Jay Aston, singer: ‘I have a leg scar and one on my neck, but it’s a small price to pay for life’

Source: www.belfasttelegraph.co.uk
Author: Gabrielle Fagan

Jay Aston says she no longer stresses about “silly little things”. After being diagnosed with mouth cancer in 2018, the former Bucks Fizz star was left wondering whether she would ever sing again – or even survive.

The experience rocked her world. But Aston, part of the original band that stormed to victory in the 1981 Eurovision Song Contest and went on to sell millions of records, is still performing with Mike Nolan and Cheryl Baker in The Fizz, a new version of the group. Before lockdown hit, they’d been busy touring and promoting their latest album, Smoke And Mirrors.

The enforced break has given her time to reflect on the “incredibly tough” two-year journey, which “made me re-evaluate my life”, says Aston.

“Surviving an experience like that makes you realise the simple things and pleasures you took for granted.

“We all get so upset about minor things and miss the fact that whatever’s happening, if you’re here it is a good day.”

Aston (59) who’s among a host of celebrities taking part in The Smiling Sessions – online sing-alongs to entertain care homes residents and isolated elderly people, – recalls the moment doctors revealed she had cancer.

“The whole thing was such a shock and completely devastating. Also I had no idea what effect the surgery would have on my voice,” she recalls. “I’m from a show-business family and singing and dancing is in my DNA and part of my identity, and to have that threatened was demoralising.”

Aston, who lives in the Kent countryside with her husband, musician Dave Colquhoun and their daughter, Josie (17), adds quietly: “I wrote my will. I’ve always felt you have to be a realist and face up to things when they happen. So I decided to plan for the worst but hope for the best.”

Aston had originally been told she had lichen planus, a type of rash, by her dentist back in 2015. “It just looked like a tiny white cobweb on my tongue,” she remembers – but by January 2018, the rash had spread to the back of her tongue.

Lichen planus can affect any part of the body and is generally harmless. However, when certain parts of the mouth are affected, there can be a slightly increased risk of oral cancer, and an exploratory procedure found cancerous cells in Aston’s tongue. A few weeks later, she had a seven-hour operation to remove 40% of her tongue.

Although she shed “tears of joy” when she was told the surgery had left her cancer-free, the road to recovery has been long and painful.

Surgeons created a new tongue using tissue from Aston’s thigh, which was fed into her mouth through her neck.

She required months of physio to regain full speech and projection – although her singing voice was unaffected. Her band mates, Aston says, have been incredibly supportive. The years of acrimony around contractual disputes – she and Baker didn’t speak for 23 years – are clearly behind them.

“We’ve had our moments but we have something special that bonds us together. It was also very emotional to get hundreds of messages of support and good wishes from our fans,” says Aston.

“I recorded as many tracks as possible on our album before the surgery, in case the worst happened and I was never able to return.

“I was actually able to start singing again just three-and-a-half months after the operation. It was nerve-racking at first and I had a lisp, which has now gone, but wonderful to know I could still perform.”

Her surgeons took care with the siting of the tissue graft, to minimise the visible scarring on her leg.

Aston says with a smile: “That’s great, as the band’s still asked to perform that skirt-ripping routine – we’ll probably still be doing it when we’re on our Zimmer frames! I have that leg scar and one on my neck, but it’s a small price to pay for life.”

The relief that she’d survive and be around for her family was overwhelming, she says.

“My biggest fear was that I might leave my daughter, who’s my world. I want to be there for her and to see her grow up, get married and see my grandchildren,” she says.

“My husband was wonderful. He was our rock. Dave’s a Northerner who doesn’t show his emotions but he’s been so strong, which is just what I needed. It wouldn’t have helped me to see him upset. We’ve coped for each other.”

Emotionally, she admits it’s been complicated. “There’s this huge feeling of being so lucky and thankful to have come through it, but you also go through different stages as you recover, when you feel very down because of all you’ve been through, and then you go up again.

“Of course, l’ll always be so grateful that it was picked up early and was treatable. I’d urge anyone with any concern, no matter how small, to check it out with their doctor or dentist.”

She readily admits that having check-ups every three months can still be nerve-racking.

“I’m still dealing with the unknown, which you do when you’ve had cancer. You cannot know for certain it won’t come back. You just hope it won’t. The threat of Covid-19 has, of course, added another level of uncertainty to everyone’s lives,” says Aston.

