text:
The Mouth and Throat
Cancer Cells
Risk Factors
Second Opinion
Follow-up Care
Sources of Support
Taking Part in Cancer Research
National Institute of Dental and Craniofacial Research Information Resources
National Institute on Deafness and Other Communication Disorders
About This Booklet
This National Cancer Institute (NCI) booklet (NIH Publication No. 09-1574) is about oral cancer. Oral cancer can develop in any part of the oral cavity (the mouth and lips) or the oropharynx (the part of the throat at the back of the mouth).
Each year in the United States, more than 21,000 men and 9,000 women are diagnosed with oral cancer. Most are over 60 years old.
Learning about medical care for oral cancer can help you take an active part in making choices about your care. This booklet tells about:
- Treatment
- Nutrition
- Reconstruction and rehabilitation
- Taking part in research studies
This booklet has lists of questions that you may want to ask your doctor. Many people find it helpful to take a list of questions to a doctor visit. To help remember what your doctor says, you can take notes. You may also want to have a family member or friend go with you when you talk with the doctor--to take notes, ask questions, or just listen.
The Mouth and Throat
The pictures below show the many parts of your mouth and throat:
- Lips
- Gums and teeth
- Tongue
- Lining of your cheeks
- Salivary glands (glands that make saliva)
- Floor of your mouth (area under the tongue)
- Roof of your mouth (hard palate)
- Soft palate
- Uvula
- Oropharynx
- Tonsils
This picture shows the parts of your mouth, including the area under the tongue.
This picture shows the parts of your mouth and throat.
Cancer Cells
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.
Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
Tumors in the mouth or throat can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors:
Benign tumors:
- are rarely a threat to life
- can be removed and usually don't grow back
- don't invade the tissues around them
- don't spread to other parts of the body
Malignant tumors:
- may be a threat to life
- can grow back after they are removed
- can invade and damage nearby tissues and organs
- can spread to other parts of the body
Almost all oral cancers begin in the flat cells (squamous cells) that cover the surfaces of the mouth, tongue, and lips. These cancers are called squamous cell carcinomas.
Oral cancer cells can spread by breaking away from the original tumor. They enter blood vessels or lymph vessels, which branch into all the tissues of the body. The cancer cells often appear first in nearby lymph nodes in the neck. The cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.
The spread of cancer is called metastasis. See the Staging section for information about oral cancer that has spread.
Risk Factors
When you get a diagnosis of cancer, it's natural to wonder what may have caused the disease. Doctors can't always explain why one person gets oral cancer and another doesn't.
However, we do know that people with certain risk factors may be more likely than others to develop oral cancer. A risk factor is something that may increase the chance of getting a disease. For example, using tobacco and drinking alcohol are risk factors for oral cancer. Three out of four people with oral cancer have used tobacco, alcohol, or both.
Studies have found the following risk factors for oral cancer:
- Tobacco: Tobacco use causes most oral cancers. Smoking cigarettes, cigars, or pipes, or using smokeless tobacco (such as snuff and chewing tobacco) causes oral cancer. The use of other tobacco products (such as bidis and kreteks) may also increase the risk of oral cancer. For cigarette smokers, the risk of oral cancer increases with the number of cigarettes smoked per day. The risk is greater for people who use both tobacco and alcohol than for those who use only tobacco or only alcohol.
Quitting is important for anyone who uses tobacco. Quitting at any time is beneficial to your health. For people who already have cancer, quitting may reduce the chance of getting another cancer, lung disease, or heart disease caused by tobacco. Quitting can also help cancer treatments work better.
There are many ways to get help:
- Ask your doctor about medicine or nicotine replacement therapy. Your doctor can suggest a number of treatments that help people quit.
- Ask your doctor or dentist to help you find local programs or trained professionals who help people stop using tobacco.
- Call staff at the NCI Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848) or instant message them through LiveHelp. They can tell you about:
- Ways to quit smoking
- Groups that help smokers who want to quit
- NCI publications about quitting smoking
- How to take part in a study of methods to help smokers quit
- Go online to Smokefree.gov (http://www.smokefree.gov), a Federal Government Web site. It offers a guide to quitting smoking and a list of other resources.
- Heavy alcohol use: People who are heavy drinkers are more likely to develop oral cancer than people who don't drink alcohol. The risk increases with the amount of alcohol that a person drinks. The risk increases even more if the person both drinks alcohol and uses tobacco.
- HPV infection: Some members of the HPV family of viruses can infect the mouth and throat. These viruses are passed from person to person through sexual contact. Cancer at the base of the tongue, at the back of the throat, in the tonsils, or in the soft palate is linked with HPV infection. The NCI fact sheet HPV and Cancer has more information.
- Sun: Cancer of the lip can be caused by exposure to the sun. Using a lotion or lip balm that has a sunscreen can reduce the risk. Wearing a hat with a brim can also block the sun's harmful rays. The risk of cancer of the lip increases if the person also smokes.
- A personal history of oral cancer: People who have had oral cancer are at increased risk of developing another oral cancer. Smoking increases this risk.
- Diet: Some studies suggest that not eating enough fruits and vegetables may increase the chance of getting oral cancer.
- Betel nut use: Betel nut use is most common in Asia, where millions chew the product. It's a type of palm seed wrapped with a betel leaf and sometimes mixed with spices, sweeteners, and tobacco. Chewing betel nut causes oral cancer. The risk increases even more if the person also drinks alcohol and uses tobacco.
The more risk factors that a person has, the greater the chance that oral cancer will develop. However, most people with known risk factors for oral cancer don't develop the disease.
Symptoms of oral cancer may include:
- Patches inside your mouth or on your lips:
- White patches (leukoplakia) are the most common. White patches sometimes become malignant.
- Mixed red and white patches (erythroleukoplakia) are more likely than white patches to become malignant.
- Red patches (erythroplakia) are brightly colored, smooth areas that often become malignant.
- A sore on your lip or in your mouth that doesn't heal
- Bleeding in your mouth
- Loose teeth
- Difficulty or pain when swallowing
- Difficulty wearing dentures
- A lump in your neck
- An earache that doesn't go away
- Numbness of lower lip and chin
Most often, these symptoms are not from oral cancer. Another health problem can cause them. Anyone with these symptoms should tell their doctor or dentist so that problems can be diagnosed and treated as early as possible.
If you have symptoms that suggest oral cancer, your doctor or dentist will check your mouth and throat for red or white patches, lumps, swelling, or other problems. A physical exam includes looking carefully at the roof of your mouth, back of your throat, and insides of your cheeks and lips. Your doctor or dentist also will gently pull out your tongue so it can be checked on the sides and underneath. The floor of your mouth and lymph nodes in your neck will also be checked.
If your doctor or dentist does not find the cause of your symptoms, you may be referred to a specialist. An ear, nose, and throat specialist can see the back of your nose, tongue, and throat by using a small, long-handled mirror or a lighted tube. Sometimes pictures need to be made with a CT scan or MRI to find a hidden tumor. (The Staging section describes imaging tests.)
The removal of a small piece of tissue to look for cancer cells is called a biopsy. Usually, a biopsy is done with local anesthesia. Sometimes, it's done under general anesthesia. A pathologist then looks at the tissue under a microscope to check for cancer cells. A biopsy is the only sure way to know if the abnormal area is cancer.
If you need a biopsy, you may want to ask the doctor or dentist some of the following questions:
- Why do I need a biopsy?
- How much tissue do you expect to remove?
- How long will it take? Will I be awake? Will it hurt?
- How soon will I know the results?
- Are there any risks? What are the chances of infection or bleeding after the biopsy?
- How should I care for the biopsy site afterward? How long will it take to heal?
- Will I be able to eat and drink normally after the biopsy?
- If I do have cancer, who will talk with me about treatment? When?
If oral cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. When oral cancer spreads, cancer cells may be found in the lymph nodes in the neck or in other tissues of the neck. Cancer cells can also spread to the lungs, liver, bones, and other parts of the body.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells as the primary (original) tumor. For example, if oral cancer spreads to the lungs, the cancer cells in the lungs are actually oral cancer cells. The disease is called metastatic oral cancer, not lung cancer. It's treated as oral cancer, not lung cancer. Doctors sometimes call the new tumor "distant" or metastatic disease.
Your doctor may order one or more of the following tests:
- X-rays: An x-ray of your entire mouth can show whether cancer has spread to the jaw. Images of your chest and lungs can show whether cancer has spread to these areas.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your body. You may receive an injection of dye. Tumors in your mouth, throat, neck, lungs, or elsewhere in the body can show up on the CT scan.
