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Kalavacherla S, Sanghvi P, Lin GY, Guo T. Updates in the management of unknown primary of the head and neck. Front Oncol 2022; 12:991838. [PMID: 36185196 PMCID: PMC9521035 DOI: 10.3389/fonc.2022.991838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Squamous cell carcinoma (SCC) from an unknown primary tumor (SCCUP) accounts for 2.0%–5.0% of all head and neck cancers. SCCUP presents as enlarged cervical lymph nodes without evidence of a primary tumor upon physical examination. Primary site detection is important to target treatment and avoid treatment-related morbidity. In this review, we discuss updates in SCCUP management. Diagnostic workup should focus on localization of the primary tumor in SCCUP. Initial workup centers on neck biopsy to confirm the presence of SCC. Given the increasing incidence of HPV-related SCC in the oropharynx, HPV testing is crucial. An HPV-positive status can localize the tumor to the oropharynx, a common site for occult tumors. Imaging includes neck CT and/or MRI, and PET/CT. After imaging, panendoscopy, palatine tonsillectomy or diagnostic transoral robotic surgery can facilitate high rates of primary tumor localization. Primary tumor localization influences treatments administered. SCCUP has traditionally been treated aggressively with large treatment fields to all potential disease sites, which can induce weight loss and swallowing dysfunction. As a result, primary localization can reduce radiation fields and provide possible de-escalation to primary surgical management. Advances in intensity-modulated radiation therapy and dose management also have the potential to improve functional outcomes in SCCUP patients. Given the improved prognosis associated with HPV-positive SCCs, HPV tumor status may also inform future treatment de-intensification to reduce treatment-related toxicity.
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Affiliation(s)
- Sandhya Kalavacherla
- School of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Parag Sanghvi
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, San Diego, CA, United States
| | - Grace Y. Lin
- Department of Pathology, University of California, San Diego, San Diego, CA, United States
| | - Theresa Guo
- Department of Otolaryngology – Head & Neck Surgery, University of California, San Diego, San Diego, CA, United States
- *Correspondence: Theresa Guo,
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Gearhart-Serna LM, Tacam M, Slotkin TA, Devi GR. Analysis of polycyclic aromatic hydrocarbon intake in the US adult population from NHANES 2005-2014 identifies vulnerable subpopulations, suggests interaction between tobacco smoke exposure and sociodemographic factors. ENVIRONMENTAL RESEARCH 2021; 201:111614. [PMID: 34216610 PMCID: PMC9922165 DOI: 10.1016/j.envres.2021.111614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 05/25/2023]
Abstract
Polycyclic aromatic hydrocarbons (PAHs) are a toxic and ubiquitous class of environmental chemicals, products of fuel combustion from human and natural sources. The objective of this study was to identify vulnerable populations for high PAH exposure and variability, to better understand where to target PAH exposure reduction initiatives. Urinary metabolite data were collected from 9517 individuals from the U.S. CDC National Health and Nutrition Examination Survey years 2005-2014 for four parental PAHs naphthalene, fluorene, phenanthrene, and pyrene. We utilized these urinary biomarkers to estimate PAH intake, and regression models were fit for multiple demographic and lifestyle variables, to determine variable effects, interactions, odds of high versus low PAH intake. Smoking and secondhand smoke exposure accounted for the largest PAH intake rate variability (25.62%), and there were strongest interactions between race/ethnicity and smoking or SHS exposure, reflected in a much greater contribution of smoking to PAH intake in non-Hispanic Whites as compared to other races/ethnicities. Increased odds of high PAH intake were seen in older age groups, obese persons, college graduates, midrange incomes, smokers, and those who were SHS exposed. Among the non-smoking population, effects of other demographic factors lessened, suggesting a highly interactive nature. Our results suggest that there are demographic subpopulations with high PAH intake as a result of different smoking behaviors and potentially other exposures. This has human health, environmental justice, and regulatory implications wherein smoking cessation programs, SHS exposure regulations, and public health initiatives could be better targeted towards vulnerable subpopulations to meaningfully reduce PAH exposures.
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Affiliation(s)
- Larisa M Gearhart-Serna
- Nicholas School of the Environment, Duke University, Durham, NC, USA; Department of Surgery, Duke University School of Medicine, Durham, NC, USA; Department of Pathology, Duke University School of Medicine, Durham, NC, USA.
| | - Moises Tacam
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA; Trinity College of Arts & Sciences, Duke University, Durham, NC, USA.
| | - Theodore A Slotkin
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA.
| | - Gayathri R Devi
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA; Department of Pathology, Duke University School of Medicine, Durham, NC, USA; Women's Cancer Program, Duke Cancer Institute, Durham, NC, USA.
