Search

I view mainly as dumb luck the way I dodged the magic bullet of opioid dependence during my treatment for throat cancer 6 years ago. My doctors forewarned that radiation and chemotherapy together wreak havoc on throat tissues. I was sent home with a quart of pink liquid and a recommendation to use it preventively, just before I felt that pain might be coming on. They guaranteed I would need it. No one mentioned any other options for pain management. I never needed the painkillers. One factor may be a cautionary view toward medication passed down in my natal family. Another may have been my use of multiple self-care and integrative methods and practitioners before, during, and after treatment. A friend who underwent a similar throat cancer treatment protocol who also took advantage of multiple integrative therapies had such pain that she needed ultimately to find her way to her new normal through a foggy tunnel of opioid dependency. My family joked that the grace that kept me from opioids could be chalked ...

Mouth and throat cancers are becoming more common, and members of the dental team should be able to detect the warning signs, refer patients appropriately and advise them on how to prevent it

The author, a practicing physician, was diagnosed with throat cancer and lost his vocal cords. He endured the side effects of radiation, repeated surgeries, and the effects of prolonged hospitalizations; confronted medical mistakes and discrimination after losing his vocal cords; and struggled to regain his speech and find new meaning and purpose for his life. Facing the hardship and trials of becoming a laryngectomee illustrated to him how dependent and helpless a patient can become. Being unable to speak, eat, and breathe normally, while dealing with a potentially terminal illness, makes the patient very vulnerable, both physically and emotionally. A skillful, competent, error-free, empathetic, and caring approach that recognizes what the patient is experiencing can expedite recovery and well-being and help the patient return to a productive and meaningful life.

Colorectal cancer and throat cancer are the world’s most prevalent neoplastic diseases, and a serious threat to human health. Plant triterpene glycosides have demonstrated antitumor activity. In this study, we investigated potential anticancer effects of mogroside IVe, a triterpenoid glycoside from monk fruit, using in vitro and in vivo models of colorectal and laryngeal cancer. The effects of mogroside IVe on the proliferation of colorectal cancer HT29 cells and throat cancer Hep-2 cells were determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, and the expression levels of p53, phosphorylated ERK1/2, and MMP-9 were analyzed by western blotting and immunohistochemistry. The results indicated that mogroside IVe inhibited, in a dose-dependent manner, the proliferation of HT29 and Hep-2 cells in culture and in xenografted mice, which was accompanied by the upregulation of tumor suppressor p53, and downregulation of matrix metallopeptidase 9 (MMP-9) and phosphorylated extracellular signal-regulated kinases (ERK)1/2. This study revealed the suppressive activity of mogroside IVe towards colorectal and throat cancers and identified the underlying mechanisms, suggesting that mogroside IVe may be potentially used as a biologically-active phytochemical supplement for treating colorectal and throat cancers.

Human Papilloma Virus (HPV) is a virus from the Papilloma virus family that affects human skin and the moist membranes that line the body, such as the throat, mouth, feet, fingers, nails, anus and cervix [1]. There are over 100 types, of which 40 can affect the genital area. Most known HPV types cause no symptoms to humans. Some, however, can cause verrucae (warts), while a small number can increase the risk of developing several cancers, such as that of the cervix, penis, vagina, anus and oropharynx (oral part of the pharynx - throat cancer). HPV strand 16 and 18 are well known for causing the advanced of Cervical Cancer (CC). Currently, integrated electrodes (IDEs) are implemented in various sensing devices including surface acoustic wave (SAW) sensors, chemical sensors as well as current MEMS biosensors. IDEs have been optimized for a variety of sensing applications including biosensors sensors, acoustic sensors, and chemical sensors. However, optimization for cancer cell detection has yet to be report...

Objectives. We examined the knowledge and prevalence of mouth and throat cancer examinations in a sample drawn from rural populations in north Florida. Methods. Telephone interviews were conducted across rural census tracts throughout north Florida in 2009 and 2010, in a survey that had been adapted for cultural appropriateness using cognitive interviews. The sample consisted of 2526 respondents (1132 men and 1394 women; 1797 Whites and 729 African Americans). Results. Awareness of mouth and throat cancer examination (46%) and lifetime receipt (46%) were higher than reported in statewide studies performed over the past 15 years. Only 19% of the respondents were aware of their examination, whereas an additional 27% reported having the examination when a description was provided, suggesting a lack of communication between many caregivers and rural patients. Surprisingly, anticipated racial/ethnic differences were diminished when adjustments were made for health literacy and several measures of socioeconomic status. Conclusions. These findings support the notion that health disparities are multifactorial and include characteristics such as low health literacy, lack of access to care, and poor communication between patient and provider.

