Biography:

Dr. Shillingford is a Pediatric Pathologist at CHLA and Assistant Professor of Pathology at The University of Southern California. He is also Associate Director of the Pediatric Pathology Fellowship. He is a member of the Education Committee of the Society for Pediatric Pathology and the Slide Survey Subcommitte where he writes questions for the CME based Slide Survey Online Program. Dr. Shillingford trained in anatomic pathology at the State University of New York, completed a surgical/gastroinintestinal pathology fellowship at Brown University and did his pediatric pathology training at Boston Children’s Hospital/Harvard Medical School. Dr. Shillingford is double board certified in anatomic pathology and pediatric pathology.

Abstract:

Cancer of head and neck is relatively uncommon in the pediatric population however in children certain tumors have a predilection for those sites. In adults, alveolar soft parts sarcoma is common in the lower extremities but in children most occur in the orbit and tongue. Salivary gland tumors may also arise in oral cavity. Of the 15 children diagnosed with mucoepidermoid carcinoma at Children’s Hospital Los Angeles since 1990, 3 were in the palate. Thankfully, most mucoepidermoid carcinomas in children are low grade. The Mastermind-like 2 (MAML2) gene rearrangement commonly seen in mucoepidermoid carcinoma is specific and portends a favorable prognosis. Other carcinomas of the salivary glands such as acinic cell carcinoma and adenoid cystic carcinoma also occur in children and do arise in minor salivary glands. Sialoblastoma is a rare primitive congenital salivary gland neoplasm that most frequently arises in the parotid gland however they do occur in the oral cavity. As recently as 2011 Safarri reported a case of congenital sialoblastoma arising in a minor salivary gland of the buccal mucosa of a newborn. Melanotic neuroectodermal tumor of infancy (MNTI) is a rare pigmented tumor of neural crest origin most commonly found in the maxilla. Rhabdomyosarcoma, Burkitt lymphoma and chloroma also have a tendency to arise in the oral cavity. NUT midline carcinoma, caused by a translocation of the NUT and BRD genes may also affect the mouth. Viruses like HPV and EBV may induce pediatric head and neck malignancies such as squamous carcinoma and lymphoepithelioma respectively.

Biography:

Seung Hee Choi has completed her PhD and postdoctoral studies from University of Michigan School of Nursing. She is an assistant professor of nursing at Michigan State University. She has published more than 10 papers in peer-reviewed journals and has been serving as an editorial board member of repute.

Abstract:

While the adverse effects of smoking on cancer prognosis has been well-documented in the literature, most of the previous studies used a cross-sectional (smoking at diagnosis) or retrospective design. To determine the effect of smoking cessation after a cancer diagnosis on overall and cancer-specific survival, prospective longitudinal data were collected from newly diagnosed head and neck cancer patients with a median follow-up time of 2079 days (N=460). Survival was censored at 8 years or September 1, 2011, whichever came first. Based on smoking status, all patients were categorized into 4 groups: continuing smokers; quitters; former smokers; or never-smokers. A broad range of confounding variables were examined and controlled. While controlling for confounding variables, smoking status had a relationship with overall and cancer-specific survival. Compared to never-smokers, continuing smokers had the highest hazard ratio of dying from both all-cause (HR=4.85, 95% CI=1.98-11.88) and cancer-specific causes (HR=4.45 95% CI=1.29-15.37). Those who smoked at diagnosis but quit and did not relapse—quitters—had the second-highest hazard ratio of dying from all cause (HR=2.82, 95% CI=1.12-7.12) and cancer-specific causes (HR=3.18, 95% CI= 0.89-11.43). Former smokers at diagnosis with no relapse after diagnosis—former smokers—had the lowest hazard ratio of dying from all-cause (HR=2.35, 95% CI=1.23-4.48) and cancer-specific causes (HR=2.38, 95% CI= 0.99-5.74). Smoking cessation even after a cancer diagnosis showed beneficial effects on both overall and cancer-specific survival among head and neck cancer patients. Healthcare providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population.

