"My Voice"

Order a paperback or Kindle Edition or e-book of "My Voice: A Physician's Personal Experience with Throat Cancer," the complete 282 page story of Dr. Brook's diagnosis, treatment, and recovery from throat cancer.

Order a paperback or Kindle Edition or e-book of "The Laryngectomee Guide," the 170 page practical guide for laryngectomees.

Obtain and/or view a video presentation, a slide presentation and an instructive manual how to ventilate laryngectomees and neck breathers (free).

Saturday, January 25, 2020

Coronavirus outbreak and how laryngectomee can prevent getting the infection:


There has been a deadly outbreak of a novel strain of coronavirus in China causing severe respiratory illness and death. The outbreak started in Wuhan, China in December of last year. The causative virus has been identified and its genome sequenced, which will allow confirmation of cases and development of a vaccine, though most likely not for several months. As of today the CDC has recommended travelers avoid all nonessential travel to Wuhan, and several US airports receiving flights from Wuhan are screening passengers for symptoms. The virus is most likely spread by droplets. Those traveling to China should practice certain health precautions like avoiding contact with people with respiratory disease symptoms and careful hand-washing. Wearing a surgical mask is helpful, but it's more effective when worn by those with the disease. To date 7 American became symptomatic from 2019-nCoV infection (the name of this virus) a few days after arriving in the USA from Wuhan; both are currently doing well.

Human coronaviruses most commonly transmit from an infected person to others via: 

  • The air by coughing and sneezing and rarely, fecal contamination
  • Close personal contact, such as touching or shaking hands
  • Touching an object or surface with the virus on it, then touching your mouth, nose, or eyes before washing your hands


   Coronaviruses are usually transmitted from animals, particularly bats, camels, and even snakes to humans. The first 4 cases were all workers in the Huanan Seafood Wholesale Market, which sells live poultry, aquatic animals, bats, and snakes to the public. Unfortunately, the virus has mutated to cause human to human transmission. 


Symptoms can range from those of a mild cold to severe respiratory distress and death. The first signs and symptoms are a fever, cough, and initially mild respiratory distress that often worsens due to development of pulmonary edema ("water on the lungs"). All deaths to date have been in Wuhan City. The incubation latent periods are not certain.
The virus is likely to spread throughout the world because of international travel and precautions may be needed to implemented everywhere. Head and neck cancer may be more vulnerable to respiratory infections and should exercise caution to prevent getting infected.


As the epidemic of corona virus is spreading throughout the world it is important for laryngectomees to protect themselves. Laryngectomee may be at increased danger of inhaling the virus directly into the lungs.

They can protect themselves by:
  • Wearing HME 24/7 especially when being around other people. HME with greater filtering ability would work better in reducing the risk of inhaling the virus ( i.e., Provox Micron TM, Atos Medical's XtraMoist)
  • Wearing a surgical mask over the stoma. A surgical mask with four strings can be modified to fit over the stoma. One of the strings can be extended with extra string; and the lower pair of strings can be tied behind the back. (see pictures)
  • Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
  • Avoid touching your stoma, eyes, nose, and mouth with unwashed hands.
  • Avoid close contact with people who are sick.
  • Clean and disinfect frequently touched objects and surfaces.


To prevent the spread to others stay home when you are sick, and cover your cough or sneeze with a tissue, then throw the tissue in the trash. 


Technique to place a surgical mask over the stoma in a laryngectomee






Message from the Japanese Head and Neck Support Society. (in Japanese and English)

Message from the Singapore Cancer Society 

Tuesday, January 14, 2020

Recreational Cannabis consumption can accelerates the growth of HPV positive head and neck squamous cell carcinoma



The ingredient that causes people on cannabis to feel the euphoria or “high” is associated with accelerating cancer growth in patients with human papilloma virus (HPV)-positive head and neck squamous cell carcinoma.  

Researchers at the University of California San Diego School Of Medicine demonstrated in animals and human cell line, showed how the presence of tetrahydrocannabinol (THC) in the bloodstream enhances the growth of HPV positive squamous cell cancer cells.  When activated, p38 MAPK pathway prevents cell death (apoptosis), thus allowing HPV positive squamous cell cancer cells to grow uncontrollably.

The team also analyzed blood samples from patients with HPV-related throat cancer and similar to the cell lines, the blood samples showed p38 MAPK activation and loss of cancer cell death in tumors from patients with THC in their blood.


The researchers stated that there is now scientific evidence that daily marijuana use can drive tumor growth in HPV-related head and neck cancer.