Her resilience has been honed by her past experiences. In 1984, Aston survived a near-fatal coach crash while on tour with Buck’s Fizz, which left her with temporary paralysis and memory loss.

In the years that followed, she lost both her parents – her mother to bowel cancer and her father to Alzheimer’s.

“Ironically, lockdown’s given me time to step back a bit and chill out, which I think I’ve needed,” she says. “I was so anxious to show I was fine after the operation, I think I pushed myself a little too much physically early on.

There are days still when I don’t have too much energy and have to rest. I have to respect the fact my body is still healing.”

Reflecting on how her attitude to life has changed, she says: “After a lot of soul-searching, you realise there’s no point going over the past. Instead it’s about focusing on the present, and I’m now at the stage where I feel positive about the future.”

She says viewing “footage of the galaxy and recognising its enormity and our tiny place within it” helps her stay balanced. “It takes my mind off things and re-balances my perspective.”

Aston adds: “I’ve never forgotten, as a school girl on holiday with my parents, when a very old lady came up to me and pressed a card in my hand.

“The message on it was, ‘Take risks – chances are you’ll never regret them.’ That was the wisest advice. It told me to get out there and live my life to the full, which I have.”

Jay Aston, along with other celebrities, is participating in The Smiling Sessions – virtual sing a-longs for care home residents. They’re raising funds for tablets so more residents can take part and improve their health and wellbeing during such difficult times for the elderly community.

Surgery, radiation yield similar efficacy for early squamous cell carcinoma of lip

Source: www.healio.com
Author: Earl Holland Jr.

Both surgery and radiation therapy were beneficial methods of treating early-stage lip squamous cell carcinoma, according to findings presented at the American Academy of Dermatology virtual meeting.

Kevin Phan, MD, of the dermatology department at Liverpool Hospital, Sydney, Australia, and Mahmoud Dibas, MD, of Sulaiman Al Rajhi Colleges, College of Medicine, Saudi Arabia, sought to examine the survival rates in low-stage lip squamous cell carcinoma (SCC) between patients who had surgery alone and patients who had radiation therapy alone.

“Squamous cell carcinoma of the lip composes 25% to 30% of all oral cancers,” the authors wrote. “Lip SCC is often detected at an early stage, due to the highly visible location and slow growth pattern.”

Results from the Surveillance, Epidemiology, and End Results database between 2010 and 2014 were analyzed. Overall survival and cancer-specific survival were measured.

The researchers identified 900 patients with early-stage lip SCC who had received either radiation alone (36 patients) or surgery alone (864 patients).

Patients who underwent surgical procedures had better overall survival and cancer-specific survival rates compared with patients who had radiation alone, the study found. The treatment modality did not have a significant effect on either survival rate; the radiation-alone group had an adjusted hazard ratio of 1.94 (95% CI; 0.83-4.53), while the surgery-alone group had an adjusted hazard ratio of 1.04 (95% CI; 0.07-15.55).

“Our results support the notion that surgery and [radiation therapy] appear to be equally effective in treating early-stage lip SCC,” the researchers wrote.

Revealed: How cancer unit kept theatres open and saved lives despite coronavirus lockdown

Source: www.sundaypost.com
Author: Janet Boyle

Patients with head and neck malignancies have continued to get vital surgery at Queen Elizabeth University Hospital in Glasgow under strict infection vigilance set up by its maxillofacial surgery unit.

More than 40 patients have been treated for head and neck ­cancer during lockdown. Others have undergone procedures for facial skin cancer and facial injuries.

The Royal College of Surgeons Edinburgh says 87% of its members in cancer surgery had stopped operating altogether or significantly reduced the number of procedures due to the danger of patients contracting the virus. And experts fear deaths from cancer could rise by a fifth over the next year as a result of scores of treatments and consultations being cancelled.

Now it is hoped the protocols ­followed by the Glasgow team can be adopted to allow more surgery to resume. Critical to the safety of the operations is that the patients are tested for coronavirus twice before the procedure – once 48 hours beforehand, and then again immediately before surgery begins.

Patients are also asked to ­self-isolate for two weeks before surgery, the surgical team works in a separate building to the main hospital and some surgical techniques have been modified to reduce the risk of infection.

Operating on head and neck malignancies poses considerable risk to theatre teams because the work is closely associated with patients’ faces and respiratory systems, making the virus easily transmissible.