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Higgins ST, Kurti AN, Redner R, White TJ, Gaalema DE, Roberts ME, Doogan NJ, Tidey JW, Miller ME, Stanton CA, Henningfield JE, Atwood GS. A literature review on prevalence of gender differences and intersections with other vulnerabilities to tobacco use in the United States, 2004-2014. Prev Med 2015; 80:89-100. [PMID: 26123717 PMCID: PMC4592404 DOI: 10.1016/j.ypmed.2015.06.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/19/2015] [Accepted: 06/21/2015] [Indexed: 01/27/2023]
Abstract
This report describes results from a systematic literature review examining gender differences in U.S. prevalence rates of current use of tobacco and nicotine delivery products and how they intersect with other vulnerabilities to tobacco use. We searched PubMed on gender differences in tobacco use across the years 2004-2014. For inclusion, reports had to be in English, in a peer-reviewed journal or federal government report, report prevalence rates for current use of a tobacco product in males and females, and use a U.S. nationally representative sample. Prevalence rates were generally higher in males than in females across all products. This pattern remained stable despite changes over time in overall prevalence rates. Gender differences generally were robust when intersecting with other vulnerabilities, although decreases in the magnitude of gender differences were noted among younger and older users, and among educational levels and race/ethnic groups associated with the highest or lowest prevalence rates. Overall, these results document a pervasive association of gender with vulnerability to tobacco use that acts additively with other vulnerabilities. These vulnerabilities should be considered whenever formulating tobacco control and regulatory policies.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, University of Vermont, USA.
| | - Allison N Kurti
- Vermont Center on Tobacco Regulatory Science, University of Vermont, USA
| | - Ryan Redner
- Vermont Center on Tobacco Regulatory Science, University of Vermont, USA
| | - Thomas J White
- Vermont Center on Tobacco Regulatory Science, University of Vermont, USA
| | - Diann E Gaalema
- Vermont Center on Tobacco Regulatory Science, University of Vermont, USA
| | - Megan E Roberts
- Center of Excellence in Regulatory Tobacco Science, The Ohio State University, USA
| | - Nathan J Doogan
- Center of Excellence in Regulatory Tobacco Science, The Ohio State University, USA
| | - Jennifer W Tidey
- Vermont Center on Tobacco Regulatory Science, University of Vermont, USA; Department of Psychiatry and Human Behavior, Brown University, USA
| | - Mollie E Miller
- Vermont Center on Tobacco Regulatory Science, University of Vermont, USA; Department of Psychiatry and Human Behavior, Brown University, USA
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Zhu W, Wang X, Zhou Y, Wang H. C2-ceramide induces cell death and protective autophagy in head and neck squamous cell carcinoma cells. Int J Mol Sci 2014; 15:3336-55. [PMID: 24566153 PMCID: PMC3958915 DOI: 10.3390/ijms15023336] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/20/2014] [Accepted: 02/11/2014] [Indexed: 12/19/2022] Open
Abstract
Ceramides are second messengers involved in several intracellular processes in cancer cells, amongst others. The aim of this study was to evaluate the anti-tumor efficacy of C2-ceramide (C2-Cer; N-acetyl-d-sphingosine) by investigating cell death and autophagy in head and neck squamous cell carcinoma (HNSCC) cells. C2-Cer showed concentration-dependent cytotoxicity in HN4 and HN30 cell lines. It simultaneously induced caspase-3-independent apoptosis and programmed necrosis. C2-Cer markedly increased the expression level of microtubule-associated protein 1 light chain 3B (LC3B) type II associated with protective autophagy. An autophagy inhibitor enhanced C2-Cer-mediated cytotoxicity, while a programmed-necrosis inhibitor produced the opposite effect. Furthermore, C2-Cer up-regulated the phosphorylation of extracellular signal-regulated kinase 1/2, but down-regulated its downstream substrate phospho-mammalian target of rapamycin (p-mTOR) during the autophagy process. These results suggested that C2-Cer exerts anti-tumor effects by inducing programmed apoptosis and necrosis in HNSCC, and these cytotoxic effects are enhanced by an autophagy inhibitor.
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Affiliation(s)
- Wenyuan Zhu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China.
| | - Xinhua Wang
- Department of Oral Implantology, the Affiliated Hospital of Stomatology, College of Medicine, Zhejiang University, Hangzhou 310003, China.
| | - Yi Zhou
- Department of Oral Implantology, the Affiliated Hospital of Stomatology, College of Medicine, Zhejiang University, Hangzhou 310003, China.
| | - Huiming Wang
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China.
