University of Michigan Comprehensive Cancer Center researchers identified a series of markers that identify which patients are most likely to survive these types of cancers. The findings are a promising step toward the development of individualized treatments for tonsil and tongue cancers, according to the authors of two papers published online May 12 in the Journal of Clinical Oncology and expected to be in the July 1 print issue.

"The chemotherapy and radiation therapy we use to treat this type of cancer is very aggressive. If we can identify those patients most likely to respond, we could reduce the intensity of the therapy for those likely to have the best outcomes. At the same time, we hope to identify new treatments that specifically target those tumors that we know are not responding to current therapies," Thomas Carey, co-director of the head and neck oncology program at the U-M Comprehensive Cancer Center, said in a prepared statement. He was the senior author on both papers.

The researchers gave an initial course of chemotherapy to 66 people with advanced oropharyngeal cancer, which includes cancer of the tonsils and the base of the tongue. Patients (54) who responded to this initial treatment then received a full course of simultaneous chemotherapy and radiation. Patients (11) who didn't respond to the initial chemotherapy were referred for surgery.

Of the 54 patients who responded to the initial chemotherapy, 62 percent are alive today without evidence of cancer, and 73 percent fully preserved their organs. Of the 11 patients referred for surgery, only four survived.

"For most patients, the chemoradiation was very effective. But a subset of patients still do not do well. Our next step was to look at the biomarkers to see if we could determine which patients were responding to treatment, based on tumor biology," said Carey, who is also an associate chair and professor of otolaryngology and pharmacology at the U-M Medical School.

The researchers found that 64 percent of the tumors were positive for high-risk strains of HPV. Almost all of the HPV-positive tumors responded to initial chemotherapy, and 78 percent of those patients survived with their organs intact. Of the HPV-negative patients, only four of 15 survived. In addition, patients with the EGFR marker had worse outcomes.

"The combination of markers was an important indicator. Patients whose tumors expressed high levels of EGFR did poorly. But those who had high EGFR and were also HPV-positive had some protection. Patients with high EGFR and low HPV fared the worst," Bhavna Kumar, a research laboratory specialist who was lead author on both papers, said in a prepared statement.

The U-M team also found that patients with low expression of protein called p53 and high expression of a protein called BCLXL also had poor outcomes.

More information

The American Cancer Society has more about oral and oropharyngeal cancers.

In their study, researchers from the University of Michigan Comprehensive Cancer Center looked at 2,582 white patients and 134 black patients, aged 66 and older.

The study found that 75 percent of whites and 73 percent of blacks saw an oncologist after being diagnosed with rectal cancer, but only 54 percent of blacks received chemotherapy, compared with 70 percent of whites. In addition, rates of referral to a radiation oncologist were similar, but only 74 percent of blacks received radiation therapy, compared with 83 percent of whites.

The findings were published in the May 13 online issue of the Journal of the National Cancer Institute.

"Although there wasn't a discrepancy between African-Americans and whites in the rates of consultation with an oncologist, we found a large discrepancy in the receipt of chemotherapy. This is very important. We knew that African-Americans were not receiving chemotherapy for rectal cancer at the same rates as white Americans, and it was contributing to their increased mortality. Now we have a better idea of where the problem lies: somewhere between the visit with the oncologist and the actual initiation of chemotherapy," study author Dr. Arden Morris, an assistant professor of surgery at the U-M Medical School and chief of general surgery at the VA Ann Arbor Healthcare System, said in a prepared statement.

Compared to whites, blacks have as much as a 20 percent worse long-term survival rate after rectal cancer surgery. It's known that the use of chemotherapy and radiation improves survival in all rectal cancer patients by as much as 20 percent. It's believed that the lack of chemotherapy and radiation treatment in blacks is largely responsible for their lower long-term survival rates.

"We now know that the initial visit with an oncologist is not the barrier to treatment. Our next step is to better understand what are the human factors that contribute to this discrepancy. We're interested in hearing what individual people have to say," Morris said.

She and her colleagues suspect social differences and priorities among different groups -- such as patient preferences or access to resources such as transportation or family care -- may contribute to these discrepancies.

"Choice is important. If there's a choice, this maybe isn't a disparity but a preference. But if it's not a choice, then we need to understand the barriers and find solutions," Morris said.

In her next study, she plans to interview patients who've been treated for colorectal cancer to learn how they reached the decision to have chemotherapy or whether they feel they even made that decision themselves.

More information

The U.S. National Cancer Institute has more about colorectal cancer.

MONDAY, May 5 (HealthDay News) -- The overproduction of a protein may be what starts harmless colon polyps on their journey to becoming malignant tumors, Finnish researchers report.

The University of Helsinki research, published online in Cancer Cell, reveals that PROX1, a protein that controls formation of normal organs in embryos, is produced in excess during the early stages of cancer development. PROX1 even encourages tumor cell growth without additional signals from surrounding normal tissues.

The removal of PROX1 from cancer cells appears to reverse their malignant behavior, suggesting that future research may focus on the protein's use in colon cancer therapies.