Further risk lies in the head and neck surgeon having to abandon a face shield to use the operating microscope vital to navigate and sew together tiny nerves and blood ­vessels in the face and throat.

Professor Jim McCaul, a ­consultant maxillofacial surgeon at the QEUH, said: “We never stopped working for our cancer patients. We have been doing major surgery throughout, with massive support from trainees and all of the outpatient, ward and theatre staff and nurses and administration team.

“Recent announcements about introducing a two-week lockdown on patients is what we have been doing from the start. There has been amazing support in theatre and no one hesitated at all about continuing surgery on patients.

“It would not have happened ­without the six other maxillofacial head and neck surgeons, outpatient, ward and administrative staff and many others.

“Our theatre nurses all wear full PPE, even though the patients have tested negative. Some staff are even isolating from their families. I cannot wear a visor at the microscope and that raises the risk, but it is a calculated risk.”

Patients will also need radio and chemotherapy, if the disease is more advanced.

“We also very worried about patients sitting on cancer and ­infection symptoms which will present later. It means more life-­changing treatment and we cannot cure them all,” Professor McCaul added.

Survival from head and neck ­cancer – between 50% and 60% depending on the area of head and neck affected and how advanced when it is diagnosed – has lagged behind other cancers such as breast and leukaemia.

“Cases diagnosed later can need extensive surgery, which can change patients’ appearance and ability to chew, swallow food and speak,” Professor McCaul added.

The Scottish Government is ­working to resume treatment halted during the Covid pandemic.

Discussions are ongoing as to how to take Scotland’s cancer surgery and other operations forward. Surgeons believe the way ahead almost certainly involves continual testing of staff and patients.

Hospitals in other countries have strived to create Covid-free units but emergency admissions of patients with the virus have made that challenging.

Besides operating on cancer patients, the QEUH’s head and neck cancer team has been treating those with facial injuries caused by trauma.

Professor McCaul said: “Only the super-urgent trauma cases have to go to theatre and we can get a test in 24 hours and wear full PPE for that.

“If we need to use plates and screws we use self-drilling screws because the drill generates aerosol.”

Nursery teacher Mandy Peebles was devastated to be diagnosed with mouth cancer at the age of 30.

“Everyone is scared when they are told they have cancer and I was prepared to go to any lengths to get the surgery needed to remove it,” said Mandy, from Cowglen, Glasgow. “I came across the pea-sized lump by accident, while looking for a wisdom tooth coming through. A referral to Glasgow Dental Hospital and a biopsy in December led to an appointment at the maxillofacial unit at the Queen Elizabeth University Hospital in Glasgow.

“Results confirmed it was cancer in January, just as Covid was spreading across mainland Europe to the UK.”

Mandy had two operations, in March and April. She said: “The government warnings about cancer patients being at extra risk made me lock down at home and when I was told by Professor McCaul that I would have to completely isolate I did everything possible to ensure I remained Covid-free. Catching the virus would mean my operation would be cancelled.

“My fiancé Calum is a railways maintenance engineer who works in isolation with PPE so all possible transmission was sealed off.

“I could only see my parents by waving to them when they passed my garden gate and that was heartbreaking.

“Not being able to hug my mum before undergoing surgery was painful for us both. But that’s what it took to get the surgery and I can only thank the surgical team for everything they did.

“I was fully aware that mouth cancer was a hill to climb and early treatment was vital.

“I was isolated in hospital for two days before the op and tested before going into theatre.

“The minutes seemed like hours as I waited for the Covid test results. When they returned negative the feeling of relief was amazing.”

Mandy added: “Calum and I are marrying in exactly a year and I now have everything to live for.”

Study: Healthy diet may avert nutritional problems in head, neck cancer patients

Source: news.illinois.edu
Author: Sharita Forrest

At least 90% of head and neck cancer patients develop symptoms that affect their ability or desire to eat, because of either the tumor itself or the surgery or radiation used to treat it. These problems, called nutrition impact symptoms, have wide-ranging negative effects on patients’ physical and mental health and quality of life.

However, patients who eat foods high in antioxidants and other micronutrients prior to diagnosis may reduce their risks of developing chronic nutrition impact symptoms up to one year after being diagnosed with head or neck cancer, according to a recent study led by researchers at the University of Illinois.

