Treatment of oral cancers during pregnancy: a case-based discussion

Salivary Gland Tumors in Pregnancy-Treatment Strategies

Background: The management of salivary gland tumors (SGTs) during pregnancy is a subject that has received scant attention in the medical literature. While treatment recommendations for cancer therapy in pregnancy have been delineated, those for benign tumors remain unspecified. The present inquiry focuses on the number of women of reproductive age with SGTs and the optimal diagnostic and treatment strategies for tumors occurring during pregnancy. Materials and Methods: This was a retrospective multicenter cohort study based on data from the Polish Salivary Network Database, collected between 2018 and 2022. From a total of 2653 patients with salivary gland tumors (SGTs), we identified 1313 women, including 300 of reproductive age (16-42 years). Among them, six cases of SGTs diagnosed during pregnancy were included for detailed analysis. Ethical approval was obtained for this study. Results: Among the 300 women of reproductive age, 285 had benign SGTs and 15 had malignant SGTs. Six tumors were diagnosed during pregnancy: four benign (pleomorphic adenomas) and two malignant (salivary duct carcinoma and mucoepidermoid carcinoma). All benign tumors were monitored during pregnancy and surgically treated postpartum. One malignant tumor was resected postpartum, while the second showed a rapid progression in late pregnancy and required early intervention. Individual case details highlighted the diagnostic and therapeutic complexity in this population. Conclusions: A standard diagnostic protocol, incorporating ultrasounds and a fine-needle aspiration biopsy, is recommended during pregnancy. For cases in which the clinical and imaging characteristics suggest a benign origin, surveillance is proposed. Conversely, surgical resection is recommended for malignant SGTs, irrespective of the gestational stage. The potential for the malignant transformation of benign tumors during pregnancy in young women underscores the necessity for surgical intervention prior to planned conception.

Tongue Squamous Cell Carcinoma and Oral Lichen Planus: A Rare Case Report of a Pregnant Woman

Squamous cell carcinoma (SCC) of oral mucosa is increasingly affecting younger individuals, particularly in the tongue. SCC can develop from disorders like oral lichen planus (OLP). This case highlights the first known instance of OLP and SCC in a pregnant woman, suggesting hormonal changes and HPV as possible risk factors.

Otolaryngologists and Reproductive Rights

Our nation faces contentious questions regarding reproductive rights and access to abortion which have long been viewed as beyond the scope of otolaryngology. The broad implications of the recent Supreme Court ruling in Dobbs v Jackson Women's Health Organization (Jackson) impact all people who are, or can become, pregnant and their health care providers. The consequences for otolaryngologists are thus far-reaching and poorly understood. Here we describe how the post-Dobbs landscape is relevant to the practice of otolaryngology and offer suggestions for how otolaryngologists can best respond, prepare, and support their patients in this tenuous political landscape.

Volumetric modulated arc therapy (VMAT): a review of clinical outcomes—what is the clinical evidence for the most effective implementation?

Modern conformal radiation therapy using techniques such as modulation, image guidance and motion management have changed the face of radiotherapy today offering superior conformity, efficiency, and reproducibility to clinics worldwide. This review assesses the impact of these advanced radiotherapy techniques on patient toxicity and survival rates reported from January 2017 to September 2020. The main aims are to establish if dosimetric and efficiency gains correlate with improved survival and reduced toxicities and to answer the question ‘What is the clinical evidence for the most effective implementation of VMAT?’. Compared with 3DCRT, improvements have been reported with VMAT in prostate, locally advanced cervical carcinoma and various head and neck applications, leading to the shift in technology to VMAT. Other sites such as thoracic neoplasms and nasopharyngeal carcinomas have observed some improvement with VMAT although not in line with improved dosimetric measures, and the burden of toxicity and the incidence of cancer related deaths remain high, signaling the need to further mitigate toxicity and increase survival. As technological advancement continues, large randomised long-term clinical trials are required to determine the way-forward and offer site-specific recommendations. These studies are usually expensive and time consuming, therefore utilising pooled real-world data in a prospective nature can be an alternative solution to comprehensively assess the efficacy of modern radiotherapy techniques.

