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|

Is poor survivorship care driving high second-cancer risk?

Source: www.medscape.com
Author: Kristin Jenkins

In the United States, men and women who survive adult-onset cancers for at least 5 years are at significantly increased risk of developing and dying from new primary cancers, particularly those driven by smoking and obesity, a new study shows.

“This was disturbing but at the same time provides tremendous opportunities for cancer prevention and control, not only to mitigate the subsequent cancer risk but also to minimize comorbidities,” lead author Hyuna Sung, PhD, of the American Cancer Society in Atlanta, Georgia, told Medscape Medical News.

“The importance of smoking cessation, weight control, physical activity, and other factors consonant with adoption of a healthy lifestyle should be consistently emphasized to cancer survivors,” Sung said.

Results from a retrospective analysis of the most recent Surveillance, Epidemiology, and End Results (SEER) data from a cohort of 1.5 million survivors of first primary cancers (FPCs) show that male survivors — excluding those with prostate cancer — had a 45% higher risk of dying from any subsequent primary cancer (SPC) compared with men in the general population without a history of cancer.

Female survivors had a 33% higher risk of any SPC-related mortality, the study authors report in the Journal of the American Medical Association.

A significant proportion of the total incidence and mortality from SPCs was made up of smoking- or obesity-associated SPCs, the analysis shows.

“The risks of smoking-related SPCs were commonly elevated following many types of smoking-related FPCs, suggesting the role of smoking as a shared risk factor,” the researchers say.

Overall, four common smoking-related SPCs — lung, urinary bladder, oral cavity/pharynx, and esophagus — accounted for 26% to 45% of the total SPC incidence and mortality. Lung cancer alone accounted for 33% of the SPC-associated mortality in men and 31% of the mortality in women.

As previously reported by Medscape Medical News, second lung cancers occurring up to a decade after the first are on the rise, supporting long-term surveillance in survivors.

The current study also shows that in both men and women, four common obesity-related cancers — colorectal, pancreatic, uterine and liver — comprised 22% to 26% of the total SPC mortality.

“Survivorship care guidelines recommending health promotion need wider dissemination and implementation in oncology and primary care,” the study authors write about recommendations from the cancer society.

The investigators point out that in spite of evidence that a body mass index beyond the range of normal in survivors of breast and colorectal cancer increased risk of second obesity-associated cancers, many patients say they have never discussed with a doctor how to modify their lifestyle for a healthy body weight.

In 2018, the National Cancer Institute (NCI) reported that 67% of US cancer survivors were overweight or obese, Sung and colleagues note.

In an accompanying editorial, Patricia Ganz, MD, and Jacqueline Casillas, MD, of the David Geffen School of Medicine at UCLA, Los Angeles, California, agreed that the current study findings indicate “research and implementation of evidence-based interventions to promote smoking cessation and energy balance are a priority.”

The editorialists also point to issues of poor communication in clinical practice. “Among patients who survive a primary cancer, concern about recurrence, especially metastatic disease, is extremely common; however, information about future risk for subsequent primary cancers is seldom communicated to these patients, leading to missed opportunities to prevent or detect SPCs at an early stage.”

Close collaboration with primary care physicians during the early follow-up period is “a must,” Ganz told Medscape Medical News.

Oncologists should start the discussion right after initial treatment, when survivors are looking for ways they can prevent cancer recurrence or the development of new cancer, Ganz suggests.

“The ones I worry about the most are the young adults who could really benefit from the prevention outlook that primary care clinicians espouse,” she says, citing a 2016 study.

“If they continue to smoke or gain weight, that increases their risk of SPCs but also of comorbid chronic conditions…so it’s very important for them to get into the hands of a primary care physician. This issue is in the primary care provider court.”

Reorganization of Care and Payment Needed
For the study, Sung and colleagues analyzed data from 12 SEERS registries of FPC survivors diagnosed between 1992 and 2011. All patients had survived 5 years or more after initial diagnosis and had been followed to the end of 2017. Mean follow-up was 7.3 years.

The incidence and mortality of SPCs per 10,000 person-years were expressed as a standardized incidence ratio (SIR) and standardized mortality ratio (SMR) compared with expected risk in the general population.

A total of 30 FPC types were identified, including 12 smoking-related cancers and 12 obesity-related cancers.

In men, the highest risk of developing and dying from any SPC was estimated among survivors of laryngeal cancer (SIR 1.75) and gallbladder cancer (SMR 3.82), and among female survivors of laryngeal cancer (SIR 2.48; SMR 4.56).