The study was published in Clinical Cancer Research in January 2020




Tuesday, January 7, 2020

Paroxismal hypertensive episodes caused by direct massage of the carotid artery by a Doppler ultrasound of the neck in a laryngectomee.




Paroxysmal hypertension can occur after radiation to the head and neck. Patients exhibit sudden elevation of blood pressure (> 200/110 mm Hg) associated with an abrupt onset of headache, chest pain, dizziness, nausea, palpitations, flushing, and sweating.
A recent case report in Journal of Medical Ultrasound describes a laryngectomee who experienced repeated paroxysmal hypertensive episodes following direct massage of the carotid artery during Doppler ultrasound of the neck. This test is often performed to detect carotid artery stenosis in head and neck cancer patients who received radiation of the neck. 

The radiation damage to the carotid artery baroreceptors might have increased their hypersensitivity to the mechanical and ultrasonic stimulation during the diagnostic test, leading to the hypertensive episodes. It is recommended that patients who had received radiation therapy for head and neck cancer and require Doppler ultrasound of the carotid artery should be monitored for paroxysmal hypertension by recording their blood pressure prior and after the test.



Wednesday, December 4, 2019

The emerging role of aspirin and metformin in the management of head and neck cancer patients.


Aspirin was found to be associated with risk reduction of secondary primary cancer for patients with head and neck squamous cell cancer (HNSCC).  A population-based analysis of 18,243 patients by Dr Yu-Shan Lin and colleagues from Taipei Medical University Hospital, Taipei, Taiwan; found that aspirin use was associated with 25% reduction in secondary primary cancer incidence of squamous cell carcinoma in head and neck cancer patients. This was attributed mainly to reduced risk of esophageal and stomach cancer.

The function of cyclooxygenase-2 (COX-2) inhibition has been recognized as major mechanism of chemoprevention for aspirin. Many growth factors and inflammatory cytokine known to promote cancer progression were produced, packaged and secreted by thrombocytes, such as platelet derived growth factor, vascular endothelial growth factor and transforming growth factor-β . The inhibition of COX-2 enzymes in thrombocytes results in blockade of synthesis of prostaglandins  from arachidonic acid.The downstream actions of PGE related with GF and cytokines plays essential roles in angiogenesis, cell proliferation and invasion. A platelet count of more than 400,000/μL was associated with higher mortality for patient with HNSCC and the poor prognosis could be overcome by antiplatelet medications.

Metformin (a sugar lowering agent) is a widely used for the treatment of type 2 diabetes mellitus. Metformin use in diabetic patients has been associated with decreased cancer incidence and mortality. This effect seems to result from a reduction in circulating insulin levels, but there are also data indicating direct anti-tumor effects of metformin. 

Several studies demonstrated that metformin is important in the inhibition of cell proliferation, G0/G1 cell cycle arrest, apoptosis and regulation of various proteins involved in cancer pathways, thus corroborating its potential in vitro and in vivo anti-tumor effects.

Three studies demonstrated that diabetics taking metformin had decreased rates of local and regional recurrence and metastasis and improved overall survival and disease-free survival rates. Individuals taking metformin had a lower incidence of HNSCC than those not taking metformin.  

Future studies are warranted to explore the use of aspirin and metformin in in the management of HNSCC patients.




Thursday, August 22, 2019

Methods of speaking after laryngectomy



Allegra and colleagues from the  University of Catania, Catania, Italy compared the acoustic quality of the rehabilitated voice achieved with esophageal speech (ES) and tracheoesophageal speech (TES), and acoustic quality impacts on 67 laryngectomees.  The authors found a significantly better  functional voice performance in TES patients compared to ES.  However, there was no significant differences between the two groups in physical, emotional, and socioeconomic performance.

The authors concluded that the rehabilitation of laryngectomized patients must be addressed by a multidisciplinary team that considers the personalities, personal needs, and relational conditions of individual patients in order to determine and apply the phonatory rehabilitation method most suitable for achieving a better quality of life.




Thursday, June 20, 2019

Comparing surgical and nonsurgical larynx-preserving treatments with total laryngectomy for locally advanced laryngeal cancer.


Patel et al. from  Boston University School of Medicine, analyzed the National Cancer Data Base  between 2003 and 2011 (published in Cancer,June 2019) comparing surgical and nonsurgical larynx-preserving treatments with total laryngectomy for locally advanced laryngeal cancer.


They identified 8703 patients with stage III/IV (excluding T1 tumors) laryngeal squamous cell carcinoma treated with chemoradiation (CRT) or partial laryngectomy (PL) and total laryngectomy(TL)  with or without adjuvant therapy.

