Podcasts about oropharynx

In this episode of the podcast, Dr. Whitney Jones, Grail's Senior Medical Advisor, joins us to discuss the Galleri cancer screening test. The Galleri test is a first-of-its-kind multi-cancer early detection test that can detect a signal shared by more than 50 cancer types and predict the tissue type or organ associated with the signal to help healthcare providers determine next steps. The Galleri test is intended to complement routine single cancer screenings for more comprehensive early cancer detection. Routine screenings are recommended for certain patients for breast, cervical, colorectal, lung and prostate cancers. Only screening for a single cancer does not effectively address the high prevalence of cancer given the probability of diagnosis for a specific cancer is uncertain, and the occurrence of individual cancers is relatively low. One in two men and one in three women are diagnosed with some form of cancer in America in their lifetime. Some of the cancers that the Galleri test screens for include: Adrenal Cortical Carcinoma Ampulla of Vater Anus Appendix, Carcinoma Bile Ducts, Distal Bile Ducts, Intrahepatic Bile Ducts, Perihilar Bladder, Urinary Bone Breast Cervix Colon and Rectum Esophagus and Esophagogastric Junction Gallbladder Gastrointestinal Stromal Tumor Gestational Trophoblastic Neoplasms Kidney Larynx Leukemia Liver Lung Lymphoma (Hodgkin and Non-Hodgkin) Melanoma of the Skin Merkel Cell Carcinoma Mesothelioma, Malignant Pleural Nasal Cavity and Paranasal Sinuses Nasopharynx Neuroendocrine Tumors of the Appendix Neuroendocrine Tumors of the Colon and Rectum Neuroendocrine Tumors of the Pancreas Oral Cavity Oropharynx (HPV-Mediated, p16+) Oropharynx (p16-) and Hypopharynx Ovary, Fallopian Tube and Primary Peritoneum Pancreas, exocrine Penis Plasma Cell Myeloma and Plasma Cell Disorders Prostate Small Intestine Soft Tissue Sarcoma of the Abdomen and Thoracic Visceral Organs Soft Tissue Sarcoma of the Head and Neck Soft Tissue Sarcoma of the Retroperitoneum Soft Tissue Sarcoma of the Trunk and Extremities Soft Tissue Sarcoma Unusual Histologies and Sites Stomach Testis Ureter, Renal Pelvis Uterus, Carcinoma and Carcinosarcoma Uterus, Sarcoma Vagina Vulva Studies: REFLECTION is a multi-center, prospective, non-interventional, cohort study The STRIVE Study: Development of a Blood Test for Early Detection of Multiple Cancer Types This podcast is NOT medical advice. Click to visit Grail's Website Click here for Dr. Jones LinkedIn Click to visit Victory Men's Health Click to follow Amy Stuttle on Instagram For questions please email podcast@amystuttle.com

Host: Jacob Sands, MD Guest: Eleni Rettig, MD HPV is the leading cause of oropharynx cancers in the United States, but with no screening tools currently available, how we can detect this cancer in our patients? Host Dr. Jacob Sands speaks with a leader in the field, Dr. Eleni Rettig, an Assistant Professor of Otolaryngology-Head and Neck Surgery at Harvard Medical School, to share risk factors and explore emerging diagnostic tools.

The tenth in our series on the head and neck describes the Mouth and Oropharynx. See our website for accompanying diagrams

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog/ BioBalance Health® has always been on the cutting edge of the newest medical methodology available. In the fight against cancer, we are now using he newest genetic methodology to find cancers early, when they are treatable. Throughout my almost 40 years of practicing medicine, I have believed that medicine should embrace preventive care and be based on the belief that we should only react to a disease that is already established.  Now we finally have one test that screens for 72% of the cancers that we can't screen for.  It is hard to believe that  out of the 55 types of cancer we can only screen for  5 Cancers!   Medicine has only developed 5 screening tests that are currently in use to find cancers early.   Galleri is one simple blood test that screens for 50 types of cancer, to find them at early treatable stages, before they create symptoms, metastasize, or produce any symptoms. Galleri was created for those patients who have a positive family history of cancer, or those patients who are fearful of getting cancer of any type, and for those patients who have been successfully treated for cancer who want to find out early, if they have a recurrence!  Galleri It is the dream child of a company who has been testing and retesting it with the finest geneticists in the US. We are offering this test through our office as an option for those who need it to truly practice preventive medicine!  With Galleri, you have a good chance of being cured of cancer through very early detection! Before Galleri® was invented patients only had 5 cancers that could be detected early by screening tests.  The following list enumerates the 5 cancers we have screening tests for. Breast cancer: Mammography can find cancer after it has been growing for 11 years. Cervical Cancer: Pap and HPV Test only finds the virus and possibly the cells that might be cancer. Colorectal Cancer, Colon Cancer: Colonoscopy and stool tests Lung Cancer: Low Dose C-T Scan Prostate Cancer: PSA Test Routine screening tests are recommended because they have been proven to save lives by detecting some cancers earlier.3 The Galleri test does not preclude the use of the 5 screening tests that are currently in use, however there are more than 50 cancers that Galleri® can test for, and you receive your results in 10 working days. It is time to look at cancer more broadly, in addition to the 5 cancers that are routinely screened for today. The most important cancer is the one that you or your loved one may have — and curing cancer starts with knowing you have it! If cancer runs in your family, and you lose sleep worrying about it you should take the Galleri® Test.  If your genetic relatives (father mother, aunt or uncle, sisters or brothers or children have had cancer then testing yourself for cancer with Galleri® will answer the question as to whether you have it or not. Our patients at BioBalance Health® are offered this test yearly for high-risk patients and as needed, often less often than yearly.  The test is not covered by insurance as it is a new test…but can you wait until it is covered?   Worrying about cancer can make you literally sick by stimulating your adrenal gland's production of cortisol.  This worry impairs your immune system that protects you from cancer, putting you at higher risk! The only risk of Galleri® is the cost…$ 1,250 paid directly to the Galleri® company at the time of your blood draw.   50 Types of cancer detected by Galleri® The Galleri test is a multicancer early detection test that detects a common cancer signal across more than 50 types of cancer through a simple blood draw. A Adrenal Cortical Carcinoma Ampulla of Vater Anus Appendix, Carcinoma B Bile Ducts, Distal Bile Ducts, Intrahepatic Bile Ducts, Perihilar Bladder, Urinary Bone Breast C Cervix Colon and Rectum E Esophagus and Esophagogastric Junction G Gallbladder Gastrointestinal Stromal Tumor Gestational Trophoblastic Neoplasms K Kidney L Larynx Leukemia Liver Lung Lymphoma (Hodgkin and Non-Hodgkin) M Melanoma of the Skin Merkel Cell Carcinoma Mesothelioma, Malignant Pleural N Nasal Cavity and Paranasal Sinuses Nasopharynx Neuroendocrine Tumors of the Appendix Neuroendocrine Tumors of the Colon and Rectum Neuroendocrine Tumors of the Pancreas O Oral Cavity Oropharynx (HPV-Mediated, p16+) Oropharynx (p16-) and Hypopharynx Ovary, Fallopian Tube and Primary Peritoneum P Pancreas, exocrine Penis Plasma Cell Myeloma and Plasma Cell Disorders Prostate S Small Intestine Soft Tissue Sarcoma of the Abdomen and Thoracic Visceral Organs Soft Tissue Sarcoma of the Head and Neck Soft Tissue Sarcoma of the Retroperitoneum Soft Tissue Sarcoma of the Trunk and Extremities Soft Tissue Sarcoma Unusual Histologies and Sites Stomach T Testis U Ureter, Renal Pelvis Uterus, Carcinoma and Carcinosarcoma Uterus, Sarcoma V Vagina Vulva The Galleri test is intended to detect a cancer signal and predict cancer signal's origin to inform diagnostic evaluation. Cancer cases enrolled in CCGA Study1 were assigned a ​“cancer type” as defined in the American Joint Committee on Cancer (AJCC) manual (8th edition)2 (For this list of Cancer types detected, some of the names were modified/​edited to organize for easy reference). Cancer signals were detected across more than 50 AJCC-cancer types, which supports the potential for the Galleri test to detect a cancer signal over a diverse range of cancers across a wide biologic spectrum.  If you are a Biobalance Health® patient you can ask your Nurse Practitioner to make an appointment to have your blood drawn at our office.  The Galleri Test was created by GRAIL. 

