Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Squamous cell carcinomas of the head and neck
- RJ Dow (16 October 2002)
-
PRECANCEROUS LESIONS DETECTED IN ORAL CAVITY OF SCHOOL CHILDREN : AN EPIDEMIC OF HEAD AND NECK CANCE
- Pankaj Chaturvedi (17 October 2002)
-
Oral Care of Head & Neck Cancer Patients
- Vinod K Joshi (3 November 2002)
-
Sq Cell Carcinoma - Treatable entity
- Abhay Gupta (19 August 2003)
-
Diagnostic delay in oral cancer
- Murat Enoz (23 March 2005)
|
|
|||
|
RJ Dow, Chief Executive Officer, Biolitec Pharma Limited Edinburgh, Scotland EH14 4AP
Send response to journal:
|
Sanderson and Ironside (1) excellently summarise the horrible burden that patients with head and neck cancer suffer, and the limitations of current treatment of the disease, especially in the advanced stage. It is unfortunate, therefore, that they omitted to mention photodynamic therapy with mTHPC (meta-tetrahydroxyphenylchlorin, Foscan), approved in all EU countries since October 2001. In a study in advanced refractory disease including 128 patients, Foscan produced, using WHO criteria in evaluable patients, a 16% complete response and a 38% overall response. Fifty-seven per cent of evaluable patients achieved a minimum 20% benefit in a key clinical symptom. Side effect burden was low, with 11% injection site pain, 11% tumour site pain, and transitory photosensitivity in 19% of patients (2). In a subgroup of patients whose tumours could be illuminated across the whole surface area and were less than or equal to 10 mm in depth (but unlimited in surface area), a complete response of 30%, an overall response of 54%, and a symptom benefit of 61% were seen (3). Surgeons, oncologists, hospice staff and general practitioners, particularly if they refer their patients with advanced refractory disease before the tumour has proliferated extensively, can now offer these unfortunate patients some hope of therapeutic benefit. (1) Sanderson RJ, Ironside JAD. Clinical review: squamous cell carcinomas of the head and neck. BMJ 2002;325:822-7. (2) Biel M, D’Cruz A, McCaffrey T. Foscan-mediated photodynamic therapy (PDT) in the palliative treatment of patients with advanced head and neck cancer incurable with surgery or radiotherapy. Poster presented at: Annual Meeting of the American Society of Clinical Oncology; May 18- 21, 2002; Orlando, FL. (3) Data on file at Biolitec Pharma Limited, Edinburgh, Scotland. |
|||
|
|
|||
|
Pankaj Chaturvedi, Assistant Surgeon, Head and Neck Tata Memorial Hospital, EB Road,Parel, Mumbai 400 012
Send response to journal:
|
I congratulate the authors for their nice article on head and neck cancers. I wish to share a very unprecedented phenomena that we are facing in India. Considering the ubiquitous nature of this challenge and its global implication, I found it pertinent to share it with your readers. Consumption of Smokeless tobacco, especially Gutka (a mixture of areca, catechu, betel nut, lime, tobacco, mint),is rising amongst school children in rural India.1It is considered as a harmless mouth freshener and therefore consumed in larger amount and kept in the mouth for a longer time by the ignorant children. A survey of school children in a coastal village of Kerala 2 showed a 29 % prevalence of tobacco chewing and another survey in Mizoram showed that incidence of 56.5%. 2.3 The age for intitiation for gutka in India has been reported between 8 – 14 years.3,4 An analysis of 986 school children in a rural part of Central India showed leukoplakia in 32, erythroplakia in 6 and Submucus fibrosis in 18. 5 Nearly 50 to 60% patients of SMF will develop in invasive cancers. In another detection camp conducted in 1991 among 200 college students found to be users of tobacco , 11 premalignant lesions were found. 4 The evidence of early onset of the smokeless tobacco habit and reports of increases in oral precancers among children raise serious concerns of an impending oral cancer epidemic in this population.6,7 The age incidence of oral cancer in india is going down and is significantly lower than reported in the rest of the world.6,7 Smokeless tobacco is becoming popular among children and adolescents in Canada, United States, Scandinavia and UK. 8,9,10 Within U.S.,the use of smokeless tobacco has increased greatly among adolescent boys and young men in recent years. 8,9,10 National data indicateS that 10-12 million Americans use some form of ST. Tobacco in its various forms has killed more people than Osama's Al Quaida yet we still lack an international coalition against “tobaccoism”.Let the tobacco companies not poison our future generations. References: 1. Krishnamurthy S, Ramaswamy R, Trivedi U et al: Tobacco use in rural Indian children. Indian Pediatr 1997: 34(10): 923 – 927 2. George A, Varghese C, Shankarnarayanan R et al. Use of alcohol and beverages by chidren and teenagers in a low socioincome coastal community in south India. J Cancer Educ 1994:9(2),111-113 3. Chaturvedi HK, Phukan RK, Zoramtharga K, Hazarika NC, Mahanta J. Tobacco use in Mizoram, India: sociodemographic differences in pattern. South east Asian J Trop Med Public Health 1998: 29(1) :66- 70 4. Jayant-K; Notani-PN; Gulati-SS; Gadre-VV Tobacco usage in school children in Bombay, India. A study of knowledge, attitude and practise. Indian J Cancer. 