Surgical treatments for mouth and throat cancer: uncertainty in the evidence

Oral cancer is among the most common cancers worldwide, with more than 400,000 new cases diagnosed in 2012. This review looks at oral cavity cancer (mouth cancer) and oropharyngeal cancer (throat cancer). The treatment of these cancers can involve surgery, chemotherapy, radiotherapy or a combination of two or all three therapies. This topic area was identified as a priority by the an expert working group for oral and maxillofacial surgery in 2014. Continue reading

Preventing oral cancer by treating oral leukoplakia: limited evidence

shutterstock_163829423Oral leukoplakia is a white patch formed in the mouth lining that cannot be rubbed off. It often does not hurt and may go unnoticed for years. People with leukoplakia develop oral cancer more often than people without it. Preventing this is critical; rates of oral cancer survival longer than five years after diagnosis are low. Drugs, surgery and other therapies have been tried for treatment of oral leukoplakia. Medical and complementary treatments can be locally applied (i.e. directly onto the white patch) or systemic (affecting the whole body, e.g. taken as a pill). Continue reading

EGFR mAb shows promising results for the treatment of oral cancer

OLYMPUS DIGITAL CAMERAOral cancers (cancer of the mouth and cancer of the throat) are the sixth most common cancer worldwide, accounting for an estimated 4% of all cancers. There is a higher frequency of these cancers in men. Smoking, alcohol consumption and betel quid chewing are the main risk factors. Cancer of the throat is associated with infection from the human papilloma virus (HPV), which can be transmitted through sexual contact. Low socioeconomic status (a measure of a person’s income, education and occupation in relation to other people’s) is associated with a higher frequency of oral cancers and poorer survival rates. Survival following a diagnosis of mouth or throat cancer remains poor, with around 50% of people still alive at five years (five-year survival rate).

New therapies targeted at the cells that give rise to oral cancers are being developed. The advantage these may have over conventional chemotherapy is that rather than affecting both healthy and cancerous cells they just target cancer cells. Immunotherapy (also known as biological therapy, biotherapy or biological response modifier therapy) may improve the functioning of the immune system so it is more effective at destroying cancer cells. Local immunotherapy delivers treatment directly into the tumour and systemic immunotherapy targets the whole body, and may be useful for stopping the cancer spreading or the return of primary tumours in more advanced cancer. Continue reading

Testing for oral cancer

shutterstock_177881789Oral cancer (OSCC – oral squamous cell carcinoma) often occurs after a condition called PMD (potentially malignant disorder), which can sometimes progress to cancer. If conditions such as oral cancer or PMD are identified early enough, outcomes for patients can be improved. The current method of diagnosing cancer of the mouth or lips involves the surgical removal of a piece of affected tissue that is sent to a laboratory for histological examination using a microscope (scalpel biopsy). This is painful for patients and involves a delay. The aim of this review was to find out the accuracy of three alternative diagnostic tests that are less invasive and provide more timely results. Continue reading

Cochrane resources on mouth cancer

shutterstock_163829423November is Mouth Cancer Action Month, and the Cochrane Oral Health Group has a range of systematic reviews dedicated to the topic. Mouth cancer can affect anybody; in the UK more than 6,700 people were diagnosed with the condition last year, and more than 2,000 people died from the disease, more than testicular and cervical cancer combined. Here’s what the evidence says… Continue reading

Taking action on oral cancer

OLYMPUS DIGITAL CAMERA

Biopsy of a highly differentiated squamous cell carcinoma of the mouth

Cancer of the mouth is a serious condition and only half of those that develop the disease survive after five years. It is the sixth most common cancer across the world. People who are heavy drinkers and also smoke have 38 times more risk of developing oral cancer than those who do neither. Geographic variation in the occurrence of oral cancer around the world is wide. It is the most common cancer for men in India, Sri Lanka and Pakistan and 30% of all new cases of cancer in these countries are oral cancer. Death rates from oral cancer and the negative effects of the disease are high and increasing compared with other forms of cancer, such as breast or colon cancer.

This month is Mouth Cancer Action Month, and the Cochrane Oral Health Group has published a new review and a review update on the diagnosis of oral cancer in The Cochrane Library. Continue reading

New publications from the Oral Health Group in the Cochrane Library, 2013, Issue 2

200Issue 2 of the Cochrane Library for 2013 was released today, and features one new review and three new protocols from the Oral Health Group.

We now have a total of 200 published systematic reviews and protocols on the Library, congratulations to all of our authors, editors and referees on this fantastic achievement!

New review:
Dental extractions prior to radiotherapy to the jaws for reducing post-radiotherapy dental complications
by Shiyana Eliyas, Ahmed Al-Khayatt, Richard WJ Porter, Peter Briggs

This new review aimed to assess the effects of maintaining the patient’s natural dentition during radiotherapy in comparison to extracting teeth before radiotherapy in areas that are difficult to access by the patient and the dentist, should reduction in mouth opening occur after radiotherapy to the jaws. No clinical trials were identified, and there is no high quality evidence on this clinically important topic.

New protocol:
Interventions for the treatment of oral and oropharyngeal cancers: targeted therapy and immunotherapy
by Kelvin KW Chan, Anne-Marie Glenny, Susan Furness, Helen V Worthington

This review is the fourth in a series of Cochrane reviews looking at different treatment modalities for oral cavity and oropharyngeal cancers: surgical treatment, chemotherapy and radiotherapy. There is a great deal of current research into new therapies for cancer and many of these make the headlines in the news. However, there is a significant time lag between laboratory discoveries and the introduction of new treatments into clinical care. This review will evaluate the randomised controlled trials of targeted and immunological therapies for patients with oral cavity or oropharyngeal cancer.

New protocol:
Maxillary distraction osteogenesis versus orthognathic surgery for cleft lip and palate patients
by Dimitrios Kloukos, Piotr Fudalej, Patrick Sequeira-Byron, Christos Katsaros

The conventional orthognathic surgery for correction of maxillary retrusion/hypoplasia is a Le Fort I osteotomy. Distraction osteogenesis is the surgical process of correction of skeletal deformity utilizing bone lengthening by gradual mechanical distraction. This review will compare the effectiveness of the two methods in patients with orofacial clefts.

New protocol:
Professionally-applied chemically-induced whitening of teeth in adults
by Alonso Carrasco-Labra, Romina Brignardello-Petersen, Nicolás Yanine, Ignacio Araya, Gabriel Rada, R Graham Chadwick

Professionally-applied bleaching treatments have been used for a long time. Despite all of the information available, it is difficult for clinicians to determine which is the most effective treatment for tooth discolouration and the level of potential harms of these treatments. This review aims to assess the evidence about the beneficial and adverse effects of in-office, professionally-applied chemically-induced whitening of teeth in adult patients. It will complement another Cochrane systematic review of the evidence for the use of home-based treatment methods.