A common classification framework for neuroendocrine neoplasms: an International Agency for Research on Cancer (IARC) and World Health Organization (WHO) expert consensus proposal
Gum Cancer: Symptoms, Treatment, And More
Gum cancer is a rare type of cancer that occurs in your mouth. Early diagnosis is important to treat this cancer, and it may be curable with a combination of surgery and other treatments.
Gum cancer (gingival squamous cell carcinoma) is a rare type of cancer of the oral cavity.
Oral cancers can affect areas throughout your mouth as well as the back of your throat. Gum cancers develop within the tissues of your gums, rather than the lips, inner cheeks, or other parts of your mouth.
As a group, oral cancers make up about 3% of new cancer diagnoses each year. The majority of all gum cancers are squamous cell carcinomas and are considered rare.
The challenging part about gum cancer is that its early symptoms may mimic other diseases of your gums, including gingivitis. However, like other oral cancers, gum cancer is aggressive and tends to spread quickly.
This article reviews possible symptoms and causes of gum cancer, as well as treatment options you can discuss with a doctor.
Many of the symptoms of gum cancer are also seen in nonmalignant diseases of the gums and may potentially be ignored or misdiagnosed.
As a general rule, you should see a dentist or healthcare professional if any of the above symptoms last for longer than 2 weeks.
What to know about the stages of gum cancer
When gum cancer is caught in its earliest stages, it's known as carcinoma in situ. Carcinoma in situ affects the outer layers (epithelium) of your gum tissues only. Cancers that have metastasized beyond the epithelium to deeper tissues may be classified as invasive squamous cell cancer.
Another possibility is having gray or white lesions (leukoplakia) or red lesions (erythroplakia) that turn into cancer. While most leukoplakia cases do not develop into cancer, erythroplakia is more likely to become cancerous at a later point.
Gum cancer develops as a result of tumors that grow in your gum tissues. While there's no single known cause, certain risk factors can increase your risk of gum cancer and other oral cancers more generally. These include:
There may also be a genetic component to oral cancer development. Additionally, these cancers are about twice as common in males versus females.
If you have a history of tobacco use or other risk factors for gum cancer, a dentist may recommend monthly self-examinations of the inside of your mouth using a mirror. Any new lesions, pain, or bleeding in your mouth warrants further evaluation.
A prompt diagnosis is important in catching this aggressive cancer as soon as possible. One way is through your regular dental checkups. During a routine oral exam, a dental hygienist or dentist may notice possible signs of cancer on your gums.
Alternatively, you can see a dentist or a primary doctor if you're experiencing any possible symptoms of gum cancer. They will perform a quick oral cavity exam to look for signs of cancer around your gum area.
If a dentist or healthcare professional sees anything suspicious, they may conduct a biopsy or refer you to a specialist who can do so.
A biopsy must be done to confirm cancer. This involves taking a sample of the suspicious tissues in your gums and sending it to a lab. If you have a history of leukoplakia or erythroplakia, a doctor may also want to take a biopsy to rule out cancer.
Additionally, a doctor may use imaging tests to see if the cancer has spread to lymph nodes or nearby bone. Imaging tests that may be used include:
When treating gum cancer, a doctor may recommend a combination of the following options:
Additionally, you may work with more than one doctor and specialist for gum cancer treatment. These include:
Surgery, along with adjuvant therapies such as chemotherapy and radiation therapy, can help cure gum cancer. However, the exact outlook for gum cancer depends on multiple factors, including your age, the stage of cancer, and your individual response to treatment.
Like other types of oral cancers, gum cancer has a favorable outlook, especially when it's caught in its early stages and hasn't spread to other areas of the mouth or lymph nodes.
Gum cancer that has spread to more distant areas of the body has a poorer outlook because it's more difficult to treat.
Gum cancer is not as common as other types of oral cancers, but it may still develop in middle-aged to older adults. This is especially true for those who have a history of using tobacco products.
The good news is gum cancer is highly treatable when detected early. Surgery can help cure it in its early stages, although you may still need other treatments to make sure all the cancer cells are gone.
Regular dental exams can help catch gum cancer early. However, you should consider seeing a dentist or doctor at any point you experience unusual symptoms lasting for longer than a couple of weeks. These include painful, bleeding gums, or unexplained sores.
