Source: www.youtube.com Keith Hern was diagnosed with throat cancer and his story is captured in the book Bangers and Mash. In this video Keith talks frankly and honestly about the moment that changed his life forever - when he found he had cancer.
Source: DrBicuspid.com May 9, 2012 -- Actor Michael Douglas' recent revelation that he has stage IV oropharyngeal cancer has highlighted the growing incidence of oral cancer, and experts say dentists can help stem the alarming increase of the disease by checking for it during routine examinations. The actor's cancer includes a walnut-sized tumor at the base of his tongue, and he will require radiation therapy, chemotherapy, and surgery. Douglas says his doctors told him he has an 80% survival rate if it hasn't spread to his lymph nodes. While tobacco was the prime cause of oral cancer in the past, recent studies have attributed the steady increase of the disease to the human papillomavirus (HPV). There are approximately 130 versions of HPV but only nine cause cancers, and the HPV16 version causes almost half of the oral cancers in the U.S., said Brian Hill, executive director of the Oral Cancer Foundation. "Tobacco is no longer the only bad guy," he told DrBicuspid.com. “HPV16 is increasing in incidence as the causative etiology, and if it continues on this trend line, it will replace tobacco as the primary cause of oral cancers." Dentists can play a key role in catching the disease in its early stages if they check for it during examinations, Hill pointed out. "But many dentists think it's such a rare disease that they don't bother to screen for it," he said. "Most Americans have never even heard of oral cancer, but it's not as rare or uncommon as [...]
Source: Medscape Today May 11, 2012 (Barcelona, Spain) — Radiotherapy alone might be just as effective as more toxic regimens in the treatment of light smokers or nonsmokers with human papillomavirus (HPV)-positive advanced oropharyngeal carcinomas, according to research presented here at ESTRO 31: European Society for Radiotherapy and Oncology 2012 Annual Conference. "Moderately accelerated radiotherapy as a single modality may be a safe and presumably morbidity-sparing treatment strategy for these patients," said Pernille Lassen, MD, a resident in medical and radiation oncology at Aarhus University Hospital in Denmark. "What we are suggesting — knowing that it's not randomized and knowing that it's not a very large series — is that perhaps we don't need to treat these patients with chemotherapy and all the other things that we do," she told Medscape Medical News. We're "not recommending one treatment over another; this is a contribution to the ongoing debate. But [we're] showing that we really cure a lot of patients with radiotherapy alone in this select group of nonsmokers or light smokers and HPV positivity." The researchers examined 181 patients from the Danish Head and Neck Cancer Group (DAHANCA) database who had advanced oropharyngeal cancer that had metastasized to the lymph nodes or beyond (stage III and IV). Cumulative smoking history was categorized as greater than or less than 10 pack-years (1 pack-year is equivalent to 20 cigarettes per day for 1 year), and pretreatment tumor immunohistochemistry was assessed on the basis of HPV-associated p16 expression (positive or negative). "p16 expression is a striking [...]
Source: European Society for Radiotherapy and Oncology (ESTRO) Barcelona, Spain: Researchers believe they may have found a way to avoid damaging salivary glands during radiotherapy treatment for head and neck cancer – a discovery that could improve the quality of life of 500,000 patients a year worldwide with the disease. Presenting their findings to the 31st conference of the European Society for Radiotherapy and Oncology (ESTRO31) [1], the researchers said that they had discovered that the stem cells essential for regenerating the parotid gland (the largest pair of salivary glands) were located mainly in its major ducts, and that these could easily be avoided during radiotherapy or given a minimal radiation dose. "This would significantly reduce complications arising from radiotherapy for head and neck cancer," said Dr Peter van Luijk, a research associate at the University Medical Center Groningen, The Netherlands. Around 40% of patients treated for head and neck cancer suffer from the distressing side-effects of dry mouth syndrome – a condition that can occur when the parotid gland stops working properly after radiation damage. This causes problems with eating, sleeping, speech, tooth loss and oral hygiene, leading to diminished quality of life, social isolation and difficulty in continuing work. Attempts to treat dry mouth syndrome and its consequences can cost hundreds or even thousands of Euros per patient per year and are mostly insufficient. Dr van Luijk said: "Parotid gland dysfunction after radiotherapy for head and neck cancer was, and still is, a major clinical problem. During radiotherapy, attempts [...]