- MRI: A powerful magnet linked to a computer is used to make detailed pictures of your body. An MRI can show whether oral cancer has spread.
- Endoscopy: The doctor uses a thin, lighted tube (endoscope) to check your throat, windpipe, and lungs. The doctor inserts the endoscope through your nose or mouth. Local anesthesia is used to ease your discomfort and prevent you from gagging. Some people also may be given a mild sedative. Sometimes the doctor uses general anesthesia to put a person to sleep. This exam may be done in a doctor's office, an outpatient clinic, or a hospital.
- PET scan: You receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan shows whether oral cancer may have spread.
Doctors describe the stage of oral cancer based on the size of the tumor, whether it has invaded nearby tissues, and whether it has spread to the lymph nodes or other tissues:
- Early cancer: Stage I or II oral cancer is usually a small tumor (smaller than a walnut), and no cancer cells are found in the lymph nodes.
- Advanced cancer: Stage III or IV oral cancer is usually a large tumor (as big as a lime). The cancer may have invaded nearby tissues or spread to lymph nodes or other parts of the body.
People with early oral cancer may be treated with surgery or radiation therapy. People with advanced oral cancer may have a combination of treatments. For example, radiation therapy and chemotherapy are often given at the same time. Another treatment option is targeted therapy.
The choice of treatment depends mainly on your general health, where in your mouth or throat the cancer began, the size of the tumor, and whether the cancer has spread.
Many doctors encourage people with oral cancer to consider taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for people with all stages of oral cancer. See the Taking Part in Cancer Research section.
Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat oral cancer include:
- Head and neck surgeons
- Dentists who specialize in surgery of the mouth, face, and jaw (oral and maxillofacial surgeons)
- Ear, nose, and throat doctors (otolaryngologists)
- Medical oncologists
- Radiation oncologists
Other health care professionals who work with the specialists as a team may include a dentist, plastic surgeon, reconstructive surgeon, speech pathologist, oncology nurse, registered dietitian, and mental health counselor.
Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. You'll want to consider how treatment may affect eating, swallowing, and talking, and whether treatment will change the way you look. You and your health care team can work together to develop a treatment plan that meets your needs.
Oral cancer and its treatment can lead to other health problems. For example, radiation therapy and chemotherapy for oral cancer can cause dental problems. That's why it's important to get your mouth in good condition before cancer treatment begins. See a dentist for a thorough exam one month, if possible, before starting cancer treatment to give your mouth time to heal after needed dental work.
Before, during, and after cancer treatment, you can have supportive care to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with the feelings that a diagnosis of cancer can bring. You can get information about supportive care on the NCI Web site at http://www. cancer.gov/cancerinfo/coping and from the NCI Cancer Information Service at 1-800-4-CANCER or LiveHelp.
You may want to ask your doctor these questions before your treatment begins:
- What is the stage of the disease? Has the oral cancer spread? If so, where?
- What is the goal of treatment? What are my treatment choices? Which do you recommend for me? Will I have more than one type of treatment?
- What are the expected benefits of each type of treatment?
- What are the risks and possible side effects of each treatment? How can side effects be managed?
- Should I see a dentist before treatment begins? Can you recommend a dentist who has experience working with people who have oral cancer?
- Will I need to stay in the hospital? If so, for how long?
- If I have pain, how will it be controlled?
- What will the treatment cost? Will my insurance cover it?
- How will treatment affect my normal activities?
- Would a clinical trial (research study) be appropriate for me?
- How often will I need checkups?
- Can you recommend other doctors who could give me a second opinion about my treatment options?
Surgery to remove the tumor in the mouth or throat is a common treatment for oral cancer. Sometimes the surgeon also removes lymph nodes in the neck. Other tissues in the mouth and neck may be removed as well. You may have surgery alone or in combination with radiation therapy.
It takes time to heal after surgery, and the time needed to recover is different for each person. You may have pain for the first few days after surgery. However, medicine can usually control the pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.
It's common to feel tired or weak for a while after surgery. Also, surgery may cause tissues in your face to swell. This swelling usually goes away within a few weeks. However, removing lymph nodes can result in swelling that lasts a long time.
Surgery to remove a small tumor in your mouth may not cause any lasting problems. For a larger tumor, however, the surgeon may remove part of the palate, tongue, or jaw. This surgery may change your ability to chew, swallow, or talk. Also, your face may look different after surgery. You may have reconstructive or plastic surgery to rebuild the bones or tissues of the mouth. (See the Reconstruction section.)
You may want to ask your doctor these questions before having surgery:
- Do you recommend surgery to remove the tumor? If so, do I need any lymph nodes removed? Will other tissues in my mouth or neck need to be removed?
- What is the goal of surgery?
- How will I feel after surgery? How long will I be in the hospital?
- What are the risks of surgery?
- Will I have trouble swallowing, eating, or speaking? Will I need to see a specialist for help?
- Will I look different after surgery? Where will the scars be?
- Will I need reconstructive or plastic surgery? When can that be done?
- Will I lose my teeth? Can they be replaced? How soon?
Radiation Therapy
Radiation therapy uses high-energy rays to kill cancer cells. It's an option for small tumors or for people who can't have surgery. Or, it may be used before surgery to shrink the tumor. It also may be used after surgery to destroy cancer cells that may remain in the area.
Doctors use two types of radiation therapy to treat oral cancer. Some people with oral cancer have both types:
- External radiation therapy: The radiation comes from a machine. Some treatment centers offer IMRT, which uses a computer to more closely target the oral tumor to lessen the damage to healthy tissue. You may go to the hospital or clinic once or twice a day, generally 5 days a week for several weeks. Each treatment takes only a few minutes.
- Internal radiation therapy (implant radiation therapy or brachytherapy): Internal radiation therapy isn't commonly used for oral cancer. The radiation comes from radioactive material in seeds, wires, or tubes put directly in the mouth or throat tissue. You may need to stay in the hospital for several days. Usually the radioactive material is removed before you go home.
- Sore throat or mouth: Radiation therapy can cause painful ulcers and inflammation in the mouth and throat. Your doctor can suggest medicines to help control the pain. Your doctor also may suggest special rinses to numb the throat and mouth to help relieve the soreness. If your pain continues, you can ask your doctor about stronger medicines.
- Dry mouth: A dry mouth can make it hard for you to eat, talk, and swallow. It can also lead to tooth decay. You may find it helpful to drink lots of water, suck ice chips or sugar-free hard candy, and use a saliva substitute to moisten your mouth.
- Tooth decay: Cavities may be a significant problem after radiation therapy. Good mouth care can help you keep your teeth and gums healthy and can help you feel better.
- Doctors usually suggest that people gently brush their teeth, gums, and tongue with an extra-soft toothbrush and fluoride toothpaste after every meal and before bed. If brushing hurts, you can soften the bristles in warm water.
- Your dentist may suggest that you use fluoride gel on your teeth before, during, and after radiation treatment.
- It also helps to rinse your mouth several times a day with a solution made from 1/4 teaspoon of baking soda and 1/4 teaspoon of salt in one quart of warm water. After you rinse with this solution, follow with a plain water rinse.
- Sore or bleeding gums: It's important to brush and floss teeth gently. You may want to avoid brushing and flossing areas that are sore or bleeding. To protect your gums from damage, avoid using toothpicks.
- Infection: Dry mouth and damage to the lining of your mouth from radiation therapy can cause infection to develop. Check your mouth every day for sores or other changes, and tell your doctor or nurse about any mouth problems.
- Delayed healing after dental care: It's important to have all needed dental treatment completed one month before radiation therapy to allow time for the mouth to heal. Dental treatment after radiation therapy can be complicated by slow healing and the risk of infection.
- Jaw stiffness: Radiation therapy can affect the chewing muscles and make it difficult for you to open your mouth. Ask your health care team to show you how to prevent or reduce stiffness by exercising your jaw muscles. For example, they may suggest opening and closing the mouth as far as possible (without causing pain) 20 times in a row, 3 times a day.
- Denture problems: Radiation therapy can change the tissues in your mouth so that dentures don't fit anymore. Because of soreness and dry mouth, some people may not be able to wear dentures for as long as one year after radiation therapy. After the tissues heal completely and your mouth is no longer sore, your dentist may need to refit or replace your dentures.
- Fatigue: You may become very tired, especially in the later weeks of radiation therapy. Resting is important, but doctors usually advise people to stay as active as they can.
- Changes in how food tastes and smells: Radiation therapy for oral cancer may cause food to taste or smell different. These changes can last for several months, especially if radiation therapy is given at the same time as chemotherapy.
