I've done quite a bit of research since I was diagnosed, but find I still don't quite understand cancer, and have some fundamental questions.

With all the bad news on the forum lately, I wonder what type of head and neck cancer is considered aggressive. Is(are) all types squamous cell-carcinoma aggressive? Is the degree of aggressiveness based on location, different types of squamous cell and/or the immunostains done on the biopsy?

Thanks
Sandy

Sandy, you are quite the thinker. I am sure there are a lot of us wondering that too. You have asked a verry good question and I for one will watch the forums for the answers that will surely come.

SCC just gives you the cell type that has gone bad. I.e. the squamous cells.
It does not tell how these cells arrived at the dark side. (There are many way screwing up a cell, it is a wonder they actually work especially if you consider the numbers and the fact that they must constantly change)
That is to say not all SCC are the same. Some respond to MAB treatments while others do not.
For example; only around 20-30% of breast cancers can respond to herceptin, were a growth factor is over expressed. .... and there are also different ways that a growth factor can get over expressed/overactive too.
Back to SCC, there are chromosomal abnormalities (translocation, detetions etc), but in cancer cells things go haywire because they are not normal anymore. Therefore it may be that some of these abnormalities are a consequence (but not the cause) of a loss of normal cellular control. Some of that you can see with FISH etc but I doubt very much that this is done routinely!
Also, this is just one side then there is also the immune system that may or may not help fighting this.

This is a gross simplification, and I will not even pretend that I am current in this. What you really need is to talk to a cancer geneticist that specializes in SCC.
On the other hand to put is bluntly: it is what it is. The treatment is essentially fairly standard, we are not at the point of (very) individualized medicine.

M

You might be interested in this:
The Journal of Laryngology & Otology (2009), 123 : 266-272 Cambridge University Press

Thanks Markus. You always did have the right answers for me and others.

Sandy

When I was first diagnosed in August 2007, I was stunned that all the internet sites and hospital web sites consistently described Head and Neck Cancer as "very aggressive" with poor survival rates. Now part of that is due to late discovery so many H&N cancers are stages III and IV - skewing the statistics. Part of the puzzle is genetic, here is a link to a news article exploring "micro-RNA": Genetic markers for Agressive H&N Cancer My wife has always been depressed by the ubiquitous 50% 5 year survival rate that appears in this article also. There was also a very informative general article in Parade magazine today in the Ask Marilyn column about fundamental cancer issue and why a cure is so elusive (it's not a foreign invader like virus or bacteria, it's your own cells gone wild; only one cell needs to survive treatment to have a recurrence; current treatment kills normal cells, etc.) Bottom line is that our cancer is one of the very worst.
One excellent source of information is the OCF feed on news plus the archived articles on the OCF board. Many times a news article that Google pulled for me is explained much better and more accurately on Brian's selection of the news.

Sandy

If you want highly technical exposition of micro RNA and the genetic component of cancer, the OCF site has this excellent article. In looking for this, I was glad to see that OCF uses the 50% survival figure also as I like to be in sync with OCF facts rather than news article distortions. OCF oncogenes and cancer
charm

I concur,
the article by Croce is an excellent starting point and it is right here at OCF.
M

Hi Sandy,
Two reasons the doctors consider my husband's cancer very aggressive (we are on #4 since 2005) are that his is poorly differentiated, which means it grows very quickly. He also has PNI or Peri-neural invasion. I don't know what the percentages are of all SCC having these characteristics, but it would be interesting to find out.
Lori

Sandy and Lori

They refer to my cancer as an agressive cancer also - it really grows quickly and did not respond to either of the chemo treatments that we tried. i'm going to quiz them about my Erbitux success this next appointment. the rash has started already though and that makes me happy. My last blood work showed a very high white blood count and that is from fighting this infection. I do know that once the biopsy was done, my tumor took on a life of it's own. right now I do not know the exact location of the cancer other than the right side of my neck as opposed to the left side and need to have some scans done so that I know what we have now so that I can tell if I am responding to the Erbitux or not. My plastic surgeon mentioned that someday they will be able to genetically identify each cancer and how to treat them differently instead of trying the same treatments on different cancers. I think that will make a huge difference in successful treatment.

Patty

Thanks Everyone:
I appreicate the technical paper, but I was hoping for a more pedestran answer. I might have good questions, but I think your giving me too much credit to be able to decipher all the technical info. LOL.

Can someone make a general statement of what the piece was stating? I think I know, but would love someone more knowledgeable than me to explain.

Thanks
Sandy

Patty:
I have read several articles on "truly" individual treatment plans. I believe it their goal.

Sandy

personally i don't think it matters a damn what all the papers and articles say.Facts and figures give you an overview of recurrence and survival rates,the bottom line is it only matters if it happens to you.Rob had SCC.At the time of diagnosis he was given a 90% chance of surviving 10 years based on the information available,ie examination,scans and pathology and histology.He had 67 lymph nodes removed which showed no sign of disease.His scans were clear for spread outside of the diseased area.7 months later after surgery and radiotherapy he was dead.His scans showed invasion of the lungs,and his recurrance was described as the most aggressive the surgeon had seen,and yet they had no indication that this was how his disease would progress.I had many online buddies whos origonal diagnosis was much worse than Robs and they are still here living full lives with no problems,one in particular who was being treated for a recurrence after 9 years out.He is now back at work,and fit and well again.Why?

