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Oral Cancer Prevention

Oral Cancer Prevention

Oral Cancer Prevention

Oral Cancer Prevention

According to the World Health Organization, oral cancer is the 13th most common cancer on the planet.   The Centers of Disease Control and Prevention estimates that oral cancer will cause 54,000 new cases of oral cancer (2022).  If not detected early, these cancers are devastating and deadly.

I recently examined a patient with a white spot in their mouth which led me to review the current state of head and neck cancers (aka oral cancer).  What I found was so interesting that I am sharing it with you.  

The potential to prevent such cancers is large.  Studies are underway to determine the best prevention strategies but until they are completed, there are sensible, affordable and safe things you can do now.  But first, lets learn about it!

What is Oral Cancer?

Oral cancer is a catch-all term for Squamous Cell Carcinoma of the Head and Neck (SCCHN).  This type of cancer occurs in the lining of the mouth, throat and esophagus.  Tobacco use, alcohol intake and human papillomavirus (HPV) are all highly linked to cancers of this type.  There is something particularly unique about cancers is this part of the body called “field cancerization”.

 

What is Field Cancerization?

In most cancers elsewhere in the body, the cancer cells develop in one part of the body and create a swelling at that site, potentially spreading through the bloodstream or directly growing into nearby tissues. This type of spread is called metastasis. 

In SCCHN, the simple occurrence of a cancer in one area of the mouth or throat dramatically increases the chances of finding another, new, unrelated cancer in other areas of the head and neck, not through metastasis.  This strange proliferation of cancers in the head and neck is called ‘field cancerization’ and is only seen in this area of the body.  Fortunately, these cancers, like others, develop in definite stages (transformed, invasive, and metastatic).  This transformational process is called multi-step carcinogenesis.  This musti-step process opens the door to attacking these cancers at intermediate and earliest stages which can result in termination of the cancer growth before irreversible damage occurs..

 

Field Cancerization

In the simplest terms, field cancerization describes the frequent observation of head and neck cancers occurring in multiple areas and from multiple lineages. It’s as if the mucus membrane of the whole head and neck is somehow primed for cancer development.  The observed cancers are either recurring at the site of the original cancer, or appear somewhere else in the mouth, throat or esophagus.  These recurrences can occur soon or many months after the first cancer is found.  Genetic tests on these cancers show that most are not related to the original growth.  In addition, pre-cancer cells have been found in the lining of the mouth far from the site of the original growth.

In total, field cancerization means that trying to treat the first cancer site with surgery or other cancer-killing approaches will be futile since other sites of not-obvious cancer are already present.

 

Field Cancerization

 

Treatment Strategies for Head and Neck Cancers

Because of field cancerization, direct treatment of newly discovered head and neck cancers often fails.  Thus,  the goal of modern head and neck cancer is to change the cancer tendency of the mucus memberane cells throughout the head and neck. These strategies are:  1. Stopping exposure to carcinogens like tobacco, alcohol; 2. Chemoprevention that reverses or prevents continued transformation in cancer cells; and, 3. Screening of patients that are at high risk due to ongoing carcinogen risk or previously recognized pre-malignant areas.

 

Stop Exposures

Since carcinogens can trigger transformation of cells from normal to cancerous at any point, it makes sense to eliminate these risk factors as soon as possible.  Unfortunately, taking these risk factors away will not cause cancer cells to reverse their cancerous transformation. In addition, in the real world, stopping exposures to alchol and tobacco can be very difficult.  Cancer due to human papilloma virus (HPV) has dramatically increased in the past few years.  This is the type of throat cancer Michael Douglas is fighting.  Stopping exposure to this carcinogen is more complex and is being actively studied.  The good news is that there is now a vaccine, Gardisil 9 that eliminates the HPV virus by immunizing against it!  This vaccine was originally approved for females, ages 9-26 years but has since been FDA approved for both men and women, ages 9-45 years.

No matter which risk factor, reduction in carcinogen exposure is practically very difficult.  For that reason, additional intervention strategies are needed.