Source: Journal of Clinical Oncology Abstract Purpose Tobacco smoking is associated with oropharynx cancer survival, but to what extent cancer progression or death increases with increasing tobacco exposure is unknown. Patients and methods Patients with oropharynx cancer enrolled onto a phase III trial of radiotherapy from 1991 to 1997 (Radiation Therapy Oncology Group [RTOG] 9003) or of chemoradiotherapy from 2002 to 2005 (RTOG 0129) were evaluated for tumor human papillomavirus status by a surrogate, p16 immunohistochemistry, and for tobacco exposure by a standardized questionnaire. Associations between tobacco exposure and overall survival (OS) and progression-free survival (PFS) were estimated by Cox proportional hazards models. Results Prevalence of p16-positive cancer was 39.5% among patients in RTOG 9003 and 68.0% in RTOG 0129. Median pack-years of tobacco smoking were lower among p16-positive than p16-negative patients in both trials (RTOG 9003: 29 v 45.9 pack-years; P = .02; RTOG 0129: 10 v 40 pack-years; P < .001). After adjustment for p16 and other factors, risk of progression (PFS) or death (OS) increased by 1% per pack-year (for both, hazard ratio [HR], 1.01; 95% CI, 1.00 to 1.01; P = .002) or 2% per year of smoking (for both, HR, 1.02; 95% CI, 1.01 to 1.03; P < .001) in both trials. In RTOG 9003, risk of death doubled (HR, 2.19; 95% CI, 1.46 to 3.28) among those who smoked during radiotherapy after accounting for pack-years and other factors, and risk of second primary tumors increased by 1.5% per pack-year (HR, 1.015; 95% CI, 1.005 [...]
Source: www.getsurrey.co.uk Author: Rebecca Younger When Thames Ditton photographer, Keith Hern, was diagnosed with throat cancer five years ago, he dealt with it the only way he knew how – by taking pictures. Through an incredibly honest and stark photographic portrayal of his treatment, Keith captured everything from the first bout of chemotherapy at the Royal Marsden Hospital in London to the making of his radiotherapy mask and the eight-inch scar left on his neck after an operation to remove dead cancer cells. The candid imagery appears in Keith’s book, Bangers & Mash, which he started writing shortly after he was first diagnosed in 2007. “I’d started writing a couple of days after diagnosis as the only way I could maintain some semblance of mental control, it would later become therapeutic,” he recounted. “My treatment consisted of five days of 24x7 chemotherapy, 11 days off, five days of chemotherapy again, 11 days off, then radiotherapy for six weeks daily with two top-up chemo sessions in weeks one and five. “Radiotherapy side effects kicked in at the end of week one – I could no longer eat, then lost my taste, then I couldn’t sleep (my mouth was so dry I was sipping water 24x7), I lost two-and-a-half stone in the six weeks.” Keith worked with a Neurolinguistic Programming (NLP) coach to stay positive and it was while talking to her about writing a book of his experiences that the idea for a photo diary came about. “She laughed at the [...]
Source: Dr.Biscuspid.com Wider surgical margins for early tongue tumors may reduce local recurrence and improve survival for most early-stage (T1 or T2) oral tongue squamous cell carcinoma (SCC) tumors, according to a new study in the Journal of Laryngology & Otology. Oral tongue SCC is usually treated with initial surgical resection with or without post-operative chemo- and radiotherapy. Regional recurrences occur in approximately one in four patients with T1 or T2 oral tongue SCC, justifying aggressive treatment, according to the study authors from the University of Melbourne (JLO, March 2012, Vol. 126:3, pp. 289-294). “We feel that wider surgical margins may be justified, being the only prognostic factor that surgeons have the ability to improve.” Among the most important histological factors that impact the prognosis for early oral cancer are lymph node metastases, extracapsular extension, and close or involved surgical margins, they noted. "Although other factors have an impact on adjuvant treatment, surgical margins is the only factor that may be improved by the surgeon," they wrote. Traditionally, a 1-cm margin is taken in all planes around a macroscopic or palpable oral tongue SCC, the study authors noted. Pathologists and clinicians have agreed to define involved margins as less than 1 mm and close margins as 5 mm or less, while margins greater than 5 mm are designated as clear. However, mucosal margins shrink by approximately 30% to 50% with formalin fixation and slide preparation. This results in a final pathological margin of approximately 5 mm where the surgeon measured [...]