Biography:

Completed my postgraduation (MD – Radiotherapy) at Madras Medical College, Chennai, South India in the year 2003. Joined in the same year at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), An Institution of National Importance, Under Ministry of Health & Family Welfare, Government of India and worked at various levels. At present working as Additional Professor. Published 12 papers in national and international journals. Reasonably Good Experience in Brachytherapy (Head & Neck and Cervix).

Abstract:

Background: The study was intended to assess the effect of high dose rate brachytherapy in early and locally advanced squamous cell carcinoma of oral cavity for local control, toxicity and functional outcome. Materials & Methods: 125 Eligible patients with mean age of 53.91 years (Range 32-73 years) were included in this study from November 2008 to June 2015. Follow-up period ranged from twelve months to eighty four months with median follow up period of 48 months. 68/125 patients were with early stage oral cancer (I & II) and 57/125 patients were with locally advanced stage (III & IVA). 60% had anterior 2/3rd tongue lesion, 34.4% buccal mucosa and 5.6% had lesions in the floor of mouth. Stage I (T1N0M0) patients received primary brachytherapy alone. Dose ranged from 38.5Gy to 42Gy (3.5Gy/# to 3Gy/#) twice daily with 6 hours interval between two fractions for 11 to 14#s. 110 patients received External beam radiation alone or concurrent chemoradiation (50Gy) where ever appropriate for their stages, Chemotherapy dose being Injection Cisplatin 70mg/m2, along with HDR interstitial Brachytherapy boost (3-3.5Gy per fraction × 6-7 fractions-twice daily). Results: Of the 125 patients, 103/125 showed complete response (82.4%) and 22/125 (17.6%) were found to have residual tumor during follow up. 11 patients died. Four patients died due to other causes. Two patients had sudden myocardial infarction and died. One patient developed sputum positive pulmonary tuberculosis after three years of post-radiotherapy period. He developed massive hemoptysis and died. One patient developed second primary in brainstem. He became quadriplegic and ultimately died. Seven patients died of disease progression. Those with residual diseases on follow up (Biopsy proven) were referred to surgical oncology department for salvage surgery. About 100% in stage I, 83% in stage II, 78% in stage III, 50% in stage IVA had local control. 5 patients developed bleeding at time of implant catheter removal after brachytherapy treatment which was effectively managed by compression for few minutes and ice packs. None of them required surgical intervention or blood transfusion. Soft tissue necrosis developed in 7 patients and 2 patients were sent for surgical intervention. 6 patients developed Osteoradionecrosis of them, one patient required surgery.

Biography:

Nathalie Tabchouri has completed her medical degree from Université Pierre et Marie Curie, France. She completed a master’s degree in Cancer Immunology after her residency in surgery at Paris University Hospitals. She is currently a second year fellow in Maxillofacial Surgery at Pitié-Salpêtrière Hospital. Her interests are in oncological surgery, and advancing medical knowlegde about immunotherapy.

Abstract:

The surgical management of oral squamous cell carcinoma invading the mandible remains controversial. The choice of the mandibular resection is based on the clinical and radiological extent of bone invasion. There are conflicting reports regarding the accuracy of tomography (CT) and magnetic resonance imaging (MRI).

Objectives : To retrospectively evaluate the accuracy of clinical exam, panoramic radiography, CT and MRI in predicting mandibular involvement by oral squamous cell carcinoma. The secondary aim was to establish the incidence of unnecessary segmental resections and insufficient mandibular resections.

Material and Methods : Ninety-two patients who presented with potential mandibular invasion by oral squamous cell carcinoma underwent CT and MR before surgery. The imaging results were correlated with histopathologic findings.

Results : A total of 40 patients underwent marginal resections and 52 underwent segmental resections. Histological bone invasion was present in 10 patients in the marginal resection group. Eight patients did not present with bone invasion in the segmental group. The sensitivity, the specificity and the accuracy for mandibular invasion were 77,5%, 93,9% and 84,9% for CT and 66,7%, 91,4% and 77,9% for MR imaging, respectively. 8.7% of all patients were undertreated. The incidence of unnecessary segmental resections was 10.9%. These over treated patients were found to be younger (p=0.016) and had less potentially malignant lesions (p=0.012).

Conclusions : In assessing the presence of mandibular invasion by OSSC, the combined use of CT and MR imaging is necessary but still insufficient for the treatment planning.