28/3 (139-147) 1991 5. Chaturvedi P, Chaturvedi U Prevalence of tobacco consumption in school children in rural India - An epidemic of tobaccogenic cancers looming ahead in the third world J Cancer Educ 2002 Spring; 17 (1): 6 6. Gupta PC, Sinor PN, Bhonsei RB et al Oral Submucus fibrosis in India : A new epidemic? National Medical Journal of India 1998: 1998:11(3):113-116 7. Gupta PC Mouth Cancer in India: A new epidemic? J Indian Med Assoc 1999: 97(9),370-373 J Indian Med Assoc 1999: 97(9),370-373 8. Schaefer-SD; Henderson-AH; Glover-ED; Christen-AG Patterns of use and incidence of smokeless tobacco consumption in school-age children. Arch-Otolaryngol. 111/10 (639-642) 1985 9. Bruerd-B Smokeless tobacco use among native American school children Public-Health-Rep. 105(2):196-201 1990 10. Peterson-JS; Barreto-LA; Brunnemann-KD smokeless tobacco: a product for the new generation of tobacco users. Dipping and chewing in the northwest territories, canada, and its global relevance Arctic-Med- Res. 49 Suppl 2:32-8 1990 |
|||
|
|
|||
|
Vinod K Joshi, Consultant in Restorative Dentistry Oral & Facial Specialties, Pinderfields Hospital, Wakefield, WF1 4DG
Send response to journal:
|
This is a very useful and timely review article that should help increase awareness of squamous cell carcinomas of the head and neck amongst my medical colleagues in time for Mouth Cancer Awareness Week (10-16 November 2002). It is important that patients with head & neck cancers receive a dental assessment and oral care prior to, and after, their treatment to ensure minimisation of oral complications for an improved qualty of life. The clinical guidelines published by the Royal College of Surgeons of England state that a clear pathway of care is necessary to prevent or minimise oral complications. 1 However, many cancer patients still receive no proper dental assessment or preventive treatment to minimise or avert the known and common oral complications of radiation therapy. This may be due, in part, to the lack of resources and recognised local standards of dental care for cancer patients undergoing head and neck radiation. It is perhaps also due to the lack of information and apathy. The apathy is reflected in this article. I had hoped to see a mention of the need for oral care for these patients but was once again disappointed. I have created the RDOC web site http://www.rdoc.org.uk to increase awareness of the oral complications of cancer treatments and to help patients, dentists and doctors find free information on oral cancer easily. The web site includes first hand patient accounts of their experiences. There is also a discussion forum for patients, carers and interested members of the public where they can ask questions, help others, share ideas and opinions, and learn about other people’s experiences dealing with head and neck cancers. The patient and professional guides link to other web sites dealing with the various basic aspects of oral cancer such as its treatment and the complications, and links covering other concerns that we as doctors rarely address, but are just as equally important, such as the financial implications of cancer, financial planning and support, and personal care and support. There is also a section on Tobacco Risks which also includes links on the 'oral cancer - gutkha/paan chewing' habit. Though this is mostly an Asian sub-continent problem, the UK has a sizeable immigrant population who continue with these habits. Among others, there are sections on treatment, complications, humour and also a section on spiritual help. A daily dental cartoon helps to bring a smile to the weary. I hope my medical colleagues will find the web site useful and also recommend it to patients and their carers, should they ask for information. Oral care for cancer patients needs more than lip service. Reference: 1. Clinical Guidelines: The Oral Management of Oncology Patients, Faculty of Dental Surgery, Royal College of Surgeons of England. Competing interests: None declared |
|||
|
|
|||
|
Abhay Gupta, Associate Professor SSR Medical COllege, mauritius
Send response to journal:
|
SInce Indian and many asian countries has high incidence of Head & Neck Malignancies, It is must that they should be diagnosed as early as possible. With ongoing awareness programmes and ban on smocking and tobacco, there is a possibility that incidence may decrease. However, for early diagnosis, screening of premalignant lesion should not be forgotten. Toludine Blue is a dye which can be used to detect early malignancies even before they spread and produce lymph node metastasis. Of course, for ocult primary, MRI remains choice of investigation, though previously, panendoscopy was used, but with advent of USG and MRI this has become a choice. Once should never forget that for squamous cell carcinomas also, the early you catch it better result you get. Though radiotherapy takes longer course in treatment still for early moderate malignancies it should remain choice due to less deformity. this can be added with minimal surgery for removal of lesion. Recently, surgery for minimal lesion is replaced by LASER which again is a better choice than deforming surgery Competing interests: None declared |
|||
|
|
|||
|
Murat Enoz, Department of Otolaryngology, Head&Neck Surgery Istanbul University, School of Medicine, Turkey.