Source: Journal of Clinical Oncology To the Editor: In their article, Chaturvedi et al1 document the rise in human papillomavirus (HPV) –associated cancers as a proportion of squamous cell carcinomas of the oropharynx over the last 25 years. The contemporary figures are mirrored by two recent British studies2,3 demonstrating that the majority of oropharyngeal cancers are now HPV related. In the accompanying editorial,4 Mroz et al rightly highlight the importance of evaluating HPV vaccination for both men and women in the light of these data and lament the lack of significant improvement in the outcomes for non–HPV-associated head and neck cancers. However, they also suggest that the benefit of targeting epidermal growth factor receptor (EGFR) through concurrent cetuximab may be confined to HPV-associated tumors. Although EGFR expression per se does not correlate closely with response to cetuximab, there is increasing evidence of an inverse correlation between p16INK4A expression (as a marker of HPV association) and EGFR expression shown by immunohistochemistry.5,6 Though suppressed by viral oncogenes, HPV-associated tumors retain wild-type P53,7 and patients with this tumor type have demonstrated excellent survival with existing protocols such as concurrent chemoradiotherapy or surgery with postoperative radiotherapy. Conversely, non-HPV tumors, harboring a range of mutations,8 may respond less well to DNA-damaging agents, but patients with these tumors might benefit from the addition of concurrent EGFR blockade to radiotherapy. Data from the recent SPECTRUM (Study of Panitumumab Efficacy in Patients With Recurrent and/or Metastatic Head and Neck Cancer) study of adding another EGFR-targeting monoclonal antibody, panitumumab,9 [...]
Source: www.sciencecodex.com/ Author: staff Researchers at the University of Granada and the university hospital Virgen de las Nieves in Granada have developed a new radiotherapy technique that is much less toxic than that traditionally used and only targets cancerous tissue. This new protocol provides a less invasive but equally efficient cancer postoperative treatment for cases of cancer of the oral cavity and pharynx. The study -conducted between 2005 and 2008- included 80 patients diagnosed with epidermoid cancer of the oral cavity and pharynx, who had undergone lymph node removal. The affected nodes were located by the surgeon during the intervention and classified into different risk levels. Classification allowed physicians to target the areas at a higher risk of recurrence. This way, neck areas at a lower risk of containing residual cancer cells were not irradiated. Researchers achieved both to minimize the side effects of radiotherapy, and to reduce treatment discontinuation, thus achieving the therapy to be more effective. A Highly Toxic Treatment Over 70% of oral and pharynx cancer treated with surgery require supplementary treatment with radiotherapy occasionally associated to chemotherapy, because of the high risk for recurrence and spread through the lymph nodes. Radiotherapy and chemotherapy are highly toxic, mainly due to the ulceration of the mucous membranes lining the oral cavity; toxicity leads may patients to stop the treatment, which significantly reduces the chances of cure. By using the risk map obtained with the collaboration of the surgeon and the pathologist, an individualized treatment was designed and adapted [...]
Source: News-Medical.net Researchers led by a senior investigator at Hofstra-North Shore LIJ School of Medicine and The Feinstein Institute for Medical Research have released initial findings from a first-of-a-kind clinical trial in adaptive radiotherapy (ART) for head and neck cancer. The trial, sponsored by the National Cancer Institute, provides evidence that ART may benefit patients with less technical difficulty than previously believed. The findings of this trial were released online in advance of publication in the International Journal of Radiation Oncology Biology Physics. Physicians commonly use radiotherapy to treat squamous cell carcinoma of the oropharynx (back of throat). Current standard-of-care treatment is called intensity-modulated radiotherapy, or IMRT. IMRT allows physicians to "sculpt" radiation to fit the anatomy of individual patients. Although appealing, this technique has a crucial Achilles' heel - it is based entirely on a CT or MRI scan taken before actual treatment begins. Since a typical course of radiation treatment for oropharynx cancer lasts 6-7 weeks, standard IMRT cannot compensate for common changes that take place in a patient's body during this time, such as weight loss, shrinkage of tumor, or gradual movement of normal tissues. Recent work suggests that the inability of standard IMRT to keep up with these changes may lead to unanticipated toxicity, or potentially worse, missing of tumor. For this new trial, which was conducted at the University of Texas M.D. Anderson Cancer Center, investigators started patients on standard IMRT. They then took CT scans while patients were lying in the radiation treatment room [...]