head and neck cancer

Internal lymphedema causes swallow dysfunction among patients with head and neck cancer

Author: Bryant FurlowSource: oncologynurseadvisor.com CHICAGO, IL— Treatment-related dysphagia symptoms are likely caused by internal lymphedema among patients with head and neck cancer, according to research presented at the 2014 American Society of Clinical Oncology (ASCO) Annual Meeting. “Internal lymphedema (correlated with subjective and objective measures of swallow dysfunction,” said lead author Leanne Kolnick Jackson, MD, at the Vanderbilt University Medical Center, Nashville, Tennessee. “Most of the time patients have silent aspiration, which is most dangerous. So if a patient ever says they have dysphagia, it warrants an exam” including imaging as well as endoscopy, Jackson said. External lymphedema is visible and recognizable, but internal lymphedema—which occurs in up to 90% of cases of external lymphedema—can go undetected, the coauthors noted. “External lymphedema is just the tip of the iceberg,” said senior author Barbara A. Murphy, MD, of Vanderbilt University Medical Center. “Only 10% of patients with lymphedema have only external lymphedema.” Secondary lymphedema and fibrosis are “ubiquitous and underreported” late effects among patients with head and neck cancers, Jackson reported. Using the Vanderbilt Head and Neck Symptom Survey (VHNSS) version 1.0, the researchers collected patient-reported swallow dysfunction among study participants undergoing treatment for head and neck cancer. They subsequently studied patients' swallow function and internal lymphedema, using endoscopic assessments, modified-barium videofluoroscopy, the Dysphagia Outcome and Severity Scale (DOSS), and National Outcomes Measurement System (NOMS). Endoscopy does not detect internal lymphedema well “for every site,” Jackson noted. “Some sites are not well evaluated by endoscopy.” At 18 months posttreatment, VHNSS swallow/nutrition scores [...]

Charlotte Parker2014-06-02T11:03:51-07:00June, 2014|Oral Cancer News|

Study finds the prognosis of HPV positive tumors in head and neck cancer patients to vary depending on site

Source: sciencecodex.comAuthor: Staff Vienna, Austria: Patients with cancer of the throat and who are positive for the Human Papilloma virus (HPV+) have a good prognosis, but until now the effect of being HPV+ on the prognosis of tumours located elsewhere in the head and neck was unknown. Danish researchers have now shown that HPV status appears to have no prognostic effect on the outcome of primary radiotherapy in head and neck cancer outside the oropharynx (the part of the throat located behind the mouth, and which contains the soft palate and the base of the tongue), the ESTRO 33 congress will hear today (Sunday). Presenting her results to the congress, Dr Pernille Lassen, MD, PhD, from the Aarhus University Hospital, Aarhus, Denmark, will say that head and neck cancers located outside the oropharynx should probably not be treated with the less intensive treatment strategies that are currently being investigated in clinical trials for HPV+ oropharyngeal tumours. "HPV status has a very potent prognostic impact in radiotherapy for oropharyngeal cancer, and DNA from HPV has been found in all types of head and neck cancer, although it is far more common in oropharyngeal tumours. We decided to investigate the impact of HPV status in non-oropharyngeal cancers in the DAHANCA database, which includes all Danish head and neck cancer patients," Dr Lassen will say. The researchers searched the database to identify patients with locally advanced cancers who had been treated primarily with radiotherapy, and identified 1606 patients with larynx and pharynx carcinomas. Overall, [...]

