call it an epidemic because it’s a viral cancer that’s gone up significantly since about the year 2000. In terms of HPV, cancer of the oropharynx (mouth, throat and tongue) is actually more common than cervical cancer now.”

Higley’s cancer came to light last fall after a yearly physical with his Olympia-based physician.

“I had no trouble swallowing, no pain,” Higley recalled. “I didn’t notice anything until my doctor said, ‘Hey, this looks like something we should check out.’ ” His referral to UW Medicine led to a biopsy in mid-December, and on Dec. 23, he learned that he had cancer.

“I’m glad they found it early and so is my wife,” Higley said. “If I could’ve had surgery the next day, it would’ve been OK with her.”

After the robotic part of the surgery, Houlton incised Higley’s neck and removed more than a dozen lymph nodes to be biopsied for cancer cells. Higley hopes they’ll concur with the pre-surgery PET scan that indicated his cancer was constrained to the tonsil.

Patient outcomes data suggests Higley’s prognosis is encouraging: 90-95% of patients who undergo surgery for this cancer survive five years or more.

Higley is already swallowing liquids and soft foods, but he’ll manage sore throat for about a month, Houlton said.

2021-02-12T18:43:12-07:00February, 2021|Oral Cancer News|

Should we be drinking less?

Source: www.nytimes.com
Author: Anahad O’Connor

Can a daily drink or two lead to better health?

For many years, the federal government’s influential dietary guidelines implied as much, saying there was evidence that moderate drinking could lower the risk of heart disease and reduce mortality.

But now a committee of scientists that is helping to update the latest edition of the Dietary Guidelines for Americans is taking a harder stance on alcohol. The committee said in a recent conference call that it plans to recommend that men and women who drink limit themselves to a single serving of wine, beer or liquor per day. Do not drink because you think it will make you healthier, the committee says: It won’t. And it maintains that drinking less is generally better for health than drinking more.

That message is a departure from previous guidelines, which since 1980 have defined “moderate” drinking as up to two drinks a day for men and one for women. Government agencies have also long defined a standard drink as 12 ounces of regular beer, five ounces of wine, or one and a half ounces of distilled spirits (40 percent alcohol), amounts often exceeded in Americans’ typical “drink.”

Between 1990 and 2010, many editions of the guidelines, which are updated every five years, discouraged heavy drinking and warned pregnant women and people with certain medical conditions not to drink. But they also noted that moderate drinking was linked to fewer heart attacks and lower mortality. The 2010 guidelines mentioned that moderate drinking may even “help to keep cognitive function intact with age.”

The new recommendation would be a victory for experts who have long questioned the health halo around moderate drinking. They say that studies showing it can protect health are deeply flawed, and that any potential cardiovascular benefits would be outweighed by the fact that alcohol is a leading preventable cause of cancer. According to the National Cancer Institute, even one drink a day increases the risk of breast, esophageal and oral cancer.

“This is significant because the committee has finally gotten away from this idea that a small amount of alcohol is good for you,” said Thomas Gremillion, the director of food policy at the Consumer Federation of America, a public interest group that has pushed for cancer warnings on alcohol. “They’re really taking a stand and saying drinking less is always better. That’s the right message and I think they deserve credit for making that change.”

The new advice is not yet final. The advisory panel is expected to include it in a report that it will release publicly in mid-July and submit to the Department of Agriculture and the Department of Health and Human Services. Those two agencies are scheduled to publish the official dietary guidelines later this year.

If accepted, the new recommendation would make the United States the latest country to issue stricter guidelines on alcohol consumption. In recent years, Britain, Australia, France and other countries have issued new guidelines lowering their recommended limits on daily and weekly alcohol intake. Health authorities in those countries have said that recent evidence suggests consuming less alcohol is safer and that even one drink a day increases cancer risk.

The scientific debate over moderate drinking dates at least back to the 1970s, when researchers in California noticed that teetotalers seemed to have more heart attacks than people who drank moderately. In the decades that followed, many observational studies looking at large populations documented what is known as a J-shaped curve between alcohol and mortality from all causes, especially heart disease: Mortality rates dipped for moderate drinkers compared to nondrinkers and then climbed higher among people whose intake exceeded one or two drinks daily.

But observational studies can show only correlations, not causation. And they have other limitations. One major confounding factor is that socioeconomic status is a strong predictor of health and life span — and it tracks closely with drinking levels. Studies show that compared to heavy drinkers and abstainers, people who drink moderately tend to be wealthier and have higher levels of education. They tend to have better health care, exercise more, eat healthier diets, and have less obesity.