A 31-Year-Old Pregnant Woman With Asthma, Presenting With Worsening Dyspnea, Wheeze, and Hoarseness

CASE PRESENTATION

A 31-year-old woman (gravida 3 and para 1-0-1-1 at 20 weeks gestation) was admitted to the hospital for a presumed acute asthma exacerbation. She had a history of severe persistent asthma since childhood. She described her symptoms as progressively worsening since the beginning of her pregnancy. In addition to her dyspnea and wheeze, both of which occurred at rest and with exertion, she complained of worsening hoarseness and mild dysphagia of solid foods over the week before admission. Her primary care provider treated her with a combined corticosteroid and long-acting beta-agonist inhaler, albuterol inhaler and nebulizer, azithromycin, and two courses of prednisone without improvement. Her allergist performed a handheld spirometry 2 months before admission that was repeated 3 weeks later in the office. She had a social history of alcohol dependence but had been sober for 9 months. She was a former one-pack-per-day smoker but quit 20 weeks before admission and used marijuana occasionally. She had no known occupational or inhalation exposures.

Pregnancy and Dentistry: A Literature Review on Risk Management during Dental Surgical Procedures

Background: Pregnancy is a unique moment in a woman’s life, accompanied with several physiologic changes that have an impact on oral health. Aim of the study: The purpose of the present study was to conduct a critical review of published literature regarding pregnancy and dentistry, the most frequent oral diseases that are encountered during pregnancy, their correlation to adverse pregnancy events, and safe dental treatments that can be performed during pregnancy. Methods: A Medline/COCHRANE search was carried using specific keywords and MeSH terms, combined with the boolean operators “OR” and “AND”. Results: The search led to 146 publications including guidelines, meta-analyses, systematic and non-systematic reviews, published between 2000 and 2021. Discussion and conclusions: Due to the increased inflammatory and immune body response that characterizes pregnancy, periodontal conditions are often aggravated during pregnancy and periodontal disease encountered frequently in pregnant patients. There are conflicting study results in the literature regarding the association between periodontitis and adverse pregnancy outcomes. Periodontal treatment did not show a significant reduction in the adverse outcomes. Many dentists, often due to lack of information, are reluctant to provide dental treatment to pregnant women. However, preventive and restorative dental treatment is safe during pregnancy. Diagnostic radiographs may be performed after the first trimester if absolutely necessary. Analgesics (such as paracetamol) and anesthetics (such as lidocaine) are also considered safe. In case of infection, antibacterial drugs such as amoxicillin, ampicillin, and some cephalosporines and macrolides can also be prescribed. Organogenesis takes place in the first trimester, the time during which the fetus is susceptible to severe malformations (teratogenesis). The ideal time to perform dental treatment is the second trimester (week 17 to 28). However, acute pain or infections make the intervention of the dentist absolutely necessary and emergency treatment can be performed during the whole pregnancy period.

Silencing of SPP1 Suppresses Progression of Tongue Cancer by Mediating the PI3K/Akt Signaling Pathway

Background:

In the present study, we aimed to find an effective target for the treatment of tongue cancer using gene chip screening and signal pathway research.

Methods:

We used microarray screening and gene expression profile analyses to find important differentially expressed genes in tongue cancer. We constructed a protein-protein interaction network, and used enrichment analysis of the Kyoto Encyclopedia of Genes and Genomes to screen for important genes. We then silenced the genes of interest in SCC154 cells to study the relationship with the Phosphatidylinositol 3-kinase/Akt signal pathway. Western blot analyses, the 3-(4,5Dimethylthiazol-yl)-2,5Dimethylthiazol-2-yl)-2,5diphenyltetrazolium bromide (MTT) test, and immunofluorescence assays were used to compare the expression levels of Phosphatidylinositol 3-kinase/Akt signal pathway-related proteins, cell viability, and cell proliferation ability in normal SCC154 cells, Si-RNA SCC154 cells, and gene-silenced SCC154 cells. The scratch test, Transwell test, and western blotting were used to determine migration, invasion, and carcinogenesis.