Join me for a summary of early treatment lectures from this years AAO meeting from May 2022. Topics will cover trauma, airway diagnosis and orthodontic treatment, and optimal timing of class 2 correction Lectures: Dental Trauma Eustaquio A. Araujo Airway-centered Orthodontic Diagnosis & Treatment for Pediatric Patients Hong He Predictors of Success for Early Mixed Dentition Treatment Heesoo Oh Dental Trauma Eustaquio A. Araujo Trauma protocol Reposition with firm grip 16x22NT Bite props to eliminate occlusal interference Soft diet Recall 2 weeks Re-implantation of avulsion success Less than 1hour 75% Up to 24 hours 25% Conclusion – look at the neighbours Airway-centered Orthodontic Diagnosis & Treatment for Pediatric Patients Hong He Nasal breathing Vs mouth breathing NB = Tongue rests on the palate. MB = Tongue floor of the mouth NB = Pressure of the cheeks is balanced with the tongue. MB Pressure of the cheeks is unopposed by tongue NB = U shape upper arch (normal). MB = V shaped arch Tonsillar hypertrophy Oropharynx obstruction Ventilation impaired Occlusal effects Tongue and mandible forwards Iwasaki 2017 Mandibular protrusion Class 3 malocclusion He's study n=1776 Greater tonsillar hypertrophy in children with class 3 Caution as limited studies pre-pubertal and controls also improved in scores Predictors of Success for Early Mixed Dentition Treatment Heesoo Oh When is it best to treat class 2 cases Study: optimal timing of the effectiveness and efficiency Early class 2 equally effective not as efficient BUT Mean changes = mask individual response Philosophy – correct some / all features of malocclusion Reduce / eliminate need for phase 2 Angle orthodontist Oh 2017 Treatment protocol 7-9 years Headgear night wear 11 hours RME 2 x 4 fixed appliances Lingual arch Greater 33 months = unsuccessful (time only marker of success, as occlusal and skeletal the same at the end) Results 15/54 (28%) phase 1 only Comparison No differences in occlusal and skeletal outcomes Time Total treatment times (phase 1 + phase 2): 67% less than 18 months in treatment active treatment 20% 4-5 years of total treatment time

I want to talk about STDs or sexually transmitted diseases and what they mean for men and women. Before I jump into my analysis I want to read a comment left by one of my viewers. I believe his youtube username is pronounced Forenamn Efternamn. But the way his name is pronounced is insignificant compared to the the understanding and knowledge I gained from his comments. This is what he has to say about STDs: "Hi Sandman, By the way, condoms protect women more than men. A woman's secretions will contaminate the skin around a man's penis, his stomach, pubic region, balls, even when he is wearing a condom. To be crude, she will soak him. This presents a route for the transmission of numerous STDs which condoms supposedly protect against. The male on the other hand, has his various juices wholly contained within the condom, assuming that it does not tear. A fact which startled me is that now, HPV spread by cunnilingus is responsible for more cases of oropharyngeal cancer in the USA, than all tobacco sources combined. "Oropharyngeal cancer is a disease in which malignant cells form in the tissue of oropharynx. Oropharynx is a middle part of the throat which includes the base of the tongue, the tonsils, the soft palate, and the walls of the pharynx" according to Wikipedia. The number of oropharyngeal cancers has been growing over the past 30 years: there are now 10,000 cases in the United States each year, a number that is likely to climb to 16,000 by 2030. An overwhelming majority are caused by HPV. Worldwide, cancer centers report that the virus is responsible for between 45% and 90% of oropharyngeal cancers. “In Europe, HPV-positive oropharyngeal cancers have almost quadrupled in number over a period of 10 to 15 years,” People with HPV-positive cancer tended to have had many oral-sex partners, but there was no statistical association with tobacco smoking or drinking; how they blamed the whisky and the tobacco for decades, sure precious princesses are not to blame for spreading a disease which kills slowly and painfully. Why rates are escalating is unknown, although one suggestion points to increasing numbers of sexual partners. ie empowerment. Why is this behavior normalized, glamorized and brushed off as harmless "fun"? Women should carry a health warning, like cigarette packets. In fact, how many of those horrific photographs we have all seen, of men with their throats and mouths rotting away supposedly due to smoking, actually ended up that way as a result of "eating out" a carousel rider? The majority of those affected by this cancer are men. No problemo, men exist to give women pleasure right, is this just another example of male disposability? Can you imagine if the situation were reversed and blow-jobs were causing women to develop throat cancer en mass? I've heard of people using something called a "dental dam", which is basically a sheet of clingfilm (saran wrap for our American brothers) placed over the woman's filth hole to provide a barrier. If it's that dangerous, I am not trusting my life to a flimsy sheet of plastic, thanks. I mentioned this incredible discovery on a PUA forum and was told that if I don't like to eat pussy I am probably gay. Seriously men, this info is mind-blowing, or should be.16 million Americans have HPV in their mouths, mostly menhttp://www.cbsnews.com/news/16-millio...Human papillomavirus (HPV) and Oropharyngeal Cancer - Fact Sheethttp://www.cdc.gov/std/hpv/stdfact-hp...HPV: Sex, cancer and a virushttp://www.nature.com/news/hpv-sex-ca...Support this podcast at — https://redcircle.com/mgtow/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Have you ever sung the 'perfect note'? You loved the tone, the clarity, and it was just so easy to produce. Then you tried to sing it again and it didn't sound quite the same. What you're seeking is resonance. Resonance is the sweet spot of your voice. In this episode, Kristal Cherelle of Indie Artist School discusses how to control all 3 resonators, The Laryngopharynx, the Oropharynx, and the Nasopharynx. Support this podcast: https://anchor.fm/thesingersarsenal/support Learn more: https://indieartistschool.com --- Send in a voice message: https://anchor.fm/thesingersarsenal/message Support this podcast: https://anchor.fm/thesingersarsenal/support

