Squamous cancer of the tongue

Early squamous carcinoma of the tongue (stage I) can be effectively treated by surgery or radiation therapy with good results. In patients with larger, but apparently localized tumors (stage II), we now favor a staging operation (supraomohyoid neck dissection) to select those who require additional treatment directed to the neck. Our preference for patients with advanced tumors (stage III and IV) has shifted to mandible-sparing surgery whenever possible, in combination with postoperative radiation therapy. Using this approach, locoregional tumor control has improved while the morbidity of extraradical surgery and high-dosage radiation therapy has been avoided. This approach may not translate into longer survival times until effective chemotherapy is available to control distant metastases. Meanwhile, there is a need for both public and professional education to increase the proportion of early, curable lesions and promote the necessary changes in lifestyle (i.e., abstinence from alcohol and tobacco) to reduce the incidence of tongue and other cancers of the aerodigestive tract.     

Clinical studies on cancer of the tongue

Thirty-nine previously untreated patients with squamous cell carcinoma of the tongue were treated by irradiation or a combination of irradiation and surgery, with or without chemotherapy, between January 1971 and December 1980. All of the patients had a follow-up period of at least nine years. Twenty-two patients were men and 17 were women. The average age was 50.1 years, with a range of 30 to 74 years. The absolute five-year survival rate was 82.1% and the cumulative ten-year survival rate 76.9% for these 39 patients. Cervical node metastases were clinically found on admission in 14 patients whose five-year survival rate was 64.3%, whereas it was 92.0% for 25 patients without metastasis. The absolute five-year survival rate decreased from 92.3% for patients with stage I lesions to 90.9%, 87.5% and 42.9% for those with stage II, stage III and stage IV lesions, respectively. Most of the patients received external irradiation and intraoral electron beam therapy. External irradiation was administered to the upper neck in all but one of 25 patients with TxN0 lesions. Subsequently partial glossectomy was performed in 12 of the 25 patients. Hemiglossectomy and hemimandibulectomy were used for 5 of 16 patients with TxN1-3 lesions. No patients with TxN0 lesions developed neck lymph node metastasis. Twenty-nine of the 39 patients had no tumor recurrence either locally or regionally for five years and 27 for nine years. None of the patients had major post-irradiation complications.     

Radiotherapy of oral tongue cancer

The results in the treatment of oral tongue cancer are analysed to suggest a highly specified therapeutic program. Two hundred and thirty-two cases, radiologically treated at the Istituto del Radio Alberti, Brescia, Italy, from 1964 to 1978 are considered. Depending on the staging, exclusive interstitial curietherapy, exclusive external radiotherapy, or external plus interstitial therapy were applied. The therapy of locoregional lymph nodes was surgical and/or radiological. The statistical analysis deals with actuarial survival, local remission, recurrences and radionecroses. Particular attention is paid to N0 cases that became N positive. The suggested therapeutic program depends strictly on the staging and defines also the optimal doses.     

Compartmental tongue surgery: Long term oncologic results in the treatment of tongue cancer

Compartmental tongue surgery (CTS) is a surgical technique that removes the compartments (anatomo-functional units) containing the primary tumor, eliminating the disease and potential muscular, vascular, glandular and lymphatic pathways of spread and recurrence. Compartment boundaries are defined as each hemi-tongue bounded by the lingual septum, the stylohyoid ligament and muscle, and the mylohyoid muscle. In this non-randomized retrospective study we evaluated the oncologic efficacy of CTS in patients with squamous cell carcinoma (SCCA) of the tongue treated from 1995 to 2008. We evaluated 193 patients with primary, previously untreated cT2-4a, cN0, cN+, M0 SCCA with no contraindication to anesthesia and able to give informed consent. Fifty patients treated between October 1995 and July 1999 received standard surgery (resection margin >1cm); 143 patients treated between July 1999 and January 2008 received CTS. Study endpoints were: 5-year local disease-free, locoregional disease-free and overall survival. After 5years, local disease control was achieved in 88.4% of CTS patients (16.8% improvement on standard surgery); locoregional disease control in 83.5% (24.4% improvement) and overall survival was 70.7% (27.3% improvement). The markedly improved outcomes in CTS patients, compared to those treated by standard surgery, suggest CTS as an important new approach in the surgical management of tongue cancer.     