The authors found that:

  • Among patients with non-T4, low nodal burden (T2N1 or T3N0-N1) disease, no survival differences were observed between CRT, PL, and TL.
  • Patients who had non-T4, high nodal burden (T2-T3N2-N3) disease who underwent TL with or without adjuvant treatment had a higher risk of death compared with those who received CRT.
  • No statistically significant difference in outcome was noted between CRT and PL for all stage groups.   

The authors concluded that patients with non-T4, high nodal burden disease may benefit from definitive CRT. Total laryngectomy remains advantageous in patients with T4 disease.




Sunday, April 28, 2019

Head and Neck Squamous Cell Carcinona ( HNSCC) is more common and advanced in those living with Human Immunodeficiency Virus (HIV)


Several studies showed that patients living with HIV have a 3 fold higher risk of developing all types of HNSCC including those associated with HPV despite anti-retroviral therapy. This may be because HIV+ patients have a higher rate of alcohol rate and tobacco rate, increased incidence of oral HPV infection and immune suppression ( low CD4 count).

Findings of several studies illustrated that :

  • HPV infection is may be more prevalent in HIV+ patients.
  • The  HIV  virus may have a direct oncogenic role in HHNSCC.
  • HIV+ patients may present with HNSCC at a younger age and a higher stage.
  • Lower CD4 count may predispose patients to HPV related HNCSCC.
  • HIV + HNSCC+  have a poorer survival rates than HIV- HPV + .
  • HNSCC patients who are HPV+ tend to have a more favorable outcomes regardless of HIV status.


As the number of aging HIV+ patients increases learning more the pathophysiology of HNSCC in these patients, outcomes, and ultimately tailored treatment to these unique patient population will become more important.






Sunday, January 27, 2019

Use of nonsteroidal anti-inflammatory drugs improved patient survival for PIK3CA-altered head and neck cancer (HNC).


A new study by UC San Francisco and University of Pittsburgh has found that regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, significantly improves survival for a third or more patients with HNC. 

NSAIDs improved the overall 5-year survival rate from 25% to 78% for patients whose cancer contained a specific altered gene, known as PIK3CA. The survival for patients whose gene was not altered was unaffected by NSAID use.

PIK3CA is the most commonly altered oncogene in head and neck squamous carcinoma, and is found in a third of all tumors. In HNC associated with the human papillomavirus (HPV), PIK3CA is mutated in more than half of tumors.

The retrospective study included 266 patients. Most patients (67%) received post-surgery chemotherapy and/or radiotherapy. PIK3CA gene activating alteration was found in 28% in the patients. Among the patients who regularly used NSAIDs, 93% used aspirin (81mg/day) as a component of the NSAID regiment, and 73% took aspirin exclusively.
The investigators learned that regular use of NSAIDs for at least 6 months provided markedly prolonged improved survival compared to non-use for patients whose PIK3CAgene was mutated or amplified. In these patients, NSAIDs raised overall five-year survival from 25% to 78%. However, patients without alterations in their PIK3CA gene were no better off by taking NSAIDs.

This is the first study to show a strong clinical advantage of regular NSAID use for HNC patients with mutations in the PIK3CA gene and may indicate a clear, biological reason to implement NSAID therapy in certain cases of HNC patients
Through analysis of both cell line and mouse studies, the researchers speculated that NSAIDs likely blocked tumor growth by reducing the production of an inflammatory molecule called prostaglandin E2.

The researchers have designed a prospective, randomized clinical trial to address the study’s limitations (small numbers and retrospective nature of the study) to assess the clinical significance of this therapeutic use.





Saturday, September 1, 2018

Head and Neck Cancer: Through the Eyes of a Patient


Itzhak Brook, MD, MSc, and Meryl Kaufman, MEd, CCC-SLP, BRS-S, discuss cancers of the head and neck and talk about how diagnosis and treatment might impact patients and caregivers. To view click this (A Cure Today presentation.)

Episodes:

a.     An Overview of Head and Neck Cancer. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, discuss the prevalence of cancers of the head and neck, emphasizing the potential risk factors and importance of prevention. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/an-overview-of-head-and-neck-cancer

b.     Head and Neck Cancer: Overcoming Challenges in Treatment. Itzhak Brook, M.D., M.Sc., shares the story of his initial diagnosis and treatment for cancer of the head and neck, outlining the challenges that came along with treatment, with fellow board member of the Head and Neck Cancer Alliance Meryl Kaufman, M.Ed., CCC-SLP, BRS-S. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/head-and-neck-cancer-overcoming-challenges-in-treatment