Oral Cancer: HPV-related Small Cell Carcinoma of the Oropharynx By Spring Hatfield, RDH Original article published on Today's RDH: https://www.todaysrdh.com/oral-cancer-hpv-related-small-cell-carcinoma-of-the-oropharynx/ Podcast audio article sponsored by Philips Oral Care. Be the first to know the latest from Philips when you join their email list at http://philipsoralhealthcare.com/. Get information about special promotions and new products, practice-building tips, and resources to help you empower patients to practice healthy routines at home. Get daily dental hygiene articles at https://www.todaysrdh.com Follow Today's RDH on Facebook: https://www.facebook.com/TodaysRDH/ Follow Kara RDH on Facebook: https://www.facebook.com/DentalHygieneKaraRDH/ Follow Kara RDH on Instagram: https://www.instagram.com/kara_rdh/

This podcast highlights original research published in the August 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Human papillomavirus (HPV)–positive oropharynx squamous cell carcinoma (OPSCC) is known to have improved survival over HPV-negative disease. However, it is largely unknown whether HPV status similarly affects survival in patients presenting with distant metastatic disease. We queried the National Cancer Database for OPSCC with distant metastasis. In conclusion, HPV-positive OPSCC has improved survival in the setting of distant metastatic presentation as compared with HPV-negative disease and shows greater responsiveness to treatment.   Click here to read the full article.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Hello and welcome to the ASCO Guidelines podcast series. My name is Shannon McKernin, and today I'm interviewing Dr. Shlomo Koyfman from the Cleveland Clinic, lead author on "Management of the Neck in Squamous Cell Carcinoma of the Oral Cavity and Oropharynx: ASCO Clinical Practice Guideline." Thank you for being here today, Dr. Koyfman. It's a pleasure. So first, can you give us a general overview of what this guideline covers? Yeah, so this is an exciting guideline because it covers a topic that we don't usually think about in head and neck cancer in a formal way, and that is management of the neck in squamous cell cancer of the oral cavity and the oropharynx. So there's a lot of literature and guidelines out there on how to manage oropharynx cancer, which is becoming a more and more common cancer, especially in the HPV-positive era, less so on oral cavity. But a lot of times it's focused on people who don't get surgery, chemoradiation, or people who do get surgery and TORS, Transoral Robotic Surgery, and different approaches. But rarely do we have something focus on management of the neck per se, which is really, really important in these cancers and often overlooked in favor of the primary tumor itself. So these guidelines really take us through some salient questions in how to manage the neck in these two cancers. And what are the key recommendations of this guideline? The recommendations came off of six fundamental questions, three in oral cavity and three in oropharynx. There are some commonalities between the two and some differences. A lot of the fundamental questions revolve around surgical quality, and neck dissection is the standard surgical approach for management of the neck in these patients. And as we enter the quality era, how do we define benchmarks of surgical quality, which is one thing that it deals with. The other is when to do adjuvant therapy like adjuvant radiation or chemoradiation. We also deal with when to do surgery for the neck or to do nonoperative approaches like radiation or chemoradiation. And then lastly, how do you follow patients after you've treated them? So those are kind of the salient issues that we dealt with. And what we came out with was nothing earth shatteringly new, but I think the way it was organized and systematically put together, I think it's going to be really, really helpful for people. So some of the most important findings that this recommendation does, I think this is the first that incorporates surgical quality, as I mentioned before. So specifically neck dissection should have 18 or more nodes as multiple studies have shown that that's associated with better outcomes. And similarly we define for different diseases of oral cavity and oropharynx, and depending on what kind of tumor it is and where, what nodal levels should be dissected or treated, whether surgically or nonsurgically, and when to do just one side of the neck versus both sides of the neck. So I think there's a lot of good guidance there in terms of the surgical quality. From a standpoint of adjuvant therapy, we define pretty clearly indications for when after surgery for oral cavity cancer, for example, when radiation should be added and when chemoradiation should be added, and I think that's very helpful. And especially for the neck itself, there's been confusion about what happens if I have 30 nodes taken out and they're all negative but I have a big, large primary tumor. What do I do with the neck? Do I radiate it? Do I not radiate it at one side, both sides? And this guideline gives some pretty clear guidance in different scenarios about how to think about that, which is pretty novel and really important, I think. I get questions about this all the time. It comes up in tumor boards all the time, and it's pretty practical. And mostly what we say is if you have a primary tumor that's like a T3 or T4 oral cavity cancer or it approaches midline, either a contralateral neck dissection should be done or radiation should be done to the contralateral neck. And even if you have a lot of lymph nodes taken out and they're negative, if you have very high-risk primary tumor features like very large tumor or multifocal perineural invasion, those kinds of things, even with a negative neck dissection we still typically do treat the neck. So the next recommendation that's really helpful is who can be observed after surgery? And specifically low-volume N1 you can consider observing in oral cavity cancer, whereas N2 or N3 patients all need radiation or chemoradiation in the setting of extranodal extension and positive margins. We did come out pretty firmly advocating for bolus cisplatin 100 milligrams per meter squared every three weeks as recent studies suggest that weekly cisplatin or other regimens are not as effective, and we were pretty clear about that. We were pretty synchronized with recent ASCO-endorsed guidelines in oropharynx cancer that say similar things. In addition, one of the very important questions that comes up is a surgeon will say, well, I'm cutting out the neck tumor, and I know it comes to midline and he's got a bunch of nodes on the right side, but do I really need to do a left neck dissection? Aren't you going to radiate it anyway? And that comes up all the time. Is radiation adequate to manage a clinically negative neck in oral cavity cancer and oropharynx cancer? I think in oropharynx cancer everybody feels pretty comfortably yes. I think in oral cavity cancer it's been somewhat controversial. We favor neck dissections when possible, but if radiation is known to be happening, especially to an elective contralateral neck, that that is adequate therapy. However, we're pretty strong in the fact that neck dissections are the tried and true way to treat oral cavity cancer and that in a T2 or above tumor where a neck dissection is indicated, just resecting the primary and leaving the neck to elective radiation is not something that we thought there was enough evidence for to advocate, and we still advocate classic neck dissection first followed by adjuvant radiotherapy as indicated. One area of controversy that we did touch on is the issue of early stage tongue cancers and whether they need a neck dissection at all. And we came down pretty consistently with all of the co-authors on the guideline that we advocated for a neck dissection for all patients with oral cavity cancer unless it is a very small tumor that we define with very compliant patient who is amenable to very rigorous follow-up that has been done in Europe and in some other places with, specifically, people trained in careful neck ultrasound techniques. So all of those really help guide, both in early stage and more advanced stage, how to manage the neck and oral cavity cancer. And in oropharynx cancer, again, many of the same quality metrics apply. We have some guidance about when doing transoral robotic surgery how to reduce bleeding risk by ligating feeding blood vessels, which is an important addition. We also discuss the fact that, as opposed to lateralized oral cavity patients where a unilateral either neck dissection of radiation is often indicated, in oropharynx cancer the group felt very strongly that bilateral neck should be treated. And typically if tumors extend to midline or involve the posterior oropharyngeal wall, which has bilateral drainage, that either bilateral neck dissection should be performed in those cases or a unilateral neck dissection can be done as long as adjuvant radiation is planned to both necks. Finally, a couple of very important questions of who should not be treated surgically and who should be treated with a nonoperative chemoradiation based approach. In oral cavity cancer, as long as they were not metastatic, we felt people should be resected as long as they were surgically resectable and medically operable. In oropharynx cancer, however, anybody who had unequivocal extranodal