Results of brachytherapy of tongue cancer

One hundred thirty-two patients with primary cases of squamous cell carcinoma of the tongue treated at National Sapporo Hospital from 1972 to 1982 were reviewed. Most primary sites were treated with interstitial needle implant with or without external beam irradiation. The local control rate by needle implant for the primary tongue lesions was 85.5%. That for the single plane implant was especially notable at 92.5%. The cumulative five-year survival rate was 92.8% in stage, I, 74% in stage II, 53.2% in stage III, 12.5% in stage IV and 64% overall.     

肺癌术后心律失常57例分析

目的 分析肺癌术后心律失常发生机制与防治措施。方法 对1995～2001年肺癌切除术后发生心律失常的57例患临床资料进行回顾性分析。结果 高龄、术前心电图异常、全肺切除术以及术后缺氧等是术后发生心律失常的主要因素。结论 术前积极治疗心脏原发病，严格掌握全肺切除适应证。术后吸氧等是减少及防止发生心律失常的重要有效措施。     

Invasion characteristics of oral tongue cancer

BACKGROUND:

The 2000 College of American Pathologists (CAP) guidelines recommend that a characterization of carcinomas of the upper aerodigestive tract, including tongue cancer, should include depth of invasion (DI) and the presence of lymphovascular invasion (LVI) or perineural invasion (PNI).

METHODS:

This study included patients who were diagnosed with cancer of the oral tongue, who underwent tumor resection, and who were reported to either the Metropolitan Atlanta and Rural Georgia Surveillance, Epidemiology, and End Results (SEER) registry or the Los Angeles SEER registry. The authors assessed the completeness of pathology reporting with respect to the documentation of PNI or LVI and DI. Generalized estimating equations were used to examine factors that influenced reporting while taking into consideration clustering of observations within the hospitals. Univariate and multivariate survival analyses were conducted to examine the impact of tumor invasion characteristics on mortality while controlling for other prognostic factors.

RESULTS:

DI reporting increased from 13% between 1997 and 1999 to 23% between 2000 and 2004 after the CAP issued its recommendations; whereas mode of invasion (the presence of LVI and/or PNI) reporting for the same period increased from 13% to 38%. The observed increase in reporting was most pronounced in the first 2 years (2000 and 2001) and appeared to decline again afterward. Tumor invasion >3 mm in depth and the presence of PNI were among the strongest predictors of survival in multivariate analyses.

CONCLUSIONS:

The current results indicated the importance of reporting tumor invasion characteristics for patients diagnosed with cancer of the oral tongue. The findings also underscore the need for continuous monitoring of adherence to the CAP protocol. Cancer 2009. © 2009 American Cancer Society.     

Retrospective study on cancer of the base of the tongue

From Feb. 1962 to Feb. 1982, 54 patients with cancer of the base of tongue were treated in our hospital. There were 44 squamous cell carcinomas and 10 adeno-cystic carcinomas. 46 patients were treated by radiotherapy only, 6 by surgery plus radiotherapy, 1 by surgery and 1 by chemotherapy alone. The 5 year survival rate was 27.1%. The result indicates that radiotherapy alone is poor. The author suggests that for cancer of the base of tongue, a combination of radiotherapy and surgery be used and prospective randomized study be carried out. The defect can be repaired using skin or myocutaneous flaps. In extensive lesions, glossectomy plus laryngectomy should be considered. For the healthy and young patients, the lesions of the base of tongue together with a part of the larynx should be extirpated but for the older man, selective glossectomy is advised.     

