Laser tongue base mucosectomy is a useful diagnostic tool in the management of unknown primary cancers of the head and neck region

OBJECTIVE

Tongue base mucosectomy identified cancer in 78 per cent of cancers of unknown primary in a recent meta-analysis. The carbon dioxide laser is an alternative technique if there is no access to a robot. This study aimed to describe the steps for undertaking tongue base mucosectomy using the carbon dioxide laser and its diagnostic utility in cancers of unknown primary.

METHOD

This was a prospective feasibility study utilising carbon dioxide laser for tongue base mucosectomy in cancers of unknown primary. Data collected included demographic data and p16 status.

RESULTS

There were 14 cancers of unknown primary with 86 per cent p16 positivity on immunohistochemistry. Laser tongue base mucosectomy alone identified the cancer primary in 7 of 12 (58 per cent) cancers of unknown primary among p16 positive tumours and 0 of 2 (0 per cent) among p16 negative tumours. Combining bilateral tonsillectomy with laser tongue base mucosectomy resulted in identification of the primary cancer in 8 of 12 (67 per cent) p16 positive tumours.

CONCLUSION

In centres without a robot, tongue base mucosectomy using the carbon dioxide laser is a viable alternative, especially in combination with bilateral tonsillectomy in p16 positive cases.

Validation of the TNM-8 AJCC classification for HPV-positive oropharyngeal cancers in patients undergoing trans-oral robotic surgery

High-risk human papillomaviruses (HPV) are associated with some oropharyngeal squamous cell carcinomas (OPSCC). HPV-OPSCC have better survival outcomes compared to HPV negative tumours. The new TNM-8 AJCC staging (2018) is based on ICON-S data with 98% of patients treated with primary chemoradiation. To validate the TNM-8 AJCC classification in HPV-OPSCC treated primarily with surgery (trans-oral robotic surgery or open). There were 102 patients with HPV-OPSCC treated between July 2009 and December 2014 at the Royal Adelaide Hospital. The median age was 57 years (range: 38-83) and mostly males (84.5%). 27.2% were active smokers and 50.5% reformed smokers. Early T-stage cancer in 72.8%. Primary treatment was surgery & adjuvant therapy (70%) while primary chemoradiation (30%). Survival analyses were performed for the 7th and 8th AJCC systems. The reclassification to the AJCC 8th edition staging system resulted in a change of 54 patients from stage 4 to stages 1 and 2. This was mainly an effect of changes with N2a and N2b nodal disease being reclassified to N1. Survival outcomes were comparable with the ICON-S data. The new TNM-8 classification is, therefore, validated in a cohort treated, predominantly, with primary surgery and adjuvant therapy.

Maternal and Child Health Pipeline Training Programs: A Description of Training Across 6 Funded Programs

Purpose

The HRSA-funded maternal and child health pipeline training programs (MCHPTPs) are a response to the critical need to diversify the MCH workforce, as a strategy to reduce health disparities in MCH populations. These MCHPTPs support students from undergraduate to graduate education and ultimately into the MCH workforce.

Description

The models and components of training across the six MCHPTPs funded in 2016–2021 are summarized, to examine the design and delivery of undergraduate pipeline training and the insights gained across programs.

Assessment

Strategies that emerged across training programs were organized into three themes: recruitment, support for student persistence (in education), and pipeline-to-workforce intentionality. Support for student persistence included financial support, mentoring, creating opportunity for students to develop a sense of belonging, and the use of research as a tool to promote learning and competitiveness for graduate education. Finally, the link to Maternal and Child Health Bureau (MCHB) long-term training and other MCHB opportunities for professional development contributed significant nuance to the pipeline-to-workforce objectives of these programs.

Conclusions

The MCHPTPs not only increase the diversity of the MCH workforce, they also actively prepare the next generation of MCH leaders. The intentional connection of undergraduates to the infrastructure and continuum of MCH training, underscores the comprehensive impact of this funding.

School connectedness, violence-related behaviours and mental health status among in-school youth

Background

Young people spend significant amount of time in school which has a substantial impact on the development of this group. Mental health problems and violence-related behaviours (VRBs) are common among youth including those in school. Studies on the relationship between school connectedness (SC), VRBs and mental health status (MHS) are currently scarce in the literature. This study was conducted to assess SC, VRBs, MHS of in-school youth in a rural community of southwest Nigeria and the association between SC, VRBs, and MHS.

Methods

A cross-sectional study was conducted among 655 respondents randomly selected students of 4 public and 4 private senior secondary schools in Eruwa, Oyo State. A semi-structured interviewer-assisted questionnaire was used to obtain information on SC, VRBs and MHS. SC comprised of a 42-item scale, VRBs had 20 and MHS had 14-item scale. Data was analysed using descriptive statistics and chi-square with level of significance set at 10%.