- Changes in voice quality: Your voice may be weak at the end of the day. It may also be affected by changes in the weather. Radiation therapy directed at the neck may cause your larynx (voice box) to swell, causing voice changes and the feeling of a lump in your throat. Your doctor may suggest medicine to reduce this swelling.
- Skin changes in the treated area: The skin in the treated area may become red or dry. Good skin care is important. It's helpful to expose this area to the air while protecting it from the sun. Also, avoid wearing clothes that rub the treated area, and don't shave the treated area. You should not use lotions or creams in the treated area without your doctor's advice. These skin changes should go away when treatment ends, but a long-term effect is that hair may not grow back in the moustache or beard area.
- Weight loss: You may lose weight if you have eating problems from a sore throat and trouble swallowing. Your health care team may suggest a feeding tube to help prevent weight loss. See the Nutrition section.
- Changes in the thyroid: Radiation therapy can affect your thyroid (an organ in your neck beneath the voice box). If your thyroid does not make enough thyroid hormone, you may feel tired, gain weight, feel cold, and have dry skin and hair. Your doctor can check the level of thyroid hormone with a blood test. If the level is low, you may need to take thyroid hormone pills.
Some side effects in the mouth go away after radiation therapy ends, but others last a long time. A few side effects (such as dry mouth) may never go away. Although the side effects of radiation therapy can be upsetting, your doctor can usually treat or control them. It helps to report any problems that you are having so that your doctor can work with you to relieve them.
You may find it helpful to read the NCI booklet Radiation Therapy and You.
You may want to ask your doctor these questions before having radiation therapy:
- What is the goal of this treatment?
- When will the treatments begin? When will they end?
- What are the risks and side effects of this treatment? What can I do about them?
- How will I feel during therapy? What can I do to take care of myself?
- Will I need a special diet? For how long?
- How will my mouth and face look afterward?
- Are there any long-term effects?
Chemotherapy uses drugs to kill cancer cells. The drugs that treat oral cancer are usually given through a vein (intravenous). The drugs enter the bloodstream and travel throughout your body.
Chemotherapy and radiation therapy are often given at the same time. You may receive chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. Some people need to stay in the hospital during treatment.
Chemotherapy and radiation therapy can cause some of the same side effects, including painful mouth and gums, dry mouth, infection, and changes in taste. Some anticancer drugs can cause bleeding in the mouth and a deep pain that feels like a toothache.
The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:
- Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug.
- Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may change in color and texture.
- Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems.
Some drugs used for oral cancer can cause tingling or numbness in the hands or feet. You may have these problems only during treatment or for a short time after treatment ends.
You may wish to read the NCI booklet Chemotherapy and You.
Targeted Therapy
Some people with oral cancer receive a type of drug known as targeted therapy. It may be given along with radiation therapy or chemotherapy.
Cetuximab (Erbitux) was the first targeted therapy approved for oral cancer. Cetuximab binds to oral cancer cells and interferes with cancer cell growth and the spread of cancer. You may receive cetuximab through a vein once a week for several weeks at the doctor's office, hospital, or clinic.
During treatment, your health care team will watch for signs of problems. Some people get medicine to prevent a possible allergic reaction. Side effects may include rash, fever, headache, vomiting, and diarrhea. These effects usually become milder after the first treatment.
You may find it helpful to read the NCI fact sheet Targeted Cancer Therapies.
You may want to ask your doctor these questions before having chemotherapy or targeted therapy:
- Which drug or drugs will I have?
- What are the expected benefits of treatment?
- What are the risks and possible side effects of treatment? What can I do about them?
- When will treatment start? When will it end?
- How will treatment affect my normal activities?
Second Opinion
Before starting treatment, you might want a second opinion about your diagnosis, the stage of cancer, and the treatment plan. You may even want to talk to several different doctors about all of the treatment options, their side effects, and the expected results. For example, you may wish to discuss your treatment plan with a surgeon, radiation oncologist, and medical oncologist.
Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some companies require a second opinion.
If you get a second opinion, the second doctor may agree with your first doctor's diagnosis and treatment plan. Or the second doctor may suggest another approach. Either way, you'll have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at your options.
It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor.
There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists. You may want to find a medical center that has a lot of experience treating people with oral cancer.
The NCI Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) and LiveHelp can tell you about nearby treatment centers. Other sources can be found in the NCI fact sheet How To Find a Doctor or Treatment Facility If You Have Cancer.
Your diet is an important part of your treatment for oral cancer. You need the right amount of calories, protein, vitamins, and minerals to maintain your strength and to heal.
However, when you have oral cancer, it may be difficult to eat. You may be uncomfortable or tired, and you may have a dry mouth, have trouble swallowing, or not feel like eating. You also may have nausea, vomiting, constipation, or diarrhea from cancer treatment or pain medicine.
Tell your health care team if you're having any problems eating, drinking, or digesting your food. If you're losing weight, a dietitian can help you choose the foods and nutrition products that will meet your needs.
You may want to read the NCI booklet Eating Hints. It contains many useful ideas and recipes.
Sore Mouth
If your mouth is sore, you may find that you want to avoid acidic foods, such as oranges and tomatoes. Also, to protect your mouth during cancer treatment, it helps to avoid sharp, hard foods, such as chips.
Dry Mouth
If your mouth is dry, you may find that soft foods moistened with sauces or gravies are easier to eat. Smooth soups, puddings, milkshakes, and blended fruit smoothies often are easier to swallow. Also, meal replacement products (such as instant breakfast, Boost®, or Ensure®) may be helpful.
Keep in mind that a dry mouth puts you at greater risk for tooth decay (cavities). Rinse your mouth often, especially after eating or drinking sweet foods.
Trouble Swallowing
If there's a chance that swallowing will become too difficult for you, your dietitian and doctor may recommend another way for you to receive nutrition. For example, after surgery or during radiation therapy for oral cancer, some people need a temporary feeding tube. A feeding tube is a flexible tube that is usually passed into the stomach through an incision in the abdomen. A liquid meal replacement product (such as Boost or Ensure) can be poured through the tube at mealtime. When not in use, the small tube attached to your stomach is not visible to others.
Some people with oral cancer may need to have plastic or reconstructive surgery to rebuild the bones or tissues of the mouth. Research has led to many advances in the way bones and tissues can be rebuilt.
Some people may need dental implants. Or they may need to have grafts (tissue moved from another part of the body). Skin, muscle, and bone can be moved to the mouth from the chest, arm, or leg. The plastic surgeon uses this tissue for repair.
If you're thinking about reconstruction, you may wish to consult with a plastic or reconstructive surgeon before your treatment for oral cancer begins. You can have reconstructive surgery at the same time as you have the cancer removed, or you can have it later on. Talk with your doctor about which approach is right for you.
Your health care team will help you return to normal activities as soon as possible. The goals of rehabilitation depend on the extent of the disease and type of treatment.
If oral cancer or its treatment leads to problems with talking, speech therapy will generally begin as soon as possible. A speech therapist may see you in the hospital to plan therapy and teach speech exercises. Speech therapy may continue after you return home.
Some people will need a prosthesis to help them talk and eat as normally as possible. A prosthesis is an artificial device that replaces the missing teeth or tissues of the mouth. For example, if part of the palate is removed, a dentist with special training (a prosthodontist) may be able to fit you with a plastic device that replaces the missing tissue.
Follow-up Care
You'll need regular checkups of your mouth, throat, and neck after treatment for oral cancer. Checkups help ensure that any changes in your health are noted and treated if needed. Checkups may include a physical exam, blood tests, chest x-rays, or CT scans.
If you have any health problems between checkups, you should contact your doctor.
People who have had oral cancer have a chance of developing a new cancer. A new cancer is especially likely for those who use tobacco or who drink alcohol heavily. Doctors strongly urge people to stop using tobacco and stop drinking alcohol to cut down the risk of a new cancer and other health problems.
You may find it helpful to read the NCI booklet Facing Forward: Life After Cancer Treatment. You may also want to read the NCI fact sheet Follow-up Care After Cancer Treatment.
Sources of Support
Learning that you have oral cancer can change your life and the lives of those close to you. These changes can be hard to handle. It's normal for you, your family, and your friends to need help coping with the feelings that a diagnosis of cancer can bring.
Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities.
Here's where you can go for support:
- Doctors, nurses, and other members of your health care team can answer questions about your treatment and its side effects. They can talk with you about how treatment may affect your work schedule and other activities.
- Social workers, counselors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. Often, social workers can suggest resources for financial aid, transportation, home care, or emotional support.
- Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.
- Information specialists at 1-800-4-CANCER and at LiveHelp can help you locate programs, services, and publications. They can send you a list of organizations that offer services to people with cancer.
For tips on coping, you may want to read the NCI booklet Taking Time: Support for People With Cancer.
Taking Part in Cancer Research
Cancer research has led to real progress in oral cancer detection and treatment. Because of research, people with oral cancer can look forward to a better quality of life. Continuing research offers hope that, in the future, even more people with this disease will be treated successfully.
Doctors all over the world are conducting many types of clinical trials (research studies in which people volunteer to take part). Clinical trials are designed to find out whether new approaches are safe and effective.
Doctors are testing chemotherapy, targeted therapy, and combinations of drugs for oral cancer. They are studying radiation therapy combined with drugs and other treatments. Doctors are also testing drugs that prevent or reduce the side effects of radiation therapy.
Even if the people in a trial do not benefit directly, they may still make an important contribution by helping doctors learn more about oral cancer and how to control it. Although clinical trials may pose some risks, doctors do all they can to protect their patients.
If you're interested in being part of a clinical trial, talk with your doctor. You may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies. It describes how treatment studies are carried out and explains their possible benefits and risks.
The NCI Web site includes a section on clinical trials at http://www.cancer.gov/clinicaltrials. It has general information about clinical trials as well as detailed information about specific ongoing studies of oral cancer. The NCI Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) and at LiveHelp can answer questions and provide information about clinical trials.
National Institute of Dental and Craniofacial Research Information Resources
The mission of the National Institute of Dental and Craniofacial Research (NIDCR) is to improve oral, dental, and craniofacial health through research and research training, and by sharing science-based information with the public and health care professionals.
Oral Complications of Cancer Treatment
Radiation therapy aimed at the head and neck and chemotherapy can cause problems in the mouth and throat. NIDCR can supply free information about taking care of your mouth during cancer treatment. Booklets are available in English and Spanish:
- Chemotherapy and Your Mouth
- Head and Neck Radiation Treatment and Your Mouth
- Three Good Reasons to See a Dentist BEFORE Cancer Treatment
Materials are available online at http://www.nidcr.nih.gov, or by contacting the NIDCR Clearinghouse:
National Institute of Dental and Craniofacial Research
National Oral Health Information Clearinghouse
1 NOHIC Way
Bethesda, MD 20892-3500
Tel: 1-866-232-4528
Fax: 301- 480-4098
Email: email@example.com
National Institute on Deafness and Other Communication Disorders
The National Institute on Deafness and Other Communication Disorders (NIDCD) supports and conducts research and research training on the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language. The Institute provides health information to the public, health professionals, patients, and industry representatives on the Internet and through the NIDCD Information Clearinghouse. Information specialists at the Clearinghouse are available by phone (toll-free), e-mail, and mail to help you find resources related to NIDCD's seven areas of research.
People who are undergoing treatment for oral cancer may be interested in the following NIDCD fact sheets, available in both English and Spanish:
Materials are available online at http://www.nidcd.nih.gov, or by contacting the NIDCD Clearinghouse:National Institute on Deafness and Other Communication Disorders Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
Tel: 800-241-1044
E-mail: email@example.com
This text may be reproduced or reused freely. Please credit the National Cancer Institute as the source. Any graphics may be owned by the artist or publisher who created them, and permission may be needed for their reuse.


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Tuesday, 22 November 2011 19:57
The Courier-Journal newspaper out of Louisville released their annual state preseason basketball rankings this past week for the boys and girls teams in Kentucky high school basketball.
The Clay County Lady Tigers rank in at ninth in the state, the highest ranking ever for Lady Tiger Head Coach James "Ivy" Burchell.
There are only three other teams rated in the top-25 in the girls' rankings from the mountain coverage area, including Perry County Central (4), Lincoln County (18), and defending state champions Rockcastle County (21).
Atop the girls' rankings is seventh region power Manual, followed by Marion County, then Boone County.
Last Updated on Tuesday, 22 November 2011 19:58
Wednesday, 16 November 2011 03:39
Clay County Holds off Male in Preseason Scrimmage
Clay County's Zach McGeorge prepares to drive past a Louisville Male defender during Saturday's scrimmage game.
Coach Robert Marcum's Clay County Tigers bounced back from a 23-9 first quarter deficit, winning the next three quarters to defeat visiting Louisville Male Saturday night 76-72.
The Tigers had a hard time adjusting to the quickness of Male in the first quarter, leading to a 23-9 deficit for the Tigers.
"You can't simulate that type of quickness in our practices, and it took us the entire first quarter to adjust," said Coach Marcum, "We didn't do hardly anything right in the first quarter."
Last Updated on Wednesday, 16 November 2011 03:40
Wednesday, 16 November 2011 03:36
The road to a fourth straight 13th region championship for the Clay County Lady Tigers begins this week, as Coach James "Ivy" Burchell's squad will play two preseason exhibitions this week.
Saturday, the Lady Tigers will travel to Bullitt East to take on Louisville based Holy Cross.
The Lady Cougars return all of their players from last year's 22-8 squad, including potential all-state candidate Kim Mingus.
Last Updated on Wednesday, 16 November 2011 03:37
Wednesday, 09 November 2011 13:52
Tigers to Get First Test in Preseason Exhibition Against Louisville Male
Pivots Steven Wagers and Zac Kemp go through drills during a recent Tiger basketball practice.
The Tigers will be in action Saturday against Louisville Male.
Clay County basketball fans will get their first taste of high school basketball Saturday evening, as second-year head coach Robert Marcum's Clay County Tigers take the court for a preseason exhibition against Louisville Male.
"They have a nice team with an outstanding basketball tradition," Coach Marcum said of this weekend's opponent, "They'll be very experienced and a tough challenge for us."
Louisville Male finished with a 23-7 record last season, falling to Seneca in the opening round of the seventh region basketball tournament.
Last Updated on Wednesday, 09 November 2011 13:53
Wednesday, 09 November 2011 13:50
Freshman Breaks Clay County Single Game Rushing Record in Loss
Freshman Sam Carr finds daylight after receiving a block from teammate Christian McNeal last Friday night.
Lexington – Despite a lopsided score to #12 Lexington Catholic in Friday night's Class 4A State Playoff opener, there was one bright spot for Coach Kenny Roark's Clay County Tiger football team.
Clay County fell to the Knights 76-18, but freshman Sam Carr rushed for 381 yards on the night with three touchdowns to his credit.
Last Updated on Wednesday, 09 November 2011 13:51
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subset: commoncrawl


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Recommend to a friend
1 and .5 Micron Diamond and Balsa Strop Pack
The Balsa Strops with the 1 and .5 Micron Diamond Paste are an excellent finishing and maintenance tool. With the semi-firm, smooth surface of the balsa, you're able to hone and polish at a very high level making a one step solution for blade maintenance
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- Who We Are
- What's ON
- The Waterfront
- Learning
- Support Us
February 24-26, 2012
Weekend of Week 08 of Year 2012
Electro Swing
Saturday, February 25, 2012 8:00 PM
Having sizzled skaters last season with his electric blend of world beat and ethno groove, DJ medicineman joins us again to dazzle the rink with his latest passion, electro swing.
February 25, 2012
POWER KIDS / Portraits
Sunday, February 26, 2012 3:00 PM - 5:00PM
Inspired by the Malabar People, the dramatic portrait series by Stan Douglas currently on view at The Power Plant, this workshop will explore creative drawing and collage approaches to portraiture.
February 26, 2012
For details inquire at the Info Desk or call 416-973-4000.
|Box Office
|Visitor Info
Harbourfront Centre is a registered Canadian charity and we rely on the generosity of people like you to help us deliver the incredible programming we offer throughout the year.