The scientists analyzed the dietary patterns of 336 adults with newly diagnosed head and neck cancers and these patients’ problems with eating, swallowing and inflammation of the digestive tract. This painful inflammatory condition, called mucositis, is a common side effect of radiation treatment and chemotherapy.

The mitigating effects of a healthy diet were particularly significant in people who had never smoked and in patients who were underweight or normal weight at diagnosis, who often experience the greatest eating and digestive problems during treatment, said Sylvia L. Crowder, the paper’s first author.

Crowder is a research fellow in the Cancer Scholars for Translational and Applied Research program, a collaborative initiative of the U. of I. and Carle Foundation Hospital in Urbana, Illinois.

“While previous work has established that the presence of nutrition impact symptoms is associated with decreased food intake and weight loss, no studies have examined how pre-treatment dietary intake may influence the presence of these symptoms later in the course of the disease,” Crowder said.

In the early 2000s, researchers hypothesized that consuming antioxidant supplements might protect patients’ normal cells from damage during radiotherapy, enabling them to better tolerate treatment and higher dosages.

Accordingly, prior research by Anna E. Arthur, a professor of food science and human nutrition at the U. of I. and the current study’s corresponding author, indicated that eating a diet of whole foods abundant in antioxidants and phytochemicals improved recurrence and survival rates in head and neck cancer patients.

Like Arthur’s prior research, the new study was conducted with patients of the University of Michigan Head and Neck Specialized Program of Excellence.

Data on patients’ tumor sites, stages and treatment were obtained from their medical records. More than half of these patients had stage 4 tumors at diagnosis.

Prior to starting cancer treatment and again one year post-diagnosis, the patients completed a questionnaire on their diet, tobacco and alcohol use, and quality of life. Patients reported whether they experienced any of seven nutrition impact symptoms – such as pain or difficulty chewing, tasting or swallowing foods and liquids – and rated on a five-point scale how bothersome each symptom was.

In analyzing the patients’ eating habits, the scientists found that they followed either of two major dietary patterns – the Western pattern, which included high amounts of red and processed meats, fried foods and sugar; or the prudent pattern, which included healthier fare such as fruits and vegetables, fish and whole grains.

Patients who ate healthier at diagnosis reported fewer problems with chewing, swallowing and mucositis one year after treatment, the scientists found.

“While the origin and development of nutrition impact symptoms are complex and varied, they generally share one common mechanism – cell damage due to inflammation,” said Arthur, who is also an oncology dietitian with the Carle Cancer Center. “The prudent dietary pattern has the potential to reduce inflammation and affect the biological processes involved in the pathogenesis of these symptoms.”

The scientists hypothesized that some patients may begin eating healthier after being diagnosed with cancer, potentially counteracting the pro-inflammatory effects of their previous dietary habits.

Reverse causation was possible too, they hypothesized – patients’ lack of symptoms may have enabled them to consume a broader range of foods, including healthier whole foods, before their cancer was discovered.

Notes:
Alison M. Mondul, Laura S. Rozek, Dr. Gregory T. Wolf and Katie R. Zarins, all of the University of Michigan, were co-authors of the study.

Additional co-authors were Kalika P. Sarma of the Carle Illinois College of Medicine, M. Yanina Pepino of the U. of I., and Zonggui Li and Yi Tang Chen, both then-graduate students at the U. of I.

In addition to the C-STAR program, an Academy of Nutrition and Dietetics Colgate Palmolive Fellowship in Nutrition and Oral Health, and the U.S. Department of Agriculture National Institute of Food and Agriculture supported the research.

2019-12-17T09:16:56-07:00December, 2019|Oral Cancer News|

Anti-malarial drug can make cancer chemotherapy more effective

Source: medicalxpress.com
Author: Emma McKinney, University of Birmingham

Scientists at the University of Birmingham have found an anti-malarial drug was effective in treating head and neck cancer in mice.

The drug quinacrine was used extensively to prevent and treat malaria in soldiers fighting in mosquito-ridden areas during World War Two. It is similar to the quinine that makes tonic water glow, has minimal side-effects, and is now used for treating parasite infections and other conditions.

Each year around 11,900 people are diagnosed with head and neck cancer in the UK. Current treatment relies heavily on debilitating surgery and toxic chemotherapy, but despite this, it has a poor outcome with three to seven in 10 people surviving their disease for five years or more.

