Tumor-resident T cell levels underlie improved survival in throat cancer ppatients

Research led by the Centenary Institute has discovered that immune cells accumulating within the tumor environment, called tumor-resident T cells, are a critical determinant in survival rates of patients suffering from throat cancer. 

Reported in the prestigious ‘Journal for ImmunoTherapy of Cancer’, the research suggests that strategies aiming to boost these T-cells at tumor sites could be beneficial to patients.
 

Oropharyngeal squamous cell carcinoma (OPSCC) is a form of throat cancer. It can be caused by environmental factors such as smoking or by human papillomavirus infection (HPV), the same virus that causes cervical cancer in women. We knew that patients with HPV-related OPSCC had far better clinical outcomes compared to other OPSCC patients but we didn’t know why.

 

Ms Rehana Hewavisenti, lead author of the study and researcher at the Centenary Institute and the University of Sydney.

In examining over sixty patient samples, Ms Hewavisenti and her colleagues discovered that increased levels of tumor-resident T cells, whether in HPV or non-HPV OPSCC cases, was clearly associated with improved patient survival outcomes.

“It was the accumulation of these immune T-cells, in and around the tumor site that appeared to be key,” said Ms Hewavisenti.

The researchers also found in their study that HPV OPSCC patients generally had far higher levels of tumor-resident T cells compared to their non-HPV OPSCC patient counterparts.
 

We think these HPV positive patients tended to have better clinical outcomes as HPV infection is likely to favor the accumulation of these beneficial T-cells within the tumor area.”

Ms Rehana Hewavisenti

 Dr Mainthan Palendira, Head of the Centenary Institute’s Human Viral and Cancer Immunology Laboratory and senior author on the research paper believes the research findings have major implications.

“Now that we understand how important this immune response is in relation to OPSCC, we can begin developing new treatment strategies focused on recruiting these favorable tumor-resident T cells directly to tumors,” he said.

Dr Palendira believes that looking at the amount of these T-cells in cancer could help clinicians to personalize the best treatment approach for individual patients.

“We also think that our research demonstrating viral (HPV) links with this tumor-resident T cell accumulation could help in future cancer vaccine development efforts too,” he said.

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This Doctor Invented a Rs. 50 Device To Give Throat Cancer Patients Their Voice Again

 
 The prosthesis – Front View
Side view

Dr. Vishal Rao, a Bangalore based oncologist, has developed a voice prosthesis that can help throat cancer patients speak after surgery. And unlike the extremely expensive ones available in the market today, this device will cost just Rs. 50.

It had been over two months since a throat cancer patient from Kolkata had eaten properly. He was depressed, unable to speak or swallow, and was being fed with the help of a pipe through his nose. His financial condition made it very difficult for him to afford proper medical treatment. It was then that a doctor informed him about a surgeon in Bangalore who could be of help. So he travelled, met the surgeon and sought his treatment. After a procedure that lasted only five minutes, he was able to speak properly, swallow his food, and was even ready to travel back home – all thanks to Dr. Vishal Rao U.S.

“That day, when I came out from another surgery after about three hours, the Kolkata patient was still standing there, waiting for me. He was so emotionally overwhelmed that he just ran towards me and hugged me saying that he had never imagined getting his voice back would be so easy,” says the 37-year-old doctor.

Dr. Rao is an oncologist and head and neck surgeon at the Bangalore-based HealthCare Global (HCG) Cancer Center. He has developed the Aum Voice Prosthesis – a voice prosthesis device that can help patients whose voice box has been removed, to speak and eat properly.

Unlike the currently available prostheses that cost anywhere between Rs. 15,000 and Rs. 30,000, and have to be replaced every six months, Dr. Rao’s prosthesis will cost just Rs. 50.

Voice prosthesis is a device made of silicone. It is used to help patients speak when the entire voice box, or larynx, has been removed. In such cases, the windpipe and food pipe are separated from each other, either at the time of the surgery or later, creating an opening between the two. The device is then placed in this opening. Dr. Rao explains that the voice box basically vibrates with the help of air provided from the lungs. The mechanism behind the prosthesis is that instead of the vocal cord vibrating, the food pipe is made to vibrate with the back end of the prosthesis sitting at the food pipe.

