Scurvy in the Postoperative Oropharyngeal Cancer Patient

Scurvy is now an almost forgotten disease, but it hasn’t yet disappeared entirely. Here, we report the case of a patient with scurvy who presented with multiple hemorrhages about 5 years after undergoing pharyngeal surgery and radiochemotherapy for oropharyngeal cancer. This 60-year-old man was admitted to our hospital because of sudden onset of dyspnea and purpura. A physical examination and computed tomography revealed multifocal hemorrhages, namely, purpuras and petechiae on the legs and intramuscular and alveolar hemorrhages. Coagulation tests indicated a normal bleeding time and mild extension of the activated partial thromboplastin time. The coagulation factor activities were not low enough to account for such severe hemorrhages. No new hemorrhages were observed after admission. On questioning about his past eating habits, the patient reported having long had an extremely unbalanced diet, namely, a diet that was composed largely of carbohydrates with few fresh fruits and vegetables. This was due to the development of mechanical dysphagia after the operation. Since his vitamin C level was 0.5 μg/mL (normal range: 5.5 - 16.8 μg/mL), a diagnosis of scurvy was established. Thus, scurvy can still occur in modern times due to poor eating habits that arise from unusual settings. We must keep in mind that scurvy may be the cause when a patient presents with an apparently inexplicable tendency to hemorrhage.

Incidence, mortality, and temporal patterns of oropharyngeal cancer in China: a population-based study

Background:Thus far,the incidence,mortality,and temporal trend data of oropharyngeal cancers(OPC)in China were few.We estimated the incidence,mortality,and temporal patterns of OPC in China during 2008-2012 according to the data from 135 population-based cancer registries to better understand the epidemiological pattern of OPC and to provide more precise information for OPC control in China.Methods:According to the data of diagnosed OPC reported to 135 cancer registries during 2008-2012,we calcu-lated age-standardized rate of incidence and mortality by 2000 Chinese standard population(ASRIC and ASRMC)and by 1985 Segi’s world standard population(ASRIW and ASRMW)by age,sex,and geographic regions;annual percent-age changes of OPC incidence and mortality were calculated using Joinpoint trend analysis.Results:ASRIW and ASRMW were 2.22/100,000 person-years and 0.94/100,000 person-years,respectively.The incidence and mortality in urban areas were higher than those in rural areas.ASRIC and ASRIW of males were higher than those of females.The overall ASRIC of OPC was significantly increased by 6.2%annually between 2003 and 2006(P=0.038),but remained stable between 2007 and 2012(P=0.392).ASRIC and ASRMC of males and in rural areas were significantly increased in the last decade(P<0.05),but the rates of females remained stable during the same period(P>0.05).Conclusions:Across multiple cancer registries in China,there was an obvious increase in OPC in the recent decade,especially for incidence and mortality of males and in rural areas,whereas the rates of females remained stable.A healthy lifestyle should be advocated and early diagnosis and early treatment of OPC should be enhanced.

Update on oral and oropharyngeal cancer staging-International perspectives

Squamous cell carcinoma of the oral cavity and oropharynx have been used synonymously and interchangeably in the world literature in the context of head and neck cancers.As the 21st century progresses,divergence between the two have become more evident,particularly due to evidence related to human papillomavirus-associated oropharyngeal squamous cell carcinoma.As such,the American Joint Committee on Cancer recently published the 8th edition Cancer Staging Manual,serving as a continued global resource to clinicians and researchers.Through changes in staging related to T and N clinical and pathologic classifications,the new system is expected to influence current management guidelines of these cancers that have distinct anatomic and etiopathogenic characteristics.This article aims to review such impactful changes in a time of critical transition of the staging of head and neck cancer and how these changes may affect clinicians and researchers worldwide.

Current Status of Human Papillomavirus-Related Head and Neck Cancer: From Viral Genome to Patient Care

Human papillomavirus(HPV)infection identified as a definitive human carcinogen is increasingly being recognized for its role in carcinogenesis of human cancers.Up to 38%–80%of head and neck squamous cell carcinoma(HNSCC)in oropharyngeal location(OPSCC)and nearly all cervical cancers contain the HPV genome which is implicated in causing cancer through its oncoproteins E6 and E7.Given by the biologically distinct HPV-related OPSCC and a more favorable prognosis compared to HPV-negative tumors,clinical trials on de-escalation treatment strategies for these patients have been studied.It is therefore raised the questions for the patient stratification if treatment de-escalation is feasible.Moreover,understanding the crosstalk of HPV-mediated malignancy and immunity with clinical insights from the proportional response rate to immune checkpoint blockade treatments in patients with HNSCC is of importance to substantially improve the treatment efficacy.This review discusses the biology of HPV-related HNSCC as well as successful clinically findings with promising candidates in the pipeline for future directions.With the advent of various sequencing technologies,further biomolecules associated with HPV-related HNSCC progression are currently being identified to be used as potential biomarkers or targets for clinical decisions throughout the continuum of cancer care.