One study that compared nondrinkers to moderate drinkers — defined as having two drinks daily for men and one for women — found that 27 out of 30 well established risk factors for heart disease were “significantly more prevalent” among nondrinkers. Rather than causing better health, in other words, moderate drinking may be a marker for higher socioeconomic status and other lifestyle factors that promote a longer life.

Another problem with observational studies is selection bias. In some large studies, people categorized as “nondrinkers” may actually be former heavy drinkers, or they may have health issues that cause them not to imbibe. Studies have found that nondrinkers have higher rates of physical disabilities, psychiatric problems and pre-existing illnesses. When rigorous studies take these factors into account, they find that the protective effect of moderate drinking disappears.

“The appearance of protection vanishes like the mist on an autumn day as the sun comes up,” said Timothy Stockwell, an alcohol researcher and director of the Canadian Institute for Substance Use Research at the University of Victoria. “All of these thousands of studies, when you do a forensic examination of them, most of them have these horrendous flaws and are open to these systematic biases.”

One way to get around these limitations is through genetic studies. Some people carry a genetic variant that disrupts their ability to metabolize alcohol, causing them to develop skin flushing, irritation and other unpleasant symptoms when they drink alcohol. As a result, they tend to abstain or drink very little. If alcohol was good for heart health, these people should in theory have more heart disease compared to others. Instead, as one large analysis published in BMJ in 2014 found, they have “a more favorable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant.”

The study concluded: “This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.”

Not everyone agrees that the health benefits of moderate drinking are illusory. Alcohol has blood-thinning properties, and red wine in particular contains polyphenols that have beneficial effects on the microbiome, said Dr. Erik Skovenborg, a family doctor and member of the International Alcohol Forum, an international group of scientists who study alcohol and health. Alcohol also raises HDL cholesterol, often referred to as the “good” kind, though recent studies have cast doubt on it being cardioprotective.

Dr. Skovenborg said the observational data makes it clear that moderate drinking is more than a marker for a healthy lifestyle.

“In these studies you have many participants that have all the healthy lifestyle factors,” he said, “and if you add moderate alcohol consumption on top of that, it increases the benefits regarding longer life and fewer health problems.”

Dr. Skovenborg said his general advice to patients who drink is to follow the Mediterranean tradition: Have a little wine with your meals, drink slowly, enjoy it, and don’t drink to get drunk. Exercise regularly, avoid smoking, eat nutritious foods, and maintain a normal weight. “It’s a pattern of things you should be doing, not just one thing,” he added.

Showing definitively that moderate drinking protects heart health requires doing a lengthy clinical trial, one that randomly assigns some people to have a drink daily and others to abstain. In 2014, the National Institutes of Health launched a clinical trial designed to do just that. But it was shut down in 2018 after a New York Times investigation revealed that N.I.H. officials had lobbied beer and liquor companies for funding and suggested that the results of the trial would support moderate drinking. As it turns out, experts have long raised concerns about industry influence on alcohol studies.

Members of the advisory committee declined to comment on their recommendations until their report is released. Dr. Stockwell said he agreed with the one-drink-a-day recommendation but he would word it slightly differently. “I’d probably say seven drinks a week for men and women and no more than two drinks on one day,” he said. “I would have a little flexibility.”

Flossing and going to the dentist linked to lower risk of oral cancer

Source: www.livescience.com
Author: Yasemin Saplakoglu, Staff Writer

Regularly flossing and going to the dentist may be tied to a lower risk of oral cancer.

That’s according to findings presented March 31, here at the American Association for Cancer Research (AACR) annual meeting.

In the new study, researchers analyzed the dental health behaviors of patients who were diagnosed with oral cancer between 2011 and 2014 at the ear, nose and throat clinic at The Ohio State University Comprehensive Cancer Center. The patients’ behaviors were compared to those of non-cancer patients who came to the clinic for other reasons, such as dizziness or an earache. [7 Odd Things That Raise Your Risk of Cancer (and 1 That Doesn’t)]

All of the patients in the study had responded to a survey that included questions about how often they flossed, how often they went to the dentist, how sexually active they were and if they smoked or drank alcohol.