The drug, quinacrine, was tested through a number of methods, including on cell cultures, in tumour biopsies from patients with head and neck cancer, and in mice.

The research results, published in Oncotarget, show that in mice quinacrine can make standard chemotherapy more effective—suggesting a lower dose may be used, reducing toxic side effects.

The results also showed the drug to be effective at reducing the growth of cancer cells grown in the lab, and in tumors.

Significantly, the research in mice showed a combination therapy of quinacrine and chemotherapy, and so allowed for the chemotherapy dose to be halved while still maintaining the same impairment of tumor growth.

Lead author Dr. Jennifer Bryant, of the University of Birmingham’s Institute of Head and Neck Studies and Education, said: “This is important research in the laboratory and demonstrates the real potential in repurposing drugs.

“The team is now looking to translate these research findings into a clinical trial for head and neck cancer patients.”

Corresponding author Professor Hisham Mehanna, Director of the Institute of Head and Neck Studies and Education at the University of Birmingham and Consultant Head, Neck and Thyroid Surgeon at University Hospitals Birmingham NHS Foundation Trust, said drug repurposing is particularly exciting due to known safety in humans and low cost, which mean they can be rapidly translated from the lab to the clinic.

He added: “Head and neck cancer patients have limited treatment options, often associated with severe, potentially life-threatening, side effects, it is important, therefore, that we find different treatments.

“My team has developed a drug repurposing platform called “AcceleraTED’ which assesses drugs that treat other non-cancerous conditions and have been approved by the Food and Drug Administration and the European Medicines Agency to see if they have the potential to be effective anti-cancer agents against head and neck cancer.

“This research is an example of the success we are having in the laboratory through this platform in identifying promising drugs that can be candidates to be used in patients in clinic.”

Psychological impact of head and neck cancers

Source: pharmafield.co.uk
Author: Emma Morriss

Bristol-Myers Squibb (BMS), in partnership with patient groups The Swallows and the Mouth Cancer Foundation, have announced the results from a patient survey into the psychological impact of head and neck cancers. The research explored the long-term burden of treatment on head and neck cancer patients.

After undergoing treatment for head and neck cancer, which can include surgery, chemotherapy or radiotherapy, many patients report an ongoing impact on their day-to-day life. However, 55% of the 118 patients surveyed indicated they did not receive the right level of information in preparation for the complications encountered from treatment.

There are around 11,900 new head and neck cancer cases in the UK every year and the incidence of head and neck cancer has increased by 32% since the early 1990s.

Following treatment, the survey showed 56% of patients had problems with simple things like swallowing, often experiencing severe pain, while two-thirds of patients experienced changes in their voice or speech. The survey also showed self-reported change from pre- to post- treatment in vital areas including a drop in the ability to communicate (37%), memory loss (21%), and trouble sleeping (20%).

As well as physical symptoms, treatment can have severe implications on mental health too. 52% of patients reported feelings of anxiety before treatment, which only reduced to 48% following treatment. However, emotional and psychological support was only offered to 46% of patients.

A majority of patients did receive access to a clinical nurse specialist, however there was still 23% who were not offered this service. Clinical nurse specialists use their skills and expertise in cancer care to provide physical and emotional support, coordinate care services and inform and advise patients on clinical as well as practical issues, which have been shown to lead to more positive patient outcomes.

“These results show the impact treatment may have on head and neck cancer patients. The continued problems and symptoms experienced by patients after treatment significantly impacts patients’ daily life. We also know physical disfigurement can increase social anxiety. It is important that we raise the awareness of this and work together to provide solutions to improve and support patient outcomes.” said Mouth Cancer Foundation, Clinical Ambassador, Mr Mahesh Kumar.

“With the incidence of head and neck cancers increasing, it is vital we understand what we can do to help patients. We are so pleased to have worked in collaboration with BMS and the Mouth Cancer Foundation to help raise awareness of this disease and understand where patients might need more help to reduce the impact on their lives. We know head and neck cancers, and the associated complications, do not get a lot of attention so it’s crucial for awareness days such as World Head and Neck Cancer Day to be used to shine a light on the disease. By doing so, it will help to improve detection, treatment and outcomes for patients.” commented Chris Curtis, Chairman of The Swallows.

Head and neck cancer: Novel treatment approaches

Source: www.curetoday.com
Author: staff

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, share insight into the role of novel treatment approaches like immunotherapy, robotic surgery and de-escalation in the management of cancers of the head and neck.

