Mouth Cancer

Head, Neck, Mouth, Throat, Salivary and Laryngeal CancersHead and neck cancers are diagnosed in more than 70,000 Americans each year. Men are nearly three times more likely to develop the disease than are women. Head and neck cancers include cancers of the mouth, such as lip and tongue, the pharynx or throat and the larynx or voice box. Early symptoms occur as a lump or nodule, numbness, swelling, hoarseness, sore throat or any difficulty moving the jaw or swallowing.

Risk Factors

Risk factors include smoking, excessive alcohol consumption and chewing smokeless tobacco. Kimmel Cancer Center doctors have found that people who smoke one pack of cigarettes a day are six times more likely than nonsmokers to get cancer of the head or neck. Those who also have two alcoholic drinks a day increase their risk 20-fold.

Diagnostic Tests

Otolaryngologists at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins are among the most experienced in the diagnosis of head and neck cancers, most of which are diagnosed by clinical examination, imaging tests and other specialized pathologic tests. These subspecialists are experts at differentiating benign from malignant tumors and accurately assessing the stage of progression. Patients suspected of disease see a physician within a few days to be evaluated for appropriate tests. Upon receipt of the test results, the physician develops an appropriate and highly individualized treatment plan.

Current Treatments

Of particular benefit to our patients is a team of specialists from a variety of departments who meet weekly to review each patient's test results and records to determine the best treatment plan. Specialists include head and neck surgeons, medical oncologists, radiation oncologists, reconstructive surgeons, pathologists, rehabilitation therapists, radiologists, neurologists, oral surgeons and dentists. Each patient's care is coordinated with the multidisciplinary team to achieve the most comprehensive treatment, reconstruction and palliative care available.

After evaluation and consultation with team members, treatment is recommended based on the location, size and type of head or neck cancer. Treatment may include surgery, radiation and/or chemotherapy. Reconstructive techniques are planned before any treatment to optimize the patient's facial restoration, speech and swallowing. For example, one program that was developed at Hopkins five years ago is aimed at preserving speech and swallowing function in situations when standard surgery would result in severe impairment or loss of these functions. Initially, these patients are treated with chemotherapy and radiation. This treatment, on occasion, has cured patients with advanced cancers of the mouth, such as tongue and palate, and cancers involving the larynx or voice box.

New Treatment Approaches

More than a dozen clinical trials are in place for selected head and neck cancer patients at the Kimmel Cancer Center.
Gene therapy is under investigation in many areas at our Cancer Center and is planned for head and neck cancers to improve early diagnosis and enhance treatment. Our physicians are developing a number of sensitive tests that may help detect head and neck cancers early, before the cancer spreads, leading to more effective treatments. One study already has shown that if a patient with cancer has a specific gene mutation, the tumor will be more resistant to radiation therapy.
In another study, our researchers are investigating the use of a vitamin A derivative for prevention of secondary cancers. Here, drugs being studied for the treatment of these disorders include topotecan, taxotere and Taxol, shown to be effective against other cancers; and tirapazamine for patients requiring radiation treatments. Preliminary information suggests that tirapazamine makes a patient more sensitive to radiation and thus enhances the treatment effect.

One of the most exciting studies in progress at Hopkins involves molecular tests to examine surrounding tissue after removal of a cancerous tumor. Researchers are finding this new test so sensitive that cancer cells that once were missed during surgery -- enabling the cancer to grow back -- now can be detected. The test has shown remarkable accuracy in identifying the most minute traces of the cancer. This means that surgeons potentially could remove all the cancerous tissue the first time while leaving as much healthy tissue in place as possible. The procedure is undergoing rigorous, confirmatory testing.

Stomach Cancer

Although the incidence of stomach cancer has declined during the last several decades, 24,000 new cases per year are diagnosed in the United States, and the disease causes about 13,000 deaths. Worldwide, more than half a million deaths result from stomach cancer, which is much more common in Asia and Latin America. Stomach cancer (also called gastric cancer) can develop in any part of the stomach. It begins in the inner lining and can spread throughout the stomach, penetrate the wall and progress to the adjacent lymph nodes. The cause is unknown but has been associated with dietary factors, Helicobacter pylori infection, smoking and alcohol consumption. Current research on the molecular genetics of stomach cancer points toward prevention and early detection of the disease.