Oral cancer can be divided into two categories: those driven by the sexually transmitted human papillomavirus (HPV) and those that aren’t, said lead study author Jitesh Shewale, a postdoctoral fellow at the University of Texas MD Anderson Cancer Center in Houston. (Smoking and drinking are both risk factors for non-HPV oral cancers.)

After adjusting for factors such as age, gender, socioeconomic status and race, the researchers found that oral HPV-negative people who went to the dentist less than once a year had nearly twice the risk of developing oral cancer than those who went once a year or more. Similarly, oral HPV-negative people who flossed less than once a day had over twice the risk than those who flossed more. In other words, poor oral hygiene was linked to increased non-HPV oral cancer risk.

The study didn’t find an association between poor dental hygiene and oral cancer in those who also had oral HPV, however.

The researchers hypothesize that the oral microbiome may play a role in the association between oral hygiene and cancer risk. In previous research, scientists from the same team found evidence that “poor oral hygiene practices causes a shift in your oral microbiome,” Shewale told Live Science. That shift “promotes chronic inflammation and [can lead to] the development of cancers.” HPV-positive oral cancers mostly affect the base of the tongue and the tonsils region, while HPV-negative cancers mostly affect oral cavities, which are more affected by oral hygiene, he added.

Denise Laronde, an associate professor in dentistry at the University of British Columbia who was not a part of the study, said that the new research was “interesting” but added that it was too early to draw conclusions. (The study found an association between oral hygiene and cancer risk, but did not show cause-and-effect.)

Still, “a lot of the times people look at their oral health as almost disconnected from the rest of their body,” Laronde told Live Science. “But so many systemic diseases are reflected in your oral health and vice versa.”

Laronde added that the new research will hopefully raise awareness about the importance of flossing. “We all know people say they floss way more than they do,” she said. But studies like this raise awareness that “you’re not just flossing to keep your teeth, you’re flossing to maintain your health.”

The findings have not yet been published in a peer-reviewed journal.

Robot that can cut out hard-to-reach throat tumours through patients’ mouths: Pioneering operation reduces need for chemo and radiotherapy

Source: www.dailymail.co.uk
Author: Fiona McCrae, Roger Dobson

British surgeons are using a cutting-edge robot to remove difficult-to-reach throat tumours – through the mouths of patients.

The pioneering operation is designed to dramatically reduce the need for gruelling radiotherapy and chemotherapy, which can leave patients unable to swallow and dependent on a feeding tube for life.

With growing numbers of people developing throat cancer, it is more important than ever to have a range of effective treatments that lessen the impact on quality of life, says Asit Arora, consultant head and neck surgeon at Guy’s & St Thomas’ NHS Trust in London.

Once most common in elderly people with a history of drinking and smoking, rates of head and neck cancers have soared by 31 per cent in the past 25 years and are now as common in people in their 50s as in those in their 80s.

The 90 minute operation is designed to dramatically reduce the need for gruelling radiotherapy and chemotherapy, which can leave patients unable to swallow and dependent on a feeding tube for life

Much of the rise is attributed to HPV – a range of viruses that can be passed on during intimate and sexual contact. At least 80 per cent of the adult population carries some kinds of HPV on their skin, although most will never know it. In some cases, HPV can cause skin or genital warts, and other types are a known cause of cervical and anal cancers.

HPV can also infect the mouth and throat and is now to blame for at least half of throat cancers in the UK. Until a tumour occurs, the infection is typically symptomless.

Conventional treatment for early-stage throat cancer involves either powerful radiotherapy and chemotherapy to destroy the tumour, or laser surgery to cut it out.

Courses of radiotherapy and chemotherapy are time-consuming – some patients make up to 30 trips to hospital over a few months. The treatment can also damage the jaw and the swallowing muscles, meaning patients cannot eat without the help of a feeding tube.

Laser treatment is more gentle on the body but it can be difficult to cut out a hard-to-reach cancer completely and most patients need radiotherapy afterwards. Some also need chemotherapy.

Using the robot, the surgeon can zero in on the tumour and cut it away precisely. With the patient under general anaesthetic, the surgeon controls the robot with his hands and feet. One of the robot arms holds a 3D camera, while two others wield tiny instruments that can be passed through the mouth and into the throat, and turned and twisted in ways impossible with the human hand alone.

Surgery in the mouth and throat can be challenging because you are working in very small areas, manipulating surgical instruments in a tight space where there are important nerves and blood vessels to be avoided,’ says Mr Arora, who has pioneered robotic surgery for throat cancer in the UK.

