Keeping an eye on oral cancer
COLLEGE STATION, Texas—While there is no shortage of companies involved in cancer research these days, the amount of attention paid to oral cancer has been fairly sparing comparatively. In Texas, however, it's an issue that's drawing attention from several organizations, including Texas A&M University and the MD Anderson Cancer Center.
Dr. Kristen Maitland, an assistant professor in Texas A&M's Department of Biomedical Engineering, is working on the development of a new imaging system that uses confocal microscopy and fluorescence lifetime imaging in order to detect precancerous and cancerous cells in the mouth. This method was developed in earlier studies on hamsters, and is now being tested on human tissue. Maitland is serving as principal investigator, with Dr. Javier Jo, an associate professor of Biomedical Engineering, serving as co-investigator.
There are imaging options available for monitoring oral cancer sites currently, such as the VELscope from LED Dental Inc., an adjunctive device that has been approved by the U.S. Food and Drug Administration to aid clinicians in detecting pre-cancerous and cancerous lesions that are difficult to spot. The blue light excites "fluorophores" in mucosal tissue, which then emit their own light. The device's filter enables fluorescence visualization by blocking the reflected blue light and enhancing the contrast between normal and abnormal tissue.
In the new imaging system, the lifetime fluorescence system will send out a bluish light to make precancerous or cancerous sites light up, while the camera can zoom in on spots of interest. This approach has been tested in hamster studies, with the results published in the paper "Fluorescence lifetime imaging and reflectance confocal microscopy for multiscale imaging of oral precancer," which appeared in the Journal of Biomedical Optics. Maitland and Jo helped to author the paper, which reported that "while [fluorescence lifetime imaging] is sensitive to biochemical and macroscopic architectural changes in tissue, [reflectance confocal microscopy] provides images of cell nuclear morphology, all key indicators of precancer progression."
As development of this imaging system moves forward, researchers from Texas A&M will partner with the Baylor College of Dentistry, where dentists often perform biopsies. Tissue samples taken from patients can be sent directly to the lab to be scanned with the imaging system, then sent to another lab for official diagnosis.
This is not the first step the organizations have made in seeking better options for oral cancer patients. A dental clinic was established in 2011 at Baylor University Medical Center's Charles A. Sammons Cancer Center in Dallas, a move supported by the Texas A&M University Baylor College of Dentistry. The Texas A&M Health Science Center noted in a July press release that prior to the clinic's opening, MD Anderson was the only Texas cancer center that offered a full-range facility that included dentistry.
Dr. Ann Gillenwater, a professor in the Department of Head and Neck Surgery at MD Anderson, considers early detection to be key in the fight against oral cancer. In a 2011 podcast in MD Anderson's Cancer Newsline series, Gillenwater called herself "a strong advocate for early detection," citing a high survival rate if oral cancers are caught in their early stages. She added that "we need to improve education of people into the early signs and symptoms of oral cancer. I also like to improve the ability of the first responders, the people in the front line to diagnose and recognize these cancers at their earlier stages."
The American Cancer Society reports than roughly 2.5 percent of all cancers diagnosed in 2013 will involve the mouth, with the Oral Cancer Foundation (OCF) forecasting approximately 42,000 people in the United States facing oral cancer diagnoses. The foundation notes that this is the fifth consecutive year in which the rate of occurrence in oral cancer has seen an increase.
"Worldwide, the problem is far greater, with new cases annually exceeding 640,000," the OCF notes on its website.
According to the OCF, if oral cancers are caught in the early stages of development, they have an 80 percent to 90 percent survival rate. Unfortunately, due to lack of public awareness, most cases are discovered in the late stages, leading to a 43-percent death rate at five years from diagnosis and "high treatment-related morbidity in survivors."