Diagnostic Tests

Unlike in Japan, where the incidence of stomach cancer is high and aggressive screening for the disease is undertaken, diagnosis of early gastric cancer in the United States remains uncommon. Nonspecific symptoms such as vague abdominal pain, indigestion or black stools (from bleeding) often are attributed to peptic ulcer disease or other more common problems, and the diagnosis of stomach cancer often is delayed.

Diagnosis is made by biopsy using flexible fiberoptic endoscopy, in which a light tube is introduced through the mouth, esophagus, stomach and first part of the small intestines. Suspicious areas are sampled by biopsy and examined under the microscope by the pathologist. Anyone in whom stomach cancer is suspected should undergo this examination. Upper gastrointestinal series is another test occasionally used to diagnose stomach cancer. Further imaging can determine the extent and stage of the cancer before surgery. Helical CT scan is used to see whether advanced or metastatic disease is present. Kimmel Cancer Center physicians use endoscopic ultrasound, which determines the depth of penetration of the tumor and whether local lymph nodes are enlarged. Such valuable information can aid the surgeon in planning the best therapeutic approach.

Current Treatments

Surgery is the mainstay of curative therapy for stomach cancer. If preoperative studies demonstrate the disease is confined to one area, an operation is recommended. Typically, surgery involves removing most of, and occasionally all of, the stomach to achieve safe removal of all cancer. An extended lymphadenectomy (removal of a wide area of lymph nodes in the area of the cancer) may increase the potential for cure. Such radical operations are being performed in selected patients by the surgeons at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

Chemotherapy and radiation therapy also are used to treat stomach cancer. Currently, the cancer center is participating in a national study using radiation and chemotherapy after surgery for stomach cancer.

New Treatment Approaches

Our physicians are participating in large national study groups to examine new drugs for the treatment of early-stage disease after successful surgical resection. For advanced stomach cancer, our doctors are investigating novel drug therapies as well as new biological therapies -- a form of treatment that helps the body's immune system attack and destroy cancer cells.

New Treatment Approaches

Physicians at the Kimmel Cancer Center have remained at the forefront of the diagnosis and treatment of liver, bile duct, and gall bladder cancers through extensive research. New studies track the role environmental factors play in the development of bile duct and gallbladder cancers. Other studies continue to examine the role that estrogen plays in the development of these tumors. Physicians research the cause and prevention of gallstones, a major risk factor for gallbladder cancer and the reason this tumor occurs more often in women. New robotic methods of delivering treatments and gene therapy are on the horizon.

Liver Cancer

Cancers of the liver, bile duct and gallbladder account for 20,000 new cancer cases per year. Liver cancer can originate in the liver (primary liver cancer) or from some other point in the body and spread to the liver.

Patients throughout the nation are referred to the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, where physicians have been providing highly advanced diagnoses and treatments for two decades. A team of experts, including hepatologists, liver and transplant surgeons, medical and radiation oncologists and diagnostic and interventional radiologists, has been assembled to provide comprehensive, state-of-the-art care. Risk Factors
There are several risk factors for liver cancer. People who have hepatitis B or C or cirrhosis of the liver are more likely than others to get adult primary liver cancer.

Diagnostic Tests

Our physicians use spiral CT scans (computerized tomography tests) and MRIs (magnetic resonance imaging studies) to determine accurately the type and stage of the tumor. Radiologic studies have evolved so rapidly that some tests that were performed routinely just a few years ago are no longer necessary. Our physicians can screen patients whose exposure to hepatitis may have put them at greater risk for developing liver cancer. Patients with rare bile duct disorders are at higher risk of developing bile duct cancer. These patients can have their bile tested for carcinoembryonic antigen (CEA), a marker that reveals tumor activity. The test for CEA originally was developed for colon cancer.

Cancer Symptoms

Please consult a physician if the following symptoms occur:
a hard lump just below the rib cage on the right side where the liver has swollen discomfort in the upper abdomen on the right side pain around the right shoulder blade yellowing of the skin (jaundice) Current Treatments

For tumors of the liver, bile duct and gallbladder, surgical removal of the tumor remains the treatment of choice. However, not all tumors are operable. For some patients, a combination of radiation and chemotherapy has been successful in shrinking the tumors so that surgery can be performed. For other patients with liver tumors, a team of interventional radiologists, radiation oncologists and medical oncologists works together to perform chemoembolization or chemoradiation. Chemoembolization delivers chemotherapy directly to the tumor at the same time that its blood supply is interrupted.