extension of nodes into soft tissues or involvement to the carotid artery or extensive cranial-nerve involvement or skull-based involvement by extensive nodal disease are not good candidates for surgery and should be preferentially treated with chemoradiation. That was pretty strong. And finally, the other thing we gave clarity on is when we treat oropharynx cancer with chemoradiation, how do we follow them and when do we decide to do a neck dissection or not? And essentially we recommended a PET CT scan at 12 weeks. And as long as that was negative, a neck dissection should not be done. If you don't have a PET scan and you just have high quality CT or MRI but all of the neck disease has resolved, similarly there should be no neck dissection. And then most importantly, the situation we all face which is very complex is what happens when you have a PET CT done three to four months after treatment and you have small nodes that are still there? You have a little bit of uptake. The FDG avidity is much less than it was. There still is a lesion there, but it's much better and the patient is feeling well. And we felt pretty comfortable not doing a standard neck dissection on those patients but rather following them closely with a follow-up CT scan two to three months later and continual assessment and reserving surgery for obvious progressive disease. So why is this guideline so important, and how will it change practice? So this guideline is really important because head and neck cancer being not the most common cancer, and especially because head and neck cancer is not really one disease-- there's so many different diseases. Even oral cavity and oropharynx, there's quite a bit of variability in how we think about it. There's not a one size fits all recipe for how to manage people properly, and that leads to a lot of confusion and sometimes doubt as to what the best thing to do is in these patients. And that is a very common thing. So I think the most important reason why these guidelines are helpful is they're really clear. They give really clear guidelines of if you're going to do surgery, here's the expectations of what nodal levels to take out and how many nodes to take out. Here's when you should do adjuvant radiation. Here's when you should do adjuvant chemoradiation. Here's when you should treat one side of the neck. Here's when you should treat both sides of the neck. If you're not going to do surgery, here's when you do radiation. And for oropharynx cancer, here's when you can consider surgery. Here's where surgery is not the best idea. And when you treat them and if you do surgically, here's how you do it. If you do with radiation, here are the nodes that should be treated, the nodal levels. And finally, after you do that, how do you watch and act to make sure that people don't fail? So I feel like all of those things lend a lot of clarity to some complicated decision-making processes for these patients, and this really lends clarity to that, which should help kind of lend consistency of practice. That's really our goal. Our goal was there a lot of great docs taking care of these patients out there, but patients are treated in very different ways depending on who they're seeing and where you go. Our goal was to try to increase the consistency of how people are treated no matter where they are. And if practitioners, surgeons, radiation oncologists, medical oncologists see this guideline and kind of follow it and, of course, reach out with any questions at any time, then what we'll be able to do is kind of harmonize the way patients are treated in this country, which should help, I think, the quality of care. And finally, how will these guideline recommendations affect patients? They're going to affect patients because right now a lot of patients get great care, but there are some patients that are not getting ideal care either because maybe they're in parts of the country that don't have the same access to resources or they're in places where the volume of these kind of very complicated and yet not so common diseases aren't seen as high and there's confusion about how to manage them or what the quality metrics are. I think patients are going to be affected knowing, hey, if I'm going to have a neck dissection, here's what I should be asking to make sure my surgeon knows to do and does consistently to make sure it's of high quality. Here's where I think I should be treated with surgery, maybe I shouldn't be treated with surgery, and here's how to follow me. Because there is a lot of variability in how patients are treated, and sometimes there's too many surgeries being done, not enough surgeries being done. If they're being done, maybe they're not the best quality. Even if we don't treat with surgery and we do chemoradiation, we're watching them and we may not be following them as closely, and then people may be recurring and we're not picking it up closely enough. So I think it's going to harmonize, for patients, the way they're ultimately treated. If everybody in the country is treated relatively compatible with this guideline, I think the standard of care will go up across the board. Great. Thank you so much for your work on this important guideline, and thank you for your time today, Dr. Koyfman. Thank you so much. And thank you to all of our listeners for tuning into the ASCO Guidelines podcast series. If you've enjoyed what you've heard today, please rate and review the podcast and refer the show to a colleague.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Hello and welcome to the ASCO Guidelines podcast series. My name is Shannon McKernin, and today I'm interviewing Dr. Shlomo Koyfman from the Cleveland Clinic, lead author on "Management of the Neck in Squamous Cell Carcinoma of the Oral Cavity and Oropharynx: ASCO Clinical Practice Guideline." Thank you for being here today, Dr. Koyfman. It's a pleasure. So first, can you give us a general overview of what this guideline covers? Yeah, so this is an exciting guideline because it covers a topic that we don't usually think about in head and neck cancer in a formal way, and that is management of the neck in squamous cell cancer of the oral cavity and the oropharynx. So there's a lot of literature and guidelines out there on how to manage oropharynx cancer, which is becoming a more and more common cancer, especially in the HPV-positive era, less so on oral cavity. But a lot of times it's focused on people who don't get surgery, chemoradiation, or people who do get surgery and TORS, Transoral Robotic Surgery, and different approaches. But rarely do we have something focus on management of the neck per se, which is really, really important in these cancers and often overlooked in favor of the primary tumor itself. So these guidelines really take us through some salient questions in how to manage the neck in these two cancers. And what are the key recommendations of this guideline? The recommendations came off of six fundamental questions, three in oral cavity and three in oropharynx. There are some commonalities between the two and some differences. A lot of the fundamental questions revolve around surgical quality, and neck dissection is the standard surgical approach for management of the neck in these patients. And as we enter the quality era, how do we define benchmarks of surgical quality, which is one thing that it deals with. The other is when to do adjuvant therapy like adjuvant radiation or chemoradiation. We also deal with when to do surgery for the neck or to do nonoperative approaches like radiation or chemoradiation. And then lastly, how do you follow patients after you've treated them? So those are kind of the salient issues that we dealt with. And what we came out with was nothing earth shatteringly new, but I think the way it was organized and systematically put together, I think it's going to be really, really helpful for people. So some of the most important findings that this recommendation does, I think this is the first that incorporates surgical quality, as I mentioned before. So specifically neck dissection should have 18 or more nodes as multiple studies have shown that that's associated with better outcomes. And similarly we define for different diseases of oral cavity and oropharynx, and depending on what kind of tumor it is and where, what nodal levels should be dissected or treated, whether surgically or nonsurgically, and when to do just one side of the neck versus both sides of the neck. So I think there's a lot of good guidance there in terms of the surgical quality. From a standpoint of adjuvant therapy, we define pretty clearly indications for when after surgery for oral cavity cancer, for example, when radiation should be added and when chemoradiation should be added, and I think that's very helpful. And especially for the neck itself, there's been confusion about what happens if I have 30 nodes taken out and they're all negative but I have a big, large primary tumor. What do I do with the neck? Do I radiate it? Do I not radiate it at one side, both sides? And this guideline gives some pretty clear guidance in different scenarios about how to think about that, which is pretty novel and really important, I think. I get questions about this all the time. It comes up in tumor boards all the time, and it's pretty practical. And mostly what we say is if you have a primary tumor that's like a T3 or T4 oral cavity cancer or it approaches midline, either a