 

Screening

This strategy is based on identifying people at increased risk of getting cancer, either from carcinogen exposure or from previous head & neck cancer.  Hopefully, these cancers will be found in an early developmental stage. Once found, these patients are then encouraged to reduce carcinogen exposure, and consider chemoprevention.

Who gets screened?  Everybody!  But especially those with known risk factors like alcohol and tobacco use.

Does if work?  Many studies around the world have shown screening programs to be quite effective at improving survival in oral cancer patients. 

 

Chemoprevention

Theoretically, it is possible to reverse or slow cancer transformation in cells. Exposure to a variety of natural and synthetic chemicals has been shown to slow or reverse cancer transformation.  The use of these substances to slow or reverse cancer is called ‘chemoprevention’.

Chemoprevention can be used in patients with a previously diagnosed cancer or pre-cancer area in the mouth (such as those spotted by screening), or it can directed toward completely preventing such changes in patients who are at high risk (alcohol, tobacco).

The natural and synthetic chemicals used for chemoprevention have been found to be effective in a variety of models, including humans.  However, clinical studies using standard double blind, randomized control trial design – the design that we use in all of western medicine – have not been done.

So, in this setting, we are considering use of chemicals that are suspected of but not definitively proven to slow or reverse cancer transformation.  If the chemicals involved were associated with toxic side effects that make them more dangerous than potentially helpful, I wouldn’t continue this discussion beyond this point.  But, as you will see, incorporating chemoprevention strategies can be achieved without significant risk of injury.  In this setting, it makes sense to talk about them.

Chemicals for Cancer Prevention?

Measuring the effect of a chemical on cancer transformation requires long-term research studies.  As an alternative, scientists study the action of a chemical on the structure, genetics or chemistry of cancer cells and use their findings to extrapolate potential effects in humans.  In such studies, the influence of these chemicals is measured at the following levels:  1) cancer cell structure; 2) genetic alterations; 3) Cancer promotion proteins; 

 

Folate

Of all the chemicals studied, folate seems to have particularly intriguing chemoprevention potential.  For example, a deficiency of folate has been noticed in many patients with SCCHN.  At the cellular level, such a deficiency may disrupt the DNA of cells in a way that sets cancer transformation in motion.  Reversing the deficiency by adding folate to the diet has been associated with better outcomes in at least one study.  

There are particular folks who might be deficient in folate because of another health issue.  These issues are: pregnancy, chronic gastrointestinal disease, weight-loss diets, alcohol dependence, and age greater than 65.

How much to supplement?  The only clue comes from a study showing that intake of at least 320 mcg folate daily was associated with better survival after SSCHN was diagnosed. Supplemental folic acid tablets come in 400 mcg, 800 mcg and 1 mg so simply taking a 400 mcg tablet daily seems sensible.

 

Other Chemicals

Zinc and selenium are two trace metals have theoretical action on cellular growth but preliminary studies have not shown benefit in oral cancer. 

 

Clinical Trials

 

Vitamins A and E and Beta carotene:  These chemicals, found in nature in vegetables, have been studied for their ability to slow or reverse cancer transformation.

All of these agents appear to slow or reverse cancer cell transformation temporarily BUT, the cancer returns when they are stopped.  At the present time, none are recommended for either prevention of oral cancer  in high risk patients or reversal of cancer transformation in patients with identified cancer or precancer.

Wellivery tracks the research in this area and will update this section with new findings as they arrive.

 

Everyday Oral Cancer Prevention

Oral cancer is a complicated problem.  But, there are simple truths and simple actions we can take in an effort to prevent or control it.  Here’s what we know:

 

  1. It is a big problem internationally.
  2. Alcohol and tobacco are strong promoters.
  3. HPV is a newly recognized promoter.
  4. Folate seems preventative.

So,

  1. Stop alcohol and tobacco use.
  2. Have regular screening to find these cancers early;
  3. Take daily folate supplementation.

We will have to wait for more research to guide our response to HPV oral cancer.

For now, If you notice a white area on the inside of your mouth, lips, or back of throat, or notice hoarseness, swallowing difficulty or a change in your voice, see your doctor for an exam.  And if you smoke, its time to stop!  Smoking Cessation for You!

