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Cancers in the oropharynx (where the back of the mouth meets the throat) often begin in the tonsil, soft palate or base of the tongue. Risk factors for throat cancer include tobacco and alcohol abuse, as well as human papillomavirus (HPV.) Symptoms can include development of asymmetrical tonsils, pain such as a persistent sore throat or pain that shoots to one ear, difficulty swallowing, a muffled sound to the voice or a lump in the neck. Occasionally a neck lump or mass may be an initial sign.
Joel Hinzman had stage four oral cancer. After participating in a clinical study at GW Cancer Center, he is now cancer free.
Doctors can often detect tumors in this area without special instruments, but they may need to use special mirrors or fiber optic telescopes, or to feel the back of the throat with a gloved finger. They may then take a biopsy to confirm a cancer diagnosis. In some cases biopsies can be formed in the office with local anesthetic. Radiologic imaging (CT scan, MRI or PET scan) maybe used to assess the tumor extent and stage of the cancer.
Treatment of oropharyngeal cancer often consists of surgery or radiation therapy, with or without chemotherapy. Small tumors may be removed surgically without the loss of throat function. Larger tumors can be surgically removed, if necessary, but these surgeries require throat reconstruction and may harm the ability to swallow.
Laser microsurgery for oropharynx tumors
An option that is available for some patients who have excellent swallowing function is minimally invasive laser surgery. With this type of surgery, reconstruction is usually not needed, particularly for the areas around the tonsils and base of the tongue. Some patients with soft palate tumors may need reconstruction that can be completed by transfer tissue from an adjacent area of the mouth instead of a major reconstructive procedure. Larger resections, however, may require major reconstruction.
When tumors are found in the early stages, surgical treatment may be all that is needed. A major advantage of minimally invasive surgery is that it can help preserve organs and salivary function when used to treat cancerous tumors. That makes it easier to maintain oral and dental hygiene and function and helps prevent dental decay often associated with radiotherapy.
Radiation therapy typically subjects a significant amount of normal tissue, including major salivary glands as well as minor salivary glands, to the side effects of radiation. Advanced radiation therapy planning followed by delivery using Intensity Modulated Radiation Therapy (IMRT) allows maximum protection of the salivary glands for those who require head and neck radiation therapy. It also may be possible for a patient to have a submandibular (salivary) gland transfer procedure, in which a surgeon moves the gland(s) out of the field of radiation to protect them and preserve salivary flow, which is critical for swallowing and speaking.
For some tumors, when organ and function-preserving surgery is not feasible, chemotherapy with radiotherapy is given as an alternative.
The larynx (or voice box) is located just below the throat. It contains the vocal cords and is necessary for voice production, breathing and swallowing. Tobacco use, secondhand smoke and excessive alcohol consumption can increase the risk of laryngeal cancers. Symptoms of laryngeal cancer can include: a sore throat that does not go away, trouble or pain when swallowing, a lump in the neck or throat, hoarseness or changes to the voice, persistent cough and ear pain.
Your doctor may use a laryngoscope to examine your larynx and the surrounding area for growths, masses or changes in tissue color. Suspicious areas can be biopsied to determine if these lesions are cancerous.
When patients receive a cancer diagnosis, a multidisciplinary team of head and neck specialists at GW Hospital works to develop a treatment plan based on the cancer’s location and stage. Treatment may include laser surgery, open surgery, chemotherapy and/or radiation. Treatment is individualized while following established national guidelines.
Minimally Invasive Laser Surgery
Many patients are candidates for minimally invasive laser treatments that can be completed through the mouth, without any incisions. Surgeons at GW Hospital are unique in using laser surgery to treat cancers of both the vocal cords and the upper portion of the larynx.
In this type of surgery, the doctor places a thin, lighted tube called a laryngoscope inside the patient’s mouth to visualize the throat and the voice box. The voice box is then viewed under high magnification with a laser-equipped microscope. Using microscopic laser cuts, the tumor is removed with high precision. In most cases, the patient won’t need a temporary tracheotomy.
Surgeons at GW Hospital also can use laser surgery to target other cancers in the back of the throat and tongue, as well as other areas of the throat. This approach allows maximal functional and aesthetic preservation and a relatively fast recovery.
Mouth cancer can occur on the lips, gums, tongue, inside lining of the cheeks, and the roof and floor of the mouth. Risk factors include tobacco and alcohol use, as well as exposure to the human papillomavirus (HPV).
Symptoms include a non-healing wound, which may or may not be painful, on the tongue, in the floor of the mouth or along the inner cheek. The sore may grow larger and additional symptoms may include new or increased pain, painful swallowing, ear pain, change in speech or a lump in the neck. If you have a sore in your mouth that does not heal within three weeks, you should see a physician.
A physician will review your medical history and complete a physical examination of the area. The examination will usually cover the entire head and neck region, including the throat, nose and ears.