Transcript:
Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Dr. Brook, traditionally the treatment for head and neck cancer has been surgery, radiation, chemotherapy or some combination of those three. But there are some new and emerging treatment approaches to head and neck cancer along with many other cancers. Can you tell us a little bit about immunology? What is immunotherapy in the care of the head and neck cancer patient?

Itzhak Brook, M.D., M.Sc.: Most days, we don’t get cancer because our immune system is like the police department of our body. They detect cancer early and eliminate it. Unfortunately, in the case of cancer, the cancer cells can fool the immune system, and they go undetected and cause the disease. The main advantage of immunotherapy is that we are using the body’s defenses, the immune system, to kill the cancer in a much better way than the chemotherapy. Chemotherapy destroys the cancer cells, but it also affects the body cells. Immunotherapy is more precise. It is directed only to the cancer cells, so the rest of the body stays unscathed. That’s the beauty of immunotherapy. So, immunotherapy is an evolving field in cancer. They have many, many new drugs in the pipeline, and many studies are being done. But right now, there are several drugs that are good and seem to help in a patient with cancer, cancer that has already spread or that surgery cannot reach. The body’s own immunity would reach it.

One of them is monoclonal antibodies that were developed specifically for the cancer cells, and the other one is checkpoint inhibitors, which overcome the attempt by the cancer cells to fool the immune system and protect the cancer cells from their own immunity. So, by blocking those checkpoints, the body’s own immunity comes in and destroys the cancer cells. Those drugs are very promising because first of all, they are more effective in getting only the cancer cells. They do cause fewer side effects, and we are hopeful that they would be the new armamentarium that we will have for head and neck cancer.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: So, would you say that’s something you should ask your physician about to find out what clinical trials and what types of medications are offered for your specific type of cancer at the time of diagnosis?

Itzhak Brook, M.D., M.Sc.: Absolutely, and that is depending on your own illness, on the seriousness or stage of the illness. And your physician would be able to consult the right specialist to tailor the specific treatment for you, and that’s very important because now we have a new tool that can augment the chemotherapy. And many of those treatments are given in combination. Conventional treatment with chemotherapy plus immunotherapy seems to work very well in many patients.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Yes. The future is exciting in that regard. In the case of the HPV-positive oropharyngeal cancers, there has also been a lot of interest and push toward robotic surgery in caring for that patient population. I know that that’s not for everybody, and it’s more suited for some of the smaller tumors because of the side effects that might go along with it. What is your understanding of the role of robotic surgery in the care of head and neck cancer patients?

Itzhak Brook, M.D., M.Sc.: Robotic therapy is an amazing new procedure. It’s being done using the robotic tools that are able to do the surgery in a much less invasive way without traumatizing many of the normal tissues of the body. They cause less damage. The recovery period is shorter, and patients benefit from it tremendously. In that procedure, there is a robotic machine that the surgeon operates, and it allows very, very precise ability to cut the cancer out, and it does cause less long-term damage to the tissues and less deformity, you may say. And that’s a wonderful tool. But unfortunately, as you said, it is limited to areas of the body that the robot can reach. And when the cancer is in places that are not reachable by the robotic approach, one needs to use the conventional approach. But even in that area, there is a development of using endoscopic surgery where one can use a laser and the endoscopic approach, or the laser can kill or burn out the cancers that are more deeply located in the throat, again saving major surgery and even saving removal of the larynx from patients.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: That’s right. And also, there’s a push toward de-escalation of the radiation and the chemotherapy in some of these HPV-positive patients, as well, because the tumors are more responsive to the treatment. So, there are many studies going on looking at whether we can do less treatment for the different types of diseases. As you spoke earlier, I think finding the right specialists is important; not everybody is a specialist in all these new and advanced technologies. If you’re looking for robotic surgery, find that specialist that really does a lot of robotic surgery and is an expert in that field. The same is true for the immunotherapy and other treatment approaches as well. So, I think being your own advocate, again, to find these different alternative options and these new treatments in clinical trials becomes exceedingly important in the age of all these new discoveries.