c.      Head and Neck Cancer: Novel Treatment Approaches. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, share insight into the role of novel treatment approaches like immunotherapy, robotic surgery and de-escalation in the management of cancers of the head and neck. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/head-and-neck-cancer-novel-treatment-approaches


d.     Getting a Diagnosis of Head and Neck Cancer. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, discuss which symptoms should lead one to seek a diagnosis of head and neck cancer and which tests are available to aid in evaluation. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/getting-a-diagnosis-of-head-and-neck-cancer

e.     Head and Neck Cancer from a Patient's Perspective.  Itzhak Brook, M.D., M.Sc., considers how experiencing cancer of the head and neck as a patient affected his understandings as a physician and outlines available patient resources with fellow board member of the Head and Neck Cancer Alliance, Meryl Kaufman, M.Ed., CCC-SLP, BRS-S. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/head-and-neck-cancer-from-a-patients-perspective


f.      Adjusting to Life With Head and Neck Cancer. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, provide their perspectives on adjusting to life with cancer of the head and neck, as a patient or as a caregiver, and share advice for those who must undergo laryngectomy. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/adjusting-to-life-with-head-and-neck-cancer

g.     understanding Treatment Options in Head and Neck Cancer. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, review the various modalities of treatment for cancers of the head and neck and identify which physicians are responsible for delivering this care. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/understanding-treatment-options-in-head-and-neck-cancer




Meryl Kaufman, M.Ed., CCC-SLP,, and Itzhak Brook, M.D.

Wednesday, August 15, 2018

"The Laryngectomee Guide” is available in English, Spanish, Russian,Turkish, Italian, Bulgarian, Romanian, Arabic, Portuguese, French, Persian, Korean, Japanese, Filipino, and traditional and simplified Chinese.

"The Laryngectomee Guide” is available now in English, Russian,Turkish, Italian, Bulgarian, Romanian, Arabic, Spanish, Portuguese, French, Persian (Farsi), Korean, Japanese, Filipino (Tagalog), and traditional and simplified Chinese in paperback, Kindle and eBookeBooks an d Kindle are available FREE.

The Guide provides practical information that can assist laryngectomees and their caregivers with medical, dental and psychological issues. It contains information about side effects of radiation and chemotherapy; methods of speaking; airway, stoma, and voice prosthesis care; eating and swallowing; medical, dental and psychological concerns; respiration; anesthesia; and travelling.





Links to obtain paperback, eBook, and Kindle Edition of the Guide in different languages:

Englishpaperback , Kindle, and eBook
Russianpaperback, and eBook
Turkish language: paperback, and eBook.
Italianpaperback and Kindle, and eBook.
Bulgarian: paperback, and eBook.
Romanian language Guide  are: paperback (in Amazon, in Lulu), and eBook
Arabic: paperback, eBook, and Kindle.
Spanish (Andine edition): paperback and Kindle, and eBook.
Spanish (Spain edition): paperback and Kindle , and  eBook.
Spanish language (Center America edition): paperback and Kindle.
Spanish (South America edition): paperback and kindle
PortuguesepaperbackKindle, and eBook.
French language: paperback and Kindle , and eBook.
Persian (Farsi) : paperback, eBook and kindle.
Korean: paperback, and eBook.
Japanese: paperback, and eBook.
Filipino (Tagalog): paperback, and eBook
Traditional ChinesepaperbackeBook and Kindle.
 Simplified Chinesepaperback, and eBook 



Links to obtain FREE eBook of the Guide:

English click this link.
Russian  click this link.
Turkish click this link.  
Italian click this link.
Bulgarian click this link.
Romanian click this link. 
Arabic click this link.
Spanish (Andine editionclick this link.
Spanish (Spain edition) click this link
Spanish (Central America edition) click this link
Spanish (South America editionclick this link.
Portuguese click this link.
French click this link.
Persian (Farsiclick this link.
Korean click this link.
Japanese click this link.
Filipino (Tagalog) click this link.
Traditional Chinese click this link
Simplified Chinese click this link.




                        Russian language Guide                       Turkish language Guide  




Italian language Guide                     Chinese language  Guide    
                                                                 
                                             



                                                                                      Bulgarian language guide                                Arabic language guide 








     Portuguese language Guide                               Persian language Guide
                


                                                       


       Romanian language Guide                                French language Guide




 

        Korean language Guide                             Spanish language Guide
                  

                                     

Japanese language Guide






Filipino (Tagalog) language Guide

Tuesday, August 14, 2018

Positive initial margins is associated with poorer disease free survival (DFS) among patients with primary laryngeal squamous cell carcinoma who undergo total laryngectomy.