Charlotte Parker2014-04-07T12:38:17-07:00April, 2014|Oral Cancer News|

After-effects of oral cancer surgery forces patients into unemployment and depression

Source: economicvoice.comAuthor: Economic Voice Staff Cancer Patients are being forced into unemployment due to the after-effects of surgery and higher levels of depression. Research into head and neck cancer patients discovered the rate of those employed fell by more than 40 per cent five years after diagnosis, where only one in three managed to secure work. They also reported unemployed cancer survivors had lower social well-being and higher depression scores For those cancer sufferers out of work prior to diagnosis, their reasons for not returning to work also included the knock-on effect of surgery as well as dangerous levels of alcohol consumption. Figures from Cancer Research UK reveal more than 331,000 people were diagnosed with cancer in 2011 – around 910 every day. According to mouth cancer campaigners, the problems are exacerbated for mouth cancer patients. Previous research identified mouth cancer survivors face a diminished quality of life. Survivors reported poor oral function, resulting in persistent eating problems and long term depression. More than half of respondents (51.6 per cent) reported problems with eating, while on average one in four survivors who lived for five or more years still experienced speech problems. It was a similar story when it came to a patient’s physical and mental health, with more than a third (36.7 per cent and 39.3 per cent respectively) recording low functionality after the five year analysis. According to Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE, the study highlights the problems mouth cancer sufferers face on a daily basis. Dr [...]

Charlotte Parker2014-03-31T15:05:13-07:00March, 2014|Oral Cancer News|

Impact of percutaneous endoscopic gastrostomy (PEG) tube placement on Head and neck cancer patients

Source: Sage Journals Authors: Scott Kramer, Matthew Newcomb, Joshua Hessler, Farzan Siddiqui MD, PhDAbstract Objective: To understand the impact of percutaneous endoscopic gastrostomy (PEG) tube placement timing on tube duration, weight loss, and disease control in patients with head and neck cancer (HNC). Setting: A tertiary academic center. Study: Design Historical cohort study. Subjects and Methods: Seventy-four patients with HNC were reviewed. Patients underwent cisplatinum-based chemoradiation therapy with or without surgical resection. They received a PEG tube either before radiation therapy began (prophylactic) or after (reactive). Patients were matched on the basis of age, gender, TNM stage, tumor subsite, human papillomavirus (HPV) status, and chemoradiation dose. Results: Patients receiving reactive PEG tubes had them in place for fewer days than those placed prophylactically (227 vs 139 days, P < .01). There was no difference in percentage weight loss at 2, 6, or 12 months. There was no difference in survival or disease control between the groups. Conclusions: Reactive PEG tube placement may afford patients a shorter duration of usage without incurring greater weight loss or poorer oncologic outcomes. *This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Charlotte Parker2014-03-18T11:08:33-07:00March, 2014|Oral Cancer News|

Contralateral submandibular gland-sparing radiation safe, effective in head, neck cancers

Source: helio.comPublished: February 24, 2014 Sparing the contralateral submandibular gland with low doses of radiation therapy appeared safe and effective among patients with locally advanced head and neck cancers, according to study results presented at the Multidisciplinary Head and Neck Cancer Symposium. “Historically ... there has been hesitation to spare the submandibular gland from radiation because there are lymph nodes near the gland that also end up not getting treated,” researcher Tyler Robin, PhD, an MD candidate at the University of Colorado School of Medicine, said in a press release. “While this seems worrisome because head and neck cancer spreads through the lymph nodes, it is well established that the risk of cancer involvement in the lymph nodes near the submandibular gland is exceedingly low, yet the benefit of sparing the gland for a patient’s quality of life is high.” Robin and colleagues evaluated data from 71 patients who underwent contralateral submandibular gland-sparing radiation therapy at the University of Colorado Cancer Center or Memorial Sloan-Kettering Cancer Center. The median age of patients was 55 years. About half of patients were current or former smokers, and half were never smokers. Nearly 50% of patients had lesions involving the base of the tongue. About 80% of patients had N2b or greater disease, and 90% of patients had overall stage IV disease. Researchers classified contralateral submandibular gland sparing as mean radiation doses to the contralateral submandibular gland of ≤39 Gy. The mean radiation dose to the contralateral submandibular gland of all patients in [...]