Compared with men in the general population without a history of cancer, male survivors had an overall risk of developing any SPC that was significantly higher for 18 of the 30 FPC types. Male survivors also had an overall mortality risk for any SPC that was significantly higher for 27 of 30 FPC types.

This increased risk pattern looked much the same in female survivors when compared with women in the general population without cancer. The overall risk of developing and dying from any SPCs was significantly higher in female survivors for 21 and 28 of 31 FPC types, respectively.

The most common SPCs — after lung cancer — included colorectal cancer (8.8% of male survivors); pancreatic cancer (8.5% of male and 9.4% of female survivors); non-Hodgkin lymphoma (6% of male survivors); and breast cancer (5.8% of female survivors).

The study also shows that the risk for alcohol- and infection-related cancers was significantly higher following a diagnosis of most alcohol- and infection-related cancers.

These findings also have implications for reducing the economic burden of care, Sung and colleagues say.

“With the growing number of long-term survivors, the costs of treating patients with multiple primary cancers will increase, amplifying financial burden for cancer survivors and their families, particularly among elderly persons who may be living on fixed incomes. This consideration also has implications for the Medicare program, the primary payer for the population aged 65 years and older, as well as other health care payers,” the authors write, citing related financial research.

When it comes to improving outcomes for cancer survivors, “SPCs are just the tip of the iceberg,” Ganz warns. We will need some reorganization of healthcare delivery and payment schemes to make it happen, I think.”

She notes that recommendations for long-term survivorship care after cancer treatment were summarized following the 2017 National Cancer Policy Forum Workshop. Since then, “there has not been much movement,” Ganz says.

Current NCI-funded studies of innovative survivorship care planning and implementation are important, but results will not be forthcoming for at least 5 more years, she points out. “We really need more immediate efforts to transform care delivery.”

This study was funded by the American Cancer Society. Sung, study coauthors, and editorialists Ganz and Casillas have disclosed no relevant financial relationships.

JAMA. Published online December 22, 2020. Full text

2020-12-30T11:53:06-07:00December, 2020|Oral Cancer News|

Fighting throat cancer with T cells

Source: www.miragenews.com
Author: press release, Centenary Institute

Research led by the Centenary Institute has discovered that immune cells accumulating within the tumor environment, called tumor-resident T cells, are a critical determinant in survival rates of patients suffering from throat cancer.

Reported in the prestigious ‘Journal for ImmunoTherapy of Cancer’, the research suggests that strategies aiming to boost these T-cells at tumor sites could be beneficial to patients.

“Oropharyngeal squamous cell carcinoma (OPSCC) is a form of throat cancer. It can be caused by environmental factors such as smoking or by human papillomavirus infection (HPV), the same virus that causes cervical cancer in women,” said Ms Rehana Hewavisenti, lead author of the study and researcher at the Centenary Institute and the University of Sydney.

“We knew that patients with HPV-related OPSCC had far better clinical outcomes compared to other OPSCC patients but we didn’t know why,” she said.

In examining over sixty patient samples, Ms Hewavisenti and her colleagues discovered that increased levels of tumor-resident T cells, whether in HPV or non-HPV OPSCC cases, was clearly associated with improved patient survival outcomes.

“It was the accumulation of these immune T-cells, in and around the tumour site that appeared to be key,” said Ms Hewavisenti.

The researchers also found in their study that HPV OPSCC patients generally had far higher levels of tumour-resident T cells compared to their non-HPV OPSCC patient counterparts.

“We think these HPV positive patients tended to have better clinical outcomes as HPV infection is likely to favor the accumulation of these beneficial T-cells within the tumor area,” she said.

Dr Mainthan Palendira, Head of the Centenary Institute’s Human Viral and Cancer Immunology Laboratory and senior author on the research paper believes the research findings have major implications.

“Now that we understand how important this immune response is in relation to OPSCC, we can begin developing new treatment strategies focused on recruiting these favourable tumor-resident T cells directly to tumors,” he said.

Dr Palendira believes that looking at the amount of these T-cells in cancer could help clinicians to personalize the best treatment approach for individual patients.

“We also think that our research demonstrating viral (HPV) links with this tumor-resident T cell accumulation could help in future cancer vaccine development efforts too,” he said.