Cancer prevention is a major goal for Wellivery!  Cancer is just one of the chronic disease problems we attack along with diabetes and heart disease.

 

 

Oral cancer can be prevented

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Cancer: Let’s Talk Prevention!

Cancer: Let’s Talk Prevention!

Cancer: Let’s Talk Prevention!

* Prevention of cancer by avoiding known causes is our first priority.
* Cigarette Smoking is the most important known cause of cancer!
* Catching cancer at its earliest stage gives the greatest chance of survival.
* That means you need to get your screenings!
* Having a diagnosis of cancer does not mean we stop working on prevention or screening.
* Some cancers are not the cause of death – they are just along for the ride!

_________________

Cancer is a scary word.

Really scary.  Most non-medical people regard it as a lethal condition.

But, really, what does cancer mean?

Cancer is a condition of out-of-control cell growth.  It usually begins a one site or organ.  If not detected and treated, it continues to grow and can spread through the blood to other organs.

We know conclusively what causes certain cancers, like lung cancer, which is triggered by cigarette smoke.  And cervical cancer, which follows infection with the human papilloma virus.

For other cancers, we don’t yet know the precise cause, but have identified risk factors that steadily push people into that cancer.

Wellivery focuses on two aspects of cancer.

  • screening to allow earliest diagnosis and treatment
  • risk reduction – to prevent cancer from emerging.

 

In the U.S., hospitals and pharmaceutical companies have worked hard and at great expense to treat cancer. Countless lives have been saved by this approach.

Unfortunately, many patients die when the cancer is diagnosed too late or when the treatment fails.

Clearly, prevention of cancer would have a vast impact.

The U.S. healthcare system has not been particularly effective at preventing cancer.  Medical research has shown how doctors should work with patients to prevent cancer and how to make screening happen.  However, this research is not universally used, and for many reasons, patients don’t have access to either screening or prevention planning.

Cancer prevention and screening for earlist diagnosis is a primary focus of Wellivery.  Our formula?

  • Use established clinical guidelines
  • Get patients screed according to these guidelines
  • Develop a prevention plan for each patient
  • Control risk factors that are already present
  • Use the smartphone and phone visits as the primary platform for patient communication and education – not the doctor office.

Cancer is like most chronic diseases that occur when a genetic susceptabilty that you inherited interacts with your environment (like: nutrition, stress, excess weight, physical inactivity, smoking, alcohol).  We can’t change your genetic profile.

You CAN change the enviromental factors that will push you into cancer.  Wellivery is designed to be your expert physician counselor, guiding you to victory over your risk of cancer.

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Everyday Health for

Everybody!

 Same Day Appointments are Available.

720-900-0943

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Winter Health Tips

Winter Health Tips

Winter Health Tips

Here are  my Top Tips for a Healthy Winter!

  • Wash Your Hands
  • Help Your Immune system with sleep and stress control
  • Practice Auto Safety
  • Stop Tobacco Intake
  • Get your Chronic Disease Screening
  • Get Vaccinated!

Ok, that was the list – let’s dig into these issues!

  1. Wash Your Hands

Why?

  • Viruses are the most common source of winter-time illness
  • Viruses need to gain entry into your body to cause infection.  The entry occurs most often by transferring virus particles from your fingers and hands to your lips, eyes, or nose.
  • Once a virus has infected a human, millions of copies of it are released into saliva, nasal secretions, vomiting, and aerosol droplets that you sneeze, cough or spread through speaking or singing.
  • These virus particles land on surfaces that you touch (doorknobs, latches, handles, counters) and there you go, they are poised to go into YOUR body from your hands or fingers.
  1. Help Your Immune System

Your immune system depends on your white blood cells being in tip-top shape.  They are your first line of defense when virus particles get into eyes, mouth, nose, or lungs.  When these white cells are healthy, they recognize cells in your body that have been infected by a virus and they take decisive action:  they destroy that infected cell, blocking the production of more virus particles!

How do we keep this system in shape?

