Condict Moore

Evaluation of size in prognosis of oral cancer

Greatest surface diameter of a cancer, together with suspicion of regional node metastasis, forms the basis for prognosis through the clinical TNM staging system for many cancers. In oral cancer, however, surface size sometimes fails to correlate, or sometimes inversely correlates, with tumor aggressiveness. To shed light on the value of measuring size per se, 155 consecutive oral squamous cancers, treated by surgery, radiation, or a combination, were analyzed to find the degree of correlation between greatest surface measurement and pathologic nodal spread and control of cancer. In tumors less than 2 cm, size correlated with very few nodal metastases and with good prognoses; in tumors greater than 2 cm, increasing size did not show a corresponding increase in pathologic node metastasis or significantly worsening outcomes except for a few very large cancers invading adjacent structures. In conclusion, greatest surface diameter of an oral cancer, when greater than 2 cm, is an unreliable predictor of tumor behavior per se. A small pilot study suggests that tumor thickness may be a better predictor. A formal study of this is planned. Cancer 58:158–162, 1986.

Marginal resection of the mandible in the management of squamous cancer of the floor of the mouth

Abstract Over a fifteen year period, marginal resection of the mandible was used as all or part of the initial treatment of twenty-three selected patients with squamous cancer of the floor of the mouth. All patients were classified as T 1 or T 2 on the basis of the extent of the primary tumor. The lesions were lying in the gingivolingual gutter close to the lingual surface of the mandible. Local control rates were obtained that were comparable to the local control rates obtained with other surgical procedures including wider bone excision and with irradiation for patients of the same T classification.

Selection of treatment in squamous carcinoma of the floor of the mouth

Summary The selection of treatment for early localized squamous cancer of the floor of the mouth must be based on a number of factors in addition to the extent of disease. The general health and nutrition of the patient, his smoking and drinking habits, and his mental and psychologic makeup must also be considered in deciding on the individual treatment modality. In a small group of patients a definite improvement in the control of the disease and survival at two years was obtained with a combination of preoperative radiation therapy (3,000 rads in fourteen days) and surgery for Stages III and IV cancers. When the number of patients so treated is larger, the over-all survival in Stages III and IV should improve because fewer patients will die of uncontrolled cancer in the regional area.

Multiple mouth-throat cancer

I NTEREST in the occurrence, incidence, and location of multiple cancers has increased in recent years because such studies are coming to provide new insights of both theoretic and practical importance. One example of their value is the finding that multiple primary cancers in the same organ or tissue occur commonly, whereas the incidence of such cancers in different organs in the same patient probably does not exceed chance expectancy [l]. The vague concept of the innate susceptibility of a particular tissue may be invoked to explain this, but a more convincing and important reason for the differences probably lies in the inadvertent, continuing exposure of the tissue to external carcinogenic substances [I]. Such a situation applies in the upper digestive and respiratory tract, where new cancer develops in the nonkeratinizing, squamous, and respiratory epithelium with greater frequency than any in other tissue, except the skin [I], and where exposure is frequent to external agents which cause cancer in animals PI. Another use of multiple cancer data was recently demonstrated by a study of multiple, nonsimultaneous cancers as a method for identifying external substances that are carcinogenic for humans [3]. By documenting patients’ exposure to an agent prior to their first cancer and then dividing the patients into two groups, after their curative treatment, according to whether or not they continue exposing themselves to the agent, one can gain direct evidence about the carcinogenicity of the particular substance. This is done simply by observing over the years any difference in the incidence of second, similar cancers between the two groups. Tobacco has been identified by this method as a necessary component of the cancer-causing complex in most cancers of the mouth, pharynx, and larynx [3]. The true incidence of new, second cancers in any tissue probably will run higher than presently reported when long term studies emerge on the health of entire, local populations. Also, as Moertel states, “if future advances in cancer therapy bring about a progressively larger percentage of long-term survivors, then the proportion of cancer patients who fall victim to a second primary doubtless will increase.” [4] In the following report we make no attempt to authenticate the true incidence of second cancers in the mouth and throat area. The numbers are too small and the criteria for second cancers too strict for this purpose. We do wish, however, to emphasize that second cancers of this tissue occur in sufficient numbers to warrant our taking strict precautionary measures against them.

Prevention of Low Back Pain in Sedentary Healthy Workers: A Pilot Study

Introduction: Low back pain (LBP) is the second most frequent neuromuscular ailment among Americans and third reason for physician visits by older people. Although remedies have been reported to palliate LBP, there is no effective prevention. We performed this one-year pilot study to determine if daily intervention of mild home exercises, focused on conditioning muscles maintaining upright 2-legged balance, prevented LBP. Methods: University of Louisville hospital and research lab volunteer employees with no history of chronic back pain were randomized after informed consent. Subjects were divided into 2 statistically similar groups, control and intervention. LBP episodes were recorded and compared over the 1-year period. Medical, blood chemistry, spirometric and clinical examinations were done on all volunteers twice, at beginning and end of the trial period. A set of 6 calisthenics, focusing on balance-control, low-back-connected musculature, was taught to the intervention group over 2 months. A matched control group was observed and examined only. Exercises, performed daily, required 15 minutes. Results: In this pilot study, LBP was completely prevented in intervention group (0 of 13), whereas nearly 60% of controls (10 of 17) experienced back pain in 1 year. Intervention group showed significant improvement in strengths of balance-controlling muscles; control group showed no change. Exercises yielded an unexpected fitness benefit ofraising automatic respiratory exchange. Conclusions: This pilot study suggests that LBP can be prevented in 50-year-old healthy working persons by daily, mild home calisthenics that improve balance-muscle strength. We hypothesize that improved respiratory function may be related to improved posture.

Preoperative Irradiation in Cancer of the Head and Neck

The policy of preoperative irradiation in patients with cancer of the head and neck engenders much discussion and controversy [I-3]. Few studies have adequate controls or sound design because of the considerable difficulty entailed. Some observers fail to find significant benefit accruing to patients receiving preoperative irradiation [4-61, but many centers have continued or increased their use of this planned combined treatment. Why is this combination of treatment so irresistible, yet still so hard to prove it of patient benefit? Perhaps we are not comparing and measuring carefully enough; or perhaps we are measuring the wrong things. For a number of years the surgical oncology staff and the radiation therapy staff of the University of Louisville hospitals have collaborated closely in pretreatment planning decisions in nearly all cancer patients, particularly those with cancer of the head and neck. We have used preoperative irradiation frequently in patients with middle and advanced stages of cancer of the head and neck. Therefore we decided to evaluate our experience and chose a pair-matching method as the best one available to us. We postulated that preoperative irradiation is of value in (1)

Pre- and postoperative care in major mouth and neck surgery☆

Abstract A discussion of pre- and postoperative care of the patient with cancer who requires major mouth and neck surgery has been presented.

Primary tuberculosis of the cervix uteri

Abstract A patient with tuberculosis of the uterine cervix, which occurred five years following supravaginal amputation of the uterus and bilateral salpingo-oophorectomy for non-tuberculous lesions, is alive and symptom-free sixteen years following the initial treatment with radium. This is the only reported case, to our knowledge, in which tuberculosis of a retained cervix has been observed several years after hysterectomy and bilateral salpingo-oophorectomy for non-tuberculous lesions.