I have come to the conclusion its a lottery,Rob thought it was genetic as all the males in his family including his father had developed cancer in their 50's but none of them had the same cancer.My sister in law lost her mother to ovarian cancer ,her father to oral cancer and bowel cancer,and her sister to breast cancer age 42,she herself has been treated for carcinoma in situ of the cervix since she was 20 and has recently had a hysterectomy because the staging moved up to three,she is 47.

Oral cancer survival rates are always quoted poorly because of ignorance,lack of information,late diagnosis,and lack of research and publicity funding....the cinderella of cancers.Being proactive in your treatment is a great thing,but time spent trawling the internet for reasons why is not the best way of moving forward and onward and hopefully away from your diease.Sqeezing every last moment you have on this earth living your life to the full is.

Liz is right
for a individual patient 90% cure rate does not mean a damn thing if you happen to belong to the 10%.
As far as individual treatment plans go.. if you take a step back you see that what is currently done it is fairly standard, despite all the cool ideas/hype.... just look at our signature lines. Eventually we will be there that genetic test will help to optimize treatment. For example could/should you use Erbitux etc.
For the sake of argument lets assume we can already do these tests.. where do all the new individualized drugs come from? I concede that some of the drugs may be old stuff.... but there just are not that many.
The quoted paper (OCF) is perhaps not that basic. This reflects how intricate the issue really is. There are many things going on..... and even if you understand all or most of this (and there is more) it will not really help you because the treatment variations are fairly minor.

M

Sandy, I am with your train of thought. Some of this I understand and others I just can't get thru my thick skull. I'm like Lit tler Denny Dumb Dumb, LOL I just shake my head and smile a DUH smile.

Sandy

Sorry, I thought you wanted more technical infomation when I posted those links. I used to specialize in doing plain english translations of medical terms decades ago so I forget how daunting they appear at first. For example the opening quote of the ocogene article [quote]Tumors often possess cytogenetically different clones that arise from the initial transformed cell through secondary or tertiary genetic alterations. This heterogeneity contributes to differences in clinical behavior and responses to treatment of tumors of the same diagnostic type. Apart from the initial clone and subclones, tumors can also contain progenitor cancer cells, all of which constitute a spectrum of cells with different genetic alterations and states of differentiation. These populations can differ in sensitivity to chemotherapy, radiotherapy, and other treatments, making clinical management difficult. For these reasons, the initiating steps in the development of cancer are of considerable clinical importance and are a priority in the development of rational cancer treatment[/quote]can be summarized as: Cancer tumors constantly change their cells' genetic makeup in series of steps that makes it hard to predict how even the same types of cancer will react to treatment. Until we know those various steps, we will not have a "rational" cancer treatment.
Now I love the medical admission that the current treatment of cut, burn and poison for all cancers is not rational but it is all we have.
My understanding is that a cancer is "aggressive" when it is resistant to treatment, reoccurs or spreads. Prostate cancer is usually not aggressive and males can live to 90 with it with no ill effects as is is slow growing. Watch and wait is an accepted therapy for such cancers. When I asked back in 2007 what if I just waited and again in 2009, all three doctors said I would die within a year of a very painful death. That is an aggressive cancer. Unfortunately most if not all head and neck cancers are aggressive. Simply the nature of the beast. Some cancers react wonderfully to treatment, like the type Lance Armstrong had - relatively easy to "cure". Not so much for ours. Various medical articles have described oral cancer as "insidious", "catastrophic", etc due to the major life impairments that even successful treatments cannot avoid since it involves our head and neck which cannot be amputated. We all cope with the new normal as best we can.

You have me laughing again Charm LOL

I sure remember when cookey and rob were going thru the troture. I used to jus sit sn wonder ow they could handle it. I felt so bad for them.

I have my 16 lb sledge and am about to fine tune this damn wireless keyboard and mouse. I type bad enough, but when I know I hit the keys ans they don't show, it,s get even time. Must be time to use the wired one and flatten this scrap.

Jim,

Check your unit that is plugged into the computer...sometimes it gets interference when its in a bad place and causes the keyboard to keep from registering. Also..possibly you need new batteries??

The ability to separate the really aggressive disease from the regular versions is discussed in this recent OCF news posting. If you subscribe to the OCF RSS news feed you would be getting this story automatically. For those of you that don
t here it is

http://oralcancernews.org/wp/2009/05/new-diagnostic-advance-seen-for-head-throat-cancer-2/

debandbill. There are new batteries in it and The only thing possibly in line where interfernce could occur is my outside dusk to dawn 13 watt lite. This happenS all the time so it can't be the lite. I just went back and put 14 letters in that it missed LOL I'll try it a few more days and check things out Thanks for the advice tho

Charm:
Thank you very much for deciphering the scientific language for me. I was asking for personal reasons, but also for general knowledge. The reason is that although my tumor was very large, it has not spread to other areas. But reading the signatures on the forum with smaller tumors seem to have a lot more involvement. I was just trying to figure out the difference. I really wasn't "trawling" the internet.

Thank you again for taking the time to convert the info to common language. Sandy

Always good to have more info Sandy. I always think my "odds" are 50/50. Either it is back, or it isn't!

Donna