Charitable Registration Number: 10746 6575 RR0003


text: MTX RTX2BT 2" bullet tweeter Zoom Front Back Photos Videos My vehicle's homepage We don't check this item for fit or compatibility. Item #: 236RTX2BT Review Summary 1 person says Low Stock Free Crutchfield lifetime tech support Free Shipping Open Box Price Loading... $34.99 each Add to cart + Add to wishlist Email me alerts for this product $39.99 New Stock $29.99 Scratch & Dent Buy this item and earn up to 35 Rewards points See more offers and ways to save Special Financing Available x By buying this product you'll earn up to 35 Rewards points. When you sign up for a Crutchfield account, you'll be enrolled in Crutchfield Rewards. You'll earn one point for every dollar you spend on gear from us. You can turn your points into Rewards Cards that you can use toward future purchases. You can sign up for an account now, or after you complete your purchase (you'll get credit for the points either way). Sign up for a Crutchfield account Overview Details Customer Reviews Q&A Articles & Videos Accessories Our take on the MTX RTX2BT by John Pollard Concert level highs Are you looking to play your music loud? If so, you'll want to check out MTX's Road Thunder Extreme speakers, which use PA system technology to bring concert sound levels to your car. If it's time to take your highs to the next level, MTX designed the RTX2BT 2" tweeter with the same compression-horn design found in most concert PA systems, so it'll play at high volumes for extended periods without breaking a sweat. And thanks to its aluminum cone and titanium diaphragm, this incredibly rugged tweeter can handle up to 100 watts RMS. Its 8-ohm impedance means you can wire up two to a single amplifier channel for maximum high-frequency intensity. Note: This package contains one tweeter. You'll need an external amplifier to drive this tweeter properly an in-dash stereo won't have enough power. See more info on this item Highlights:2" aluminum bullet tweeter with compression horn designpower range: 25-100 watts RMS (300 watts peak power)frequency response: 3,500-23,700 Hzsensitivity: 94 dBtop-mount depth: 2-1/16"warranty: 1 yearOur 60-day money-back guarantee Hands-on research from the Crutchfield Labs (what are the Labs?) What's in the box? | In-depth notes Product Research What's in the box? Download owner's manual One 2" Tweeter Our Product Research Team At Crutchfield, you'll get detailed, accurate information that's hard to find elsewhere. That's because we have our own in-house Product Research team — they open the box, verify contents, check the owner's manual, and record dimensions, features and specs. We stay on top of new products and technologies to help people make informed choices. Features Warranty Features Crossover: A capacitor is soldered to the positive terminal of the tweeter as a first order high-pass crossover. The crossover point using the capacitor is approximately 9 kHz. Optimally, the capacitor should be removed and an electronic crossover used. Installation: The determining factor of how large the mounting hole needs to be to mount this tweeter is the magnet diameter, which is 2-3/4 inches. However, the wire terminals protrude approximately 3/8 of an inch beyond the magnet, so additional notches in the opening may be necessary.Warranty 5 Year Warranty Terms: This product carries a 5-Year Prorated Warranty with the following terms: Years 1-2: Products found to be defective in materials or workmanship during the first two years will be, at Mitek's option, repaired or replaced by Mitek at no charge. The warranty period does not renew, but continues on from the original date of purchase. Years 3-5: The purchase price of an item which becomes defective after the first two years and prior to the end of the warranty period will be prorated and credited toward the purchase of a new MTX product. The amount of proration is determined by dividing the original purchase price by the number of months in the warranty period (60), then multiplying the result by the number of months remaining in the warranty period. Review this product Submit a review and then enter to win a $500 rewards card MTX RTX2BT Reviews Average Customer Review: 1 people say: Review this product: Thanks for taking the time to share your experiences about this product. Please be sure to focus your comments on the product itself. Read our Review Guidelines for more information. Review title * Email Your email won't be visible. Please use the email address that is associated with your order. Display name (e.g., JohnD) Your review will be signed using the display name and location * Your location (e.g., Charlottesville, VA) * Your rating Click on a star to rate the overall product on a scale of 1-5 1500 characters left * Your review Attach a YouTube Review Crutchfield Video Review Guidelines Only submit videos that you made or are authorized to use. Do not submit videos that contain music, video or visuals that are copyrighted and belong to someone else. Please see our Review Guidelines for more information. Submit the URL of your YouTube™ video review or product demonstration. e.g., "http://www.youtube.com/v/o79TWHh598U" 500 characters left Pros 500 characters left Cons * Agree to Terms By checking this box you agree your review becomes the property of Crutchfield, that you are over 18 years of age, that you own or have owned this product, and that you are located within the United States or its territories. Please see our Review Guidelines for more information. We reserve the right (but are not obligated to) review all submissions and edit or remove any review in any manner which we deem necessary. Your review should be posted within seven days. Filter by rating: 5 Star: (0) 4 Star: (0) 3 Star: (0) 2 Star: (0) 1 Star: (0) 5 out of 5 MTX RTX2BT Written By jmsafran, Mercer, PA on Monday, July 09, 2012 Crutchfield Customer Review (What's this?) Serious powerful tweeters. Very clear and can handle a lot. Pros: Outstanding addition to any system. Cons: None 3 out of 3 people found this helpful Was this review helpful? Yes | No Add accessories for the MTX RTX2BT Add Accessories Add a Warranty You may need speaker wire to get the signal to your tweeters. It's sold by the foot, so enter the amount you'll need when you get to your cart. See all categories & accessories You may need speaker wire to get the signal to your tweeters. It's sold by the foot, so enter the amount you'll need when you get to your cart. Speaker Wire Metra SW18 18-gauge Speaker Wire Clear jacket priced per foot 2 people say Your Price: $0.30 Add to Cart T-Spec 16-gauge Speaker Wire Black/white jacket priced per foot 13 people say Your Price: $0.69 Add to Cart T-Spec 12-gauge Speaker Wire Black/white jacket priced per foot 29 people say Your Price: $1.99 Add to Cart Stinger PRO Series Speaker Wire Priced per foot (16 Gauge) Options 16 Gauge-$0.39 14 Gauge-$0.65 Priced per foot (16 Gauge) Priced per foot (14 Gauge) 50 people say Your Price: $0.39 Add to Cart Why choose SquareTrade? The #1-Rated Protection Plan Thousands of people have reviewed SquareTrade Protection Plans — and made us #1. 5-Day Service Guarantee & Free Shipping We'll repair or replace your item in five business days or less after we've received it, or your plan is free. And, as always, we pay for all shipping. Protection from Normal, Everyday Use Repairing your average mechanical or electrical failure can cost as much as buying a new device. With SquareTrade, you're covered — including parts and labor. 3 Year Protection Plan Your Price: $8.49 Add to Cart For a more in-depth review and enhanced detailed information on the MTX RTX2BT, please visit the Crutchfield website product page (/ISEO-rccbcspd/p_236RTX2BT/MTX-RTX2BT.html ). × Front Back


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The BMC Racing Team looked ahead to a decisive final stage of Circuit Franco-Belge after Saturday's 158-kilometer race ended in a bunch sprint.
Burghardt Finding Form
BMC Racing Team's Alessandro Ballan and Michael Schär are two of nearly 90 riders within 20 seconds of the lead of Adam Blythe (Omega Pharma-Lotto), who won his second stage Saturday. Marcus Burghardt, who was out nearly two months due to infection, said his form has improved by the day. "Tomorrow, we'll support Alessandro and Michi and try to jump up them up to the top 10 or top five," Burghardt said. "It's really close in this race."


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My nickname, it's Millie (from Amelia). My blog consists of things that I like, things of interest, things I'm passionate about, and sometimes how I feel at any given moment. I breathe: art, design, music, food, movies/tv shows (die hard horror and science fiction fan, but you wouldn't know that judging from my blog), fashion, Old Hollywood, and some current/recent actors and actresses.
DISCLAIMER: All images are copyrighted by their respective owners unless otherwise stated. Links/Credits are provided via click-through link or caption. Clicking the link of the image will lead you to its source. If reblogged, please do not remove the original artist/credit/source info. FOR PHOTO OWNERS/CREATORS: If it happens that you see your work posted here, and you don't want it to be, and you want it removed/credited please message. FOR OTHERS: If you see a photo that is not properly credited, and you know the real owner, please message.
Catching Elephant is a theme by Andy Taylor


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Satellite View Selection
12:30 AWST on Friday 31 October 2014 | Cloud/surface composite, Australia
Images from Japan Meteorological Agency satellite MTSAT via Bureau of Meteorology.
Australian Government Bureau of Meteorology
Bureau National Operations Centre
Satellite Notes for 0000UTC chart on 31 October 2014
Issued at 11:35 am EDT Friday on 31 October 2014
Scattered thunderstorm activity can still be seen across the interior of Western Australia, the southwest of the Northern Territory and the far west of South Australia. This convective activity lies near to, and to the east of, a surface trough. High cloud extends further east across South Australia, Queensland, New South Wales and Victoria.
High cloud is streaming over Tasmania from a frontal system well to the west of the state. The northern portion of this front, and its associated cloud band, is moving across southern WA.


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Bears FS Chris Conte (95 tackles, 3 INTs in 2013) underwent shoulder surgery, 4-5 months recovery time (ESPN) http://bit.ly/NDdHCW
via Facebook http://bit.ly/NDdHCW
Civic Lesson
I said what?!