Results

Mean age of students was 16.4±1.3 years (public 59.2%; private 40.8%). Above one-half (55.8%) were disconnected from school, 86.4% reported participation in or experience of VRBs and 28.3% had poor mental health. Students who did not experience VRBs were less likely to have poor MHS (OR: 0.438; 95%CI: 0.23-0.82; p = 0.010). Students from monogamous family setting were less likely to have poor MHS than those from polygamous setting (OR: 0.672; 95%CI: 0.46-0.99; p = 0.046). Non-smokers were less likely to have poor MHS than their smoking counterparts (OR: 0.298; 95%CI: 0.12-0.73; p = 0.008). Students who rarely experienced being sent out of school were less likely to have poor MHS than those who had regular experience (OR: 0.315; 95%CI: 0.11-0.89; p = 0.029).

Conclusions

There was high prevalence of VRBs among students with majority of them having good MHS. Predictors of poor MHS were experience of VRBs, family setting, smoking status and experience of being sent out of school.

Key messages

Predictors of poor MHS among youth lacking in literature were found. Pathway to addressing these globally is shown below. International bodies’ support for restriction of cigarette’s use by < 18years. Funding of education in rural areas to reduce financial difficulty, parents modelling their children to correct attitude to violence and more studies unravelling mediating factors of polygamy on MHS.

Incidence and survival trends of lip, intra-oral cavity and tongue base cancers in south-east England

BACKGROUND

Oral cavity cancers are on the increase in the UK. Understanding site-specific epidemiological trends is important for cancer control measures. This study demonstrates the changing epidemiological trends in lip, intra-oral cavity and tongue base cancers in south-east England from 1987 to 2006.

AIM

METHODS

This was a retrospective study using anonymised data obtained from the Thames Cancer Registry (TCR) London. Data were analysed using SPSS v.17 and survival analyses with Kaplan-Meier and Cox regression. Age standardisation of the incidence rates was performed. It was conducted in south-east England, which has an average population of 12 million. The study analysed 9,318 cases (ICD-10 code C00-C06, C14). Kent Research Ethics Committee UK granted ethical approval.

RESULTS

Oral cancers were more common in men, with male: female ratio of 1.6:1. Tongue cancers had the highest frequency at 3,088 (33.1%). Incidence varied with each cancer type. Mean incidence (per 1,000,000) ranged from 2.3 (lip cancer) to 13.8 (tongue cancer). There has been a statistically significant increase in incidence for cancers of the tongue base, other parts of tongue, gum and palate (p<0.001). Median survival time varied by sub-site, with lip cancer having the best median survival time (11.09 years) compared with tongue base cancer (2.42 years). Survival analyses showed worse prognosis for men, older age at diagnosis, and presence of synchronous tumours (p<0.001).

CONCLUSION

There is a rising incidence of tongue and tongue base, gum and palate cancers in south-east England with wide variability in survival. Oral cancer awareness and screening programmes should be encouraged.

A 20-year retrospective study of tonsil cancer incidence and survival trends in South East England: 1987-2006

BACKGROUND

There has been an increasing incidence of tonsil cancer worldwide. Documenting these changes is crucial to cancer prevention and control measures, resource allocation and understanding disease aetiology.

OBJECTIVE

To analyse the changing epidemiology of tonsil cancer in South East England over a 20-year period between 1987 and 2006.

DESIGN

A retrospective, quantitative study using secondary anonymised data obtained from the Thames Cancer Registry, London. Data were analysed using spss v.17 and survival analyses with Kaplan-Meier and Cox regression.

SETTING

This study was conducted in South East of England comprising London, Kent, Surrey and Sussex counties with an average population of 12 million. This population increased from 10.7 to 11.8 million (a 10% increase) between 1987 and 2006.

PARTICIPANTS

All patients with tonsil cancer in South East England registered with the Thames Cancer Registry (ICD-10 code C09) between 1987 and 2006. A total of 1794 patients' data were analysed. Ethical Considerations: Ethical approval was granted by the Kent Research Ethics Committee.

MAIN OUTCOME MEASURES

Data were analysed for demographic trends including gender, age at diagnosis, yearly incidence and survival.

RESULTS

Tonsil cancer incidence has increased significantly from 0.60 to 1.45 per 100,000 in the 20 years (P < 0.001). This increase is mainly amongst men and age groups 40-59 years with a significant reduction in age at diagnosis by 2 years from 61.6 years in the first decade to 59.6 years in the second decade (P < 0.001). Survival was worse in men, older age groups and in the presence of synchronous tumours (P < 0.001). There has been a statistically significant increase in median survival times from tonsil cancer by about 3 years from 2.7 years in the first decade to 5.7 years in the second decade of this study (P < 0.001).

CONCLUSIONS

Tonsil cancer incidence has increased in the 20 years of this study in South East England, especially amongst men and age groups 40-59 years. There has also been significant reduction in the mean age at diagnosis and an increase in median survival times for tonsil cancer. Further studies are needed to explain these trends.

Malignant otitis externa with skull base osteomyelitis

Malignant otitis externa associated with skull base osteomyelitis is a condition seen classically in the elderly, diabetic patient. This disease is difficult to manage, often requiring long-term antibiotic therapy. Here we present such a case, seen in a 74- year-old lady. Initially, she was treated for a number of years in the outpatient department with intermittent ear complaints, but eventually required a hospital admission that lasted for 6 months due to a severe malignant otitis externa complicated by skull base osteomyelitis. We will discuss the clinical features, diagnostic criteria, imaging and management of this life-threatening clinical entity.