Diet and NPC 2

Lowered risk of nasopharyngeal carcinoma and intake of plant vitamin, fresh fish, green tea and coffee: a case-control study in taiwan.

More NPC-specific cancer protective diet data available to us now.

In this study: phytocarotenoids, fresh fish (as opposed to salted fish) and coffee are significantly risk lowering.

High rate of neck cancer

The Star highlighted the importance of head & neck cancers in Malaysia, though that paragraph about isn't very clear, it is to say that...
1) NPC is the 5th most common cancer in Malaysia
2) NPC is the top head & neck cancer in Malaysia, and
3) As a group, head & neck cancer is the second most common, after female breast cancer, in Malaysia.

http://thestar.com.my/news/story.asp?file=/2012/1/20/nation/10300494&sec=nation

Chemoradiotherapy for Early-stage Nasopharyngeal Disease - The ASCO Post

Given the better outcomes of Stage III and IV NPC on CCRT, one wonders if the same radiosensitising effect would benefit the earlier stages.

Stage I and IIa NPC has up to now never been candidates for concurrent chemotherapy, since outcomes have been good on radiotherapy alone.

This trial addresses that particular gap in our knowledge and the results suggest that the benefit is not only significant, it is a worthwhile endeavor given the minimal and controllable adverse effects.

http://www.ascopost.com/articles/january-15-2012/chemoradiotherapy-for-early-stage-nasopharyngeal-disease/

Sent by Maxis from my BlackBerry® smartphone

The Master speaks

When it comes to surgical management of NPC, William Wei always has the last word.

So, it's good that he issues refreshers like this one to keep our management strategies abreast with latest developments.

This appears as the article 'Current management strategy of nasopharyngeal carcinoma' in Clin Exp Otorhinolaryngol. 2010 Mar;3(1):1-12
(http://www.ncbi.nlm.nih.gov/pubmed/20379395)

Other review articles of relevance are linked as well.
(http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=20379395)

Risk of CA in MNG

I was asked this by a friend who has a progressively enlarging non-toxic goitre and a CT scan that showed a huge multinodular goitre with tracheal compression: do I need surgery and why? Should the whole thyroid be removed or can some be spared?

My quick answer was YES you need surgery, and a total thyroidectomy, both because of the risk of occult carcinoma. An FNAC can easily miss malignant foci, MNGs have a risk of malignant change, imaging has no reliable sign of malignancy, and compression heralds worse complications (with or without op).

But what's the risk exactly, and what does evidence say about how much of thyroid to remove? This is what the evidence says:

1)In a review of 317 patients operated for multinodular goiter, the incidence of occult micro-carcinoma was 3.3% (Wahl RA, Goretzki P, Meybier H, Nitschke J, Linder M, Roher HD. Coexistence of hyperthyroidism and thyroid cancer. World J Surg 1982; 6: 385-390)
2) Another review of 98 total thyroidectomies done for MNGs revealed an incidence of 10 cases (10.2 percent) occult carcinomas - seven patients were diagnosed with papillary carcinoma, two with the follicular variant of papillary and one with follicular carcinoma.
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijs/vol17n1/goiter.xml
2) Total thryoidectomy may avoid need for reoperation in case of incidental thyroid
cancer; a study of 218 patients with euthyroid multinodular goiter and no suspicion for malignancy were randomized to total or near-total thyroidectomy (remnant tissue < 1 g) vs. bilateral subtotal thyroidectomy (remnant tissue> 5g); no significant differences in rates of temporary unilateral vocal cord dysfunction (0.9% vs. 0.9%), hypoparathyroidism (1.8% vs.0.9%) or finding of papillary cancer (9.2% vs. 7.3%) (Arch Surg 2004 Feb;139(2):179 in JAMA 2004 May 5;291(17):2058)

So, with a risk of somewhere between 3-10% occult carcinoma (papillary still being the commonest) and near-total also mean could-miss; I think it's still right to say MNGs should be treated with total thyroidectomies unless surgically difficult; upon which post-operative suppressive thyroxine may be an option.

Saliva Testing for Head and Neck Cancer?

by Robert Preidt
'New discoveries in proteomics -- the study of proteins found in saliva and elsewhere throughout the body -- is bringing saliva testing within spitting distance of other much-used screens, such as blood or urine testing, the experts said.
Saliva and other oral fluids contain many of the same proteins and other molecules found in blood and urine that can reveal the presence of diseases, including head and neck cancers, the researchers noted.'
Read the FULL ARICLE at Forbes Health

Gene Profiling May Improve Treatment of Head and Neck Cancer

NEW YORK JAN 10, 2005 (Reuters Health)
'The gene expression profile of metastatic head and neck cancer is distinct from that seen with forms that have not spread, a finding that could improve the treatment of this malignancy, Dutch researchers report.

For certain cancers, such as head and neck squamous carcinomas (HNSCCs), early detection of metastases to nearby lymph nodes is critical for appropriate therapy, senior author Dr. Frank C P. Holstege, from University Medical Center Utrecht, and colleagues note. Unfortunately, these metastases are often difficult to detect, resulting in inappropriate treatment for many individuals.

In the present study, reported in the February issue of Nature Genetics, Dr. Holstege's team describes the identification of gene expression profiles that correlate with HNSCC lymph node metastases.'

Link Between Cancer And Common Asian Nut

Study Confirms Link Between Cancer And Common Asian Nut - from NewsRx.com

November 4, 2004

Over the past couple of decades, scientists have been perplexed by a substantial rise in the incidence of head and neck cancers among Taiwanese men. According to cancer statistics, the disease increased by 85% among men there from 1981-2000.

A new study, presented at the American Association for Cancer Research Third Annual International Conference on Frontiers in Cancer Prevention Research, now suggests that the increased incidence may be linked to increased domestic production of a popular legal stimulant in Asia called betel quid.

Chewing betel quid, traditionally practiced in many parts of Asia and in Asian immigrants around the world, can be likened to tobacco use in the U.S. It is often rolled like a cigar or intricately folded and generally consists of a betel palm leaf spread with lime paste (calcium hydroxide) wrapped around a slice of areca nut. Betel quid is chewed for many reasons, including for its stimulant effects, to satisfy hunger, to sweeten the breath, and as a social or cultural practice.

However, betel quid also is considered a nuisance in Asia where the reddish juice, generated by the act of chewing betel quid, can be found all over the ground and on public buildings. Also considered a major public health risk, it is believed to be a leading cause of oral cancer in this part of the world.