Stress Control and Restful Sleep

Let’s talk about stress

When you are under stress, your whole body is ramped up.  Your heart rate is increased, you breath faster, and your body releases more adrenaline. Over time, this always-on stress reaction seems to wear your body out, and makes your white blood cells too weak to fight.

Sleep!

Sometimes easier said than done for sure.  But, quality sleep IS ESSENTIAL in keeping your immune system healthy.  A host of repair processes are at work in your body during quality sleep.  Without this repair time, or with sleep that is broken-up by awakenings, your immune system just can’t be ready to fight.

  1. Auto Safety

Buckle Up!

No Texting!

No Drinking and Driving!

It’s so simple but if you’ve ever been in a car wreck, you know that it happens way faster than you can imagine or even remember.  With the winter pandemic we have ahead, going to the ER because you weren’t in your seat belt, were distracted by your phone, or had your vision or reactions slowed by alcohol – just don’t do it!  And remember, there are other people – precious people, that can be hurt by you.  Just Don’t.

  1. STOP TOBACCO INTAKE

Of all the things you can do to your body to really wreck it, none is quite so effective as tobacco.  Heart disease, cancer, diabetes, chronic lung disease – all shoot way up when tobacco is in the picture.  This is a recommendation not just for this winter – it applies to every season!  STOP TOBACCO USE!

  1. CHRONIC DISEASE SCREENING

We weren’t doing a good job screening for heart disease, cancer and diabetes before this pandemic!  And now, everyone is afraid to or discouraged from going to the clinic for fear of COVID19.  That doesn’t mean we should let up on finding these diseases early and talking about ways to prevent them!  If we find them early, we can head off complications.  If we can PREVENT THEM, we are way ahead of the game!  This is a special focus of Wellivery – let’s get your screening up-to-date!

  1. GET VACCINATED!

All you adults listen up!

We have proven good success with seasonal influenza vaccinations!  You can get them at any corner drug store these days.  Blocking influenza infection protects you from serious pneumonia and blood infections.  Why wouldn’t you want that protection?

Are you up-to-date on your Tetanus?    This shot protects you from tetanus, diphtheria, and pertussis.

Do you have a chronic disease?  Chronic disease opens you for serious lung and blood infections from bacteria.  We have excellent pneumonia vaccine – talk to your doctor or make an appointment on Wellivery to talk about it.

Shingles.  Anybody over age 50 is a sitting duck for this grown-up version of chicken pox.  It is very painful and can create lingering nerve problems.  We have a good vaccine to protect adults from shingles.  Nobody needs the inconvenience and pain of shingles!

I appreciate that you have a bunch of channels of information to manage, many being major or minor emergencies.

But, by just devoting a little effort to these SIX priorities, you can dodge some preventable illness and injury that just makes you life more difficult.

Prevention effort that pays!

Now, if you want to get an email when I have updated these health topics, just fill in the ‘subscribe’ box to the right.

Until next topic, I wish the best of health to you!

 

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Is Tirzepatide For You?

Is Tirzepatide For You?

* As you know, excess body weight increases your chances of: heart disease, diabetes, and cancer.* Studies show that medication, hospital and doctor costs are higher if you are overweight or obese.* Good News! Small changes in your weight can pay off big in reducing...

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Change Your Weight for Better Health!

* Extra body weight increases your chances of: heart disease, diabetes, and cancer.* On top of these scary issues, medication, hospital and doctor costs are higher if you are overweight or obese.* Good News! Small changes in your weight can dramaticlaly...

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Doctor Visits on Your Phone!

Quality chronic disease care depends on self-management by patients. A large part of my role as a physician is teaching self-management skills. Crucial to these skills are techniques you will use to assess: - Your Symptoms, and, - Your Chronic Disease...

Gout Pain Can Be Controlled!

* Gout is a type of arthritis affecting a small number of joints. * Joint pain, swelling and redness, usually starting at night, are the main symptoms. * The joints involved are usually in the fingers, toes, wrists, and knees. * The pain is caused by uric...

Everyday Health for

Everybody!

 Same Day Appointments are Available.

720-900-0943

Telemedicine for You!