Triple Therapy Approach Yields Major Survival Gains In Unresectable Esophageal Cancer
Triple therapy combining radiation, chemotherapy, and immunotherapy improves surgical resectability and survival in patients with advanced esophageal cancer. Adding immunotherapy to neoadjuvant chemoradiation can improve survival and enable surgery in esophageal cancer, reveals research results published in a journal of the American Association for Cancer Research. 'Did You Know?Esophageal cancer is more common among men than among women. The lifetime risk of esophageal cancer in the United States is about 1 in 127 in men and about 1 in 434 in women. #medindia #esophagealcancer #cancer'
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Bottom Line In patients with unresectable, locally advanced esophageal cancer, the combination of radiation, chemotherapy, and immunotherapy increased the likelihood of tumors becoming surgically removable, leading to significantly better outcomes (1✔ ✔Trusted SourceChemoradiotherapy and Subsequent Immunochemotherapy as Conversion Therapy in Unresectable Locally Advanced Esophageal Squamous Cell Carcinoma: A Phase II NEXUS-1 TrialGo to source).The study was published in Clinical Cancer Research, a journal of the American Association for Cancer Research.
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Background "Curative resection unequivocally serves as the cornerstone for treating resectable esophageal squamous cell carcinoma (ESCC); however, because of lack of symptoms and early detection, fewer than half of patients have resectable disease at the time of diagnosis," said Yin Li, M.D., senior author of the study and director of the section of esophageal and mediastinal oncology at the Chinese Academy of Medical Sciences and Peking Union Medical College.Given the unfavorable long-term prognosis of patients who receive chemoradiation alone—only about 36% survive at least five years, according to Li—there is a desperate need for improved strategies.
Immune checkpoint inhibitors, both alone and in combination with chemotherapy, are standard –of care for those with advanced, recurrent, and metastatic ESCC. They're also approved for adjuvant therapy after complete resection following neoadjuvant chemoradiation. But Li and his team wanted to investigate whether adding immune checkpoint inhibitors to chemoradiation can help downstage tumors and improve resectability.
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How the Study was Conducted To address this possibility, in a phase II clinical trial, patients between the ages of 18-75 were enrolled at their institution to receive three steps of treatment: radiation in conjunction with nab-paclitaxel (Abraxane) and cisplatin chemotherapy in step 1, the immune checkpoint inhibitor tislelizumab (Tevimbra) plus chemotherapy in step 2, and, if possible, surgery in step 3. Results Of the 30 patients enrolled, five discontinued treatment during chemoradiotherapy and one patient received surgery ahead of schedule without subsequent immunotherapy. Of the 24 patients who also received subsequent chemoimmunotherapy, four discontinued the treatment, and 19 received surgery. Overall, 20 patients underwent surgery and had complete resections.Of these 20 patients, 19 had experienced major pathologic responses at the time of surgery, with 13 having complete pathologic responses. Most importantly, compared to the 10 patients who did not undergo surgery, the 20 who had surgery had significantly longer survival, both overall and without disease progression, with 82% and 72% reductions in risk of death and progression, respectively, at one year follow-up. More than half of those who underwent surgery were still free of disease at two years.
Author's Comments "The neoadjuvant treatment approach we tested has the potential to make initially unresectable tumors resectable, giving patients the opportunity to have a durable cancer-free state.""Our trial clearly demonstrated the effectiveness of combining chemoradiotherapy, chemoimmunotherapy, and surgery compared to nonsurgical management alone," according to Li. "We were confident in potential benefits of adding immunotherapy to chemoradiotherapy, but the remarkable pathologic complete response and the strong survival outcomes far exceeded our expectations."
The clinical study also utilized circulating tumor DNA (ctDNA)-based liquid biopsies throughout the course of care, including monitoring for relapse, which, Li said, "allowed us to gain valuable insights into the molecular landscape and minimal residual disease trajectory of these patients."
Study Limitations Limitations of the study include its small sample size, due in part to treatment discontinuations, and thus point to the need for phase III trials to validate these findings as well as explore the optimal sequencing of therapies.Reference:
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