Coffee Reduces Risk of Death from Oral Cancer

In a prior blog, I mentioned that researchers found that regular coffee drinkers who drank more than four cups of coffee a day had a 39 percent decreased risk of two types of head and neck cancer: oral cavity and pharynx cancers. In the study published in the Journal of Cancer Epidemiology, Biomarkers & Prevention, they found however, that coffee did not decrease the risk of laryngeal cancer. Read a CNN report on this here.

In a more recent study (Dec 2012), researchers have found that not only does coffee reduce risk of cancer, but that consuming more than four cups of caffeinated coffee per day was associated with a 49 percent lower risk of oral/pharyngeal cancer death relative to no/occasional coffee intake.

Coffee contains over 1,000 different chemical compounds, including cancer-fighting antioxidants, and it’s those antioxidants that may provide a “plausible explanation” for reducing the cancer risk as well as cancer death.

However, patients should not take this study as an excuse to increase their coffee intake specifically to counteract known cancer-causing behaviors including smoking, drinking alcohol, and chewing tobacco.

Reference:
Coffee and Tea Intake and Risk of Head and Neck Cancer: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev. 2010 Jul;19(7):1723-36. doi: 10.1158/1055-9965.EPI-10-0191. Epub 2010 Jun 22.

Coffee, Tea, and Fatal Oral/Pharyngeal Cancer in a Large Prospective US Cohort. American Journal of Epidemiology, 2012 DOI: 10.1093/aje/kws222

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Brooke Burke Has Thyroid Cancer

Brooke Burke, TV personality best known for winning the 7th season of Dancing with the Stars and later co-hosting the show starting in 2010 announced in a self-published video the fact that she has thyroid cancer and will soon be undergoing thyroid surgery.

Apparently, on a routine physical exam, a thyroid nodule was appreciated in July 2012. This was biopsied (presumably via an ultrasound guided fine needle aspiration) and came back as "atypical". Given atypical findings, a diagnosis of cancer or no cancer can not be definitively made. As such, more studies were than pursued and finally, she was informed she had a "good" type of thyroid cancer if there is such a thing.

Some of these additional studies may have included CT scan of the neck and thyroid scan.

The type of thyroid cancer was never specifically mentioned, but she most likely has papillary thyroid carcinoma which is the most common form of thyroid cancer and is highly curable (which is where the comment of being a "good" cancer comes from).

Other less common thyroid cancers include follicular thyroid carcinoma and medullary thyroid carcinoma.

Thyroid cancer mandates thyroidectomy with post-operative radioactive iodine treatment to ensure complete thyroid tissue eradication.

Her surgery date has not been announced.

It should be stated that until the thyroid is removed, one can NOT be absolutely sure that thyroid cancer actually truly is present. Indeed, the president of Argentina made a similar announcement of thyroid cancer only to find out after her thyroid was removed that no cancer was actually present. Read blog post about this "mistake".

Source:
Brooke Burke: I Have Cancer. NY Post 11/8/12

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R&B Singer Maxwell with Vocal Cord Hemorrhage

At least that's what the Washington Post reported on June 22, 2012. This has resulted in cancellation of his summer tour.

Per media reports, his vocal cords are swollen with hemorrhage.

Some fans may recall that something similar happened to Adele in winter of 2011 which resulted in her also canceling a number of engagements. She ultimately had surgery to correct her problem.

Normally, the vocal cords are pearly white without any vasculature. Watch a video of how this exam is performed.

However, when a blood vessel is present in the vocal cords, they may look something like this:

The issue with a blood vessel within the vocal cord itself is that it fluctuates in size due to whether it is irritated from phono-trauma or even hormones. Such fluctuation in size causes the voice to change in pitch and quality on an hour to hour basis depending on how much swelling occurs. For a singer, it makes the voice unpredictable.

When the blood vessel becomes engorged and traumatized, it may even rupture leading to a vocal cord hemorrhage. Especially in a woman, the blood vessel may be more prone to hemorrhage during her menstrual cycle.

This is a dangerous situation for a singer because of their regular voice use and need to use it forcefully. However with too much force, the blood vessel may suddenly rupture (even in the middle of a performance) resulting in a hemorrhage into the vocal lining itself causing a sudden and complete loss of voice. If a voice is present, it is much deeper than normal due to the additional "weight" of blood and edema (just like a violin string where the thicker the string, the deeper the pitch). There may even be mild pain associated with this occurrence.

To the right is a picture of a vocal cord hemorrhage. Note the entire vocal cord on one side (which is the patient's right side for those in the know) is brilliant red indicative of the presence of blood throughout the cord.

How is this treated?

Initially during an acute vocal cord hemorrhage, STRICT VOICE REST is mandatory. With continued voice use, the patient risks abnormal healing that may result in a vocal cord polyp or vocal cord scarring. Along with strict voice rest, steroids are often prescribed to help reduce the inflammatory swelling that often occurs as well as minimize risk of scarring.

Unfortunately, though such treatment may resolve the hemorrhage, it will typically not get rid of the culprit blood vessel.

For that, surgical intervention is required.

Such surgical intervention is much like trying to get rid of varicose veins in the leg.

One option is to precisely cut it out. Watch a video on this approach (video shows a vocal cord mass removal, but just pretend the mass is a blood vessel as the approach is identical).

The other option is use of a laser which is typically what I recommend. Why? It is relatively non-invasive and I feel the risk of scarring to be less compared with excision (though not zero). Shown below is a video of a vascular polyp being obliterated using a pulsed-dye laser (courtesy of Dr. Chandra Marie-Ivey). Another type of laser that may be used is a KTP laser.