“If you send air into the food pipe through the lungs, it will vibrate, create noise, and that can be converted into intelligent speech with coordination from the brain. As food or water should not fall into the lungs, it is a one-way valve device,” he elaborates. The device weighs 25 grams and is 2.5 cm long.

The foundation for Aum Voice Prosthesis was laid about two years ago, when a throat cancer patient from a remote Karnataka village came in to meet Dr. Rao.

“That man had not eaten since about a month and he could not speak. After the cancer surgery, his voice box had been removed, but he could not afford the prosthesis. When he came to me, he did not find life worth living anymore,” remembers Dr. Rao, who promised the patient that he would try and help.
  
Till then, every time he had encountered a case like this, Dr. Vishal had to contact some pharmaceutical companies, ask for discounts, raise funds, and arrange donations – but he had been able to help patients in spite of all this trouble. So raising funds was his first thought this time as well. But then, something amazing happened. “I would call it serendipity that right after the patient a friend walked in to meet me,” he says. This friend, Shashank Mahes, promised that he would try and arrange the required funds but he also asked the doctor a simple question:
“Why are you dependent on all these people. Why don’t you make something on your own?”

Dr. Rao felt that something like this was beyond his capacity. He was familiar with the technical side but didn’t have the industrial expertise to turn his idea into a viable product. Fortunately, Shashank was willing to help him with that. They decided to collaborate for this cause – Dr. Rao got the entire technical plan ready and Shashank helped him convert it into reality using his expertise as an industrialist. They put in the required funds from their own pockets and developed the device.

“I never want to donate torn old clothes to the poor because they deserve more dignified donations. That’s why I didn’t want to create a medical product of cheaper quality only because my patients are poor. Don’t they deserve the best? So we brought in the best materials,” says Dr. Rao.

The duo has filed for a patent for the device; it will be available in the market by next month. They have also received approvals from scientific and ethical committees at HCG to start using the product on patients. Testing will begin on 30 patients initially.

Most voice prostheses are very costly because they are imported. Dr. Rao and his friend took two years to come up with the final product. But in order to keep it affordable, they decided not to charge for their time and effort.

“We believe that speech and communication are not a privilege but a right. We cannot hold them back from a patient only because he/she is poor,” he says.

Dr. Rao has used the device on three patients so far. His aim is to study and fine tune it further, in the hope that its use will soon become widespread in every cancer centre in the country.

“My first patient was a watchman from Peenya. Two years ago, we arranged for his prosthesis with the help of donations. While the shelf life of the device is only six months, he used it for two years because he could not afford a replacement. Eventually, the device led to many complications. When he came in, I felt that he deserved the Aum Voice Prosthesis. And after the procedure, he happily called me in the middle of the night from his duty to tell me that the device is working well. That call gave me immense satisfaction,” says the doctor, with pride.

Why is the device called ‘Aum’?

“In older scriptures, ‘Om’ was written as ‘Aum.’ ‘A’ stands for creation, ‘U’ for sustenance and ‘M’ for annihilation. These are the three basic principles of our universe. When a person speaks again after losing his voice box, for me it is more like rebirth, like Aum being recreated, because it is the origin of all sound,” concludes Dr. Rao.
 
This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     
 

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25 things that happen inside your body when you smoke

Stress out, bored or simply craving that nicotine fix – smoking is usually a solution to all of these problems. But did you know that in order to beat that boredom you are slipping down the unending crevasse of death. How you ask? Here is what smoking does to your health and eventually causes cancer, right from when you light up to when you exhale.
Your first drag:
1. Whether you light your cigarette using a matchstick or a lighter, the first puff is the most damaging. The smoke emitted from the match and the cigarette form a strong cocktail that can leave the mucous lining in your nose damaged.

2. Apart from that the heat from the cigarette affects the skin on your face and most importantly around your nose and mouth. The heat causes your lips to darken, leads to wrinkles and the appearance of age spots. Another reason for darkening of a smokers lips is the fact that the tar in the cigarette tends to adhere to the lips, soon staining them.

3. Not to mention the constant pouting and sucking that one has to do in order to take a puff also leads to what is known as a smoker’s pout. Where when you pout you will see the appearance of fine lines around the lips – something that does not happen in non-smokers.

What the smoke does to the insides of your mouth:
4. When the smoke is inside your mouth, the tar starts to coat the enamel of your teeth, discolouring them.
 
