Bay Biosciences provides high-quality, fresh frozen biopsy tissue samples. Formalin fixed paraffin embedded (FFPE) tissue blocks with matched fresh frozen sera (serum), plasma, and peripheral blood mononuclear cells (PBMC) bio-fluids, from patients diagnosed with oral and oropharyngeal cancer.
The sera (serum), plasma and PBMC biofluid specimens are processed from patient’s peripheral whole-blood using customized collection and processing protocols from oral and oropharyngeal cancer patients.
Fresh frozen tissue and matched biofluid samples are collected from unique patients diagnosed with oral and oropharyngeal cancer.
Bio-samples are provided to a valued pharmaceutical customer for research, diagnostics, discovery and drug development.
Oral and Oropharyngeal Cancer Overview
Oral cancer can appear anywhere in the mouth, including the inside of the cheeks and the gums. It is a type of head and neck cancer. It often comes under the category of oral and oropharyngeal cancer.
Oropharyngeal cancer affects the back of the mouth and the lining of the throat. Oropharyngeal cancer is a type of head and neck cancer in which cancer cells are found within an area of the throat called the oropharynx.
Oropharynx is the middle part of the throat (pharynx) just beyond the mouth. The oropharynx includes the back part of the tongue (base of tongue), the tonsils, the soft palate (back part of the roof of the mouth), and the sides and walls of the throat.
The function of the oropharynx is to makes saliva, keeps the mouth and throat moist and to help start digest the food we eat.
More than 90% of oropharyngeal cancers are squamous cell carcinomas, which are cancers arising from the flat surface cells lining the mouth and throat.
According to the American Cancer Society (ACS), around 54,000 patients in the United States will receive a diagnosis of oral or oropharyngeal cancer this year.
The average age at diagnosis is 62 years old, but around 25% of cases happen before the age of 55, say the ACS. The disease is more likely to affect males than females. Oral and oropharyngeal cancer are the eighth most common cancer among men.
Types of Oral and Oropharyngeal Cancer
Cancer of the oral cavity and cancer of the oropharynx are two of the most common types of cancer that develop in the head and neck region, a grouping called head and neck cancer. The oral cavity and oropharynx, along with other parts of the head and neck, give us the ability to chew, swallow, breathe, and talk.
The oral cavity cancer includes the following:
- Lips
- Lining of the lips and cheeks, called the buccal mucosa
- Upper and lower gums, called the gingiva
- Front two-thirds of the tongue
- Floor of the mouth under the tongue
- Roof of the mouth, also called the hard palate
- Retromolar trigone, which is the small area behind the wisdom teeth
The oropharynx cancer begins where the oral cavity stops, this includes the following:
- Soft palate at the back of the mouth
- Part of the throat behind the mouth
- Tonsils
- Base of the tongue
More than 90% of oral and oropharyngeal cancers are squamous cell carcinoma. This means that they begin in the flat, squamous cells found in the lining of the mouth and throat. The most common locations for cancer in the oral cavity are:
- Tongue
- Tonsils
- Oropharynx
- Gums
- Floor of the mouth
Stages of Oral and Oropharyngeal Cancer
The stage of cancer refers to how far it has spread.
In the earliest stages, there may be precancerous cells that could eventually become cancerous.
This is sometimes called stage 0 cancer, or carcinoma in situ. A doctor may advise a person to stop smoking and to monitor for further changes.
- Localized cancer affects one area and has not spread to other tissues.
- Regional cancer has spread to nearby tissues.
- Distant cancer has spread to other parts of the body, including, possibly, the lungs or liver. Untreated, oral cancer may start in one part of the mouth, then spread to other parts of the mouth. It may also spread to the head, neck, and the rest of the body.The treatment options and outlook will depend, to some extent, on the stage of cancer.
Causes of Oral and Oropharyngeal Cancer
Cancer happens when a genetic change in the body results in cells growing without control. As these unwanted cells continue to grow, they form a tumor. In time, the cells can migrate to other parts of the body.
Around 90% of mouth cancers are squamous cell carcinoma. They start in the squamous cells that line the lips and the inside of the mouth.
It’s not known exactly what triggers the DNA changes that lead to mouth cancer, or why only a small number of people develop it.
Signs and Symptoms of Oral and Oropharyngeal Cancer
In the early stages, there are often no signs or symptoms of oral cancer.
Smokers and heavy drinkers should have regular checkups with the dentist, as tobacco and alcohol are risk factors for mouth cancer. The dentist may be able to spot any signs at an early stage.
Sometimes, patients with oral or oropharyngeal cancer do not have any of the signs and symptoms described below. Or, the cause of a symptom or sign may be a medical condition that is not cancer.
Precancer
Following are the common symptoms of precancerous stage:
Leukoplakia: This is where there are white patches in the mouth that do not disappear when a person rubs them.