Charlotte Parker2014-02-26T15:59:38-07:00February, 2014|Oral Cancer News|

Effects of Chemoradiation on Voice and Speech Quality of H&N Cancer Patients

Source: Med Page TodayPublished: February 23, 2014By: Charles Bankhead SCOTTSDALE, Ariz. -- Patients with oropharyngeal cancer reported significant voice and speech impairment for up to 2 years after chemoradiation therapy, but most of their doctors saw no evidence of it, data from a prospective study showed. Two years after treatment, a fourth of patients said their voice and speech remained below baseline levels, whereas none of their clinicians noted any impairment. At no time did as many as 10% of clinicians report patients with speech and voice issues, whereas the proportion of patients reporting problems ranged as high as 56%. The likelihood of patient-reported difficulties with oral communication increased with the radiation dose to the glottic larynx, reported Jeffrey M. Vainshtein, MD, and colleagues at the Multidisciplinary Head and Neck Cancer Symposium. "Our findings highlight the critical role of patient-reported outcomes in identifying areas of improvement of our current therapies, which may ultimately translate into improvements in quality of life for our patients," Vainshtein, of the University of Michigan in Ann Arbor, said during a press briefing. Dysphagia and xerostomia are recognized adverse effects of chemoradiation for head and neck cancer and have been studied extensively in recent years. In contrast, a paucity of information exists relative to the effects of chemoradiation on voice and speech quality, Vainshtein said. To examine the issue, investigators assessed voice and speech outcomes in 93 patients who underwent chemoradiation for oropharyngeal cancer, using intensity-modulated radiation therapy (IMRT). At baseline, and then every 3 to [...]

Charlotte Parker2014-02-24T17:36:33-07:00February, 2014|Oral Cancer News|

Study: Recurrence of SCCOP may differ in HPV-positive and HPV-negative patients

Source: News MedicalPublished: February 21, 2014 Patients with HPV-positive squamous cell carcinoma of the oropharynx (SCCOP) had a longer time to development of distant metastasis (DM) after initial treatment, and had more metastatic sites in more atypical locations compared to HPV-negative patients, according to research presented today at the 2014 Multidisciplinary Head and Neck Cancer Symposium. Culled from records of an IRB-approved registry, the study reviewed 285 patients with stage III-IV SCCOP (originally thought to be a smoking-related head and neck cancer) treated with chemotherapy and radiation from 2002 to 2013. HPV status was determined by in situ hybridization for HPV DNA and/or by strong and diffuse (>75 percent) staining for p16 immunohistochemistry. There were 245 HPV-positive and 40 HPV-negative patients. Twenty-seven HPV-positive and eight HPV-negative patients failed with DM and were the subjects for more detailed evaluation. Radiation therapy (RT) was either 3-D RT (HPV-positive = 15/27; HPV-negative = 4/8) or intensity modulated radiation therapy (IMRT) (HPV-positive = 12/27; HPV-negative = 4/8) with doses from 66-79 Gy. Patients received concurrent chemotherapy of cisplatin (HPV-positive = 9/27; HPV-negative = 2/8), cisplatin/5 fluorouracil (FU) (HPV-positive = 10/27; HPV-negative = 3/8) or cetuximab (HPV-positive = 8/27; HPV-negative = 2/8). One HPV-negative patient received cisplatin/paclitaxel chemotherapy. One patient in each group was treated with adjuvant chemoradiotherapy after initial resection. Student t-tests were used to compare the difference between the means of the samples. Both HPV-positive and HPV-negative patients were found to have similar rates of DM, however the mean time to develop DM [...]