‘With the latest robotic systems, we can be more targeted than ever before in how we treat these throat conditions in order to reduce unwanted side effects, particularly related to swallowing.’

Studies suggest that trans-oral robotic surgery (TORS) is at least as good as conventional surgery, although a definitive comparison has yet to be carried out, says Mr Arora. But importantly, by cutting out the tumour so precisely, it may reduce the amount of chemotherapy and radiotherapy patients need.

A £4.5 million Cancer Research UK trial into the procedure is now being carried out at Guy’s and hospitals around the country.

Mr Arora has used the method to remove about 30 throat tumours in the year since setting up the service with Jean-Pierre Jeannon, Guy’s clinical director for cancer.

The operation takes 90 minutes and patients are usually discharged after two days. They then undertake rehab, including speech therapy.

Retired policeman David Wonfor, 60, chose to take part in the trial after being diagnosed with early-stage throat cancer last summer. After his operation, David, 60, of Petts Wood, Kent, started on five weeks of low-dose radiotherapy. Although he lost weight and his sense of taste at first, he has now largely recovered, and says he is convinced that his recovery would have been very different if he had had chemotherapy.

Dad-of-two, 35, dies after being told he was too young to have throat cancer

Source: www.mirror.co.uk
Author: Amber Hicks

Ryan Greenan went to his doctor in Edinburgh in September after he started having trouble swallowing, eating and drinking.

The 35-year-old from Scotland was advised his symptoms were most likely caused by reflux and anxiety, reports the Scotsman , despite his family having a history of throat cancer.

Ryan’s sister Kerry, 33, said her brother took this diagnosis at face value “because the general advice was that oesophageal cancer only really affected older people”.

However, the symptoms persisted and Ryan started to rapidly lose weight before collapsing at work in December. 

He was taken to hospital and it was then that a tumour was discovered in his throat and he was diagnosed with cancer on December 28.

There was more heartache when it was revealed it had also spread to his lungs and liver and there was nothing that could be done to save him.

Three weeks later Ryan sadly died.

His sister is now calling on doctors to thoroughly test for the illness, even in younger patients.

Kerry told the Scotsman : “When Ryan first went to the doctor, he was told it was anxiety and that he was too young for it to be cancer because he was only 35.

“He just took that as his diagnosis and didn’t go back because the general advice was that oesophageal cancer only really affected older people.

“If it had been picked up earlier, they could have operated, they could have given him chemotherapy, but after three months it had spread, there was nothing else they could do at that point.

“I’m just absolutely destroyed. I’m so angry. If they had caught it earlier, my big brother would still be here today.”

It was while Ryan, who has two daughters aged eight and 11, was receiving treatment that he proposed to partner Natasha Robertson, 35, on January 11.

Heartbroken Natasha told the Evening Telegraph : “Ryan was my soulmate. We were together for eight months and he just made me so happy during such a short time.”

2019-02-05T12:55:53-07:00February, 2019|Oral Cancer News|

Restaging raises hope against HPV oral cancer

Source: atlantajewishtimes.timesofisrael.com
Author: Cady Schulman

Jason Mendelsohn was diagnosed with Stage 4 tonsil cancer from HPV in 2014 after finding just one bump on his neck. He survived thanks to a variety of treatments, including a radical tonsillectomy and neck dissection to remove 42 lymph nodes, seven weeks of chemotherapy, radiation and a feeding tube.

But if Mendelsohn’s cancer had been discovered today, just four years later, it would have been classified as Stage 1. That’s because HPV-related oral cancers now have a high survival rate through a better response to treatment, said Meryl Kaufman, a speech pathologist specializing in head and neck cancer management who worked for Emory University’s department of head and neck surgery for 10 years.

“Cancer staging is taking into account the HPV-related cancers,” said Kaufman, who now owns her own practice. “It was kind of all lumped together. The survival rates for people who have HPV-related cancers are much higher than the typical head and neck cancers associated with smoking and drinking.”

For Mendelsohn, finding out that patients with HPV-related cancers likely face easier treatments and higher success rates made him extremely happy.

“If I was diagnosed and I heard Stage 1 instead of Stage 4, while it’s still cancer, it would make me feel like I could beat it,” said Mendelsohn, who made a video for his children a month after his diagnosis with advice for their lives after he was gone. “When I hear Stage 4 to Stage 1, I think people have hope they can beat it. My hope is that it will give people hope that they can beat this.”