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Abstract
Gender differences in substance use disorders (SUDs) and treatment outcomes for women with SUDs have been a focus of research in the last 15 years. This article reviews gender differences in the epidemiology of SUDs, highlighting the convergence of male/female prevalence ratios of SUDs in the last 20 years. The telescoping course of SUDs, recent research on the role of neuroactive gonadal steroid hormones in craving and relapse, and sex differences in stress reactivity and relapse to substance abuse are described. The role of co-occurring mood and anxiety, eating, and posttraumatic stress disorders is considered in the epidemiology, natural history, and treatment of women with SUDs. Women's use of alcohol, stimulants, opioids, cannabis, and nicotine are examined in terms of recent epidemiology, biologic and psychosocial effects, and treatment. Although women may be less likely to enter substance abuse treatment than men over the course of the lifetime, once they enter treatment, gender itself is not a predictor of treatment retention, completion, or outcome. Research on gender-specific treatments for women with SUDs and behavioral couples treatment has yielded promising results for substance abuse treatment outcomes in women.
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Affiliation(s)
- Shelly F. Greenfield
- Alcohol and Drug Abuse Treatment Program, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA
| | - Sudie E. Back
- Clinical Neuroscience Division, Department of Psychiatry, Medical University of South Carolina, 67 President Street/PO Box 250861, Charleston, SC 29425, USA
| | - Katie Lawson
- Clinical Neuroscience Division, Department of Psychiatry, Medical University of South Carolina, 67 President Street/PO Box 250861, Charleston, SC 29425, USA
| | - Kathleen T. Brady
- Clinical Neuroscience Division, Department of Psychiatry, Medical University of South Carolina, 67 President Street/PO Box 250861, Charleston, SC 29425, USA
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Studts JL, Burris JL, Kearns DK, Worth CT, Sorrell CL. “Providers Practice Prevention”: Promoting Dental Hygienists’ Use of Evidence-Based Treatment of Tobacco Use and Dependence. J Dent Educ 2009. [DOI: 10.1002/j.0022-0337.2009.73.9.tb04794.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jamie L. Studts
- Department of Behavioral Science; College of Medicine; University of Kentucky
| | | | - Dana K. Kearns
- Behavioral Oncology Program; James Graham Brown Cancer Center
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Williams CT, Grier SA, Marks AS. "Coming to town": the impact of urbanicity, cigarette advertising, and network norms on the smoking attitudes of black women in Cape Town, South Africa. J Urban Health 2008; 85:472-85. [PMID: 18563573 PMCID: PMC2443257 DOI: 10.1007/s11524-008-9286-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was conducted to examine the effect of urban living on smoking attitudes among black African women in South Africa. We examine how urbanicity affects attitudes toward smoking and how it moderates the relationship between both advertising exposure and network norms on black women's smoking attitudes. Respondents were 975 black women currently living in Cape Town townships, some of which were raised in rural villages or small towns. Respondents completed a cross-sectional survey, which included data on smoking attitudes, norms, and exposure to cigarette advertising. Multiple linear regression analysis was performed with smoking attitudes as the response variable, and urbanicity, cigarette advertising exposure, and network smoking norms as primary explanatory variables. Interactions were tested to determine whether urbanicity modified the effect of advertising exposure and network norms on smoking attitudes. Independent effects of urbanicity, exposure to cigarette advertising, and greater smoking prevalence within women's networks were associated with more favorable smoking attitudes. In addition, urbanicity moderated the relationship between network smoking norms and smoking attitudes, but not cigarette advertising exposure and smoking attitudes. Urbanicity, cigarette advertising, and networks play important roles in women's attitudes toward smoking, and potentially, smoking behavior. Overall, our results suggest that strong and creative anti-smoking efforts are needed to combat the potential for a smoking epidemic among an increasingly urbanized population of black women in South Africa and similar emerging markets. Additional research is warranted.
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Affiliation(s)
- Chyvette T. Williams
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, MC923, Chicago, IL 60612 USA
| | - Sonya A. Grier
- Kogod School of Business, American University, 4400 Massachusetts Avenue, NW, Washington, DC 20016-8044 USA
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Perkins KA. Sex differences in nicotine reinforcement and reward: influences on the persistence of tobacco smoking. NEBRASKA SYMPOSIUM ON MOTIVATION. NEBRASKA SYMPOSIUM ON MOTIVATION 2008; 55:143-69. [PMID: 19013943 DOI: 10.1007/978-0-387-78748-0_9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Kenneth A Perkins
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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