- Playing Disney Infinity 2.0. raptr.com/michaelwasz?ty… 1 day ago
- Bears Video: Ed Werder discusses the state of the Bears' locker room after Brandon Marshall's outburst (ESPN) ift.tt/15TLX3B 1 day ago
- Bears: Coach Marc Trestman disputes notion that WR Brandon Marshall called out QB Jay Cutler (ESPN) ift.tt/1FsyUWQ 2 days ago
- Bears: Kyle Long changes course, admits it was wrong for him to cast blame on fans (ESPN) ift.tt/10ebJQg 2 days ago
- Bears Video: Guard Kyle Long calls out Bears fans for booing during Sunday's loss (ESPN) es.pn/1DsB3jn 2 days ago
- Bears Video: Brandon Marshall calls team's offensive showing in loss to Dolphins "unacceptable" (ESPN) ift.tt/1upmOVQ 2 days ago
- Bears: G Kyle Long criticizes fans for booing team during 27-14 loss to Dolphins (ESPN) ift.tt/1psi4NR 2 days ago
- Played Disney Infinity 2.0 (360) in the last 24 hours. raptr.com/michaelwasz?ty… 3 days ago
- Bears: WR Brandon Marshall says "a lot of frustration" over team's "unacceptable" 3-4 record (ESPN) ift.tt/1tDC2we 3 days ago
- Bears: Have lost 4 straight home games for first time since 2002 (ESPN) ift.tt/1upmOVQ 3 days ago
Say "Fromage!"
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Latest News
AJR Concert Lunch 2013
AJR members enjoyed an afternoon of socialising, good food and entertainment at the annual AJR Concert and lunch on Sunday 20th October 2013.
In his welcoming remarks, AJR Chairman, Andrew Kaufman, spoke of this being "another bumper year at the AJR crowned by the events we organised in June to commemorate and celebrate the 75th anniversary of the Kindertransport."
He also spoke of his sadness at the forthcoming closure of the AJR Centre and paid tribute to the late Ludwig Spiro, our President and former Treasurer, "not only for his eloquent, witty and wise remarks on occasions such as today's but also his visionary role in creating a Centre for our members. We also recall the contribution of the late Paul Balint whose generous donation helped us realise the project."
He concluded by saying that "there is much to celebrate about the work of the AJR this year as in all years."
As in previous years, guests at the Lunch were regaled by singers from the Royal Opera who performed A Medley of Memories. We were delighted to see Glenys Groves and Jonathan Fisher again and to welcome for the first time at our Celebration, Mark Luther. They were accompanied on piano by the AJR's Diana Franklin. .
Click here for pictures


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The 1st RSPO European Summit on Sustainable Palm Oil held in Berlin on 3rd September 2013, organized by the Roundtable on Sustainable Palm Oil (RSPO). Read More
Orang-utans are facing extinction due to the unsustainable production of palm oil, an ingredient in around half of all supermarket products. Read More
This document intends to present the lessons learned by the Dutch Task Force for Sustainable Palm Oil in setting up a voluntary industry commitment to only source certified sustainable palm oil (CSPO) by 2015. Read More
In line with the vision to transform markets to make sustainable palm oil the norm – we are glad to present the initial version of RSPO's Online CSPO Market Directory. The aim of having this information presented in this accessible manner is to allow players along the supply chain to be aligned on the demand and supply of certified sustainable palm oil and derived products.


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SolarShare Community Solar Bonds (Finalist.)
Thanks for the comments and words of encouragement on the SolarShare submission conversation and posting page - in particular we appreciate the intent of most of the commentators to participate in SolarShare's community power model when we reach regulatory approvals stage.
Our vision for SolarShare is to build the co-op's project pipeline and maximize the number of citizens who can become members and invest in solar in Ontario through SolarShare bonds - inclusion, engagement, education and empowerment through economic returns are key. How expansion plans are going to play out is tough to say: in addition to the regulatory hurdles, there are many variables including access to capital, new energy prices, and effective widespread marketing outreach.
And that's what we're hoping to accomplish with the support of ClimateSpark. We're hoping SolarShare Co-operative makes it to the next round, to access the advice and direction we need to keep our idea growing, so that everyone in Ontario can "Solar Power their Portfolio" through the purchase of SolarShare community solar bonds and participate in the solar economy in Ontario.
SolarShare bonds are about 'community power'; opening the door to everyone to participate in the solar economy in Ontario, and reaching individuals who would otherwise not have access to solar generation (those living in apartments, shaded homes, or having limited capital for project investment). It exemplifies what the Green Energy Act and the Feed-in-Tariff program were designed to enable - profitable businesses generating green energy and green returns to the community.
SolarShare has taken on the initial investment, risk, and work in installing solar power projects across Ontario. The co-op currently owns 18 projects representing over 600 kW of capacity, and has launched an offering of Community Solar Bonds to the public.
Individuals and businesses in Toronto and across Ontario are invited to become members of the co-op and purchase SolarShare bonds. The $1000 bonds earn 5% annual returns over a 5-year term, generating revenue from 20-year power purchase contracts.
The co-op model supports the interests of communities in developing new solar power projects, instilling a sense of ownership and allowing members to feel enthusiastic about uniting with other individuals who want to participate in the green energy economy and develop community owned power.
In the few weeks since we posted our SolarShare submission, the total output of our installations has climbed to 270 MW, which using Environment Canada's latest .186 g/kWh equation means carbon displacement of over 50,000 kg. Why is our track record to date so important? One of the arguments we hear against solar development is that the technology isn't efficient and doesn't really produce any significant power. We as a co-op are very keen to provide transparent information to our members and to the general public about how solar works to create energy and limit emissions - and educate 'solar nay-sayers'!
POTENTIAL: That said, we're very excited about the future power generation potential and carbon emissions offsets inherent in our portfolio of PV projects. If we never installed another solar power plant, our current portfolio of 18 plans representing over 600 kW of installed capacity, should displace about 152,000 kg of carbon per year, decreasing by 0.5% annually as panels age.
VISION: The vision for SolarShare is to build the co-op's project pipeline and maximize the number of citizens who can become members and invest in solar in Ontario through SolarShare bonds. How expansion plans are going to play out is tough to say: there are many variables (access to capital is a big one) and a lot depends on the current Feed-in-Tariff review and the new prices being set by the Ontario Power Authority soon. Regardless, the co-op looking to add another 250-500 kW of projects in the very short term, bringing potential offsets to between 200,000 - 250,000 kg of carbon displaced annually.
Anyone can monitor SolarShare installations by viewing a live-feed meter on the SolarShare website (solarbonds.ca), measuring electricity and revenue generated. Each project site, spanned across a Google map of Ontario, is marked by a sun icon and leads to photos of the projects and real-time data. Co-op members from the solar technology industry particularly get a kick out of the interactive nature of the projects. Others like to watch the revenue generated and see tangible results of their investments.
TREC: TREC Renewable Energy Co-operative is a non-profit, environmental co-operative that develops community-owned renewable energy projects and educates Ontarians about renewable energy, energy conservation and the community power model. TREC consists of three 'divisions': TREC generation (of which SolarShare is a part), TREC Services (building capacity and serving other members of the cooperative community) and TREC Education (an award-winning charity with a range of energy education programs that create a lasting impression on more than 20,000 students and citizens each year).
TREC was the incubator for the WindShare Co-operative, the pioneering 'for-profit' co-op that installed and, through it's 400 members, co-owns the iconic wind power turbine at Exhibition Place, providing renewable electricity to the people of Ontario through community ownership.
SolarShare partners with a variety of organizations that promote sustainability and community development, including the Ontario Sustainable Energy Association, the Community Power Fund, the Centre for Social Innovation, Evergreen, the Canadian Solar Industries Association, On Co-op, and others.
SolarShare has a comprehensive 20+ year business plan that spans the length of the power purchase agreements (PPA's) all SolarShare projects have secured with the Ontario Power Authority. These PPA's guarantee revenue for each electron generated by SolarShare's portfolio of 18 solar power projects until 2031. Projected annual generation for the installed capacity, which totals over 600 kW, is $489,000 in the first year, with about 0.5% degradation in panel output (and thus revenue) over 20 years.
CHALLENGE: Building project pipeline with limited access to more bridge / construction financing, and tied to a 'one bond per member' restriction until such time as the co-op receives regulatory approval from the Financial Services Commission of Ontario (FSCO).