As a cancer survivor, the Florida resident wants to give hope to other patients. He talks to people throughout the world every month and is creating a worldwide survivor patient network to connect cancer survivors with patients.

“While cancer is scary, Stage 1 is a lot less scary than Stage 4,” Mendelsohn said. “Stage 4 was overwhelming. When I was looking for information, there was nothing out there that made me feel like I was going to be OK. What I’m trying to do is give people hope and let them know that it’s all temporary.”

Another way Mendelsohn is trying to reach those affected by cancer is through his website, supermanhpv.com. He shares his story, news articles featuring him and oral cancer caused by HPV, and information for survivors, patients and caregivers.

The site also features Mendelsohn’s blog, putting himself out there so people can see that someone who, just four years ago, was diagnosed with Sage 4 cancer is now a Peloton-riding, travel-loving cancer advocate.

“People see me and say (they) can’t believe (I) had cancer three to four years ago,” Mendelsohn said. “I was in bed 18 hours a day for a month. I was choking on my saliva for a month. I was consuming five Ensures a day and two Gatorades a day through a feeding tube in my stomach. If people going through that can see me working out, going on the bourbon tour in Louisville. I’ve been on an Alaskan cruise. I’ve been to the Caribbean. I’ve been to the Grand Canyon.”

Mendelsohn, who started his campaign to raise awareness of HPV and oral cancer by raising money for the Ride to Conquer Cancer in Washington, now serves on the board of the Head and Neck Cancer Alliance. The organization’s goal is to advance prevention, detection, treatment and rehabilitation of oral, head and neck cancers through public awareness, research, advocacy and survivorship.

“I feel like it’s gone from me raising money for a bike ride to me on two boards helping create awareness and raise inspiration and creating a survivor patient network,” Mendelsohn said. “Now it’s not about me and my three doctors. Now it’s about helping people with diagnosis globally. There are great doctors. I think we’re going to do great things.”

One way to help prevent children from getting cancer caused by HPV when they grow up is the Gardasil vaccine, which protects against HPV Strain 16, which causes oral cancer. Mendelsohn said 62 percent of college freshmen and three-quarters of adults by age 30 have HPV.

But he doesn’t tell people to get the vaccine. Instead, he advises parents to talk to their kids’ doctors about the benefits and risks.

“I talk about the importance of oral cancer screenings when they’re at the dentist,” he said. “And if you feel a bump on your neck, go to your ENT. I had no symptoms and just a bump on my neck, but I was diagnosed with Stage 4. I’ve had so many tell me that they didn’t know the vaccine is for boys. They thought it was just for girls.”

Kaufman said that the HPV vaccine is recommended for use in boys and girls and that it’s important for the vaccine to be given before someone becomes sexually active. The vaccine won’t work if a person has already been exposed to HPV, as most sexually active adults have been, she said.

Men are much more likely to get head and neck cancer from HPV.

“Usually your body fights off the virus itself, but in some people it turns into cancer,” Kaufman said. There hasn’t been specific research that the HPV vaccine will protect you from head and neck cancer, she said, “but if you’re protected against the strains of HPV that cause the cancer, you’re probably less likely to get head and neck cancer.”

Treatment for this cancer isn’t easy, Kaufman said. Radiation to the head and neck can affect salivary glands, which can cause long-term dental and swallowing issues. Treatment can affect the skin, taste and the ability to swallow.

“A lot of people have tubes placed,” she said. “It’s not easy. It depends on how well you respond to the treatment.”

While getting the vaccine can help protect against various cancers, awareness about head and neck cancer is the key. And knowing the signs and symptoms — such as sores in the mouth, a change in voice, pain with swallowing and a lump in the neck — is important.

“If one of those things lasts longer than two weeks, you should go to your doctor,” Kaufman said. “This can affect nonsmokers and nondrinkers. It’s not something that people expect. The more commonplace it becomes and the less stigma, the better.”

Chronic heartburn might increase chance of neck, head cancers

Source: www.upi.com
Author: HealthDay News

Millions of American seniors suffer the discomfort of chronic acid reflux. Now, new research suggests the condition might raise their odds for even more dangerous foes — head and neck cancers.

The research can’t prove cause-and-effect, and the odds of any one person with chronic heartburn developing one of these relatively rare cancers remains low, experts noted.

But the study of nearly 28,000 Americans over the age of 65 did show a heightened risk.