Send response to journal:
|
Dear Editor, Squamous cell carcinoma (SCC) of the oral cavity and oropharynx is rare in patients of age 45 and younger, being primarily a disease that occurs in males in their sixth or seventh decade. Younger patients (aged less than 45 years) account for approximately 6% of all oral cancers in the United Kingdom [1]. Alarmingly, recent reports on the incidence of oral cancer (particularly tongue) among younger adults have shown approximately a 6-fold increase in Europe (for patients aged 20 to 39 years, between 1960 and 1994) [2]. Analysis of the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database provide evidence for a similar increase in the percentage of cases of SCC of the tongue, between 1973 and 1997, in adults younger than 40 years in the United States [3]. Variables like age, sex, nutritional or immunological status, location and size of the tumour, stage of the disease, lymph node status, several histopathological parameters, oncogene expression, proliferation markers, ploidy pattern or response to treatment have been investigated as prognostic markers for oral cancer[4]. Oral cancer diagnostic delay has also been associated to advanced stages and poor prognosis [5]. Length of time between patient delay and stage of tumor may be related, however ‘‘unnoticed’’ or minor symptoms may be responsible for the discrepancy reported in the literature between prognostic stage of tumor and reported patient delay [6, 7, 8]. Obviously, this period cannot be considered part of patient delay as patients have to be aware of the symptom in order to be engaged in making attributional decisions about it. An alarming lack of awareness of oral cancer symptoms among the general public has previously been reported in Britain [9]. Finally, if the pattern of oral cancer is changing, it can no longer be assumed by health care professionals that only elderly males from low social classes, reporting tobacco use and excess consumption of alcohol, are likely to develop malignant tumors. Although oral cancer among under 45-year-olds is stil relatively rare, our results have shown that oral cancer cannot be discounted in patients of any age who report no history of tobacco or alcohol use [10, 11]. Continued education among health care professionals such as general dentists and general medical practitioners is imperative if oral cancer is to be diagnosed without delay [12]. Health care professionals principally family physicians and dentists are an important source of professional diagnostic delays [12, 13]. Educational intervention about features of oral cancer lesions for dental receptionists are also needed to eliminate the diagnostic delaying and to favour early diagnosis of oral cancer. Sincerely Dr. Murat Enoz References 1- British Dental Association. Opportunistic cancer screening. Occasional paper no. 6. London: BDA; 2000. 2- Annertz K, Anderson H, Biorklund A, Moller T, Kantola S, Mork J, et al. Incidence and survival of squamous cell carcinoma of the tongue in Scandinavia, with special reference to young adults. Int J Cancer 2002;101:95-9. 3- Schantz SP, Yu GP. Head and neck cancer incidence trends in young Americans, 1973-1997, with a special analysis for tongue cancer. Arch Otolaryngol Head & Neck Surg 2002;128: 268-74. 4- Tytor M, Olofson J, Ledin T, et al. Squamous cell carcinoma of the oral cavity. A review of 176 cases with application of malignancy grading and DNA measurements. Clin Otolaryngol 1990;15:235–51. 5- Kowalski LP, Franco EL, Torloni H, et al. Lateness of diagnosis of oral and oropharyngeal carcinoma: factors related to the tumour, the patient and health professionals. Oral Oncol Eur J Cancer B 1994;30:167–73. 6- Kowalski LP, Carvalho AL. Influence of time delay and clinical upstaging in the prognosis of head and neck cancer. Oral Oncol 2001;37:94- 8. 7- Guggenheimer J, Verbin RS, Johnson JT, Horkowitz CA, Myers EN. Factors delaying the diagnosis of oral and oropharyngeal cancers. Cancer 1989;64:932-5. 8- Wildt J, Bundgaard T, Bentzen SM. Delay in the diagnosis of oral squamous cell carcinoma. Clin Otolaryngol 1995;20:21-5. 9- Warnakulasuriya KA, Harris CK, Scarrott DM, Watt R, Gelbier S, Peters TJ, et al. An alarming lack of public awareness towards oral cancer. Br Dent J 1999;187:319-22. 10- Llewellyn CD, Johnson NW, Warnakulasuriya KA. Risk factors for squamous cell carcinoma of the oral cavity in young people—a comprehensive literature review. Oral Oncol 2001; 37:401-18. 11- Llewellyn CD, Linklater K, Bell J, Johnson NW, Warnakulasuriya KA. Squamous cell carcinoma of the oral cavity in patients aged 45 years and under: a descriptive analysis of 116 cases diagnosed in the South East of England from 1990 to 1997. Oral Oncol 2003;39(2):106-14. 12- Schnetler JFC. Oral cancer diagnosis and delays in referral. Br J Oral & Maxillofac Surg 1992;30:210-3. 13- Scully C, Malamos D, Levers BGH, et al. Sources and pattern of referrals of oral cancer: role of general practitioners. Br Med J 1986;293:599–601. Competing interests: None declared |
|||