Men and women face a lifetime risk of nearly 6 percent for the development of invasive colorectal cancer, making it one of the most common malignancies in the Western world. Past epidemiologic studies have cited obesity and several dietary factors -- including fat, red meat and a lack of vegetables and fiber -- as increasing the risk of the disease.

More information

The National Cancer Institute has more about colorectal cancer screening.

FRIDAY, May 2 (HealthDay News) -- Prompt treatment of a common stomach infection reverses the damage that can lead to gastric cancer, according to tests on mice done by researchers at the Massachusetts Institute of Technology (MIT).

The findings should put a stop to any questions about whether, and when, antibiotic treatment of Helicobacter pylori can reduce or eliminate the risk of developing stomach cancer.

"We concluded that H. pylori eradication prevented gastric cancer to the greatest extent when antibiotics were given at an early point of infection, but that eradication therapy given at a later point also delayed the development of severe lesions that can lead to cancer," study author James G. Fox, director of the division of comparative medicine at MIT, said in a prepared statement.

Stomach cancer is the second-leading cause of cancer death worldwide and about half the world's population is infected with H. pylori, which is recognized as a major cause of both peptic ulcers and stomach cancer. It typically takes several decades for stomach cancer to develop in people who are susceptible -- about 3 percent of people infected with H. pylori.

It's been unclear when doctors should screen and treat people with antibiotics -- other than immediate relatives of patients with stomach cancer and peptic ulcer disease -- or when to treat H. pylori infection for maximum benefit, Fox said.

He and his colleagues created mice prone to accelerated H. pylori infection and progression to stomach cancer. The researchers found that mice treated with antibiotics had less severe disease at every stage of advancing infection.

Mice treated eight weeks post-infection had the same risk of cancer as uninfected mice. However, treatment at 12 and 22 weeks post-infection didn't reverse damaging changes, such as inflammation and development of precancerous lesions, to levels seen in uninfected mice.

"Our mouse model mimics the progressive process we know occurs in the development of human gastric cancer. This [study] shows early intervention provides the maximum benefit," Fox said.

The study appears in the May 1 issue of Cancer Research.

More information

The American Cancer Society has more about stomach cancer.

The costs for treating patients varies by type of cancer, with expenditures highest for lung, colorectal and prostate tumors, said the researchers, who based their estimates on patients diagnosed with cancer in 2004.

"Because the U.S. population is aging and growing, we think that these costs are going to get higher in the future," said lead researcher Robin Yabroff, an epidemiologist at the U.S. National Cancer Institute. "We think there are going to be a lot more cancer patients in the future."

"The main goal of this study," Yabroff added, "was to provide cost of care estimates that could be useful for policy makers and health planners and researchers that might want to do cost-effectiveness analyses."

The findings are published in the April 29 issue of the Journal of the National Cancer Institute.

For the study, Yabroff's team estimated the cost of cancer care among 718,907 cancer patients and compared that to 1,623,651 people without cancer. The researchers used data from the Surveillance, Epidemiology, and End Results (SEER) and SEER-linked Medicare files to identify these patients.

The researchers then subtracted Medicare costs for people without cancer from costs among those with cancer. The resulting number was the estimated cost of cancer care per person.

Costs varied over five years from about $20,000 for people with breast cancer or melanoma to $40,000 for people with lymphoma, brain or other cancers of the nervous system, as well as malignancies of the esophagus, ovaries or stomach.

The study authors found that costs were highest during the first year of treatment and also during the last year of life. Patients are more likely to be hospitalized during the last year of life, which increases costs, Yabroff said.

"We also found the cost of care is generally higher for patients diagnosed with a later stage disease, compared with patients diagnosed with earlier stage disease," Yabroff said.

To help contain costs, Yabroff suggested that more emphasis be placed on cancer screening and early diagnosis, as well as lifestyle changes, such as not smoking.

Paul Precht, policy director at the Medicare Rights Center, said he thinks Medicare will have to change some of its policies to keep costs down while continuing to offer care to the elderly with cancer.

"Clearly, treatment of cancer is expensive," he said. "When people talk about the sustainability of Medicare, they have to look at findings like this, because we are paying for treatments of very serious diseases, and that's why it's so expensive."

Precht agreed that one way to lower costs is to put more emphasis on early detection and increase Medicare benefits for prevention. Also, federal law needs to be changed to allow Medicare to negotiate drug prices with the pharmaceutical companies, he said.

"The cost of cancer drugs is going through the roof," he said. "Medicare really has to look at ways to deal with that."

People are already paying high co-payments and coinsurance for care under Medicare, and these costs are likely to grow, Precht added. And as those costs increase, it could reach a breaking point. "People will say: 'Yes, I want to live, but I don't have the money, so I guess I'm not going to,' and that's not right," he said.

Increasing costs don't necessarily lead to the rationing of health care, Precht said. "But there needs to be cost-effectiveness analysis, so there is some relationship to the effectiveness of the treatment we are paying for," he said.

More information

To learn about financial assistance and other resources for people with cancer, visit the U.S. National Cancer Institute.