Overall, a history of gastroesophageal reflux disease — the clinical term for chronic heartburn — was linked to nearly triple the odds of developing cancers of the voice box (larynx); about a 2.5 greater odds for cancers of the pharynx (top of the throat); a doubling of risk for cancers of the tonsils; and a 40 percent higher odds for cancers in the sinuses.

Head and neck cancers of the respiratory and upper digestive tracts cause more than 360,000 deaths worldwide each year, the researchers noted.

The new study was led by Dr. Edward McCoul, of the Ochsner Clinic Foundation in New Orleans, and published Thursday in the journal JAMA Otolaryngology Head & Neck Surgery.

One gastroenterologist said the findings aren’t surprising, given what’s known about the effect of acid reflux on sensitive tissues.

“Reflux material from the stomach can rise high in to the esophagus, the food tube between the mouth and the stomach,” explained Dr. Anthony Starpoli. He said the same juices “can invade the throat, sinus passages and the lungs, causing [chronic] inflammation.”

The link between GERD and another tumor type, esophageal cancer, is already well-known, said Starpoli, associate director for esophageal endotherapy at Lenox Hill Hospital in New York City.

In the new study, McCoul’s team tracked data from 13,805 U.S. seniors who’d had cancers of the respiratory and upper digestive tracts between 2003 and 2011. Their medical histories were then compared to the same number of similarly aged people without cancer.

While the study found an association between GERD and head-and-neck cancers, McCoul’s team stressed that the data they sourced did not include information about each patient’s smoking and drinking history. Both of those habits are major risk factors for head and neck cancers, the study authors noted, so more investigation is needed to tease out the findings.

Dr. David Hiltzik directs otolaryngology at Staten Island University Hospital in New York City. Reading over the findings, he agreed that the study wasn’t designed to prove cause-and-effect.

But Hiltzik believes chronic heartburn remains a potential carcinogen and needs to be treated when it occurs.

“We know clinically that acid reflux causes problems throughout life in these areas in the head and neck,” he said. “This study reinforces the fact that we need to address these issues early and perhaps more aggressively. I believe patients should be more aware of how their daily diet and behavioral habits can have serious long-term effects.”

More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on acid reflux.

2017-12-22T21:58:58-07:00December, 2017|Oral Cancer News|

Teens drink less if they know alcohol causes cancer — but most don’t — study finds

Source: http://www.adelaidenow.com.au/
Author: Tim Williams, Education Reporter

Teens are less likely to drink if they know that alcohol is a major cause of cancer, but most are unaware of the link, a South Australian study has found. More than 2800 school students aged 12-17 were surveyed about their drinking behaviour by Adelaide University and South Australian Health and Medical Research Institute (SAHMRI) researchers.

Those aged 14-17 were deterred from drinking if they knew about the link between alcohol and cancer, but only 28 per cent of students were aware of the connection. Parental disapproval was another deterrent, while smoking and approval from friends resulted in higher rates of drinking. Most students had tried alcohol by age 16 and a third drank at least occasionally. Wealthy students were more likely to drink.

Cancer Council SA chief executive Lincoln Size said there was clear evidence drinking caused cancers of the mouth, pharynx, larynx and oesophagus, as well as bowel cancer in men and breast cancer in women. It likely raised the risk of liver cancer and bowel cancer in women too.

“Any level of alcohol consumption increases the risk of developing an alcohol-related cancer; the level of risk increases in line with the level of consumption,” he said.

“This latest evidence highlights the need to educate young people about the consequences of alcohol consumption and for parents to demonstrate responsible drinking behaviour.

“We need to get the message through that what may be considered harmless fun actually has lifelong consequences.”

Lead author Jacqueline Bowden, a behavioural scientist with both the uni and SAHMRI, said drinking patterns were often set in adolescence.

“With alcohol contributing to four of the top five causes of death in young people, and a leading cause of cancer in our community, it’s important for us to better understand drinking behaviour among young people so we can help to prevent or delay it,” Ms Bowden said.

“One of the major messages from our study is that parents have more influence on their teenagers’ decisions regarding alcohol than they probably realise.

“Parental behaviour and attitudes towards alcohol really do make a difference, and can help prevent children from drinking at an early age.

“Many parents believe providing their children with alcohol in the safe environment of their home teaches them to drink responsibly.

“However, the weight of evidence suggests that this increases consumption, and is not recommended.

“Our results also found that those adolescents who thought they could buy alcohol easily were more likely to drink regularly. The issue of availability — including price — and marketing of alcohol in the community is a major hurdle to be overcome.”