Throat cancer has always struck people's imagination. This type of cancer affects some of the patient's most essential physiological functions: speaking, swallowing and breathing. At advanced stages, radical surgery is disabling. The impact of a mutilated larynx corresponds to a very real trauma that is both individual and social. Our aim is to define how a total laryngectomy (TL) is represented by both the surgeon and the patient. The history of TL makes it possible to understand the changes that were needed for the key players in the subject to impose or accept this operation. Without doubt, the implementation of the "cancer plan" in the early 2000s was a major turning point in the management of patients with neoplasia. Increased awareness among the elite, encouraged by the mobilisation of patients and their families, is the explanation for the new role played by TL in 2008. The progress made in medical and surgical techniques, modifications to the patient-carer relationship and the appearance of the concept of Quality of Life are all themes that have changed the approach to this operation and the management of patients undergoing a TL.

Objective To study incidence rates (Is) of oral cavity and pharynx-throat cancer in adults age 20+ years from 1973 to 2003, and to estimate how many of these cancers occurred in the United States in 2003. Study design We used data and software from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program to generate age-adjusted Is, reported as cases per 100,000 person-years. Results For oral cancer, the Is for young men were stable, and Is at ages 40+ years declined by one third after the mid 1980s. Is declined by one third in women ages 40 to 74, but increased in the youngest and oldest groups. In 2003 there were 10,432 cases of oral cavity cancer among persons age 20+ years in the United States, and there were 12,157 cases of pharynx-throat cancer. Conclusion The Is of cancers of the oral cavity and pharynx-throat are stable or declining for men and women in most age groups. Of the nearly 30,000 malignant neoplasms occurring in the SEER “oral cavity-pharynx” category in 2003, almost three quarters (21,455) were detectable during a routine oral examination.

Laryngeal neuroendocrine carcinoma (LNEC) is a rare malignancy with various subtypes, each with different characteristics. Classification of these subtypes is used to delineate treatment and management, as most are clinically aggressive with poor prognosis. This study analyzes the characteristics and survival outcomes of LNEC using population-based data.Analysis of a population-based tumor registry.Academic medical center.The Surveillance, Epidemiology, and End Results (SEER) database (1973-2011) was queried for LNEC cases. Data analyzed included patient demographics, incidence, treatment modality, and survival.In total, 257 LNEC cases were extracted from the SEER database. Sixty-three percent were male, and the mean age of diagnosis was 61.9 years. Most cases were located in the supraglottis (62.6%), were of the small cell carcinoma (52.9%) histologic subtype, and were grade IV (40.9%) and American Joint Committee on Cancer (AJCC) stage IV (59.4%). Surgery and radiotherapy were used as treatment modalities in 38.3% and 59.8% of patients, respectively. Overall 5-year disease-specific survival (DSS) for all LNEC was 30.2%, with lower grade, lower AJCC stage, and treatment with surgery having higher 5-year DSS.LNEC often presents as an aggressive tumor at an advanced stage and has poor survival outcomes. Poor prognostic factors include high histologic grade, advanced stage disease, and not undergoing surgical resection. LNEC may be best treated depending on its histologic differentiation, with surgery being beneficial for early grade tumors while radiotherapy is inconclusive in its benefit for late-stage disease.

Background: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive human malignan- cies with a mean survival time of 6 months regardless of treatment. Aim: To present a case of lo- cally advanced anaplastic thyroid carcinoma with long-term survival. A 10-year literature review of locally advanced ATC with long-term survival (more than 2 years) is also presented. Case pres- entation: We present a case of locally advanced anaplastic thyroid carcinoma (ATC) with tracheal invasion in a 67-year-old elderly Chinese man who was treated with radical surgery encompassing total thyroidectomy, neck dissection and tracheal resection followed by adjuvant radiotherapy. Long-term disease-free survival is more than 7 years to date. Conclusion: The prognosis of ATC remains poor as it is characterized by aggressive and extensive disease at presentation, the inabil- ity in most patients to perform radical enough surgery in order to achieve clear margins, high morbidity of complete extirpation and limited response to radiotherapy or chemotherapy. How- ever, if complete surgical resection is possible, patients should be treated aggressively with a combination of surgery and adjuvant radiotherapy.

266 Nurse Prescribing 2013 Vol 11 No 6 © 2 01 3 M A H ea lth ca re L td studies of 1,316 patients with oral cancer found that 57% of them were HPV-16 positive. HPV-16 is responsible for the majority of throat cancers. An advanced search on Pubmed using the words 'HPV', 'throat cancer' and 'oral sex' in Pubmed did not bring up any articles, but a less specific search bought up a recent article from researchers from the George Washington University where they claim that many people are unaware that HPV can cause oral cancers. Dr Gypsyamber D'Souza, from the Johns Hopkins School of Public Health, explained at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago, Illinois, that throat cancers that arise from HPV do not appear to raise the risk for domestic partners of the same cancer. Her team carried out a pilot study which showed that the prevalence of HPV among partners/spouses of an affected patient was approximately 7%, no different from that of the general population. The team found that HPV-16 subtype was present in just 2% of female partners and 0% of male partners. Of the partners/spouses who underwent a visual oral exam, none had cancer or pre-cancer. D'Souza explains Human papilloma virus, cancer, and sex