Oral lichen planus: This is where there are areas of white lines with a reddish border, possibly with ulceration.
Many oral lesions may be precancerous. They do not mean that someone has cancer, but patients should speak to their doctor about any changes that occur in the mouth.
Monitoring changes may help spot mouth cancer in the early stages when it is easier to treat.
Once cancer develops patients will have the following signs and symptoms:
- A lump in the neck
- Coughing up blood
- Difficulty opening up the mouth fully, or moving the tongue
- Fatigue
- The most common symptom is a sore in the mouth or on the lip that does not heal
- Red or white patch on the gums, tongue, tonsil, or lining of the mouth
- Lump on the lip, mouth, neck, or throat or a feeling of thickening in the cheek
- Persistent sore throat or feeling that something is caught in the throat
- Hoarseness or change in voice
- Numbness of the mouth or tongue
- Pain or bleeding in the mouth
- Difficulty chewing, swallowing, or moving the jaws or tongue
- Ear and jaw pain
- Chronic bad breath
- Changes in speech
- Loosening of teeth or toothache
- Dentures that no longer fit
- Unexplained Weight Loss
- During later stages of the disease, patients may experience a loss of appetite
- White patch on the tongue or lining of the mouth that doesn’t go away
Risk Factors of Oral and Oropharyngeal Cancer
Following are some of the risk factors which can increase the chances of developing oral cancer:
- Alcohol consumption
- Bad diet/nutrition
- Smoking or chewing tobacco
- Using snuff, which comes from tobacco
- Regularly chewing betel nuts, a popular habit in parts of Southeast Asia
- Human papillomavirus (HPV) infection , and especially HPV type 16
- Male gender
- Marijuana use
- Previous history of a head and neck cancer
- Poor oral hygiene
- Weakened immune system
Other factors that may increase the risk of oral cancer include:
- Ultraviolet (UV) exposure to the lips from the sun exposure, sunlamps, or sunbeds
- Gastroesophageal reflux disease (GERD)
- Previous radiation therapy in the head, neck, or both
- Exposure to certain chemicals, especially asbestos, sulfuric acid, and formaldehyde
- Having a long standing wound or chronic trauma, for example, from jagged teeth
- Drinking very hot mate tea, popular in South America
Diagnosis of Oral and Oropharyngeal Cancer
If a patient has symptoms that could indicate oral or oropharyngeal cancer, a doctor will:
- Ask about their symptoms
- Carry out a physical examination
- Ask about their personal and family medical history
Following tests may be used to diagnose oral or oropharyngeal cancer:
- Physical examination: Doctors and dentists often find lip and oral cavity cancers during routine checkups. If a person shows signs of oral or oropharyngeal cancer, the doctor will take a complete medical history, asking about the patient’s symptoms and risk factors.
- Endoscopy: An endoscopy allows the doctor to see inside the mouth and throat. Typically, a thin, flexible tube with an attached light and view lens, called an endoscope, is inserted through the nose to examine the head and neck areas.
- Biopsy: A biopsy is the removal of a small amount of tissue for examination under a microscope. During a fine needle aspiration biopsy, cells are removed using a thin needle inserted directly into the suspicious area. A pathologist then analyzes the cells for cancer diagnosis.
- Oral brush biopsy: During routine dental examinations, some dentists are using a newer technique to detect oral cancer in which the dentist uses a small brush to gather cell samples of a suspicious area. The specimen is then sent to a laboratory for analysis.
- HPV testing: HPV has been linked to a higher risk of oropharyngeal cancer. HPV testing may be done on a sample of the tumor removed during the biopsy.
- X-ray: An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. X-rays may be recommended by your dentist or doctor to look for abnormal findings in the mouth or neck.
- Barium swallow/modified barium swallow: During an x-ray exam, the patient is asked to swallow liquid barium. This lets the doctor look for any changes in the structure of the oral cavity and throat and see whether the liquid passes easily to the stomach.
- Computed tomography (CT or CAT) scan: A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors.
- Magnetic resonance imaging (MRI): An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the tonsils and the base of the tongue. MRI can be used to measure the tumor’s size.
- Ultrasound: An ultrasound uses sound waves to create a picture of the internal organs. This test can detect the spread of cancer to the lymph nodes in the neck,
- Positron emission tomography (PET) or PET-CT scan: A PET scan is usually combined with a CT scan, called a PET-CT scan. A PET scan is a way to create pictures of organs and tissues inside the body.
Treatment of Oral and Oropharyngeal Cancer
Treatment for oropharyngeal cancer will depend on the stage of the cancer, where the oral or oropharyngeal cancer is located, the overall health and age of the patient.
Surgery to remove the cancer is the preferred method of treating all people with oropharyngeal cancer. This is especially true for those with HPV, because this particular population is younger and otherwise healthy.