To ensure the viability of SolarShare, emphasis is placed on marketing memberships to all Ontario citizens and businesses, enabling everyone to invest in SolarShare. In the emerging 'impact investing' market, SolarShare Community Solar Bonds offers 'triple bottom line returns,' presenting economic, social, and environmental benefits.
CHALLENGE: making a lean marketing budget stretch through the 'one bond per member' development period and through the grassroots building of community memberships and education. Having a budget leftover to reach out in a comprehensive manner with a new way of impact investing to a large audience across the Province.
FSCO regulatory approval is pending, most likely until late 2011 or even into 2012. At that time, members will be able to file their Community Solar Bonds into self-directed RRSP/ RESP/ TFSA accounts, and purchase an unlimited number of bonds. Market research indicates investors are keen to invest an average of $5,000 in SolarShare bonds, and to hold bonds in registered accounts.
CHALLENGE: Covering legal costs through the approvals process and determining / actualizing RRSP eligibility.
Tue, 11/01/2011 - 10:02
This project leverages a lot of private money to deal with climate change while some governments delay or cut back on funding.
National Round table
I was one of the participates of the National Round Table on the Environment http://nrtee-trnee.ca/
At the top level of government and industry they are trying to figuring out how to create a carbon savings program.
I think Co-ops are a great idea.
How do you regulate things and get transparency on th HOEP
Community bonds - a new way for the future
At last community ventures are figuring a way to tap capital markets to meet Their objectives. Imagine social benefit and aa reasonable return...why not!
Selling more community solar bonds would be a terrific improvement to this proposal.
Tue, 11/01/2011 - 15:15
Solar Bonds are a great opportunity for each of us investors
Solar Bonds are a great opportunity for each of us to become impact nvestors. This is a great proposal and an excellent way for everyone to get involved in developing local renewable power. I hope that retail banks start to sell such products. This will drive a lot of much needed captial into this new industry, and thus boost local economic develop while meeting energy needs. It is a win - win.
Solid return in a shakey investment world
Projects that don't rely on the committed few have a much greater chance to succeed, and this investment is excellent in multiple ways. The return is strong, the investment can be modest, and the vision is fantastic. This enables the economics of solar to work better than individual installations - another plus.
Wed, 11/02/2011 - 07:33
I think that this is a great
I think that this is a great way to provide capital to the renewable energy sector. With a reduction in required returns, we can all get closer to the grid parity that the solar industry is seeking.
Wed, 11/02/2011 - 12:51
Can solar bonds become national in scope?
This proposal is a great start for tapping into a retail investor market. For instance, TAF has been a leader in proving or protoyping new financing strategies that can then be used broadly in the market; such as the Green Condo Loan.
I think this proposal could be a protoype for a bond that has a national scope to finance numerous communtiy owned renewable projects, through a Green Bond.
What role can guarantors have in establishing a scalable product like a national Green Bond and how can we get to that tipping point.... hmmm.
It would be great if the consumer of the solar bond can also become informed as to how much energy their investment has supported through an easy app or online function.
Wed, 11/02/2011 - 20:07
Can't wait to purchase my solar bond!
This is a great opportunity to contribute to the renewable energy movement!
If only it was offered at my bank, I could get my friends and family from across Canada to buy one
Thu, 11/03/2011 - 09:41
Great stuff
SolarShare makes me proud to be an Ontarian and Canadian. It's innovative and has excellent financial and environmental returns. Great stuff!
Thu, 11/03/2011 - 09:46
Great way to invest in green energy without your own system!
I love how SolarShare provides Ontarians, who do not have the capacity to buy their own system, a chance to invest in clean energy and the Green Energy Act. I also love how SolarShare is a co-op, meaning that it focuses on a sense of democracy, community and membership in addition to the financial trasactions that take place. Even more, I love how SolarShare is helping shift our energy systems towards an alternative resource that is free and accessible to all.
Let's continue to build familiarity with the renewable energy co-op sector so that we can build stronger relationships with the general public, government institutions and the financial industry.
Thu, 11/03/2011 - 11:20
unique investment opportunity
Its a rare to find an investment opportunity that is not only offers triple bottom line returns but where you can become personally involved. And as a co-op SolarShare also offers people a democratic voice - one member one vote, regardless of your investment amount. That's a pretty exciting model in todays 1%:99% ratioed world. While SolarShare may not be quite accessible to everyone, its gets pretty damn close. Where else would you get 5% return on a $1000 investment.
This concept needs to be expanded - new groups, new projects and higher investment levels. The regulatory challneges around good ideas are astoundingly entrenched.... I hope SolarShare will be able to break through these barriers in the next year to enable others to replicate the model.
Thu, 11/03/2011 - 12:53
We're working on it!
Hi solar girl,
TREC and SolarShare are both working hard to help similar groups in Ontario start-up, develop and grow! We're strategising and planning to ensure that groups have access to the resources they need to build their own projects and continue this model!
James from TREC
promoting SolarShare
The strength of this proposal is that it allows residents of large, urban residential buildings - a very large proportion of Ontarians - to participate directly in promotion of renewable energy. This is a unique opportunity.
I've recently spoken about SolarShare to two friends who may be interested in becoming SolarShare bondholders. Prehaps it would be a good idea to promote SolarShare in publications such as NOW, EYE, and GRID. Also, an article in SPACING might help.
you had me after the first
you had me after the first paragraph about $1000 @5%.
I'm going to simply assume that you've done the due dilligence on available space, demand for additional hydro purchases through current utilities, rates for small/fluctuating grid contributions, etc. etc.
If all that works out.... you had me at 5% on $1000. In today's economic times where mutual funds are in the tanks and bank interest is <1%, this sounds brilliant.
If the investment is proven relatively safe, I'd love to see this promoted as an investment opportuntiy... even if only at 4%... to a wider base of middle-income families, Not for profits, etc. It's not a cure-all, but it would help those who can't access 8%bond markets, but might be able to pull up 1k.
more renewables - less nuclear
The strength is that every citizen of Ontario can vote with their investment $ to increase renewable power generation. The guarantee of 5% return is also an opportunity to get a good safe return, without taking a risk with the stock market. The weakness is that the opportunity is not available on a more local basis - that is, you can't direct your investment to your own municipality or neighbourhood.
I would like to see more advertising that links the increase in renewables with the opportunity to phase out nuclear. Big nuclear plants on the shore of Lake Ontario near major cities is foolishly risky and also expensive - even after the sale of AECL the federal government is still putting over $200 million dollars into it this year. Enough of the 'hidden' subsidies that make the nuclear industry in Canada seem economically viable. We are paying off the nuclear project overruns from the 80's now, and will be for another 10 or 20 years - just in time to pay off the next budget overruns.
Mon, 11/07/2011 - 10:11
I am investing my point in Solar Share
Today, I will join in on the Ciimate Spark Market and purchase my share for this idea!
Mon, 11/07/2011 - 15:39
Great Project!
With GICs at less than 3% interest this is a great opportunity economically and environmentally!
Can't wait until these bonds are RRSP eligible!
well you got me sold. I'm just disappointed I can only invest $1000, and it's not eligible for RRSP until next year.
Others should follow
You guys have a great idea and model here to get people to take ownership and invest in climate changing initiatives such as solar power. I think this can be applied to other areas as well!
Solar Becoming Risky
Serveral articles this week have been warning of the risks involved with investing in solar. Today in particular it is being said that solar is in limbo after a report was released about falling prices.
What effect does this news have on this project? Is it protected against a volatile market?
Wed, 11/09/2011 - 10:54
FIT contracts locked in
There is a FIT review process coming up to review the rates. However, SolarShare's FIT contracts have been approved and are locked in and we will be paid the agreed upon rates for the next 20 years.
Great Business Case
Solid return on investment while promoting the shift to green jobs and renewable energy make this project amazing. Top that off with a co-op model and this is a real winner!
Getting financial planners/advisors informed about the opportunities so that even more people get in on this chance to boost solar power and make profit.
Give ownership
The bond system is grate way to engage the public sector allowing those who may not play the stock market a new vehicle for investment.
Increase the rate of return
Thu, 11/10/2011 - 12:53
Great option for renters
We live in an appartment building and can't build our own solar installation so this project lets us participate and invest in renewable energy.
Can't wait until these bonds are RRSP eligible!
Thu, 11/10/2011 - 16:13
Always good to make use of
Always good to make use of something that occurs naturally and with positive return on our investment!
it requires a huge amount of
it requires a huge amount of investment.
it does not serve the complete demand and needs of the people residing in the building.
it can be improved by cutting unnecssary cost and lowering the budget of the proposal.
by making it eco friendly is a very good example to society.