Results:

Using GSE9844, GSE13601, and GSE31056 gene chips, we identified 93 upregulated genes and 76 downregulated genes in tongue cancer. Using the protein-protein interaction network and Kyoto Encyclopedia of Genes and Genomes enrichment analyses, we further identified 47 differentially expressed genes. Using Kaplan-Meier plotter online tools, we also identified 3 genes (SPP1, Recombinant Human Secreted Phosphoprotein 1; PLAU, plasminogen activator urinary; and APP, amyloid precursor protein). Compared with normal SCC154 cells and Si-RNA control SCC154 cells, the expressions of Phosphatidylinositol 3-kinase/Akt pathway proteins in si-SPP1 SCC154 cells were significantly decreased (*P < 0.05), and the protein activities and proliferation abilities were also significantly decreased (*P < 0.05), while the migration ability, invasion ability, and cancer forming ability were significantly increased (*P < 0.05).

Conclusion:

Inhibition of the SPP1 gene may have a therapeutic effect on tongue cancer, and could be an effective target for the treatment of this disorder.

Supraglottic p16+ squamous cell carcinoma during pregnancy: a case report and review of the literature

BACKGROUND

Head and neck cancer during pregnancy is uncommon. Specifically, laryngeal cancer in pregnancy has only been previously reported 10 times. HPV p16+ supraglottic cancer during pregnancy has never been described in the literature prior to this case report. This case is important to report to understand the most effective and safe diagnostic, treatment and follow-up options available for pregnant patients with laryngeal cancer.

CASE PRESENTATION

This report describes a case of a 33-year-old patient who was 24 weeks pregnant presenting with dysphonia and odynophagia. After laryngeal biopsy and MRI she was diagnosed with T3N1M0, stage three p16+ squamous cell carcinoma of the supraglottis. After inter-disciplinary consultation as well as extensive patient discussion, an awake tracheostomy, PEG tube placement and then elective C-section at 28 weeks' gestation was completed. This was followed by chemoradiotherapy. The patient has remained free from disease with a healthy child at four years post-treatment.

CONCLUSION

Supraglottic cancer during pregnancy is rare with only four previous cases reported in the literature. This case report elucidates the importance of including multiple specialities as well as patient preference in the decision-making process regarding treatment for patients with supraglottic cancer during pregnancy. Furthermore, diagnostic and treatment guidelines for pregnant patients with head and neck cancers should be established to promote the best possible oncological, obstetrical and neonatal care.

Multi-Region Sequence Analysis of a Pregnancy-Related Oral Squamous Cell Carcinoma Exhibiting Low-Level Aggressive Behavior

We analyzed the genetic and epigenetic profiles of an oral squamous cell carcinoma affecting a 41-year-old pregnant female. The patient presented with an oral mass located at the hard and soft palate with bone involvement and lymph node metastases (T4N1M0). She had been treated with multimodal radiotherapy and chemotherapy, and she is currently alive with no evidence of disease 8 years after treatment. DNA methylation and DNA mutation analyses were used to analyze multiple samples from the tumor mass and from the non-neoplastic mucosa to verify tumor heterogeneity. Genetic and epigenetic analyses revealed the presence of one shared TP53 driver mutation with the same DNA methylation profile in each of the 3 areas of the tumor mass; only 2 additional passenger mutations were detected, suggesting a simple clonal homogeneous carcinoma, which usually is associated with low-level aggressive behavior. Additionally, no genetic or epigenetic alteration in the non-neoplastic oral mucosa was detected, demonstrating the absence of field cancerization. The low aggressiveness of the lesion was confirmed by the patient being free of disease at a long-term follow-up examination. These data suggest a different molecular transformation pathway in pregnancy-related oral squamous cell carcinomas, providing new perspectives for further investigation.