Itzhak Brook, M.D., M.Sc.: Fortunately, the knowledge of experience in those procedures, the laser and the robotic surgery, is becoming more prevalent in the United States. And when I had my cancer, when I needed to make choices 10 years ago, there were only a handful of experts. But right now, almost every major medical center has an expert in those fields, so it’s more available for people.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Absolutely. So, even if you have to travel a distance to get to those major medical centers, it’s worth the effort and travel and time to be able to seek these other opinions and see what your other options are before pursuing your treatment.

Itzhak Brook, M.D., M.Sc.: Absolutely.

Meryl Kaufman, M.Ed., CCC-SLP, BRS-S: Yes, I agree.

2018-09-04T12:56:32-07:00September, 2018|Oral Cancer News|

Complex cancer decisions, no easy answers

Source: blogs.biomedcentral.com
Author: Jeffrey Liu

With the many different options now available for the treatment of cancer, it can be very difficult for both clinicians and patients to decide on the best possible treatment strategy, particularly when faced with a complicated cancer. In this blog, Dr Jeffrey C. Liu reflects on the challenges encountered in cancer decision making, particularly when presented with difficult cases.

When treating cancer, sometimes the treatment decisions are straightforward and unambiguous. For example, surgery is the treatment of choice for an early, uncomplicated tongue cancer. However, many times, the recommendation for cancer treatment is not straightforward and requires combination treatment – one or more of surgery, radiation or chemotherapy.

As a head and neck cancer surgeon, I work with a team to make these treatment decisions, and usually team consensus is achieved. However, when we are faced with the choice of multiple treatments that all have the same chance of cure available, it seems to result in a never ending discussion amongst our team.

Take for example an advanced tonsil cancer. These cancers can sometimes be removed first with surgery, a process which removes both the primary cancer and the lymph nodes in the neck. Then, depending on the pathology results, patients may need radiation treatment, chemoradiation or sometimes no further treatment at all. Meanwhile, chemoradiation alone, and no surgery, is an excellent option. Whether the patient receives surgery or no surgery, the chance of cure is pretty much the same. However, based on the need for additional treatment after surgery, the patient may have better, equivalent, or worse function than chemoradiation alone.

How then can a patient make a decision with imperfect data? I wish I could help my patients better with these complex decisions. Most patients will make this decision only once in their lives. With the increased emphasis on patient autonomy, there is sometimes a feeling to just “present the options and let the patient decide.”

However, when a group of smart experienced doctors who all treat the same cancer, cannot reach an agreement, how is a patient with no experience expected to make the right decision? There is not enough time to explain to patients the observations of hundreds of such decisions and their thousands of outcomes. Some patients are so overwhelmed by the decision, that they just want someone to tell them what to do. Others have so many questions and concerns that they get lost in the details and paralyzed by the process. I don’t know the right answer for such patients.

Unfortunately, there is no option but to choose a treatment strategy and move forward. We all carry the hope that one day, with more research and better understanding, such complex decisions for the treatment of cancer, will become the easy ones.

Penn surgeons become world’s first to test glowing dye for cancerous lymph nodes

Source: www.phillyvoice.com
Author: Michael Tanenbaum, PhillyVoice Staff

Surgeons at the University of Pennsylvania have achieved a global first with the use of a fluorescent dye that identifies cancerous cells in lymph nodes during head and neck cancer procedures.

The study, led by otorhinolaryngologist Jason G. Newman, seeks to test the effectiveness of intraoperative molecular imaging (IMI), a technique that illuminates tumors to provide real-time surgical guidance.

More than 65,000 Americans will be diagnosed with head and neck cancers in 2017, accounting for approximately 4 percent of all cancers in the United States, according to the National Cancer Institute. About 75 percent of these cancers are caused by tobacco and alcohol use, followed by human papillomavirus (HPV) as a growing source for their development.

Common areas affected by these cancers include the mouth, throat, voice box, sinuses and salivary glands, with typical treatments including a combination of surgery, radiation and chemotherapy.

Lymph nodes, which act as filters for the immune system, are often among the first organs affected by head and neck cancers as they spread or resurface. Initial surgeries may leave microscopic cancerous cells undetected in the lymphoid tissue, heightening the risk that a patient’s condition will return after the procedure.

“By using a dye that makes cancerous cells glow, we get real-time information about which lymph nodes are potentially dangerous and which ones we can leave alone,” Newman said. “That not only helps us remove more cancer from our patients during surgery, it also improves our ability to spare healthy tissue.”