contralateral neck dissection should be done or radiation should be done to the contralateral neck. And even if you have a lot of lymph nodes taken out and they're negative, if you have very high-risk primary tumor features like very large tumor or multifocal perineural invasion, those kinds of things, even with a negative neck dissection we still typically do treat the neck. So the next recommendation that's really helpful is who can be observed after surgery? And specifically low-volume N1 you can consider observing in oral cavity cancer, whereas N2 or N3 patients all need radiation or chemoradiation in the setting of extranodal extension and positive margins. We did come out pretty firmly advocating for bolus cisplatin 100 milligrams per meter squared every three weeks as recent studies suggest that weekly cisplatin or other regimens are not as effective, and we were pretty clear about that. We were pretty synchronized with recent ASCO-endorsed guidelines in oropharynx cancer that say similar things. In addition, one of the very important questions that comes up is a surgeon will say, well, I'm cutting out the neck tumor, and I know it comes to midline and he's got a bunch of nodes on the right side, but do I really need to do a left neck dissection? Aren't you going to radiate it anyway? And that comes up all the time. Is radiation adequate to manage a clinically negative neck in oral cavity cancer and oropharynx cancer? I think in oropharynx cancer everybody feels pretty comfortably yes. I think in oral cavity cancer it's been somewhat controversial. We favor neck dissections when possible, but if radiation is known to be happening, especially to an elective contralateral neck, that that is adequate therapy. However, we're pretty strong in the fact that neck dissections are the tried and true way to treat oral cavity cancer and that in a T2 or above tumor where a neck dissection is indicated, just resecting the primary and leaving the neck to elective radiation is not something that we thought there was enough evidence for to advocate, and we still advocate classic neck dissection first followed by adjuvant radiotherapy as indicated. One area of controversy that we did touch on is the issue of early stage tongue cancers and whether they need a neck dissection at all. And we came down pretty consistently with all of the co-authors on the guideline that we advocated for a neck dissection for all patients with oral cavity cancer unless it is a very small tumor that we define with very compliant patient who is amenable to very rigorous follow-up that has been done in Europe and in some other places with, specifically, people trained in careful neck ultrasound techniques. So all of those really help guide, both in early stage and more advanced stage, how to manage the neck and oral cavity cancer. And in oropharynx cancer, again, many of the same quality metrics apply. We have some guidance about when doing transoral robotic surgery how to reduce bleeding risk by ligating feeding blood vessels, which is an important addition. We also discuss the fact that, as opposed to lateralized oral cavity patients where a unilateral either neck dissection of radiation is often indicated, in oropharynx cancer the group felt very strongly that bilateral neck should be treated. And typically if tumors extend to midline or involve the posterior oropharyngeal wall, which has bilateral drainage, that either bilateral neck dissection should be performed in those cases or a unilateral neck dissection can be done as long as adjuvant radiation is planned to both necks. Finally, a couple of very important questions of who should not be treated surgically and who should be treated with a nonoperative chemoradiation based approach. In oral cavity cancer, as long as they were not metastatic, we felt people should be resected as long as they were surgically resectable and medically operable. In oropharynx cancer, however, anybody who had unequivocal extranodal extension of nodes into soft tissues or involvement to the carotid artery or extensive cranial-nerve involvement or skull-based involvement by extensive nodal disease are not good candidates for surgery and should be preferentially treated with chemoradiation. That was pretty strong. And finally, the other thing we gave clarity on is when we treat oropharynx cancer with chemoradiation, how do we follow them and when do we decide to do a neck dissection or not? And essentially we recommended a PET CT scan at 12 weeks. And as long as that was negative, a neck dissection should not be done. If you don't have a PET scan and you just have high quality CT or MRI but all of the neck disease has resolved, similarly there should be no neck dissection. And then most importantly, the situation we all face which is very complex is what happens when you have a PET CT done three to four months after treatment and you have small nodes that are still there? You have a little bit of uptake. The FDG avidity is much less than it was. There still is a lesion there, but it's much better and the patient is feeling well. And we felt pretty comfortable not doing a standard neck dissection on those patients but rather following them closely with a follow-up CT scan two to three months later and continual assessment and reserving surgery for obvious progressive disease. So why is this guideline so important, and how will it change practice? So this guideline is really important because head and neck cancer being not the most common cancer, and especially because head and neck cancer is not really one disease-- there's so many different diseases. Even oral cavity and oropharynx, there's quite a bit of variability in how we think about it. There's not a one size fits all recipe for how to manage people properly, and that leads to a lot of confusion and sometimes doubt as to what the best thing to do is in these patients. And that is a very common thing. So I think the most important reason why these guidelines are helpful is they're really clear. They give really clear guidelines of if you're going to do surgery, here's the expectations of what nodal levels to take out and how many nodes to take out. Here's when you should do adjuvant radiation. Here's when you should do adjuvant chemoradiation. Here's when you should treat one side of the neck. Here's when you should treat both sides of the neck. If you're not going to do surgery, here's when you do radiation. And for oropharynx cancer, here's when you can consider surgery. Here's where surgery is not the best idea. And when you treat them and if you do surgically, here's how you do it. If you do with radiation, here are the nodes that should be treated, the nodal levels. And finally, after you do that, how do you watch and act to make sure that people don't fail? So I feel like all of those things lend a lot of clarity to some complicated decision-making processes for these patients, and this really lends clarity to that, which should help kind of lend consistency of practice. That's really our goal. Our goal was there a lot of great docs taking care of these patients out there, but patients are treated in very different ways depending on who they're seeing and where you go. Our goal was to try to increase the consistency of how people are treated no matter where they are. And if practitioners, surgeons, radiation oncologists, medical oncologists see this guideline and kind of follow it and, of course, reach out with any questions at any time, then what we'll be able to do is kind of harmonize the way patients are treated in this country, which should help, I think, the quality of care. And finally, how will these guideline recommendations affect patients? They're going to affect patients because right now a lot of patients get great care, but there are some patients that are not getting ideal care either because maybe they're in parts of the country that don't have the same access to resources or they're in places where the volume of these kind of very complicated and yet not so common diseases aren't seen as high and there's confusion about how to manage them or what the quality metrics are. I think patients are going to be affected knowing, hey, if I'm going to have a neck dissection, here's what I should be asking to make sure my surgeon knows to do and does consistently to make sure it's of high quality. Here's where I think I should be treated with surgery, maybe I shouldn't be treated with surgery, and here's how to follow me. Because there is a lot of variability in how patients are treated, and sometimes there's too many surgeries being done, not enough surgeries being done. If they're being done, maybe they're not the best quality. Even if we don't treat with surgery and we do chemoradiation, we're watching them and we may not be following them as closely, and then people may be recurring and we're not picking it up closely enough. So I think it's going to harmonize, for patients, the way they're ultimately treated. If everybody in the country is treated relatively compatible with this guideline, I think the standard of care will go up across the board. Great. Thank you so much for your work on this important guideline, and thank you for your time today, Dr. Koyfman. Thank you so much. And thank you to all of our listeners for tuning into the ASCO Guidelines podcast series. If you've enjoyed what you've heard today, please rate and review the podcast and refer the show to a colleague.