5. The heat from the smoke also damages the cells in and around your mouth, and in some cases leading to a change in their DNA – causing mutations. Once  inside the mouth the tar and other chemicals affect all parts of your oral cavity.

6. The chemicals present in a cigarette are numerous and they form a coat your tongue, palate and the inside of your cheeks. It deadens your taste buds, hyperactivates your salivary glands and eventually blocks them, leading to a lack of saliva in your mouth. That is also one of the reasons smokers need a drink of water after a smoke.

7. The tar and chemicals also coat the roof of your mouth, leading to a condition called the ‘smoker’s palate’ where the roof of your mouth gets coated with a whitish residue with small red spots protruding from it. These protrusions  are actually the opening of ducts of glands present on the palate.

8. Smoking also kills the good bacteria within your mouth, giving way to bad breath and a condition called oral thrush. 

9. It also leads to gum disease, discolours your gums – turning them black, leads to cavities and causes oral cancer. This is mainly because the heat combined with the chemicals in smoke tend to damage cells leading to mutations and change in their DNA. This change may affect either their mechanism of multiplying in a uniform manner or the one that stops their multiplication.

10. Smoking also affects your olfactory system (nose) leading an eventual loss in your ability to smell.

When the smoke enters your throat:
11. Once you start to inhale the smoke, it first hits the back of your mouth or the beginning of your throat, this place is packed with blood vessels that immediately contract. It also affects the mucosal cells lining this part of your throat, eventually deadening them. This can lead to infections, excessive dryness and irritation. One of the commonest complaints a smoker has is that they feel an itchy sensation at the back of their mouth. This is due to the irritation and dryness of this region.

12. Once the smoke travels lower down your throat it causes irritation and in some people the need to cough. According to experts the formaldehyde and acrolein abundantly present in cigarettes are primary reasons for throat irritation smokers experience. 

13. Apart from that cigarette smoke also causes changes in one’s voice. Commonly seen as hoarseness of the voice, it is mainly because of the effect the chemicals have on the vocal chords. Another reason for this is the constant clearing of one’s throat, commonly seen in smokers.

14. Smoking can also cause throat cancer. This is because the constant irritation of the lining of the throat combined with the erosion and damage of the cells lining the throat leads to a change in the way the cells form and regenerate.


When it enters your trachea or wind pipe:
15. Trachea is the pipe that leads to your lungs. It is lined with tiny hair like processes (called cilia) that help throw out any foreign objects. These cilia get damaged by the smoke of cigarettes and tend to function less optimally. It also leads to itchiness in the trachea leading to what is called the smoker’s cough.

16. Smoking can also lead to irritation of the larynx and laryngitis (infection of the larynx)

It also affects your oesophagus:
17. Smoking affects your food pipe as well. The chemicals and heat from the smoke tend to affect your oesophageal sphincter muscle. This is the muscle responsible for keeping the contents and acids in your stomach from rising back up into your throat. The weakening of this muscle is one of the main reasons for GERD (Gastro oesophageal reflux disease), acidity, ulcers and other stomach ailments.  

When it enters your bronchus and alveoli:
18. This where the cigarette smoke does the most damage, that is slow, progressive and deadly. Cigarette smoke attacks the cleaning mechanism of the respiratory system that is guided by cilia and mucous. The cilia moves the mucous that has trapped foreign object like dust, bacteria etc and throws it out of the body. In a smoker these cilia tend to get paralysed and eventually die. Smoking also causes an increase in the amount of mucous produced, and since the cilia can no more function and throw out the mucous, a person develops a smoker’s cough. 

19. Apart from that the cells along the bronchioles get damaged and tend to multiply abnormally. These cells cause the hardening of the outer surface of the bronchioles and leads to lesser ability to exchange gas with the microscopic air sacs (called alveoli) present around them. Eventually these air sacs burst and lead to what is known as emphysema. A common condition seen in long-term smokers. 

20. Smoking also leads to a buildup of tar within the bronchioles. This coupled with the thickening of its walls leads to breathlessness, wheezing, fatigue and in some cases dizziness.