For some patients with liver tumors, cryotherapy is a treatment option. Using this technique, which presently requires surgery, our physicians freeze the tumor, rendering it harmless without damaging the surrounding liver.

For patients with bile duct cancer, Kimmel Cancer Center medical oncologists and radiation oncologists work together to insert tubes into the bile ducts, then deliver irridium 192, a radioactive isotope, through the tubes. This treatment usually is performed along with traditional radiation and chemotherapy. These physicians have been using this treatment for two decades.

AIDS-Related Cancers

Cancers that commonly arise in AIDS patients include lymphomas and Kaposi's sarcoma. Other cancers also occur, and many are characterized by the presence of a virus in the cancer cells. Scientists are studying the role of those viruses and a weakened immune system in the growth and development of such cancers. Our physicians have played a major role in defining AIDS-related cancers and in developing therapeutic approaches to treat them.

Current Treatments

A variety of options are available for patients with AIDS-related cancers, ranging from chemotherapy and radiotherapy to biological interventions (enhancing or altering natural body responses to fight cancer) to supportive care. The choices are discussed with the patient by physicians with special interest and experience in the treatment of AIDS-related cancers.
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins is a leader in national programs for the treatment of new and relapsed AIDS-related cancers. There are many opportunities for participation in research studies and for treatment outside the research setting.

Testicular Cancer

Testicular Cancer

Testicular cancer is one of the most common cancers in young men between the ages of 15 and 34 and quite rare after age 40. Caucasian men are affected more than men of other races. Only 7,400 new cases are diagnosed in the United States each year. The cure rate is very high when testicular cancer is diagnosed and treated early.
Diagnostic Tests


Most testicular cancers are found by men themselves. Whereas any testicular abnormality is cause for concern, an actual lump inside the testis is frequently a sign of cancer and should be evaluated immediately. The earlier testicular cancer is identified, the greater the likelihood of a cure. Physicians rely on the diagnostic test, transillumination, in which a bright light is shined through the scrotum; tumors will appear opaque, whereas other abnormalities such as hydrocele or spermatocele will appear translucent. Sonography is another test that confirms a testicular tumor. The only way to confirm the presence of cancer is to remove the testicle surgically and examine a tissue sample under the microscope. Ultrasound, CT scans and X-ray are used to determine whether the cancer has spread beyond the testicle. Blood tests for specific biochemical markers of testicular cancer can be used to track the response to treatment and detect the recurrence of cancer.

Current Treatments

In most cases, surgery is performed to remove the testicle. Subsequent treatment depends on the extent and cell type of the tumor. Often, radiation, chemotherapy, or more surgery also are recommended. Hopkins urologists are particularly sensitive to the emotional and physiologic impact of testicular cancer.
16.AIDS-Related Cancers
Cancers that commonly arise in AIDS patients include lymphomas and Kaposi's sarcoma. Other cancers also occur, and many are characterized by the presence of a virus in the cancer cells. Scientists are studying the role of those viruses and a weakened immune system in the growth and development of such cancers. Our physicians have played a major role in defining AIDS-related cancers and in developing therapeutic approaches to treat them. Current Treatments
A variety of options are available for patients with AIDS-related cancers, ranging from chemotherapy and radiotherapy to biological interventions (enhancing or altering natural body responses to fight cancer) to supportive care. The choices are discussed with the patient by physicians with special interest and experience in the treatment of AIDS-related cancers.

The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins is a leader in national programs for the treatment of new and relapsed AIDS-related cancers. There are many opportunities for participation in research studies and for treatment outside the research setting.

Lung Cancer

About this Cancer Lung cancer is the most common type of cancer in both men and women. It is estimated that more than 175,000 new cases will be diagnosed in the United States this year alone. The majority of these cancers are directly linked to cigarette smoking.
Lung cancer has three main classifications:
Non-small cell lung cancer is the most common type of lung cancer, accounting for 75 percent of cases. Non-small cell lung cancer includes squamous cell carcinoma, adenocarcinoma, large cell carinoma, and undifferentiated carcinomas.
Small cell lung cancers grow more rapidly and are more likely to spread to other organs. They account for about 20 percent of lung cancers.