Biography:

Dr. Noguchi’s career started from a technical officer, the Department of Oral Surgery, National Medical Center in Tokyo (1983-87). He headed for the Department of Oral & Maxillofacial Surgery, Sapporo Medical University School of Medicine (1987-2005), where he had pursued his career as an oncological surgeon for oral cancer: Resident (1987-88), Assistant 1988-1997), Assistant Professor (1997-2002), Associate Professor (2002-2005). During that time he received PhD degree from Sapporo Medical University by working in research on oral cancer (1993), Professional Oral and Maxillofacial Surgeon (1994) and Diplomate (Consultant) of Oral and Maxillofacial Surgeon, Board Certified of Japanese Society of Oral and Maxillofacial Surgeons (1999). He has currently organized the Department of Oral & Maxillofacial Surgery, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama as a professor and chair since 2007.

Abstract:

Oral cancers arise in a major functional unit, the maxillo-oral region. Treatment of such cancers is aimed at preservation of form and function as well as radical cure. Aggressive treatment is associated with a higher rate of sever dysfunction. Therefore, optimal treatment suited to each individual case is very important in order to avoid overtreatment or oversurgery. The factors that influence choosing initial treatment are related to characteristics of the tumor (tumor-related factor), to the patient (host-related factors), and to environment of treatment (environment-related factors). Tumor-related factors are composed of clinical factors and pathological factors, including some biological information. In our efforts, initial therapeutic modalities have been selected based on tumor-related factors for optimization of treatment for individual case. I would like to present our treatment results for locally advanced oral squamous cell carcinoma.

Biography:

Dr. Shillingford is a Pediatric Pathologist at CHLA and Assistant Professor of Pathology at The University of Southern California. He is also Associate Director of the Pediatric Pathology Fellowship. He is a member of the Education Committee of the Society for Pediatric Pathology and the Slide Survey Subcommitte where he writes questions for the CME based Slide Survey Online Program. Dr. Shillingford trained in anatomic pathology at the State University of New York, completed a surgical/gastroinintestinal pathology fellowship at Brown University and did his pediatric pathology training at Boston Children’s Hospital/Harvard Medical School. Dr. Shillingford is double board certified in anatomic pathology and pediatric pathology.

Abstract:

A large proportion of childhood oral cancer arises in salivary glands. Minor salivary glands are distributed throughout the oral cavity and the sublingual and submandibular glands are situated in the floor of the mouth. Parotid gland tumors often extend inferiorly to involve the oral cavity. Similar to adults, the most common salivary gland neoplasm in children is the benign pleomorphic adenoma (PA), while mucoepidermoid carcinoma (MEC) is the most common malignant neoplasm. Between 1990 and 2015, 56 salivary gland neoplasms were diagnosed at Children’s Hospital Los Angeles. Of those, 27 were benign PAs. The remaining 31 tumors were malignant, of which 24 were MECs diagnosed in 15 children. Three of those children had lesions in the palate and one in the maxilla extending to the palate. The remaining cases were adenoid cystic (AdCC) and acinic cell carcinomas (AcCC). Thankfully, most mucoepidermoid carcinomas in children are low grade. The Mastermind-like 2 (MAML2) gene rearrangement commonly seen in mucoepidermoid carcinoma is specific and portends a favorable prognosis. In general, salivary gland tumors demonstrate a variety of histologic patterns which oftentimes overlap causing diagnostic dilema. Poorer outcomes of AdCC and higher recurrence rates of AcCC and AdCC in children emphasize the importance of accurate diagnosis. We postulated that Mucin 4 (MUC4) expression would serve as a good distinguishing marker in MEC. Immunohistochemical staining with MUC4 was performed on all the salivary gland tumors from our archives. All MECs showed strong MUC4 expression. All AdCCs, ACCs and PAs were negative supporting our hypothesis.

Biography:

Véronique Regnier Denois, PhD, is a French medical anthropologist. She works in a multidisciplinary research team focused on cancer. She is interested in all aspects of cancer prevention. She uses qualitative methodologies in several contexts: to observe, in the French context, the practice of shared decision-making in encounters between patients and physicians; to identify the unmet needs of survivors in order to integrate them into educational programs; to develop a patient-centered and comprehensive approach for the understanding of oral cancer therapies adherence.