21. Cigarette smoke also contains carbon monoxide. This is a potentially lethal gas since it attaches to the iron part of your blood and does not allow it to carry oxygen to other organs. Inhaling too much of this gas can kill you. In cigarette smoke carbon monoxide leads to lack of oxygen in the body, which eventually effects all your organs. It not only sets off the roller coaster of events leading to cancer it also starts the process of eventual decay of your organs — starting from your mouth to your brain, kidneys, liver, digestive system and blood. 

If all you can think about is how you have tried to quit but failed? Here is some research on why you tend to lose motivation and why smoking is now easier than ever. 

When you exhale:
22. When you exhale the entire process is repeated and all the chemical, smoke, tar etc deposited along your airway is doubled.

23. Apart from all the damage it causes on your body, smoking also leads to various other problems like cardiovascular disease due to plaque formation, constriction of blood vessels leading to vascular disorders.

24. Smoking also causes loss of bone density leading to conditions like osteoarthritis, loss of teeth and joint paints. 

25. It also affects your skin by reducing the effects of antioxidants in your body by releasing free radicals, depleting collagen below your skin and causing wrinkles, edema and stains your fingers and nails. 
So, the next time you light up that cigarette, think about what your body goes through to support your habit.

THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.    
 
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EARLY WARNING SIGNS OF THROAT CANCER

Throat Cancer Growths on the vocal chords and the lining of the throat are symptomatic of throat cancer, and can spread to the esophagus, neck, and lymph nodes. Changing to a healthy lifestyle, as well as quitting cigarettes and alcohol can drastically reduce the risk of developing this type of cancer.
Lumps or swelling in the neck that last more than three weeks
Any inflammation or lumps you notice that last more than three weeks can be a symptom of throat cancer. Whether the swelling/lumps are painful or not, or whether they’re big or small, you will want to contact your physician.
Pain in the esophagus and trouble swallowing
When we swallow our food, it goes through our esophagus on its way to the stomach. If you are having difficulties swallowing your food, or feel pain while doing so, or feel that the food has gotten stuck in the esophagus and won't go on - you should immediately check the issue with your doctor. 
Other symptoms:

• Hoarseness
• Chronic vomiting
• A chronic cough or cough with blood
• Unexplained loss of weight 
•  
•  this is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.
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Affordable voice box prosthesis for throat cancer patients

THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.

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Here is some good news for patients suffering from throat cancer but can't afford to spend around Rs 30,000 on prosthesis. Patients who lose their voice can look forward to speaking again, without having to spend much money for an artificial voice box, thanks to Dr Vishal Rao, Head and Neck Surgeon, HCG. 

Dr Rao has come up with voice box prosthesis, an artificial device made of silicon that can help laryngectomized patient to speak again.

One of the major disadvantages for throat cancer patients has been the removal of the voice box when they undergo Laryngectomy wherein they have their larynx removed surgically. Imported prosthesis currently available in the market costs about Rs 30,000 and needs to be changed once in six months, which is not viable for many patients, especially for those who belong to below poverty line.

Dr Rao has used the device on some of the patients so far, one among the successful cases being a 55-year-old Ramakrishna. Ramakrishna is a watchman from Peenya Industrial Area who needed a change in the imported prosthesis and could not afford it. He was provided with the Indian prosthesis and now has got his voice back. 

Two years ago, Dr Vishal Rao treated him and arranged for prosthesis through donations. Though the shelf life of the device is only six months, Ramakrishna used it for two years as he could not afford a replacement. 

"Being a watchman, I was addicted to smoking ‘beedi’ to keep myself awake at night. When I was suffering from throat cancer, my voice box was removed and imported voice prosthesis was given which I used for two years. But I had trouble eating as food used to leak through the device. Post using the new device by Dr Rao, I am doing much better and my problems are solved,'' Ramakrishna said.

Commenting on his innovation, Dr Vishal Rao said that if air passes through the food pipe in the lungs, it would vibrate and create noise which can be converted into intelligent speech with the coordination from brain. 

"Food or water should not fall into the lungs, as it is a one-way valve device. It weighs about 25 grams and is 2.5 cm long and is called ‘AUM’ device as that is the sound which first resonated across the universe, thus regaining one's voice is much like a re-birth. The imported prosthesis currently available in the market costs about Rs 30,000 and needs to be changed once in six months, which is not viable for many patients. My objective was to design something that is affordable, hence we came up with this device which costs less than a dollar (Rs 50) and gave them their voice back,'' Dr Rao said.