skip to main content
Press Release | May 26, 2011

Pan-Canadian Surgical Study Offers New Hope for Patients with Early-Stage Oral Cancer


Pic #1
, #2 - TFRI is providing $4.7 million in funding for a new pan-Canadian study in oral cancer surgery. Principal investigators involved in the nine-site study met in Victoria , BC on May 23 to discuss the five-year study, which has the potential to revolutionize clinical practice in oral cancer surgery for tumours and pre-cancerous lesions of the mouth. The surgeons are using fluorescence visualization to guide surgery. Above, unveiling the project logo are (l-r): Dr. Victor Ling, TFRI president and scientific director, and Drs. Miriam Rosin, Scott Durham and Catherine Poh, TFRI COOLS Study principal investigators.
Vancouver, BC – Currently, about 30 per cent of patients who receive oral surgery have their cancer recur. But a new, Canada-wide surgical trial using a new approach to remove tumours and pre-cancerous cells from the mouths of those diagnosed with early-stage oral cancer offers new hope for patients.

The Terry Fox Research Institute (TFRI) announces the launch of a $4.7 million Pan-Canadian Phase III clinical trial aimed at improving outcomes for patients undergoing surgery for oral squamous cell cancers. The Canadian Optically Guided Approach for Oral Lesions Surgical Trial (The COOLS Study) has the potential to revolutionize clinical practice here and around the world for this kind of cancer.

"Our investment in this promising study is our response to a serious clinical concern expressed by head and neck surgeons across Canada and it has the potential to change surgical practices for cancer of the mouth nationally and internationally," said Dr. Victor Ling, TFRI President and Scientific Director.

Using a new surgical approach guided by an existing hand-held light tool, the surgeons, pathologists, and scientists involved in this nine-centre study will determine whether recurrence is reduced when they shift the surgical field for the removal of tumours or pre-cancerous cells in the mouth.

The surgeons will use fluorescence visualization (FV) or "blue light" provided by the optical aid rather than traditional white light to determine the tissue to be removed. Under the blue light, normal tissue generates a fluorescence which is absent in tumour or pre-cancerous tissue. The study will aim to spare normal healthy tissue from surgery while catching high-risk, pre-cancerous tissue identified through FV.

"This study will have an immediate impact on practice if the study turns out the way we hope," says TFRI COOLS Study principal investigator Dr. Miriam Rosin, a senior scientist with the BC Cancer Agency who holds joint appointments at the University of British Columbia and Simon Fraser University. "If the study is successful, it will help to reduce the number of deaths from oral cancer as well as to improve the quality of life for people living with this disease. Working with scientists, we will have this new approach ready to disseminate to the surgical community at large and even globally."

"In work we've conducted to date in Vancouver, there has been almost no recurrence where surgery followed the contour of the lesion shown by using FV-guided surgery. Working together with surgeons, pathologists, research staff and scientists, this TFRI-funded study will enable us to test the approach on a broader cohort of patients at sites across the country and obtain the evidence required to change current practice." remarks principal investigator Dr. Catherine Poh, a senior scientist with BC Cancer Agency and oral pathologist and associate professor, University of British Columbia and oral pathologist and consulting dentist, Vancouver General Hospital.

This is the first Canadian study ever to bring together this group of clinicians to address a surgical challenge in oral cancer. "Our surgical community has expressed great interest in participating in this trial which provides a unique and important opportunity to assess a surgical intervention in a controlled prospective manner across many sites," says principal investigator Dr. Scott Durham, an ear, nose and throat surgeon and clinical professor and head, division of otolaryngology, Vancouver General Hospital. The study aims to build a network of clinicians, pathologists and research staff across the country to fight oral cancer.

About The Terry Fox Research Institute:

Launched in October 2007, The Terry Fox Research Institute is the research arm of The Terry Fox Foundation. TFRI seeks to improve significantly the outcomes of cancer research for the patient through a highly collaborative, team-oriented, milestone-based approach to research that will enable discoveries to translate quickly into practical solutions for cancer patients worldwide. TFRI collaborates with over 50 cancer hospitals and research organizations across Canada as MOU partners. TFRI headquarters are in Vancouver, BC.