Abstract:

A majority of head and neck cancers are associated with smoking and alcohol exposure. Smoking and alcohol cessation (ASC) is associated with improved quality of life, cancer therapy efficacy, decreased treatment-related and cardiovascular risks, and is expected to decrease the risk of second primary tumor. It is therefore a high priority in the plan of care. However, results of current ASC programs are disappointing and understanding the reasons of this is critical.

Material and Methods: We started a sociological and qualitative study in 6 academic centers including 3 university hospitals, one regional hospital and one comprehensive cancer center. Results: We first interviewed surgeons and care givers involved in ASC programs. Poor communication between stakeholders, absence of alignment of care goals between patients, surgeons and other caregivers, and low level of understanding by patients of the benefits of ASC were felt to represent frequent obstacles to successful outcome. Face-to-face interviews of 30 patients by a sociologist are pending to understand how the patients do react to the information given concerning their disease, what is their understanding of the risks of smoking and alcohol consumption and of the benefits associated with ASC, whether they feel supported by their caregivers, and what are the obstacles and incentives that may impact ASC in their view.

Conclusion: More work is needed to identify hurdles associated with successful ASC. We are funded by the International Head and Neck Prevention Act (IHNPACT), an integrated research program supported by the regional cancer network Cancéropôle Lyon Auvergne Rhône-Alpes.

Biography:

Assistant Professor, Dental Division, Regional Cancer Centre, Thiruvananthapuram, India

Abstract:

Oral cancer is an important health problem in South East Asia, several parts of Europe and Africa. Though tobacco and alcohol are the important causative agent, Human Papilloma Virus (HPV) infection is also attributed in the carcinogenesis of oral and oropharyngeal cancer. However information on the prevalence of HPV virus in oral cancers from India is sparse. The objective of the study is to identify the frequency of HPV infection in oral cancer and its correlation to p16INK4A expression and to assess its impact on treatment response and survival. A total of 201 paraffin embedded tissue blocks of oral squamous cell carcinoma (SCC) patients treated at Regional Cancer Centre, Thiruvananthapuram, India during the period of 2009-2011 were retrieved. HPV DNA was isolated from these tissue blocks by Polymerase chain reaction and expression of p16INK4A was analyzed by immunohistochemical method. Survival curves were obtained by using the Kaplan-Meier method and were compared with log rank test. The frequency of HPV 16 in oral SCC patients in the present study was 6.6% and all the HPV positive cancers were carcinoma tongue. All HPV positive cases showed intense p16INK4A expression and the survival was better. In future the expression of p16INK4Aand HPV status will be a good marker in decision making for oral cancer management.

Biography:

Dr. Mercy Okoh is a Dental surgeon by profession. She completed her BDS from University of Benin and postgraduate training from the West African College of Surgeons (FWACS). She is an Oral Medicine lecturer in University of Benin with 21 published/accepted papers in reputable journals. She was overall best graduating student, School of Dentistry, 2001/2002 Academic Session. University of Benin. Benin City, Edo State and best researcher, School of Dentistry, College of Medical Sciences. 1st University of Benin Annual Research Day Conference. October, 2015.

Abstract:

INTRODUCTION

In our environment, oral cancer is one of the most common lethal diseases that will be encountered in dental practice. It is frequently diagnosed in late stages because most patients present to the hospital late into the course of the disease. This may be attributed to their low socioeconomic status, illiteracy, and some traditional beliefs in alternative native therapies. World-wide, oral cancer is regarded as the sixth most common cancer. Several authors in different geographic locations in our setting have reported on oral cancers generally; however few studies have reported specifically on carcinomas, sarcomas and haematolymphoid cancers of the orofacial region. This study aims to review the prevalence, awareness and clinicopathologic patterns of oral cancers in our own environment. Methods Information was sourced from journals, electronic data base such as Medline, Pubmed, Elsevier ScienceDirect , and Cochrane Library and personal research work. The search words were oral cancers, Orofacial carcinoma, and orofacial sarcoma.