Community investment in RE common in Europe
Why don't we adopt the best from around the world? Why leave investment to bankers? This is a solid investment, and enables people to benefit financially. Let's get this investment off the ground and build awareness in communities across Ontario.
Mon, 11/14/2011 - 13:04
More city projects ?
It's a great way to bring more people into supporting renewable energy including those without space for their own solar array. And an attractive rate of return for greening your portfolio.
It would be good to have more urban sites to increase exposure and awareness to a larger population. The Daimler rooftop project is a good start but there are a lot more rooftops in Toronto alone. A local elementary school near me (Kew Beach)is trying to gather people into their own community co-op to put solar on the school roof. There must be lots more opportunities like this rather than having most of the projects in the distant countryside.
Mon, 11/14/2011 - 13:33
Emissions reduction potential
Great project, can't wait until you get FSCO approval so I can buy a bunch!
Improve the emissions reduction potential section. First, the numbers in your emissions reduction statement simply don't add up. If your systems installed to date have generated 236 mWh of solar power to date, that is equal to about 44,000 kg of carbon displaced, or about 96,000 lbs (not 320,000 lbs). The carbon coefficient for ontario's electricity supply is .186 g/kwh according to environment canada's latest numbers.
Second, you should tell us about the potential, not whats been achieved to date. How much do you want to expand your installed base of solar projects, and how much carbon will you reduce if you are successful in hitting that target? Don't tell us where you've been, tell us where you are going.
Sun Bonds
I have seen this same idea with Wind power, I think its great idea!
Could be expanded to renewable energy bonds! Although starting with Solar is a good idea.
Tue, 11/15/2011 - 09:24
A great social investment with real returns
I think it is fantastic that this is providing community members the opportunity to invest in a way that will provide solid financial returns, as well as benefitting the environment. The city, province, and country needs more investment like this.
More investors are needed to demonstrate that this is a viable investment opportunity. Hopefully this contest and continued promotion will help to sell more shares and get there soon.
Tue, 11/15/2011 - 12:30
Congratulations for 100 members in Solar Share!
I wanted to let people know that MaRS is having an "Investing in Good Deals" conference on December 13th and 14th. One of the workshops is digging into community power and how to move investment in this area. You can check out the program and register here http://socialfinanceforum.eventbrite.com.
Bursaries are avialable for Nonprofits and social enterprises.
It would be great to have supporters of solarshare at the conference.
Tue, 11/15/2011 - 13:01
Financing the next stage of Innovation
The SolarShare proposal is about the future and how to finance the change the world needs - encouraging the purchase of these kinds of bonds is a great idea and makes me think that parents might consider buying these for their children. It is this kind of PSA or commercial that would be great to see on TV!
Some sort of a video or infographic as well as a PSA that give people the option of participating. We wonder too how mainstream financial institutions could get involved if they are not already.
Tue, 11/15/2011 - 15:04
Transmission corridors, anyone?
This proposal provides great integration between business ideals and environmental purpose - a great social venture. It helps build renewable energy in Ontario and could be applicable to other energy systems and approaches, too (see ZooShare!)
For now, this is a big first step with lots of nagging details to iron out - Go TREC Go! But again, this is just the beginning - I recall a community power conference a few years ago detailing a community in Europe that was fashioning a collective to build, own and rent our supplmentary transmission corridor space - now we're talking.
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c'est tout ce que j'aime,c'est trop beaux,j'adore
Patrick le N. Thursday, 3 April 2014
Complimenti l'Irlanda è Bellissima, attivate anche la condivisione tramite Twitter, grazie
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Last winter, Bonny Doon resident Sigrid Oseberg said propane cost so much — more than $700 to fill a 250-gallon tank — that her family took drastic measures to conserve.
"We sat here and froze because I didn't think we could afford to heat the house," she said.
Hoping to combat high prices, Oseberg and more than 200 fellow Bonny Doon residents have switched their propane service provider to the Elk Grove outpost of Ferrellgas as part of a negotiated cooperative.
Now, Oseberg said, she is paying a rate of $1.97 per gallon — 55 percent less than the $4.35 per-gallon rate she was charged a year ago.
It's a trend that's gaining traction with some communities in Santa Cruz County, as neighborhood associations and communities negotiate reduced prices for fuel.
Boony Dooners band together
Oseberg said that in September, a small group of Bonny Doon residents met to explore forming a propane co-op, something that a homeowner's association in the Rodeo Gulch community of Soquel had previously done with Ferrellgas.
"A lot of us were very frustrated with the pricing and the customer service of propane services around here," Oseberg said.
Especially of concern, she said was the "very inconsistent" pricing of local operators.
As of January 2012, five propane companies in Santa Cruz County charged an average per-gallon price of roughly $2.96 — the highest was AmeriGas at $3.50, and the lowest was Dassel's Petroleum's rate of $2.38. Prices fluctuate by the month.
Oseberg said the Bonny Doon committee sent out requests for a quote to several fuel companies, but it received only two responses — one from Suburban Propane, and one from Ferrellgas.
Once the contract was signed, Ferrellgas trucks began delivering tanks to Bonny Doon residents by mid-October, Osegard said.
According to Ferrellgas regional manager Ward Sutherland, the company's contract with the co-op called for an agreed-upon price per gallon calculated by adding 85 cents per gallon over the monthly wholesale price.
"People have been figuring out there's money to be saved in numbers," he said, adding that the company's non-co-op customers were charged at a rate of wholesale plus $1.20 per gallon. "It's an increasing endeavor that people are getting into."
Sutherland said the arrangement was good for the company and its customers alike. In spite of the cost of trucking in fuel and equipment from facilities in Newark and Los Banos, he said, "We're actually very happy with the (profit) margin we're getting."
The increased number of customers in Santa Cruz County has led Ferrellgas to try to establish a more permanent local presence, beginning with a propane storage facility near Watsonville. Sutherland said that would allow Ferrellgas to keep its prices low.
"If our expenses are down, then the margins can be down," he said. "We did this with the idea that we will be local."
Sutherland said that while the contract signed with the Bonny Doon co-op was for one year, it was an open-ended arrangement. The company plans to offer the same price rate after the original term expires.
"We don't plan on making any changes in price," he said. "As long as (customers are) happy with us, they'll stay with us."
Other communities take notice
The lower rates in Bonny Doon haven't escaped the notice of residents in neighboring Boulder Creek.
Gregg Schlaman said he is in the early stages of organizing his neighbors into another cooperative.
"It's very preliminary at this point," said the Boulder Creek resident. "We're still just seeing how many people are interested."
Schlaman said he is using the online Boulder Creek Family Network Yahoo group to seek input and inform people.
He was inspired to investigate options for propane suppliers when he learned that his parents, residents of Grass Valley, were paying less than $2 per gallon through their homeowners' association.
"We started looking into it in December, maybe early November," said Schlaman, who said he is working with more than 30 Boulder Creek homeowners. "It seems to be spreading slowly."
He has spent time asking around and comparing prices among local suppliers.
"I noticed the prices between the five major providers were varying by a dollar per gallon," he said. "The local companies are pretty fair — it's most of the national ones (that charge more)."
Schlaman said that while he would continue his efforts online, plans are in the works for more public outreach. His goal is to enlist 50 households before approaching providers about a contract.
"If you don't ask questions, (companies) will just charge you what they think they can get," he said.
Too good to be true?
While lower propane costs may entice customers, one local propane provider suggested that Ferrellgas' prices might be an introductory rate only — a tactic sometimes employed by an outside company seeking to gain a toehold in a new market.
"I think that many individuals feel that group buying is advantageous," said Jim Dassel, president of Dassel's Petroleum based in Hollister. "In the end, if you find that the pricing is almost too attractive, you're going to give up something for it."
Dassel said his company is committed to its Santa Cruz County customers and has always relied on fair pricing and good customer service as its business model.
His company has no plans to offer special prices for cooperatives, because a deal for one group would come at the expense of other customers.
"We don't think that a good retail customer needs to be part of a buying group to get quality service at a competitive price," he said. "I think when you do that, the loyal, faithful customers end up subsidizing it."
To comment, email reporter Joe Shreve at email@example.com, call 438-2500 or post a comment at www.pressbanner.com.
At a glance
For information: https://groups.google.com/forum/#!forum/bonny-doon-propane-co-op.


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Any item that says "Auction" will be auctioned off through our eBay Store. Find more information about our auctions on the Big Ticket Page.
Below you will find Jerry Garcia for $1,000 & over
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