Mesothelioma is a rare tumor of the lining of lungs, often attributed to asbestos exposure, and represents 5 percent of lung cancer cases. Risk Factors
Cigarette smoking is the most important risk factor in the development of lung cancer. It is estimated that as many as 90 percent of lung cancer diagnoses could be prevented if cigarette smoking (see information on screening trial below) were eliminated. Exposure to certain industrial substances such as arsenic, some organic chemicals, radon, asbestos, radiation exposure, air pollution, tuberculosis, and environmental tobacco smoke in non-smokers also increases a person’s risk of developing lung cancer. Diagnostic Tests Lung cancer is usually diagnosed by X-rays and CT scans that provide images of the lung and show if a tumor is present.

Other tests used to diagnose lung cancer are:

examination of cells – cells obtained from sputum are examined under a microscope to see if they contain cancer cells.
fiberoptic examination – under anesthesia, a thin, fiberoptic camera is inserted into the bronchial passages of the lungs to examine the organ for tumors or lesions.
biopsy – a small sample of cells is removed from the tumor and examined for cancer cells under a microscope to see if it contains cancer cells. Cancer Symptoms The most common signs of lung

cancer are:

-- persistent cough-- sputum streaked with blood-- chest pain-- recurring pneumonia or bronchitis Current Treatments
Standard therapies for lung cancer typically include surgery , chemotherapy , and radiation therapy. In recent years, a number of innovative therapies have greatly improved the treatment of lung cancer. New anticancer drugs, better staging and imaging techniques, new surgical procedures, and combined approaches have shown promise in the treatment of these cancers.
At the Johns Hopkins Kimmel Cancer Center, a diverse team of specialists including surgeons, medical oncologists, radiation oncologists, pulmonary experts, radiologists, pathologists, and others come to together to plan and tailor a course of treatment for each patient based on their specific lung cancer diagnosis.

Non-Small Cell Lung Cancer

For non-small cell lung cancers that have not spread beyond the lung, surgery is used to remove the cancer. Surgery may also be used in combination with radiation therapy and chemotherapy in cancers that are more advanced. These treatments can also be given prior to surgery to shrink tumors and prevent the spread of cancer cells through the blood stream. This is called neoadjuvant therapy.

Small Cell Lung Cancer

Surgery is most commonly used in non-small cell lung cancers and less frequently in small cell lung cancer (SCLC), which tends to spread more quickly to other parts of the body. Chemotherapy is the most common treatment for small cell lung cancer, as these medicines circulate throughout the body killing lung cancer cells that may have spread outside of the lung. Radiation therapy is frequently used in combination with chemotherapy when the tumor is confined to the lung and other areas inside of the chest. Radiation therapy may also be used to prevent or treat the development of SCLC that has spread to the brain (metastasis). In radiation therapy, precisely targeted x-rays are used to destroy localized cancer cells. Radiation therapy can be used to prevent tumor recurrence after surgery, to treat tumors in patients who are not candidates for surgery, or to treat tumors causing symptoms in other parts of the body.
Mesothelioma

Chemotherapy, radiation, and surgery can all be part of the treatment for mesothelioma. Combined approaches that utilize these therapies together, particularly using chemotherapy prior to surgery, as well as new drugs that specifically target mesothelioma cells, are currently being tested.

New Treatment Approaches Johns Hopkins is a major center for the development and testing of new anticancer therapies. A number of these agents are now in clinical trials for patients with newly diagnosed and recurrent disease.

Laboratory Research:

Genetic DiscoveriesHopkins researchers have cloned a gene known as hASH1 and found it to be a critical factor in the development of SCLC and certain NSCLC. Our scientists continue to study the mechanisms by which this gene leads to lung cancer in hopes of identifying novel therapeutic strategies. Polyamine pathways are another genetic area of research in lung cancer. Our scientists are developing anticancer agents that target this pathway as an effective therapy for

lung cancer.

Molecular Analysis and ScreeningLung cancer often does not exhibit any symptoms until it has reach an advanced stage. A major objective of Hopkins clincians and scientists is to identify molecular screening markers for lung cancer to allow for earlier dectection. Our research scientists have created a panel of genetic alterations common to lung cancer that can be detected in cells washed from the lining of the lung. In screening selected high-risk populations for these alterations, our clinicians can diagnose cancers in their earliest stage and monitor existing lung cancer patients for recurrence.