CONCLUSION

Several prevalence rates have been reported by several authors in different geographic locations in our environment. Orofacial carcinomas were reported mostly in the older age groups while the Orofacial sarcomas were mostly found in the slightly younger age groups. Squamous cell carcinoma is the predominant histological type seen. There is a low level of awareness of these lesions especially among the low socio-economic group which makes them present late in our health care facilities for treatment hence a poor prognosis. There is a need for increased awareness, advocacy, preventive care and oral cancer screening.

Biography:

Dr Nasir Ahmad Salati is currently working as Assistant professor in Oral Pathology/ Oral Medicine & Radiology department of DR. Ziauddin Ahmad Dental College, A.M.U., Aligarh, India. He is involved In Teaching Oral Pathology, Oral Medicine, Histopathology, Oral Microbiology & Clinical Oral Pathology. His area of interest and research are: Special stains, Immunohistochemistry, FNAC, Salivary Gland Histochemistry & Cryosurgery. He has got publications in various journals of International repute.

Abstract:

Objectives: Studies indicate the immunolocalization of human osteopontin (OPN) in human pathologies. Despite new diagnostic techniques in evaluation of oral lesions, rate of transformation and prognosis largely remains obscure. This study compared and correlated the expression of OPN with prognostic factors in normal epithelium, mild dysplasia, severe dysplasia, oral lichen planus (OLP), oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) Study design: A total of 350 cases, 50 each of normal oral tissues, mild, moderate, & severe dysplasia, OLP, OSMF and OSCC were selected. The normal human oral mucosa samples were collected from tooth extraction sites and human cadavers. The remaining cases were the biopsies from different sites of oral cavity. The staining was evaluated in epithelial layers in cases of OLP, OEDs, OSMF, and in tumor islands in case of OSCC. The immune-staining distribution was considered positive in any one or all of the layers when more than 70% of the cells were positive for osteopontin. The OSCC samples were further graded into well differentiated, moderately differentiated and poorly differentiated squamous cell carcinoma. The clinical data were retrieved from the medical records. The immunopositive reaction and score for each case was evaluated. Expression of OPN was correlated with clinical findings. Results: In mild and moderate dysplasia, OPN expression was confined to basal cell layer with moderate intensity. OLP showed expression in basal and middle cell layers with varied intensity. The expression was strong throughout whole epithelium in severe dysplasia. OPN expression with moderate intensity in basal cell layers was observed in OSMF. The expression was very strong in OSCC. Conclusion: This study suggests potential role of osteopontin in prognosis of oral lesions.

Biography:

Dr. Tomihara received his Ph.D. degree in 2006 from Sapporo Medical University, working on immune gene therapy by adenovirus vector. He then moved to Cancer Therapy and Research Center (CTRC) at The University of Texas Health Science Center at San Antonio (UTHSCSA) to work with Dr. Shin as a post-doctoral fellow. He obtained an assistant professor position in 2013 in the Department of Oral and Maxillofacial Surgery Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, where he started independent research on cancer immunology.

Abstract:

Gemcitabine (GEM) is a pyrimidine nucleoside analogue that is a new chemotherapeutic agent used for treating various cancers. Because accumulating evidence indicates that GEM may activate host immune responses, its potential as an immune modulator in cancer chemotherapy has generated considerable interest. In the present study, we investigated the antitumor effects of GEM using a mouse oral cancer model using immunological analyses. We examined apoptotic cell death of tumor cells with GEM treatment both in vitro and in vivo. We also investigated whether in vivo administration of GEM affected the distributions of immune cells, tumor-cell surface expression levels of immune accessory molecules and T cell immune responses in tumor-bearing mice. GEM induced significant oral cancer-cell apoptosis in vitro, and in vivo GEM administration markedly attenuated established mouse tumor growth. In vivo GEM administration decreased the numbers of both myeloid-derived suppressor cells (MDSCs) and B cells in tumor-bearing mice and enhanced dendritic cell maturation. Moreover, GEM treatment upregulated tumor-cell surface expressions of several immune accessory molecules and adhesion molecules, including CD80, CD86, CD40, ICAM-1, VCAM-1, and P-selectin. Remarkably, these tumor cells augmented tumor specific T-cell responses. These results suggest that GEM can induce host antitumor immune responses, which would facilitate antitumor effects in the treatment of oral cancer.