Gambling today: time to ban smoking in casinos

Source: www.si.com
Author: Frankie Taddeo

Casinos are working feverishly towards making guests feel they are not at risk when they travel back to properties with newly implemented safety measures. Among all these new features, there is one important change blatantly missing: prohibiting smoking.

Smoking could easily spread the COVID-19 virus, not only because of the need to remove your mask but because of an individual’s pattern of fingers to mouth while in constant contact with each game they decide to participate in.

Many doctors and experts have gone on record expressing that smoking or exposure to secondhand smoke can lead to coughing which in turn can aid in the spread of the infection. Unfortunately, casino operators don’t appear to have all the health interests of both their guests and employees at the heart of their newly implemented changes. Should that change, now is the time to play the hand being dealt and push all the collective chips into the middle.

Patrons either turning on the news or coming across signs in local establishments are told to avoid touching surfaces others have touched, and then touching your face, mouth, or eyes. In casinos, gamblers continuously touch cards, chips, dice, slot machine buttons, and above all, money. Even those of us who are not medical experts can rationalize that the act of smoking could likely lead to a higher risk of transmission during uncertain times

Also, what about the risks to non-smokers resulting from secondhand smoke? Part of the outline in the current Nevada Gaming Control Board’s reopening plan only requires properties to provide face masks or cloth face coverings upon request. Rather than make it a requirement, they only encourage guests to wear them.

The rationale behind the decision is not about safety, but money. Management running the properties are worried people would stop coming to play, leading to money lost from international tourism where many gamblers do not face such restrictions.

Dating to the days of Frank Sinatra to Sammy Davis Jr, many iconic images depict “Sin City” as a gambling destination where smoking has been synonymous with the lifestyle and imagery of the city’s bustling nightlife. But times have changed, and the goal should be to not only attempt to limit the spread of COVID-19, but to help others avoid the fate of Davis, an avid smoker who eventually passed away from throat cancer.

University of Nevada, Las Vegas gambling expert and author David Schwartz recently told USA Today that the current state of the world presents an ideal time for Nevada gaming operators to consider implementing the change:

“Coming back from COVID-19, both casino patrons and employees may have increased concerns about the presence of cigarette smoke. Given that the customer experience will be very different when casinos reopen, this may be an ideal time for Nevada gaming operators to consider changing where they allow smoking on their properties.”

Additionally, Ashley Herbert, Director of Government Relations with the American Heart Association, recently told the Shreveport Times:

“No one should have to choose between their health and a paycheck…there should not be one class of worker that is unprotected from the harmful effects of secondhand smoke,” Herbert told The Times.

If the focus of state officials is truly on the health and safety of the public, then directives should be made demanding casinos in every state become smoke-free. If considered, the greatest gambling destination in the world can implement a change that validates the health and safety of guests and workers at the forefront of the new reality.

Novel intervention looks to improve timeliness, equity of head and neck cancer care delivery

Source: www.miragenews.com
Author: staff report, Medical University of South Carolina

Many factors go into surviving cancer.

Hollings Cancer Center researcher Evan Graboyes, M.D., specializes in head and neck cancer, a disease with poor survival prospects despite intense therapy with combinations of surgery, radiation and chemotherapy. While head and neck cancer only accounts for 4% of all cancer cases each year in the US, it has a high mortality rate. The American Cancer Society estimates that more than 14,000 patients died from this disease in the U.S. in 2019.

Overall, only 50% of head and neck cancer patients are alive at five years. Unfortunately, the mortality rate is even worse for African American head and neck cancer patients. That’s why researchers are looking for new strategies to improve patient survival and decrease racial disparities in outcomes for these patients.

Graboyes and MUSC Hollings Cancer Center researchers Chanita Hughes-Halbert, Ph.D., Katherine Sterba, Ph.D., Hong Li, Ph.D., and Graham Warren, M.D., Ph.D., have teamed up to develop and test a novel intervention to improve the timeliness, equity and quality of head and neck cancer care delivery, which they think might one day be the key to improving survival for these patients.

Funded by a $1.3 million 5-year grant from the National Cancer Institute, their study – Improving the Timeliness and Equity of Adjuvant Therapy Following Surgery for Head and Neck Cancer-started in September 2019 and built upon important research funded by grants from Hollings Cancer Center.

Graboyes explained that for patients with advanced head and neck cancer who are treated with surgery, national guidelines recommend that postoperative radiation therapy should start within six weeks of surgery.