Positive initial margins, even among patients with negative final margins, appeared associated with poorer DFS among patients with primary laryngeal squamous cell carcinoma who received total laryngectomy, according to recently published findings. These were the findingof Tassone and colleagues of the Thomas Jefferson University.
The researchers performed a retrospective cohort study of 237 patients who underwent total laryngectomy for squamous cell carcinoma from February 2008 to July 2016. They considered margins positive if they contained invasive carcinoma, carcinoma in situ or severe dysplasia.

A total of 225 patients had negative final margins, and 127 underwent primary total laryngectomy, whereas 98 received salvage total laryngectomy. Salvage laryngectomy was associated with significantly worse, whereas primary total laryngectomy was not.

The authors concluded that surgical margin status may be an important prognostic factor in head and neck cancer. Furthermore, positive initial frozen margins even in patients with negative final margins, are associated with increased risk of local treatment failure in the context of primary total laryngectomy.


                                                         
                                                          Positive and negative tumor margins

Friday, July 27, 2018

Immunotherapy in head and neck squamous cell carcinoma

Head and neck squamous cell carcinoma is an immuno-suppressive malignancy, with many defects in the host immune system contributing to the progression of disease, as cancer cells evade immune-surveillance due to accumulation of genetic mutations and tumor heterogeneity. Improved understanding of the role of the immune system in cancer has led to the identification of novel therapeutic targets, and the development of a range of novel therapeutic targets which are being investigated for their potential to provide durable responses and improve the outcomes of this disease.

Immuno-oncology is an evolving field of investigation that includes active immunotherapies that are designed to target and harness the patient’s own immune system directly to fight cancer. More specifically, it is designed to leverage the unique properties of the immune system (specificity, adaptability, and memory).The primary goal of immunotherapy is to shift the balance in favor of an immune response against the tumor, allowing tumor eradication or long-term suppression of tumor growth, and the generation of immunological memory. Therapeutic approaches include: Monoclonal antibodies, Immune checkpoint inhibitors, Dendritic cells vaccines, and Adoptive T cell therapy.  The better understanding of the mechanisms of immune escape has led to the development of novel immunotherapies that has shown initial promising results in many solid tumors including Head and neck squamous cell carcinoma.




Saturday, December 16, 2017

Association of neurocognitive deficits with radiotherapy or chemoradiotherapy for patients with head and neck cancer


A study by Zer and colleagues of the University from Toronto General Hospital investigated the short- and long-term neurocognitive deficits (NCD) after treatment in patients with head and neck cancer (HNC). The investigators evaluated 80 newly diagnosed patients with head and neck cancer and 40 noncancer controls over a period of 2 years. Most patients had oropharyngeal SCC (76%); and received cisplatin-based chemoradiation (61%). The neurocognitive domains assessed were: intellectual capacity, concentration/short-term attention span, visual memory, verbal memory, processing speed, executive function, and motor dexterity.

The investigators found that neurocognitive function, although not immediately affected after treatment, progressively declines in 38% of the patients in the 2 years after definitive treatment with chemotherapy or radiation. A retrospective study by the same investigators suggested an association between radiation therapy for HNC and NCD and demonstrated an association of temporal lobe and cerebellum radiation dose with impaired memory and motor dexterity, respectively. Chemotherapy-induced NCD have been documented in other cancer populations (e.g., breast cancer and hematologic malignancy).

The authors recommend that adverse cognitive risks should be communicated to patients and families, and strategies to reduce toxic effects and cognitive rehabilitation options should be available for HNC survivors.



Tuesday, December 5, 2017

Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline 2017 Update


The American Society of Clinical Oncology has released new guideline recommendations for the use of larynx-preservation strategies in the treatment of laryngeal cancer, which was published in the Journal of Clinical Oncology.

A panel of expert confirmed that the use of a larynx-preservation approach for patients does not compromise survival. Furthermore, there was no larynx-preservation strategy found that offered a survival advantage compared with total laryngectomy and adjuvant therapy. Changes to the previous recommendations involved the use of endoscopic surgical resection in patients with T1 and T2 disease, initial total laryngectomy in patients with T4a disease, and PET imaging for evaluating regional nodes.

According to the new recommendations, patients with T1 or T2 laryngeal cancer should begin treatment with intent to preserve the larynx by using endoscopic resection or radiation therapy. As for patients with T2 or T4 disease, organ-preserving surgery in combination with chemotherapy and radiation (or radiation alone) may preserve the larynx without compromising overall survival. Selected patients with extensive T3 or large T4a lesions or poor laryngeal function prior to treatment are recommended total laryngectomy to achieve better survival rates and quality of life.