Host: Lee Freedman, MD Oropharyngeal cancer is part of a growing proportion of head and neck malignancies. This has also been associated with the increase in infection of the oropharynx by oncogenic strains of the human papillomavirus (HPV). And, transoral robotic surgery, or TORS, has allowed for minimally invasive surgery for HPV-related and non-HPV-related oropharyngeal cancer. To discuss this topic and much more, host Dr. Lee Freedman welcomes Dr. Gregory Weinstein, Professor and Vice Chair and the Director of the Division of Head and Neck Surgery. He is also the Co-Director of The Center for Head and Neck Cancer in The Department of Otorhinolaryngology: Head and Neck Surgery at the Hospital of the University of Pennsylvania.

Host: Lee Freedman, MD Oropharyngeal cancer is part of a growing proportion of head and neck malignancies. This has also been associated with the increase in infection of the oropharynx by oncogenic strains of the human papillomavirus (HPV). And, transoral robotic surgery, or TORS, has allowed for minimally invasive surgery for HPV-related and non-HPV-related oropharyngeal cancer. To discuss this topic and much more, host Dr. Lee Freedman welcomes Dr. Gregory Weinstein, Professor and Vice Chair and the Director of the Division of Head and Neck Surgery. He is also the Co-Director of The Center for Head and Neck Cancer in The Department of Otorhinolaryngology: Head and Neck Surgery at the Hospital of the University of Pennsylvania.