Following are some of the treatments used for oral and oropharyngeal cancer:
Surgery
Surgery is the removal of the tumor and some surrounding healthy tissue. The goal of the surgery is the complete removal of the tumor.
Following are some of the common surgical procedures used for the removal of oral or oropharyngeal cancer:
- Primary Tumor Surgery: The tumor and a margin of healthy tissue around it are removed to decrease the chance that any cancerous cells will be left behind. The tumor may be removed through the mouth or through an incision in the neck.
- Glossectomy: In this procedure the tongue is partially or totally removed.
- Mandibulectomy: If the tumor has entered a jawbone but not spread into the bone, then a piece of the jawbone or the whole jawbone will be removed. If there is evidence of destruction of the jawbone on an x-ray, then the entire bone may need to be removed.
- Maxillectomy: In this surgical procedure part or all of the hard palate, which is the bony roof of the mouth is removed.
- Neck Dissection: Cancer of the oral cavity or oropharynx often spreads to lymph nodes in the neck. Removal of some or all of these lymph nodes through a surgical procedure is called neck dissection.
- Laryngectomy: A laryngectomy is a surgical procedure in which the larynx or voice box is partially or completely removed. A laryngectomy is rarely needed to treat oral or oropharyngeal cancer. However, when there is a large tumor of the tongue or oropharynx, the doctors may need to remove the larynx to protect the airway during swallowing.
- Transoral robotic surgery and transoral laser microsurgery: Transoral robotic surgery (TORS) and transoral laser microsurgery (TLM) are minimally invasive surgical procedures. In this procedure large cuts are not required to get to and to remove the tumor.
- Micrographic surgery: This type of surgery is used for oral cavity tumors, it can reduce the amount of healthy tissue removed. This technique is often used with cancer of the lip.
- Tracheostomy: If a tumor is blocking the airway or is too large to completely remove, a hole is made in the neck, this hole is called a tracheostomy. A tracheostomy tube is then placed, and a patient breathes through this tube.
- Gastrostomy tube: If a cancer patient is unable to swallow food because of a tumor blockage a feeding device called a gastrostomy tube is placed. The tube goes through the skin and muscle of the abdomen and directly into the stomach.
- Reconstructive surgery: If treatment requires removing large areas of tissue, reconstructive surgery may be necessary to help the patient swallow and speak again. Healthy bone or tissue may be taken from other parts of the body to fill gaps left by the tumor or replace part of the lip, tongue, palate, or jaw.
Radiation Therapy
Radiation therapy is a type of cancer treatment that uses beams of intense energy to kill cancer cells. It uses high-energy x-rays or other particles to destroy cancer cells, but protons or other types of energy also can be used.
This may be the main treatment for oral cavity cancer, or it can be used after surgery to destroy small areas of cancer that could not be removed. Radiation therapy can also be used to treat the lymph nodes.
Combining radiation therapy with a chemotherapy drug may be used for this purpose in some cases. This approach is called chemoradiation.
- External-beam radiation therapy: This is the most common type of radiation treatment for oral or oropharyngeal cancer. During external-beam radiation therapy, a radiation beam produced by a machine outside the body is aimed at the tumor. This is generally done as an outpatient procedure.
Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells.
Intensity modulated radiation therapy (IMRT), allows for more effective doses of radiation therapy to be delivered to the tumor while reducing damage to healthy cells.
- Internal radiation therapy: When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Tiny pellets or rods containing radioactive materials are surgically implanted in or near the cancer site. The implant is left in place for several days while the person stays in the hospital.
Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.
A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.
The use of chemotherapy in combination with radiation therapy, called chemoradiation, is often recommended. The combination of these tow treatments can sometimes control tumor growth, and it often is more effective than giving either of these treatments alone.
This combined treatment, using cisplatin, may be an option for oral or oropharyngeal cancer that may have spread to the lymph nodes.
Chemotherapy may be used as the initial treatment before surgery, radiation therapy, or both, which is called a neoadjuvant chemotherapy. Or it can be given after surgery, radiation therapy, or both, which is called adjuvant chemotherapy.
Immunotherapy
Immunotherapy, which is also known as biologic therapy, is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the human body or in a lab to improve, target, or restore immune system function.
Pembrolizumab (Keytruda) and nivolumab (Opdivo) are two immunotherapy drugs approved by the U.S. FDA for the treatment of patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) that has not been stopped by platinum-based chemotherapy.
Targeted Therapy
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.
To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in the tumor. This helps doctors better match each patient with the most effective treatment.
Currently, antibodies directed against a cellular receptor called the epidermal growth factor receptor (EGFR) are being used in combination with radiation therapy for head and neck cancers. Cetuximab (Erbitux) is the only targeted therapy approved for this use in combination with radiation therapy.
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