For more information, contact:

Kelly Curwin

Chief Communications Officer
C: 778-237-8158



9am, BC Cancer Agency

Please meet in front lobby of BC Cancer Agency Vancouver Centre

600 West 10th Avenue

COOLS study principal investigator Dr. Catherine Poh will demonstrate the Fluorescence Visualization (Blue Light) Tool at a demonstration in the Oral Oncology laboratory with a former patient who underwent oral surgery four years ago. Dr. Poh will also make available clinical images depicting lesions as seen under white light and flourescence visualization. Both Dr. Poh and the cancer survivor will be available during this time to be interviewed by media.

For more information, or to attend this demonstration, please contact:

Allison Colina
BC Cancer Agency
t. 604-861-8079
Lisa Carver
Vancouver Coastal Research
t. 604-319-7533


The Canadian Optically Guided Approach for Oral Lesions Surgical Trial (COOLS Study)

Total Invested: $4,734.469

Study Leads:
  • Dr. Miriam Rosin, Principal Investigator (Director of the British Columbia Oral Cancer Prevention Program; Senior Scientist, BC Cancer Agency; Professor, Biomedical Physiology and Kinesiology, Simon Fraser University and Professor, Pathology and Laboratory Medicine, University of British Columbia
  • Dr. Catherine Poh, Principal Investigator (Oral Pathologist, BC Provincial Oral Biopsy Service; Senior Scientist, BC Cancer Agency; Associate Professor, Faculty of Dentistry, University of British Columbia; Oral Pathologist, Anatomical Pathology and consulting dentist in Dentistry at Vancouver General Hospital).
  • Dr. Scott Durham, Principal Investigator (Head, Department of Otolaryngology, Vancouver General Hospital; Clinical Professor and Head, Division of Otolaryngology, Faculty of Medicine, University of British Columbia; Consulting Surgical Oncologist, BC Cancer Agency )
  • Dr. Calum MacAulay, Project Imaging Lead (Head, Integrative Oncology Department, BC Cancer Agency; Professor, Pathology/Laboratory Medicine and Physics and Astronomy departments, University of British Columbia)
  • Dr. Stuart Peacock, Health Economist (Co-Director, Canadian Centre for Applied Research in Cancer Control (ARCC), Associate Professor, University of British Columbia) and Dr. Jeffrey Hoch Health Economist (Co-Director, ARCC)
  • Dr. Kitty Corbett, Knowledge Translation and Public Health Communication Specialist (Professor, Faculty of Health Sciences, Simon Fraser University)
About the Study

Primary Objective: The primary objective is to determine whether a simple hand-held light device to guide surgery can reduce oral cancer recurrence
Design: Double-blinded, controlled randomized Phase III study
Duration: 5 years
Participants: Patients diagnosed with severe dysplasia, carcinoma in situ and invasive squamous cell carcinoma and undergoing surgery treatment with intent to cure.

Led by Vancouver-based clinicians and scientists, this pan-Canadian study will recruit 400 patients from across Canada over the next two years; study teams at the nine sites will continue to follow their patients' progress for an additional three years to determine if there is any recurrence. Teams of clinicians and scientists have been formed at each site and they include surgeons, pathologists, dental specialists, and research nurses and coordinators. Participating surgeons will recruit eligible patients.

As part of the study, health economists will collect health economic evidence and data relative to the cost-effectiveness of the study and cost per quality of adjusted life years gained. As well, a knowledge translation specialist will partner with the team to collect and exchange health service information and develop plans to apply, both in Canada and abroad, the knowledge gained.

Specialized Fluorescence Flash Camera: A special, user-friendly "all in one" camera has been developed which will allow the FV specialist to automatically capture clinical lesion images under white light and fluorescence visualization without needing changes to filters or settings.

Participating Sites


In Canada, it is estimated that 3,400 Canadians are diagnosed with oral cancer every year. In 2010, the estimated number of deaths due to oral cancer was 1,150. (Source: Canadian Cancer Society, 2010) Surgery is often used to treat oral cancer. Reconstructive surgery may be needed after the surgeon removes the tumour and some healthy tissue around it. If the cancer has spread, surgery may be required in other areas such as the neck, lymph nodes and throat.