Charlotte Parker2014-02-24T17:27:06-07:00February, 2014|Oral Cancer News|

New Association found between Obesity in patients with Tongue Cancer

Source: US NewsPublished: February 7, 2014By: Robert Preidt, HealthDay Reporter FRIDAY, Feb. 7, 2014 (HealthDay News) -- Obese people who are diagnosed with tongue cancer might be at increased risk of dying from the disease, a small new study finds. Researchers looked at about 150 people who had surgery for early stage squamous cell carcinoma of the tongue and found that obese patients had a five-fold increased risk of death. Three years after surgery, 87 percent of normal-weight patients were alive, compared with 68 percent of obese patients, according to the findings, which were published recently in the journal Cancer. The study is the first to link obesity and increased risk of death in patients with any type of head or neck cancer, the researchers said. They said previous studies have found an association between obesity and worse outcomes among patients with several common cancers, including breast and colon cancers. "The role of obesity across several common cancers is a focus of increased attention," study senior author Dr. Clifford Hudis, chief of breast cancer medicine at the Memorial Sloan Kettering Cancer Center in New York City, said in a center news release. Hudis is also president of the American Society of Clinical Oncology. Because the study was so specific in terms of the cancer's location in the body and disease stage, it helped clarify the effect of obesity, another researcher said. "Most prior research investigating the interaction between [obesity] and head and neck cancers included multiple tumor sites and disease [...]

Charlotte Parker2014-02-10T16:31:09-07:00February, 2014|Oral Cancer News|

New RNA interference technique finds seven genes for head and neck cancer

Source: The Rockefeller UniversityPublished: Friday, January 24, 2014 In the hunt for genetic mutations that cause cancer, there is a lot of white noise. So although genetic sequencing has identified hundreds of genetic alterations linked to tumors, it’s still an enormous challenge to figure out which ones are actually responsible for the growth and metastasis of cancer. Scientists in Rockefeller’s Laboratory of Mammalian Cell Biology and Development have created a new technique that can weed out that noise — eliminating the random bystander genes and identifying the ones that are critical for cancer. Applying their technique to head and neck cancers, they’ve discovered seven new tumor-suppressor genes whose role in cancer was previously unknown. Interfering with cancer. A section of a head and neck tumor — red and green markers show the proliferation of cancer stem cells — that formed when one of several newly characterized genes, Myh9, was suppressed. A recently developed genetic screening technique using RNA interference identified Myh9’s protein, myosin IIa, as playing an important role in tumor suppression. The new technique, which the lab recently applied to a screen for skin tumor genes, is particularly useful because it takes a fraction of the resources and much less time than the traditional method for determining gene function — breeding genetically modified animals to study the impact of missing genes. “Using knockout mice, which are model organisms bred to have a particular gene missing, is not feasible when there are 800 potential head and neck cancer genes to [...]

Charlotte Parker2014-01-24T13:05:29-07:00January, 2014|Oral Cancer News|

Number of cancer stem cells might not predict outcome in HPV-related oral cancers

Source: Medical XpressPublished: January 22, 2014By: Amanda J. Harper (Medical Xpress)—New research from The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) suggests that it may be the quality of cancer stem cells rather than their quantity that leads to better survival in certain patients with oral cancer. The researchers investigated cancer stem cell numbers in oral cancers associated with human papillomavirus (HPV) and in oral cancers not associated with the virus. Typically, patients with HPV-positive oral cancer respond better to therapy and have a more promising prognosis than patients with HPV-negative tumors. The latter are usually associated with tobacco and alcohol use. The OSUCCC – James team's findings, published in the journal Cancer, suggest that relying on the number of cancer stem cells in a tumor might inaccurately estimate the potential for the tumor's recurrence or progression. "We show that high levels of cancer stem cells are not necessarily associated with a worse prognosis in head and neck cancer, a finding that could have far-reaching implications for patient care," says principal investigator Quintin Pan, PhD, associate professor of otolaryngology and scientist with the OSUCCC – James Experimental Therapeutics Program. Head and neck cancer is the sixth most common cancer worldwide, with an estimated 600,000 cases diagnosed annually. Although the disease is often linked to alcohol and tobacco use, cancer-causing types of HPV are a major risk factor for the malignancy, and cases of HPV-associated oral cancers have [...]

Charlotte Parker2014-01-22T16:03:37-07:00January, 2014|Oral Cancer News|