With the aid of a fluorescent dye, surgeons are able to key in on suspicious tissue without removing or damaging otherwise healthy areas. Previously adopted for other disease sites in the lungs and brain, the practice now allows Newman’s team to experiment with indocyanine green (ICG), an FDA-approved contrast agent that responds to blood flow.

Newman explained that since tumor cells retain the dye longer than most other tissues, administering the dye prior to surgery singles out the areas where cancer cells are present.

The current trial at Penn will enable researchers to determine whether ICG is the most suitable dye for head and neck cancers and provide oncologists with a deeper understanding of how cancer spreads in the lymph nodes.

Magnolia man joins exclusive trial in battle against cancer

Source: www.cantonrep.com
Author: Denise Sautters

Rich Bartlett is looking forward to getting back to his hobbies — woodworking and nature watching — and enjoying a good steak and potato dinner. Until then, though, he is in a fight for his life, one he plans to win.

Bartlett is a cancer patient and the first participant in a clinical trial at University Hospitals Seidman Cancer Center in Cleveland to test the safety of an immunotherapy drug — Pembrolizumab — when added to a regimen of surgery, chemotherapy and radiation therapy.

Back to the beginning
Bartlett went to the dentist in October for a checkup.

“He had a sore in his mouth he thought was an abscess,” explained his wife, Nancy Bartlett, who pointed out that, because radiation and chemo treatments cause the inside of the mouth to burn and blister, it is hard for Bartlett to talk.

“When the dentist looked at his sore, he sent Richard to a specialist in Canton, and in early November, he had a biopsy done. It came back positive for cancer.”

From there, he was referred to Dr. Pierre Lavertu, director of head and neck surgery and oncology at University Hospitals, and Dr. Chad Zender from the otolaryngology department, who did Bartlett’s surgery.

“They let us know it was serious,” said Nancy. “It had gone into the bone and the roof of the mouth, but they were not sure if it had gone into the lymph nodes. By the time we got through that appointment, it was the first part of December and (they) scheduled him for surgery on Dec. 22.”

The cancer tripled in size by then and the surgery lasted 10 hours. Doctors had to remove the tumor, all of the lymph nodes and parts of the jaw and the roof of Bartlett’s mouth.

“They harvested skin from his hand to rebuild the inside of his mouth, and took the veins and arteries and reattached everything through his (right) cheek,” she said. “He could not even have water until February because of the patch. He uses a feeding tube to eat now.”

The tube is temporary until Bartlett heals.

Clinical trial
Just before he started chemo and radiation therapies, the hospital called him about the clinical trial.

The trial is the first to use quadra-modality therapy — or four different types of therapy — against the cancer, according to Dr. Min Yao, the principal investigator.

Yao said Bartlett has squamous cell carcinoma of the oral cavity, with only a 50 percent chance of survival.

“Patients have surgery, then followed by six weeks of radiation and chemotherapy and immunotherapy,” Yao said in an email interview. “That is followed by six more months of immunotherapy, one dose every three weeks.”

Bartlett currently is in the radiation, chemotherapy and immunotherapy part of the study.

“It is too early to tell how he is responding,” said Yao. “His tumor has been resected. After the treatment, we will see them periodically with scans. Cancer often recurs in the first two years after treatment.”

Pembrolizumab originally was developed to activate the body’s immune system in the fight against melanoma. Former president Jimmy Carter was treated with the drug for his brain metastases from melanoma in 2015.

A truck driver by trade, Bartlett will undergo daily fluoride treatments for the rest of his life to protect his teeth.

“We did not realize until we got to Cleveland just how bad this was,” said Nancy. “When you have oral cancer, and they are getting ready to do radiation and chemo, you have to go have your teeth cleaned and examined and get anything done that needs to be done because radiation tends to compromise your blood flow in your mouth. That was a step we didn’t know.”

Although he was shocked to hear the outcome of that sore in his mouth, Bartlett is grateful to be a part of the trial.

“Who wouldn’t feel good about something like this? I mean, you got something that was used on Jimmy Carter, who is recovered and is now making public appearances again,” said Bartlett, who is looking forward to June when hopefully he can start eating again and enjoying his hobbies.

“I am very hopeful about this. The whole thing has been a trial. I have a dentist in Cleveland who said I was going to be in the fight of my life, and I am. I am in a huge fight. The chemotherapy is what has knocked me down the most, but I am very positive about the outcome of this.”

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