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Researchers exploring whether tongue can reveal colon cancer

Study takes cue from Chinese medicine

Tuesday, October 01, 2002

Christopher Snowbeck, Post-Gazette Staff Writer

If eyes are windows to the soul, then maybe the tongue provides a view of the gut. A small study being conducted by a Carnegie Mellon University computer scientist and a UPMC Health System physician is exploring whether a visual inspection of the tongue can provide an early warning of colon cancer.

Yang Cai is a computer scientist at Carnegie Mellon University is interested in learning whether the precepts of Traditional Chinese Medicine may help Western doctors one day diagnose colon cancer through an examination of the tongue. (Annie O'Neill,Post-Gazette)

The idea comes from Traditional Chinese Medicine, in which the tongue is a key diagnostic tool.

Traditional doctors in China believe different parts of the tongue correspond to internal organs. The tip of the tongue, for example, reveals heart and lung conditions, and the middle tongue conditions of the spleen and stomach.

Specifically, the Pittsburgh researchers are testing a different set of traditional beliefs: Whether changes in the tongue's color and coating can reveal clues to cancer.

Yang Cai, the computer scientist, said research from his Chinese homeland shows that the growth of some tumors gives the tongue a bluish cast and changes its texture. That's just one finding from "12,448 Cases of the Clinical Observation of Cancer Patients' Tongues," published in 1987 in a Chinese cancer journal.

As a computer scientist, Cai was intrigued by the challenge of making a digitial image of the tongue that accurately reflects both color and texture. To do the job, he's applying computer vision technology that was first developed by the army to detect tanks.

If the tongue does speak to cancer, Cai's research partner at UPMC, Dr. Robert Schoen, doesn't yet understand it. Supporting studies are written in Chinese, which he can't read.

Still, Schoen grooved to the idea of putting the tongue to the test.

"I'm a big proponent of applying rigorous scientific methodology to things like Traditional Chinese Medicine or other sorts of alternative medicine," said Schoen, director of colorectal and gastrointestinal cancer prevention and control research at the University of Pittsburgh Cancer Institute.

He has some skepticism about the project, in which more than 30 patient tongues were photographed this spring. But it's worth testing because a tongue screening would be a simple, cheaper alternative to colonoscopy, an invasive colon cancer screening technique.

"People would be happy to just stick out their tongues," Schoen said.

The idea of studying Traditional Chinese Medicine in Oakland got a big boost in January 2000 when Pitt Medical Center announced plans to raise $10 million to develop medicines from Chinese herbs. A minister from the Chinese government attended the announcement and plans were made to hire a world-class director and use a $100,000 Jewish Healthcare Foundation grant to recruit researchers.

More than two years later, the center has been created, but has no director or special researchers. UPMC recently agreed to return the $100,000 grant.

"At the time, there was an expectation that we could immediately secure substantial funding for the center," said Scott Lammie, executive vice president for UPMC Diversified Services. "But the interest level wasn't there to be able to secure the funding [from other sources]. So, from the UPMC Health System's perspective, we decided to call it a day as far as that being a major area of emphasis."

Cai's tongue project represents one of the remaining pockets of interest.

Dr. Ronald Herberman, director of Pitt's Cancer Institute, traveled more than a year ago to the leading Traditional Chinese Medicine hospital in Beijing.

The Chinese have long used herbal medicines to treat cancer and other maladies. Patients drink the herbs in teas, but also receive them through injections and IVs.

One such treatments is an herb mixture called hungliang. The main ingredient is berberine, which has been reported in U.S. scientific journals as having some effect on cancer cells, Herberman said.

UPCI decided to study whether hungliang helps breast cancer patients, but learned that an oncologist at Memorial Sloan-Kettering Cancer Center in New York City had already begun a similar study.

"We discussed with him how we could partner on studies of hungliang and decided we would await his results on ... safety and effectiveness," Herberman said. "If things look promising, we told him, we would use our connections to help us and him get a larger batch" for future studies.

The only other Traditional Chinese Medicine project at UPCI is a study of whether acupuncture can reduce chemotherapy side effects, such as nausea and fatigue.

The cancer center is looking for other herbal mixtures to study, Herberman said, and if Cai's tongue research proves promising, it could be brought into the center, too.

"There may be valuable insights to come from the traditional Chinese experience. ... I can't dismiss out-of-hand what's been going on for hundreds of years because many of the drugs that actually are used in the United States and Europe started out as folk medicines."

If Cai's study shows value, it wouldn't be the first time Western doctors have noted a correlation between the tongue's appearance and disease, Schoen said.

Glossitis, also known as tongue inflammation or tongue infection, can be caused by a variety of problems. The tongue usually has a dark "beefy" red color, but can turn pale due to pernicious anemia or fiery red from a deficiency of B vitamins.

Schoen added that an enlarged tongue might also be a sign of amyloidosis, the disease that killed former Pittsburgh Mayor Richard Caliguiri.

"The tongue is one of the first parts of the GI tract that's visible," Schoen said.

Whatever the results of the tongue study, Cai insists that people shouldn't try self-diagnosis by looking at their tongues in the mirror.

"It's a tool for professional medical doctors," he said. "Unless you have very clear guidance, sometimes it's misleading."

Christopher Snowbeck can be reached at csnowbeck@post-gazette.com or 412-263-2625.

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