Hosts: Vincent Racaniello, Alan Dove, Rich Condit, and Kathy Spindler Vincent, Alan, Rich and Kathy association of a virus with sea star melting disease, and the finding of a phycodnavirus in the oropharynx of humans with altered cognitive functions. Links for this episode National Influenza Immunization Week (CDC) Densovirus associated with sea star wasting disease (PNAS) A virus that melts sea stars (virology blog) Chlorovirus in human oropharynx (PNAS) Algal virus in humans (virology blog) Image credit Letters read on TWiV 315 Weekly Science Picks Alan - ReelLife Science 2014 WinnersRich - The Martian by Andy WeirKathy - Dance Your Ph.D. WinnerVincent - Time Person of the Year 2014 - The Ebola Fighters Listener Pick of the Week Ricardo - MiniPCREli - Let's outsmart Ebola together AND The Ebola virus explained Send your virology questions and comments (email or mp3 file) to twiv@twiv.tv

This podcast describes the rising epidemic of HPV-associated oropharynx cancer, its unique demographic profile and natural history, and comments on new findings from Carole Fakhry et al. regarding patterns of disease recurrence seen in patients enrolled on RTOG 0129 and 0522.

Dr. Jared Weiss, University of North Carolina, discusses chemotherapy options and practice in late stage oropharynx cancer.

Dr. Jared Weiss, University of North Carolina, discusses chemotherapy options and practice in late stage oropharynx cancer.

Dr. Jared Weiss, University of North Carolina, discusses chemotherapy options and practice in late stage oropharynx cancer.

Dr. Jared Weiss, University of North Carolina, discusses chemotherapy options and practice in late stage oropharynx cancer.

Dr. Jared Weiss, University of North Carolina, discusses chemotherapy options and practice in late stage oropharynx cancer.

Dr. Jared Weiss, University of North Carolina, discusses chemotherapy options and practice in late stage oropharynx cancer.

Dr. Geoffrey Geiger, University of Pennsylvania, outlines the course of radiotherapy treatment and side effects for head and neck cancer.

Dr. Geoffrey Geiger, University of Pennsylvania, provides an introduction to head and neck cancer and the human papilloma virus.

Dr. Geoffrey Geiger, University of Pennsylvania, discusses the process of planning radiotherapy for head and neck cancer.

Dr. Geoffrey Geiger, University of Pennsylvania, provides an introduction to head and neck cancer and the human papilloma virus.

Dr. Geoffrey Geiger, University of Pennsylvania, provides an introduction to head and neck cancer and the human papilloma virus.

Dr. Geoffrey Geiger, University of Pennsylvania, discusses the process of planning radiotherapy for head and neck cancer.

Dr. Geoffrey Geiger, University of Pennsylvania, discusses the process of planning radiotherapy for head and neck cancer.

Dr. Geoffrey Geiger, University of Pennsylvania, outlines the course of radiotherapy treatment and side effects for head and neck cancer.

Dr. Geoffrey Geiger, University of Pennsylvania, provides an introduction to head and neck cancer and the human papilloma virus.

Dr. Geoffrey Geiger, University of Pennsylvania, provides an introduction to head and neck cancer and the human papilloma virus.

Dr. Geoffrey Geiger, University of Pennsylvania, discusses the process of planning radiotherapy for head and neck cancer.

Dr. Geoffrey Geiger, University of Pennsylvania, provides an introduction to head and neck cancer and the human papilloma virus.

Dr. Geoffrey Geiger, University of Pennsylvania, discusses the process of planning radiotherapy for head and neck cancer.

Dr. Geoffrey Geiger, University of Pennsylvania, discusses the process of planning radiotherapy for head and neck cancer.

Dr. Geoffrey Geiger, University of Pennsylvania, outlines the course of radiotherapy treatment and side effects for head and neck cancer.

Dr. Geoffrey Geiger, University of Pennsylvania, outlines the course of radiotherapy treatment and side effects for head and neck cancer.

Dr. Geoffrey Geiger, University of Pennsylvania, outlines the course of radiotherapy treatment and side effects for head and neck cancer.

Dr. Geoffrey Geiger, University of Pennsylvania, outlines the course of radiotherapy treatment and side effects for head and neck cancer.

Runtime 52:01 Medical oncologist David Pfister of Memorial Sloan Kettering explains the link between the human papillomavirus and head and neck cancer. read more

Thu, 17 Mar 2011 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/12864/ https://edoc.ub.uni-muenchen.de/12864/2/Boeck_Dominique.pdf Böck, Dominique

Phillip S. Barie, MD, MBA, FCCM, discusses decontamination of the digestive tract and oropharynx in an attempt to prevent ventilator-associated pneumonia. He discusses a recent article published in The New England Journal of Medicine, "Decontamination of the Digestive Tract and Oropharynx in ICU Patients." Barie is Immediate Past President of the Society of Critical Care Medicine (SCCM), as well as professor of surgery and public health at Weill Medical College of Cornell University in New York. He is also the director of surgical critical care and the surgical intensive care unit at New York Presbyterian Hospital. While Barie has not authored either of these articles, he is considered an expert in this field, which is very important to critical care practice.

Thu, 13 Nov 2008 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/9346/ https://edoc.ub.uni-muenchen.de/9346/1/Jaiser_Sonja.pdf Jaiser, Sonja