Radical causes of cancer

Free radicals are ubiquitous in our body and are generated by normal physiological processes, including aerobic metabolism and inflammatory responses, to eliminate invading pathogenic microorganisms. Because free radicals can also inflict cellular damage, several defences have evolved both to protect our cells from radicals--such as antioxidant scavengers and enzymes--and to repair DNA damage. Understanding the association between chronic inflammation and cancer provides insights into the molecular mechanisms involved. In particular, we highlight the interaction between nitric oxide and p53 as a crucial pathway in inflammatory-mediated carcinogenesis.     

Causes of oral tongue cancer treatment failures. Analysis of autopsy cases.

Eighty-three autopsy cases of squamous cell carcinoma of the oral tongue were reviewed to identify retrospectively the causes of treatment failure. The cure rate for the primary cancers at autopsy was 48.2% (40 of 83). Regional lymph node metastases were found in 71.1% (59 of 83). Regional metastases and/or juxtaprimary recurrence frequently spread continuously and diffusely, forming bulky neck tumors in 38.6% (32 of 83). The incidence of distant lymph node metastasis (below the clavicle) and hematogenous metastasis was 35.4% (29 of 82) and 58.5% (48 of 82), respectively. The lung was the most common site of hematogenous metastases (52.4%, 43 of 82). Hematogenous metastasis occurred more frequently in the younger age group (less than 40 years of age; P = 0.03). Distant lymph node metastases were identified in the lung hilar, bifurcation, and paratracheal nodes in 89.7% (26 of 29) and had a statistically significant association with lung hematogenous metastasis. Univariate analysis revealed that gross appearance, tumor stage, clinical stage, presence of cervical lymph node metastasis, and interval from N0 to NX were significant predictors of survival time (duration from initial treatment to death). Rupture of the neck vessels was fatal in eight patients (9.6%), and hypercalcemia was seen in six (7.2%). Pulmonary infection was the direct cause of death in 33.7% of patients (28 of 83). Secondary malignant lesions occurred in 22.9% (19 of 83).     

Risk factors for cancer of the tongue in Uruguay

From 1987 to 1989, a hospital-based case-control study of cancer of the tongue was conducted in Montevideo, Uruguay, as part of a large study to investigate a number of risk factors for cancer of the oral cavity, pharynx, and larynx. The study involved interviews with 57 cases and 353 controls and was restricted to men. Relative risks (RR) associated with tobacco smoking, alcohol drinking, and selected dietary items were obtained by unconditional logistic-regression analysis. Users of black tobacco had a RR fourfold higher than users of blond tobacco, and heavy drinkers of alcohol had a RR of 11.6. Infrequent consumption of vegetables was associated with a significant RR of 5.3, and heavy drinkers of the local infusion "mate" had a RR of 2.5. It was concluded that black tobacco smoking and alcohol drinking were the strongest risk factors for cancer of the tongue in Uruguay. Their effects combine according to a multiplicative model. Also, infrequent vegetable intake and mate ingestion contribute to the risk of cancer of the tongue.     

Historical review of the causes of cancer

In the early 1900s, numerous seminal publications reported that high rates of cancer occurred in certain occupations. During this period, work with infectious agents produced only meager results which seemed irrelevant to humans. Then in the 1980s ground breaking evidence began to emerge that a variety of viruses also cause cancer in humans. There is now sufficient evidence of carcinogenicity in humans for human T-cell lymphotrophic virus, human immunodeficiency virus, hepatitis B virus, hepatitis C virus, human papillomavirus, Epstein-Barr virus, and human herpes virus 8 according to the International Agency for Research on Cancer (IARC). Many other causes of cancer have also been identified by the IARC, which include: Sunlight, tobacco, pharmaceuticals, hormones, alcohol, parasites, fungi, bacteria, salted fish, wood dust, and herbs. The World Cancer Research Fund and the American Institute for Cancer Research have determined additional causes of cancer, which include beta carotene, red meat, processed meats, low fibre diets, not breast feeding, obesity, increased adult height and sedentary lifestyles. In brief, a historical review of the discoveries of the causes of human cancer is presented with extended discussions of the difficulties encountered in identifying viral causes of cancer.     