Richard I. Shader, MD “Loose lips sink ships.” I remember that phrase from my childhood during World War II. I knew what it meant, but as kids, we used to say it laughingly while making silly faces with floppy lips. We regularly saw these words on posters made by the United States Office of War Information; the wording originated from the War Advertising Council. Many years later, when learning about the mental status exam, I was exposed for the first time to the proverb: “The tongue is the enemy of the neck.” For many people, even those who easily interpret “People who live in glass houses should not throw stones,” this proverb was a little too abstract. Taken together, the overall message from these phrases is clear—your mouth can get you or others into big trouble. What has this to do with cervical cancer? My lips may not be loose, but my associations often are. The word cervix is Latin for neck. One way to spread the human papilloma virus (HPV), the virus responsible for nearly all cases of cervical cancer, is through oral sex—a behavior not uncommon among teens and other age cohorts. The link between oral sex and HPV-caused mouth and throat cancer is reasonably well supported by data. The link between oral sex and cervical cancer is still ambiguous. How can many HPV-caused cancers be prevented? Vaccination of preteens and teens provides the most hope, particularly for cervical cancer. An old adage clearly applies here—“A stitch in time saves nine.” Consistent with this view, 13 months ago, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention recommended the use of 9-valent HPV vaccine *; it is now the third HPV vaccine available in the United States, and it protects against nine strains of the virus. Unfortunately, this effective strategy for HPV prevention is still not as widely in use as it should be in the United States or elsewhere in the world. This is the second time our Update theme focuses on cervical cancer, underscoring the challenge of tackling this disease. Sadly, it is the last contribution from our former Topic Editor and current Guest Editor, Linda R. Duska, MD. Dr. Duska is leaving our editorial team because of the responsibilities and demands of her new position as Associate Dean for Clinical Research at the University of Virginia School of Medicine. We at Clinical Therapeutics thank her for her contributions and wish her the best in her new role. Dr. Duska’s final Update sheds light on aspects of prevention, detection, and treatment of cervical cancer. Greater use of vaccination in both girls and boys will certainly reduce the occurrence of this sometimes-deadly disease. Detection and diagnosis are enhanced by improved cytologic methods. Better treatment outcomes may be achieved through the adjunctive use of antibodies, such as programmed cell death inhibitors (PD-1 and PD-L1 inhibitors), agents that allow the immune system to reduce or halt cancer growth. Dr. Duska is leaving us with much to think about and reasons to be hopeful about conquering this widely occurring cancer.

Summary Objective To compare the diagnostic yield, safety, and cost of biopsies of laryngopharyngeal tumor performed in an office setting with those performed in the operating room (OR) under general anesthesia. Study Design This was a retrospective review of patients’ records at Boston Medical Center from 2006 to 2008. Methods In-office biopsies were performed using flexible digital videolaryngoscopy with cup forcep biopsies taken via the working channel in patients in whom cancer was strongly suspected. Patients whose in-office biopsies were nondiagnostic or suspected to be falsely negative were taken to the OR for biopsy under general anesthesia and served as the control group. Results Twelve patients fit the selection criteria and had in-office biopsies attempted. One patient could not tolerate the in-office biopsy. Seven of the 11 in-office biopsies performed were diagnostic for squamous cell carcinoma. The average cost (facility and professional otolaryngology charges) for an in-office biopsy was $2053.91. Five of these patients required further biopsy in the OR at an average cost (charges for surgeon, OR, anesthesia, and recovery room) of $9024.47. There were no significant complications reported for any of the procedures. Conclusions In patients with strongly suspected laryngopharyngeal cancer, in-office cup forcep biopsies were 64% diagnostic. When compared with the OR, in-office cup biopsies of laryngopharyngeal tumor are safe and considerably more cost-effective. Although 36% of patients required operative biopsies, the cost would have been considerably higher in this cohort if all patients had gone to the OR for biopsies.

The use of p53 as a biological marker to predict chemotherapeutic outcome has been challenging, with clinical research showing positive as well as negative correlations with p53 mutations. Recent research reveals the complexity that underlies the use of p53 as a single predictive marker as well as the challenges associated with classifying p53 mutations. It is becoming clear that various p53 mutations are associated with differential treatment response and outcomes. In addition, different drug regimens could also play a role in modifying the effects of p53 mutations on therapeutic outcome. Finally, we discuss improvements in the diagnostic detection of p53 mutations and gene signatures that may better reflect p53 functionality in tumors, which may serve as a more reliable tool in correlating p53 mutations to clinical response.

The author presents his personal experiences as a physician who had several surgical procedures to remove pyriform sinus squamous cell carcinoma, which included laryngectomy. He recently published a book that captures the three years of his life that followed his throat cancer diagnosis and tells his story of facing and dealing with medical and surgical treatments and adjusting to life afterwards. The editorial highlights some of the book's features that relate to the important role of head and neck surgeons in the care of patients with cancer.