“However, we know from our research that despite national guidelines, over half of the patients nationally don’t get radiation started in a timely fashion. Patients who have delays with radiation are more likely to die and have their cancer recur,” he said. “We are trying to find new ways to deliver timely head and neck cancer care. It’s an appealing way to help improve survival for this group.”

Innovative approach
The study is designed in three parts. The first part aims to identify the underlying reasons for why delays starting postoperative radiation are so common for this patient population. The researchers then developed a new multilevel health care delivery intervention called NDURE (Navigation for Disparities and Untimely Radiation thErapy), that specifically targets the barriers that lead to delays.

In the second part of the grant, the researchers will pilot the NDURE intervention in a small group of patients to make sure that it’s feasible and acceptable and refine the intervention based on participant feedback. In the third and final part of the study, they will compare NDURE to standard care in a randomized controlled trial to see whether NDURE is effective at decreasing treatment delays.

“This study interests me because it is clinically important. To help patients with head and neck cancer live longer, you don’t need to invent a new drug. All you need to do is get them the treatment they’re supposed to be getting. If we can find a way to deliver timely guideline-recommended care, it could have such a large impact on their survival,” he said

“It’s also a scientifically important study. Head and neck cancer treated with surgery followed by radiation is a great model system for us to understand how we deliver cancer care. Right now, we spend a lot of time and effort helping get people in to initiate cancer care. However, we understand a lot less about how cancer patients move through complicated treatment plans.”

Graboyes said South Carolina is primarily a rural state with some geographic barriers that present obstacles for patients to navigate. “Many of the patients will have surgery at a regional center like MUSC, then because radiation is five days a week for six weeks, they’ll get radiation at a different facility closer to where they live. We have to coordinate cancer care across health care systems, which presents some barriers that can lead to treatment delays.”

Graboyes emphasized that head and neck cancer is a major concern for the state of South Carolina and Hollings Cancer Center, a National Cancer Institute-Designated Cancer Center. The two major causes of head and neck cancer are smoking and human papillomavirus (HPV). The state’s population is affected by both, due to high rates of tobacco use and very low rates of HPV vaccination.

“As a result, Hollings has recognized this issue and has really invested a lot in the clinical enterprise of head and neck cancer because it’s such a problem in South Carolina.”

Hollings also has a strong cancer control program dedicated to reducing issues of health disparities and equity in the state, he explained.

“We think that NDURE, our intervention targeting the multilevel barriers to timely head and neck postoperative radiation, will be an effective way to help improve timely cancer care delivery for these patients, which will lead to higher rates of survival and low recurrence and decrease racial disparities and outcomes. That’s very exciting to our team.”

Did you know?
About 70% of cancers in the oropharynx (which includes the tonsils, soft palate and base of the tongue) are linked to HPV.

Dedicated to the mission of raising HPV vaccination rates for teens and young adults, Hollings Cancer Center has initiated a $700,000 three-year project. The Centers for Disease Control and Prevention recommends speaking with a doctor about the HPV vaccination. The HPV vaccine can prevent new infections with the types of HPV that most often cause oropharyngeal and other cancers.

Test that looks at your spit to tell if you have mouth or throat cancer caused by HPV ‘could save thousands of lives if rolled out for doctors to use’

Source: www.dailymail.co.uk
Author: Connor Boyd, Health Reporter

A saliva test that diagnoses mouth and throat cancer caused by HPV could save thousands of lives each year, a study suggests. Scientists at Duke University in North Carolina discovered the test was 80 per cent accurate at spotting the killer diseases.

Doctors say it is able to detect the cancers early on, giving patients much higher hopes of surviving their battle. Before it can be used in hospitals around the world, further trials will be needed to confirm the technology works. But the researchers are hopeful, claiming the cheaper test – which gives results in as little as 10 minutes – has significant ‘potential’.

Rates of oral cancers are soaring in the Western world, with the number of patients diagnosed in the UK having doubled in a generation. US doctors have also seen a similar spike in the diseases, which can be caused by human papilloma virus (HPV).

The infection – spread through oral sex, as well as anal and vaginal intercourse – is thought to cause around 70 per cent of all cases. Other risk factors include drinking excessive amounts of alcohol over long periods of time and smoking cigarettes.

Professor Tony Jun Huang, study co-author, said there are around 115,000 cases of oropharyngeal cancers each year across the world. He said it is ‘one of the fastest-rising cancers in Western countries due to increasing HPV-related incidence, especially in younger patients’.