Results of surgical treatment of tongue cancer

Fourty-four patients with squamous cell carcinoma of the tongue have been treated by surgery. Twenty-two out of 44 patients were treated by a glossectomy alone and the remaining 22 by en bloc dissection with a glossectomy and neck dissection. The 5-year cumulative survival rate of these 44 cases was 86.1%, broken down as follows: stage I (20 cases), 100%; stage II (9 cases), 88.9%; stage III (11 cases), 72.7%; and, stage IV (4 cases), 50%. Four cases had a recurrence in the primary site, and 6 in the cervical region. Five out of 44 cases died (4 from tongue cancer, and one from other causes). Further, 3 out of 5 cases died of a recurrent cancer in the primary focus or in the neck. Thus, it has been concluded that control of the primary focus and neck metastasis is important for the treatment of tongue cancer, and that surgery also is an excellent therapy for tongue cancer.     

Epidemiology and the causes of breast cancer

This article describes the characteristics of 3 dominant features of breast cancer epidemiology. These characteristics include the association of disease risk with childbearing, its relationship to ovarian activity and its international variation (particularly as the latter differs in the years before and after menopause). Equivocal tests of one hypothesis that reconciled some of these features through variations in levels of the fractions of estrogen are described. Other hypotheses with a similar objective are needed. The 3 known causes of human breast cancer, ionizing radiation, exogenous ovarian hormones and beverage alcohol, offer some preventive possibilities but do little to explain the epidemiologic features of the majority of cases of the disease that occur in their absence.     

Breast cancer survivors' beliefs about the causes of breast cancer

Objective: To explore the beliefs held by breast cancer (BC) survivors about the factors that contribute to the development of their BC. Methods: The BUPA Health Foundation Health and Well‐being after Breast Cancer Study is a prospective cohort study of 1684 women recruited within 12 months of their first diagnosis with invasive BC. Participants completed an enrollment questionnaire (EQ), first follow‐up questionnaire (FQ1) and a second follow‐up questionnaire (FQ2), 12 months and 24 months post‐EQ, respectively. In the FQ2, women were asked whether they believed anything contributed to the development of their BC and whether they had made lifestyle changes since the FQ1. Well‐being was assessed at the FQ2 using the Psychological General Well‐being Index (PGWB). Results: In total, 1496/1684 women completed the FQ2 and 43.5% reported belief in a factor that may have contributed to their developing BC. These women were more likely to be younger (p<0.0001) and educated beyond high school (p<0.0001). Stress (58.1%) was the most common reason given, followed by previous use of hormone therapy (17.0%) and a family history of any cancer (9.8%). Women who believed stress contributed to their BC had lower PGWB scores than other study participants (70.9 ± 16.1, n = 361 versus 77.3 ± 14.9, n = 1071, mean difference = 6.4, 95% CI: 4.6–8.2 p<0.0001) and were more likely to have made lifestyle changes since their BC diagnosis. Conclusions: Many women with BC believe that stress has contributed to their condition. Women who held this belief were more likely to adopt strategies to reduce stress than those who did not. Copyright © 2011 John Wiley & Sons, Ltd.     

Elective treatment of the neck in cancer of the oral tongue

Management of the clinically negative neck in patients with carcinoma of the oral tongue remains a complex and controversial subject. While statistical proof of the value of elective neck dissection in tongue cancer remains elusive, the high incidence of occult cervical metastases, even with small primary tumors, and the poor salvage rates and increased incidence of extracapsular spread in cases that have developed palpable adenopathy, provide a logical basis for treatment of the neck in a preclinical stage.     

Remote life-style causes of cancer

Most epidemiologists regard more or less proximal variables as life-style factors--smoking, diet, sex behavior, occupation. Within this framework, life-style factors making for high risk of cancer are defined and presented. Three estimates of the contribution to cancer incidence by the major proximal causes are presented, using the variables specified by each estimator. For purposes of completeness and possible prevention action, however, intermediate and distant precursors should be considered--local ecology, culture, industrialization, etc. The possibility that stress may affect cancer risk is addressed and evidence presented to suggest that any contribution to risk, if it exists at all, is probably small.