Der obere Aerodigestivtakt ist das primäre Kontaktorgan für viele inhalative Karzinogene. Dies spielt insbesondere bei der tabak-assoziierten Karzinogenese eine entscheidende Rolle. Polyzyklische Kohlenwasserstoffe und der Metabolit des Benzo[a]pyrens, das Benz[a]pyren-7,8-diol-epoxid (BPDE) sind hierbei von herausragender Bedeutung. Mutationen an der DNA sind dabei nicht gleichmäßig über die gesamte DNA verteilt, sondern auf speziellen Chromosomen bzw. Genen lokalisiert. Zur Erstellung eines individuellen Risikoprofils wurde in dieser Arbeit die alkalische Einzellzell-Mikrogelelektrophorese (Comet Assay), eine etablierte Methode zur Quantifizierung von DNA-Schäden, erstmals mit der Fluoreszenz in situ Hybridisierung (FISH) an Mucosazellen des oberen Aerodigestivtraktes kombiniert. Nach Inkubation mit BPDE konnte so eine Bestimmung der DNA-Schädigung an den Chromosomen 3,5,8 und dem Vergleichschromosom 1 durchgeführt werden. Dabei wurden frisch entnommene, makroskopisch gesunde Mukosaproben von Patienten mit Oropharynxkarzinom und tumorfreien Patienten verglichen. Es stellte sich heraus, dass Tumorpatienten eine höhere Schädigung der Chromosomen 5 und 8 im Vergleich zu Chromosom 1 aufwiesen. Bei tumorfreien Patienten konnten keine Unterschiede der einzelnen Chromosomen untereinander und im Vergleich zur Gesamt-DNA nachgewiesen werden. Neben einer quantitativen Bestimmung der DNA-Schädigung an Interphasezellen sollte in der vorliegenden Arbeit auch strukturelle DNA-Schädigungen an Metaphasechromosomen untersucht werden. Zur Einschätzung der Mutagensensitivität bei der Karzinogenese im Oropharynx wurden in multiplen Vorarbeiten Lymphozyten als Kontrollzellen herangezogen. Deshalb wurden auch in der vorliegenden Arbeit Metaphasechromosomen aus Lymphozyten präpariert und mit FISH untersucht. Zusätzlich wurde auch eine neue Methodik zur Präparation von Metaphasechromosomen aus Mukosazellen des oberen Aerodigestivtraktes etabliert. Es konnte jedoch an keinem der untersuchten Chromosomen ein statistisch signifikanter Unterschied in der Schädigung zwischen tumorfreien- und Tumorpatienten ausgemacht werden. Das in der vorliegenden Arbeit etablierte Modell zur Präparation von Chromosomen aus Mukosazellen bietet zur weiterführenden Erfassung des Risikoprofils für die Entstehung von Karzinomen des oberen Aerodigestivtraktes einen geeigneteten Ansatz. Unter Umständen lassen sich zusätzliche Gene lokalisieren, die für die Tumorentstehung im Kopf-Hals-Bereich von Bedeutung sind. Die vorliegende Arbeit zeigt, dass einige dieser Veränderungen bereits in makroskopisch gesunder Schleimhaut des oberen Aerodigestivtrakts auftreten. Weitere Untersuchungen müssen ergeben, ob spezifische Veränderungen am Genom nicht schon vor Entstehung des Tumors nachweisbar sind. Aus solchen Veränderungen ließe sich eine umfangreiche Frühdiagnostik zur Einschätzung der individuellen Mutagensensitivität entwickeln. Dies eröffnet die Möglichkeit für künftige präventive und therapeutische Strategien für die Karzinogenese des oberen Aerodigestivtraktes.

In der vorliegenden Arbeit wurde die Rolle des kürzlich identifizierten Polymorphismus im Gen der Rezeptortyrosinkinase FGFR4 (fibroblast growth factor receptor 4) im besonderen Hinblick auf seine Zusammenhänge mit der humanen Tumorpathogenese näher untersucht. Es handelt sich dabei um eine Keimbahnmutation, die zu einem Austausch der hydrophoben Aminosäure Glycin gegen die hydrophile, stark geladene Aminosäure Arginin an Position 388 (Arg388) und somit zu einer veränderten Proteinstruktur in der Transmembrandomäne des Rezeptors führt. Zuvor publizierte Studien, die Tumore verschiedener Organsysteme mit Fokus auf den FGFR4 Polymorphismus untersuchten, postulieren einen Zusammenhang zwischen der Rezeptormutation und seinem Einfluss auf die Tumorprogression und das Metastasierungspotential. Um diesen Einfluss der Mutation in unserem Tumorkollektiv zu untersuchen, führten wir bei Tumorproben von 301 Patienten, die an einem Plattenepithelkarzinom aus dem Bereich des Oropharynx litten, eine Genotypisierung mittels RFLP-PCR sowie immunhistochemische Untersuchungen durch, um die Expressionsstärke des FGFR4 feststellen zu können. Dabei zeigte sich, dass der FGFR4 in 34% der Fälle in heterozygoter oder homozygoter mutierter Form im Kollektiv vorliegt. Das entspricht einer Allelfrequenz für das Arg388 von 0.2. Die Verteilung der Rezeptorexpression im Kollektiv war weitgehend gleichmäβig verteilt. Um die Auswirkungen der durch die Untersuchungen gewonnenen Parameter auf die Tumorpathogenese festzustellen, wurden sie mit einem umfassenden Datensatz, der aus den Patientenakten gewonnen wurde, korreliert. Statistische Untersuchungen wiesen keine signifikanten Zusammenhänge zwischen dem FGFR4 Genotyp und der Tumorprogression oder einem gesteigertem Metastasierungspotential nach. Auch die in anderen Organsystemen zuvor festgestellte verringerte rezidivfreie Überlebenszeit bei Vorliegen des Arg388 Allels konnte in dem Kollektiv dieser Studie nicht reproduziert werden. Bezüglich der Rezeptorexpression ergaben unsere Untersuchungen Hinweise auf einen Überlebensvorteil bei starker FGFR4 Expression. Signifikante Zusammenhänge zwischen Rezeptorexpression und Tumorgröβe oder Tumorprogression konnten jedoch nicht nachgewiesen werden und decken sich mit den Ergebnissen von Streit et al. Somit können wir die bereits mehrfach postulierte Perspektive nicht stärken, den FGFR4 als Prädiktor oder prognostischen Parameter bei Krebserkrankungen zu deklarieren.

Data from clinical studies often contain time-dependent covariates, e.g. events like transplantation or an adverse drug reaction, or the changing measurements of laboratory data. The common approach uses only the covariate information at time t=0 for regression analyses, but this baseline analysis is not very satisfying. This paper applies the linear counting process by Aalen for failure time analysis, modified to deal with time-dependent covariates. In the main part we describe methods to estimate and visualize the cumulated regression function with respect to time-dependent covariates. After introducing a test for significance of the influence of covariates we display different methods to investigate model validity depending on martingale residuals, or by use of the Arjas plot. Coding and interpretation problems are shortly discussed. Results are illustrated with data from the Stanford Heart Transplantation Study and a study on Oropharynx carcinoma.