Orophayngeal cancer starts in the oropharynx, the back of the throat which includes the base of the tongue and tonsils. It sits under the branch of head and neck cancers, which also includes mouth cancer – another type that can be caused by HPV. Detecting the disease early can boost survival odds from 50 per cent to 90 per cent, according to the NHS. But patients are often not diagnosed until they become advanced, partly because their location makes them difficult to see during routine clinical exams.

The new test uses a chip developed to isolate tiny micro-particles, known as exosomes, in saliva.These particles are secreted into body fluids and several types of cancers are known to multiply their numbers. Exosomes are responsible for transferring molecules between cancer and various cells.

The new test isolates them by filtering out larger particles in the saliva and probing the exosomes for DNA shed by tumours. It also scans fluid in the mouth for HPV-16, one strain of the STI that can put people at risk of oropharyngeal cancer. The test takes five minutes to conduct and a further five to process the results. Experts also said it is cheap – but did not elaborate on the cost. In comparison, current biopsies take around eight hours because they need to be sent away to be assessed by a surgeon.

Professor Huang said: ‘It is paramount that surveillance methods are developed to improve early detection and outcomes.’ He added the successful detection of HPV from saliva ‘offers advantages including early detection, risk assessment, and screening’.

The test was a collaboration between Duke University, the University of California and University of Birmingham in Britain.

Orophayngeal cancer killed 2,722 Britons last year and took the lives of 9,750 people in the US, figures show. New cases of the disease in the UK have risen to 8,302 a year, a jump of 135 per cent compared with 20 years’ ago.

According to the researchers, this technology can also be used to analyse blood, urine, and plasma. The findings were published in the Journal of Molecular Diagnostics.

The Oral Health Foundation last month urged people to wise up to the causes of the ‘devastating’ disease, mainly HPV and alcohol. Dr Nigel Carter OBE, chief executive of the OHF, said: ‘While most cancers are on the decrease, cases of mouth cancer continue to rise at an alarming rate.

‘Traditional causes like smoking and drinking alcohol to excess are quickly being caught by emerging risk factors like the human papillomavirus (HPV).

‘We have seen first-hand the devastating affect mouth cancer can have on a person’s life.’

2019-12-14T11:12:24-07:00December, 2019|Oral Cancer News|

Researchers: Favorable survival, fewer side effects after reduced therapy for HPV-linked head and neck cancer

Source: medicalxpress.com
Author: University of North Carolina at Chapel Hill School of Medicine

University of North Carolina Lineberger Comprehensive Cancer Center researchers reported that reducing the intensity of radiation treatment for patients with human papillomavirus-associated head and neck cancer produced a promising two-year progression-free survival rate and resulted in fewer side effects.

The findings, published in the Journal of Clinical Oncology, were drawn from a phase II clinical trial that included 114 patients with HPV-linked head and neck cancer and a limited smoking history. The researchers reported that they saw a similar progression free survival rate, and that patients experienced fewer long-term side effects in the study compared with patients who received standard intensity treatment in previous studies.

“A simple de-intensification strategy of reducing radiation and chemotherapy appears to be as effective at cancer control as the standard seven-week regimen,” said UNC Lineberger’s Bhishamjit S. Chera, MD, associate professor in the UNC School of Medicine Department of Radiation Oncology. “Furthermore, there were fewer toxicities.”

For the trial, patients received six weeks of treatment, including a reduced intensity of radiation therapy of 60 Gray with weekly low-dose chemotherapy of cisplatin. The standard of care regimen is seven weeks of treatment 70 Gray and high-dose chemotherapy.

The main outcome that the researchers were studying was two-year progression-free survival. On the reduced regimen, researchers found that the two-year progression free survival was 86 percent, compared to a two-year progression free survival reported from other studies using standard treatment doses of 87 percent.

Chera said the major long-term side effects of radiation treatment are related to swallowing and dry mouth. Previous studies have shown the majority of patients treated with standard intensity chemoradiotherapy require a temporary feeding tube and some have significant long-term swallowing dysfunction.

Notably, in this study, patients reported that their swallowing returned to baseline after de-intensified treatment, and only 34 percent required a temporary feeding tube.

The results need to be validated in larger, randomized clinical trials, Chera said, and studies are ongoing to investigate this.

He added that while this study included patients with a limited smoking history, other current studies include patients with more extensive smoking histories.