Genetic Epidemiology of Lung Cancer ProjectJohns Hopkins Kimmel Cancer Center lung cancer experts are collaborating with colleagues at the University of Maryland and the National Institutes of Health to examine hereditary factors associated with lung cancer. They believe that certain individuals may be predisposed to certain genetic alterations that lead to an increased risk of lung cancer. This project studies DNA repair, p53 gene mutations, and cell death to identify potential culprits of lung cancer susceptibility.

SPORE

The Kimmel Cancer Center at Johns Hopkins is one of a select few cancer centers in the United States to receive the prestigious National Cancer Institute SPORE (specialized programs of research excellence) grant for translational lung cancer research. This grant provides funding for lung cancer research and its rapid transfer from the laboratory to the clinic.

Master Switches Found for Adult Blood Stem Cells

Johns Hopkins Kimmel Cancer Center scientists have found a set of "master switches" that keep adult blood-forming stem cells in their primitive state. Unlocking the switches' code may one day enable scientists to grow new blood cells for transplant into patients with cancer and other bone marrow disorders.

The scientists located the control switches not at the gene level, but farther down the protein production line in more recently discovered forms of ribonucleic acid, or RNA. MicroRNA molecules, once thought to be cellular junk, are now known to switch off activity of the larger RNA strands which allow assembly of the proteins that let cells grow and function.
"Stem cells are poised to make proteins essential for maturing into blood cells, but microRNAs keep them locked in their place," says cancer researcher Curt Civin, M.D., Ph.D., who led the study. The journal account will appear online the week of February 5 in the early edition of the Proceedings of the National Academy of Sciences.
To halt protein assembly, microRNAs pair up with matching full-length RNA, then fold and twist it, rendering the larger RNA useless. But the RNA pairings are not perfect, and one microRNA can latch on to several hundred RNA strands. "They act like a single circuit breaker to efficiently control hundreds of RNAs," says Civin, the Herman and Walter Samuelson Professor of Cancer Research.

"We're looking for ways to flip these microRNA switches, to control when stem cells grow into new blood cells," says Robert Georgantas, Ph.D., research associate at the Johns Hopkins Kimmel Cancer Center and first and corresponding author of the study.

To identify the key microRNAs, Georgantas sifted through thousands of RNA pieces with a custom-built, computer software program. Its algorithms let the software, fed data from samples of blood and bone marrow from healthy donors, match RNA pairs. The outcome was a core set of 33 microRNAs that match with more than 1,200 of the larger variety RNA already known to be important for stem-cell maturation.

Georgantas and Civin currently are testing whether these pair predictions are valid by using a non-reproducing virus to insert genetic instructions for each of the 33 microRNAs into adult stem cells. They'll then be cultured in Petri dishes. MicroRNA-155 -- the first microRNA tested -- was predicted to stop stem cells from developing into red and white blood cells. As expected, stem cells without microRNA-155 matured: they formed approximately 75 red and 150 white blood cell colonies per dish. Stem cells with microRNA-155 matured into far fewer red and white cell colonies -- about seven and 30 per dish, respectively.

"Using microRNAs to stall an adult blood stem cell in its early stage could help us grow new ones in test tubes, and perhaps give us more insight into stem-cell maturation for other tissue types," says Civin.

Civin and his team have filed for patents on the microRNA technology. The research was funded by the National Institutes of Health, National Cancer Institute, National Foundation for Cancer Research, and Kimmel Foundation for Cancer Research.

Additional authors include Richard Hildreth, Sebastien Morisot, and Jonathan Alder from Johns Hopkins; Chang-gong Liu, George A. Calin, and Carlo Croce from Ohio State University; and Shelly Heimfeld from the Fred Hutchinson Cancer Research Center.

The Johns Hopkins University holds patents on the CD34 monoclonal antibodies and inventions related to stem cells. Civin is entitled to a share of the sales royalty received by the University under licensing agreements between the University, Becton Dickinson Corporation and Baxter HealthCare Corporation. The terms of this arrangement are being managed by the Johns Hopkins University in accordance with its conflict-of-interest policies.