GNYDM 2015 Preview: Oral cancer experts to be featured

2015 04 20 15 39 28 178 Cancer Cell Target 200

A panel of oral cancer experts will discuss the current surgical and medical management of oral and oropharyngeal cancer patients at the upcoming Greater New York Dental Meeting (GNYDM), held November 27 to December 2. Experts in otolaryngology, pathology, craniofacial surgery, oncology, and maxillofacial prosthetics will present diagnostic criteria, rehabilitative care, and guidelines for oral cancer.

The meeting's International Oral Cancer Symposium will cover "The science and practice of treating head and neck Cancer" on Saturday, November 28.

Jack Martin, MD, chief medical officer, PeriRx.Jack Martin, MD, chief medical officer, PeriRx.

"Dentists are on the front lines and well-suited to find people at risk," Jack Martin, MD, chief medical officer for salivary diagnostic test maker PeriRx, told "They can make a difference and save lives."

Dr. Martin will discuss "Clinical application of salivary markers for the early detection of oral squamous cell carcinoma (OSCC)."

Oral cancer is the sixth-leading form of cancer, despite recent advances in the diagnosis and treatment of the disease, noted Ian Lerner, DDS, the general chairman of the meeting. The symposium is designed to help dental professionals connect the dots between the latest research and what they can do in their day-to-day practices.

“Dentists are on the front lines and well-suited to find people at risk; they can make a difference and save lives.”
— Jack Martin, MD

Topics will include the following:

  • Guidelines for oral cancer management and the role of community dentists and otolaryngologists in the management regimen
  • Diagnostic criteria of potentially malignant and malignant oral lesions and understanding how to apply the criteria to standard of care in community practice
  • Rehabilitation concerns of oral cancer patients and understanding the role of rehabilitative medicine
  • How community dentists and otolaryngologists can partner with cancer specialists in the overall care of oral cancer patients

Oral cancer: Difficult to detect

Awareness of oral cancer among dentists and primary care physicians is low, which has led to delayed diagnosis of oral cancer, Moni Abraham Kuriakose, MD, BDS, a professor of oncology at the Roswell Park Cancer Institute, told Dr. Kuriakose will discuss "Implant-borne dental rehabilitation" at the symposium.

More than 70% of oral cancers are diagnosed at stages III and IV, even though the oral cavity is easily accessible for clinical examination, he noted.

Moni Abraham Kuriakose, MD, BDS, Roswell Park Cancer Institute. Image courtesy of Roswell Park Cancer Institute.Moni Abraham Kuriakose, MD, BDS, Roswell Park Cancer Institute. Image courtesy of Roswell Park Cancer Institute.

"This is mainly because of the low incidence of oral cancer and the high prevalence of infections and benign lesions that mimic cancer of the mouth," Dr. Kuriakose said. It is necessary to develop adjuvant point-of-care diagnostic devices that can help dentists detect oral cancer, he noted.

Many oral cancer patients say they had oral lesions for a few years, but dentists told them it was just a cold sore and nothing to worry about, Dr. Martin said. It often took two or three years before these patients finally were diagnosed with oral cancer. He also noted that, in his experience, when patients are sent for biopsies for these lesions, the tests often come back negative, he said.

According to Martin, the advantage of the PeriRx salivary test is that it is a noninvasive way for dentists who spot a suspicious lesion to see if a patient has specific RNA markers that are increased in the presence of oral cancer. The sample is then sent to a lab that checks the saliva for six messenger RNAs that are highly and significantly upregulated in cancer patients.

"If a doctor sees something and they are not quite sure whether to act on it or not, they can use our test to help decide if a patient should be sent to a specialist for an evaluation," Dr. Martin said.

The test has close to a 99% negative predictive value that the patient doesn't have cancer, he said. Dentists should still watch low-risk patients to ensure that suspicious lesions are not progressing. If it's a new lesion, it could be from a misfitting denture, and they should check to make sure it goes away, Dr. Martin said.

Dental rehabilitation

Dr. Kuriakose will discuss the need for and technique of dental rehabilitation after jaw reconstruction for oral cancer. Until recently, reconstruction of the jaw ended with restoring the bony continuity defect using bone from either the fibula or the iliac crest, he explained.

"Very little attention has been paid to dental rehabilitation," Dr. Kuriakose told "With oral cancer treatment, we need to look beyond cure to improve quality of life. To this end, it's essential that the patient is dentally rehabilitated."

He said a 2002 study (pdf) found that among 87 patients who had undergone jaw reconstruction, only 14% of the patients had subsequent dental rehabilitation. “With oral cancer treatment, we need to look beyond cure to improve quality of life,” Dr. Kuriakose said. “To this end, it’s essential that the patient is dentally rehabilitated.”

Dental rehabilitation is now possible with advances in technology, he said, especially using image-guided surgery. The technique is called inverse planning, which starts with the end product (such as restored occlusion) and works backward on how to reconstruct the jaw to facilitate appropriate placement of an implant and later dental restoration, Dr. Kuriakose said.

"In this work flow, we expect the patients who undergo jaw resection to wake up after surgery with a reconstructed jaw bone, placement of dental implants, and a temporary denture." The technique is being refined at Roswell Park Cancer Institute, he said.

"Dentists need to play a significant role in overall care of oral cancer patients, from diagnosis to rehabilitation," Dr. Kuriakose said.

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