Chera said that researchers want to continue to improve two-year progression free response rates while achieving better side effect results. They want to do that by identifying additional biomarkers to drive precision medicine strategies.

Although traditional clinical risk help clinicians predict outcomes and select patients for clinical trials of de-intensified treatments, Chera said that these risk factors are imprecise. He and his colleagues are currently evaluating additional novel biomarkers that they believe could be used to better predict a patient’s prognosis and outline a course of treatment.

Specifically, they have shown in a previous study how levels of circulating HPV DNA in the blood, and how quickly patients clear this from the blood, were linked to outcomes.

2019-09-14T09:18:38-07:00September, 2019|Oral Cancer News|

‘Whitish patch’: increase in oral dysplasia in young adults

Source: www.medscape.com
Author: Kristin Jenkins

Most 8-year-olds with a wiggly tooth expect the Tooth Fairy to tuck some money under their pillow. In the case of one little Canadian boy, his wiggly tooth got him an incisional biopsy, a diagnosis of oral squamous cell carcinoma (OSCC), a partial maxillectomy, and a defect that was closed with local advancement flaps.

“This was the most unusual case we’ve seen,” said Marco A. Magalhaes, DDS, PhD, assistant professor of oral pathology and oral medicine in the Faculty of Dentistry at the University of Toronto in Ontario, Canada.

“OSCC predominantly affects patients 40 years of age and older,” write Magalhaes and colleagues in a case study report published in November 2016 in Oral Surgery Oral Medicine Oral Pathology Oral Radiology. “It is extremely rare in patients younger than 20 years of age.”

The clinical, radiographic, and histologic findings in this young patient were distinctive. Although the diagnosis and treatment were challenging, the clinical course was favorable at follow-up, the authors said. This case illustrates the fact that even pediatric patients can be at risk for OSCC. Magalhaes said that he and other dentists are concerned about the rising number of OSCC cases in patients who are in their 20s and 30s. These patients have no known risk factors and are often without symptoms. Many are diagnosed with high-grade oral epithelial dysplasia (OED) that rapidly progresses to cancer, Magalhaes told Medscape Medical News.

“When you look at the distribution of cases of oral dysplasia or carcinoma, you see that they tend to occur in older males in their 50s with a history of smoking and a low risk of [malignant] transformation,” he explained.

“What we are seeing in practice, however, is a lot of dysplasia in younger individuals without risk factors. These cases are the most concerning,” he commented.

At the time of presentation, patients may say, “I’m not sure why I’m here, but I saw a whitish patch in my mouth,’ ” said Magalhaes.

Others may be asymptomatic and have “absolutely no concerns,” he pointed out. “Unfortunately, this story is becoming more common.”

Nonhealing Sore in Mouth
Oral cancer usually presents as a nonhealing sore that is often painful. OED can be more difficult to diagnose because it manifests as a faint whitish or red patch anywhere in the oral cavity.

The gums, tongue, soft palate, and the inside of the cheeks can be affected. Most commonly, the floor of the mouth is affected.

Currently, Magalhaes and colleagues are conducting a review of more than 3000 cases of dysplasia in Ontario to determine group distribution, pattern, and, potentially, risk factors.

Although oral cancer has multiple causal factors, Magalhaes noted that smoking is “by far” the most significant and well-recognized risk factor. Heavy alcohol consumption is also a well-known risk factor. Human papillomavirus accounts for 5% to 6% of oral cancers, he noted.

A regular dental checkup is important, and early detection is critical for survival, Magalhaes emphasized.

For high-grade OED, the risk for progression to frank carcinoma is 18% to 30%, he noted. For moderate-grade OED, the risk is 10% to 15%, and for low-grade oral dysplasia, it is 1% to 4%.

“Physicians should reinforce to their patients the importance of dental checkups at least twice a year,” Magalhaes said. “This alone would increase the chances of early lesion detection.”

Review of Biopsy Specimens
A recent review of 63,483 biopsy specimens submitted by dentists to the Toronto Oral Pathology Service (TOPS) primarily from 2005 through 2015 bears this out. The review, led by Magalhaes, was published online April 25 in the Journal of the American Dental Association.

TOPS is operated by the Faculty of Dentistry at the University of Toronto and is one of the largest oral pathology services in Canada, noted Magalhaes, who works there.