The findings of the study, which was supported by Cancer Council SA and the State Government, have been published in the journal BMC Public Health.

Trans oral robotic surgery saves public Australian hospital patients from disfiguring procedure

Source: www.smh.com.au
Author: Kate Aubusson

The cancerous tumour growing at the back of Brian Hodge’s tongue was about as hard-to-reach as cancers get. The 73-year-old was told he’d need radical, invasive surgery to remove the 50¢-sized tumour. His surgeon would make an incision almost from ear-to-ear and split his jaw in two for the 10-12 hour surgery.

After five days in intensive care, another three weeks in hospital and four to six months recovery, re-learning how to eat and talk Mr Hodge would have been left with disfiguring scars, and a voice that he may not recognise as his own.

“My kids didn’t want me to have it,” Mr Hodge said. “But I’m not one to throw in the towel … Then the unbelievable happened,” he said.

Mr Hodge became one of the first public patients to undergo robotic surgery for head, neck and throat cancer at Nepean Hospital, the state’s only hospital offering the service to patients who can’t afford private healthcare.

Mr Hodge’s surgeon, Associate Professor Ronald Chin, performed the trans oral robotic surgery (TORS) by guiding the robot’s arm into his patient’s open mouth to remove the cancerous tumour.

“I went in on Monday morning for the surgery and I was discharged Tuesday night,” Mr Hodge said of his surgery performed on June 19.

“It’s just amazing. Two days compared to six months recovering.

“What’s got me is that before it was only available to people who could pay the big money. I’ve worked all my life, I’ve paid tax and I think, why can’t we people get this surgery as well,” he said.

TORS is available for private health patients in other NSW hospitals, but its use at a major tertiary hospital in Sydney’s west – surrounded by suburbs with some of the highest smoking rates and lowest private health insurance rates in Sydney – was significant.

“It’s an enormous step forward to be able to offer this state-of-the-art treatment with such obvious benefits both cost-wise and [avoiding] disfigurement-wise … to patients who may not have previously had the resources to access it,” Dr Chin said.

The da Vinci robot Dr Chin used was the same one Nepean Hospital’s urological surgeons use to perform prostatectomies on prostate cancers. The TORS procedure takes about 45 minutes.

“Traditionally surgery is incredibly invasive. We had to make very large incisions across the neck, then lift the skin well above the lower lip and cut the jaw open,” said the otolaryngology, head and neck surgeon.

“We’re talking about a massive operation. Then reconstruction is very difficult.

“Not only did people face a horrendously long operation, they had to deal with long post-operative recovery and rehabilitation to regain speech, language, voice and the ability to eat and drink.

“With TORS, patients can go home the next day [with minimal discomfort],” he said.

More than 400,000 cases of oropharyngeal squamous cell carcinomas are diagnosed each year worldwide. The five-year survival rate for head and neck cancer in Australia is 69 per cent, according to government estimates.

Nepean Hospital would see between 10 and 15 patients with head and neck cancers per year who would be suitable for TORS, Dr Chin said. The cancerous tumours, usually linked to smoking and excessive drinking as well as the human papilloma virus, were “extraordinarily difficult to access, almost impossible”, said Dr Chin.

Robotic surgery costs significantly more than traditional surgeries. But Dr Chin said TORS could save the public health system up to $100,000 per procedure, where patients no longer needed to spend days in ICU, costing more than $3000 per night, or weeks in hospital. The robotic surgery is primarily indicated for patients with oropharyngeal carcinomas of up to four centimetres in size. Roughly one-third of TORS patients will not need chemo and radiotherapy.

“The early evidence available on trans oral robotic surgery for oropharyngeal cancer is promising,” said Dr Tina Chen, medical and scientific adviser at the Cancer Institute NSW.

“However, higher-quality research is needed to definitively say whether it means better clinical outcomes for patients, compared to other treatments already available,” she said.

There was currently no high-quality evidence from randomised controlled trials comparing TORS to chemotherapy and radiotherapy for these types of cancers, a 2016 Cochrane review concluded. It noted “data are mounting”.

Mr Hodge will soon be able to swap the pureed food he has eaten since the day after his surgery for his favourite meal, barbecue chicken, and the avid karaoke singer is already planning his first post-surgery crooning set-list. First, Engelbert Humperdinck’s Please Release Me, and the song he has been singing to his wife for decades, Anne Murray’s Could I Have This Dance.

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