Read more about laser treatment of vocal cord pathology here.

Read the Washington Post story here.

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Beastie Boys Adam Yauch Dies of Parotid Cancer

On May 4, 2012, Adam Yauch, one of the founding members of the Beastie Boys, died of a "rare parotid gland cancer" that he had been battling since its diagnosis in 2009. For those who do not know what a parotid gland is... it is one of the major glands that produce saliva or spit and is located immediately in front of the ear (looks like fish eggs in the picture taken from Wikipedia). It is about the size of the palm of the hand.

It is unclear exactly what type of parotid gland cancer Adam Yauch had, but here's a list of what it could have been:

• Acinic Cell Carcinoma

• Adenocarcinoma

• Squamous Cell Carcinoma

• Mucoepidermoid Carcinoma

Thankfully, the vast majority of parotid tumors are benign growths such a pleomorphic adenoma or Warthin's tumor.

Typically, with any type of parotid mass, the sequence of events to diagnose and treat such masses occur in a standard fashion:

1) Mass appreciated by patient or primary care doctor

2) Patient sees ENT who confirms mass localized to parotid gland

3) CT scan of the neck with contrast ordered to further evaluate the mass

4) Fine needle biopsy obtained of the mass for pathologic diagnosis

5) Surgical excision performed... an operation called "parotidectomy"

6) If needle biopsy indicated cancer, neck dissection is also performed to remove all lymph nodes that may contain cancer followed by radiation therapy to the whole area.

Parotidectomy surgery is a "difficult" surgery mainly in the sense that one of the main risks of surgery is permanent facial paralysis. Why? It is because the nerve that allows facial movement goes right through this gland (in yellow in the picture above).

As such, the vast amount of time dedicated to this surgery which may last anywhere from one to several hours is identifying and isolating all involved branches of the facial nerve. The actual parotid gland mass removal takes less than 15 minutes. 

Read more about this surgery here.

Source:

Adam Yauch Dead: Beastie Boys' MCA Dies After Battling Cancer. Huffington Post 5/4/12.

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Celebrity Chef Grant Achatz With Stage 4 Tongue Cancer

Chicago news recently published a story about their very own celebrity chef Grant Achatz who suffered from Stage 4B squamous cell carcinoma of the tongue.

Grant Achatz, chef and co-owner of Alinea/Next/Aviary, approached multiple physicians throughout the country who essentially told him the oral cancer was terminal. In the end, he underwent treatment at University of Chicago successfully, though he certainly is not out of the woods yet.

There are several approaches in the treatment of tongue cancer, especially one as advanced as Mr. Achatz's, each with its own advantages and disadvantages.

In one approach is surgery first to remove all visible disease followed by radiation and chemotherapy to get rid of microscopic tumor cells. Surgery is huge... it entails removal of most of the tongue, involved jawbone, and removal of lymph nodes in the neck (neck dissection). Given how much tissue is removed, reconstruction of the defect is typically performed using bone, skin, and muscle typically taken from the arm (radial forearm free flap). Given how massive the surgery is, a tracheostomy as well as stomach feeding tube is placed. Hospitalization is typically 1-2 weeks long.

An alternative approach is surgery second. Radiation and chemotherapy is done first to shrink the tumor. Once this course is completed, surgery is performed to remove residual disease. The amount of surgery depends on the degree of residual cancer that is left. This course of action is what Mr. Achatz chose to pursue.

Regardless of what step is pursued, there are lots of side effects from cancer treatment including:

• loss/alteration in taste and smell
• dry mouth
• difficulty with swallowing
• stiff neck
• poor teeth (often they get removed prior to cancer treatment)
• leathery skin

Unfortunately, cancer being cancer, risk of recurrence is VERY high especially for stage 4 tongue cancer no matter how well the initial response appears to be. Regularly monitoring over the next 5 years is absolutely essential starting with an exam every 2-3 months for the first two years as that's when the risk of cancer recurrence is highest.

Source:

Celebrated chef gives back. WGN 3/22/12

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Dental X-rays Linked to Brain Tumors

In a study spanning over decades, researchers have found an association between dental x-rays and increased risk of a non-malignant type of brain tumor called meningioma.

Of the four types of dental x-rays, only the full-mouth series was associated with this increased risk. More specifically, the risk was elevated with the aggregate number of full-mouth series in 10-year periods from approximately 15–40 years before diagnosis, with significant elevations in the 10-year periods beginning 22–30 years before diagnosis. The risks in these analyses were even greater when only women were considered.

One needs to be aware that radiation exposure from full-mouth series was much greater in the past than it is now and as such, this risk may be nominal (though not zero) with current dental x-ray technology.

However, it also should be a reminder that x-rays should not be routinely performed unless there is a very good reason to obtain especially in children who are more susceptible to radiation injury... and that applies to not only x-rays, but any kind of testing involving ionizing radiation including CT scans.

Some x-rays should NEVER be performed including sinus x-rays for sinus problems given a nearly 50% error rate in diagnosing the presence OR absence of sinus problems.

X-rays for nasal fractures is not recommended given x-rays rarely change how such fractures are managed.

Soft-tissue lateral x-rays to look for large adenoids should also be discouraged as nasal endoscopy can provide similar if not better information without any radiation exposure.

To know what the cancer risk is with different types of x-rays, check out this website!

Source:

Dental X-rays and the risk of intracranial meningioma. Cancer. Volume 100, Issue 5, pages 1026–1034, 1 March 2004

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