The results show that generally, the incidence of OED (2679 cases) and OSCC (828 cases) in Ontario remained stable from 2005 to 2015. It also showed that when it comes to early detection of oral lesions, dentists have seriously stepped up their game. During the 10-year period, detection of OED by dentists increased 3.8-fold. The number of OSCC cases they detected doubled. OSCC accounted for about 10% of all oral cancers in the province in 2015.

“These biopsy specimens were submitted mostly by specialists in oral and maxillofacial surgery, periodontics, endodontics, and oral and maxillofacial pathology and oral medicine,” the authors write.

“However,” they continue, “informal discussion with clinicians who submitted the biopsy specimens has indicated that the initial detection of the mucosal abnormality was often accomplished by the general practice dentist, dental hygienist, or both, who referred the patient to specialists for evaluation, biopsy, and case management.”

The study also shows that potentially malignant lesions made up 4.68% of all cases and that OED accounted for 90%. An increased awareness of early lesions with malignant potential can result in early diagnosis and decreased morbidity and mortality from OSCC, the researchers say.

Both dentists and patients appear to be maintaining a high index of suspicion, according to Magalhaes.

“Dentists are increasingly aware of the presence of these early lesions and are either biopsying them themselves or sending them for biopsy,” he explained. “We’ve also noticed that patients are more aware of mouth changes and are asking dentists about lesions that they have identified.”

During a routine dental checkup, an examination for early signs of oral cancer is performed. This includes inspection of the lymph glands in the neck and a check of all mucosal surfaces in the oral cavity for signs of ulcers or red or white patches.

The severity of OED determines treatment, noted Magalhaes. In cases of low-grade OED, the lesion is monitored every 6 months, and a repeat biopsy is performed if warranted. A high-grade OED that is accessible and relatively well contained is treated with complete surgical excision. This is followed by monitoring two or three times a year. When the lesion is diffuse, affects 60% of the oral cavity, or extends into areas that are difficult to access without significant morbidity, the patient is closely monitored with examinations four times a year, he said.

Source:
J Am Dent Assoc. Published online April 25, 2019. Abstract

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Nov;122:e179-e185. Full text

April is Oral Cancer Awareness Month: Self-exams, early detection can save lives

Source: www.prnewswire.com
Author: press release

Because early detection of oral cancer offers a greater chance of a cure, the American Association of Oral and Maxillofacial Surgeons (AAOMS) is reminding the public during Oral Cancer Awareness Month of the importance of performing monthly self-exams.

AAOMS promotes self-exams and screenings every April with the Oral Cancer Foundation, which predicts about 53,000 new cases of oral cancer will be diagnosed in 2019 in the United States – leading to more than 9,000 deaths.

“A monthly self-exam takes only minutes and could potentially save your life,” said AAOMS President A. Thomas Indresano, DMD, FACS. “If done on a regular basis, you’re increasing the chances of identifying changes or new growths early. The survival rate for oral cancer is between 80 and 90 percent when it’s found at early stages of development.”

Oral and maxillofacial surgeons (OMSs) encourage a six-step oral cancer self-exam that involves looking and feeling inside the mouth for suspicious sores and feeling the jaw and neck for lumps. Using a bright light and a mirror:

  1. First remove any dentures.
  2. Look and feel inside the lips and the front of the gums.
  3. Tilt the head back to inspect and feel the roof of the mouth.
  4. Pull the cheek out to inspect it and the gums in the back.
  5. Pull out the tongue and look at its top and bottom.
  6. Feel for lumps or enlarged lymph nodes in both sides of the neck, including under the lower jaws.

Oral cancer symptoms may include one or more of the following if they are persistent and not resolving:

  • Red, white or black patches in the soft tissue of the mouth.
  • A sore in the mouth that fails to heal within two weeks and bleeds easily.
  • An abnormal lump or hard spot in the mouth.
  • A painless, firm, fixated mass or lump felt on the outside of the neck that has been present for at least two weeks.
  • Difficulty in swallowing, including a feeling food is caught in the throat.
  • Chronic sore throat, hoarseness or coughing.
  • A chronic earache on one side.

The risk factors for oral cancer include smoking and tobacco use, alcohol consumption and the human papillomavirus (HPV).

“About 25 percent of oral cancer patients have no known risk factors,” Dr. Indresano said. “It’s important that everyone perform a monthly self-exam. And if you have any of the symptoms for more than two weeks, promptly contact an oral and maxillofacial surgeon. OMSs are experts in diagnosing and surgically treating oral cancer.”

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.

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