Physicians may recommend a specialized type of X-ray, such as a CT scan and/or an MRI. Physicians may also order an X-ray or CT scan of the chest to evaluate for spread of disease to the lungs, the most common site of spread outside of the neck.
At this point, a biopsy — a small piece of tissue taken from the suspected tumor — is often taken from the patient in the doctor’s office. The surgeon may also wish to obtain a biopsy with the patient under anesthesia. Evaluation of the entire throat, voice box, esophagus, and windpipe is also often recommended as a percentage of patients who have one cancer of the mouth, throat or voice box may also have another tumor present elsewhere in the head and neck.
The three main tools for treating cancers of the oral cavity are surgery, radiation therapy and chemotherapy, depending on the staging. For this reason, someone with a cancer of the oral cavity may also meet a specialist from radiation oncology as well as medical oncology.
Surgical removal is the first line of treatment for the majority of mouth cancers. For tumors that are at the early stage, the tumor is addressed through the mouth, sometimes using a laser. Because tumors from the mouth may spread to the neck lymph nodes, removal of those nodes may also be required.
For larger tumors, reconstructive surgery may be needed following the removal of the cancer to restore the form and function of the mouth. This can often be done in the same procedure.
Surgeons at GW Hospital use advanced surgical techniques to help patients who have had oral cancer surgery restore function and appearance. Reconstruction may be as simple as putting the tongue muscles back together in the best possible fashion after the removal of the tongue cancer, or placing a skin graft to replace the missing oral cavity lining. With advanced cancers, more advanced reconstruction may be required. In such cases, not only is new lining of the oral cavity needed in greater amount, but bone — such as the jawbone — may need to be replaced with tissues taken from elsewhere in the body. For example, skin and muscle can be moved from the chest to rebuild the tongue and mouth. Skin can also be moved from the area of the wrist and used to reline the mouth and rebuild the tongue. Bone can be moved, with or without skin, from the lower leg, hip or shoulder blade and used to rebuild the upper or lower jaw.
Following treatment of cancers in the oral cavity with surgery, radiation therapy, chemotherapy or combinations of the techniques, several important functions of the oral cavity may be severely affected. These include lubrication of the mouth and throat, swallowing without choking on foods or liquids, speech and movement in areas where surgery has been done. Rehabilitation of various mouth functions can be accomplished with the help of a speech therapist.
Parathyroid glands are four small glands in the neck that produce a hormone to help regulate calcium. A parathyroid adenoma is a noncancerous (benign) tumor found in these glands and can be caused by a genetic problem. The most common cause of parathyroid adenoma is hyperparathyroidism, which leads to increased blood calcium levels.
There is a rare cancer that forms in the tissues of one or more of the parathyroid glands. It is treated with surgery and/or radiation therapy. Surgeons at GW Hospital offer minimally invasive guided parathyroidectomy with and without video assistance.
In the video-assisted surgery, physicians use targeted incisions and endoscopes in order to provide more precise localization of parathyroid tumors through smaller incisions and remove the affected gland.
Salivary ducts drain the salivary glands but sometimes the chemicals in saliva can crystallize into a stone that blocks the ducts leading to pain and swelling. In addition to pain and swelling, people with salivary stones may also experience dry mouth, difficulty swallowing and/or opening their mouths and, if left untreated, can lead to repeated salivary gland infections.
Salivary gland stones are often discovered through an examination of the head and neck by a physician who observes one or more enlarged, tender salivary gland. The doctor may be able to feel the stone during examination. Scans such as X-rays, ultrasound or CT scan of the face can confirm the diagnosis.
Innovative, minimally invasive treatment
Previous treatments for salivary gland stones required open surgery and a brief hospital stay. However, surgeons at GW Hospital are now offering a new treatment for salivary gland stones. Pioneered in Europe, sialoendoscopy is a technique that allows minimally invasive treatment of salivary gland stones, as well as the treatment of a variety of salivary gland problems.
This technique uses a specially designed endoscope (a small, lighted tube with a camera on the end) and other instruments to allow unique access to the salivary ductal system, where the interventional procedures are then performed to remove or fragment the stone(s). The procedure can be performed safely with local anesthesia in a surgeon’s office and typically takes 30 minutes to complete.
The parotid glands, the largest salivary glands, are found on each side of the face, just in front of the ears. The majority of salivary gland tumors are found in the parotid glands. Most of these tumors are benign (non-cancerous), and the most common tumors of the parotid glands are pleomorphic adenomas. The most common cancerous lesions of the parotid gland are mucoepidermoid cancer and adenoid cystic cancer.
A large number of minor salivary glands exist throughout the lining of mouth, palate, throat, and even the nose and sinuses, and tumors can occur in any of these areas. They sometimes occur in voice box and upper airway of lung particularly the trachea and bronchi.
Most of these tumors are identified as an asymptomatic mass. For parotid gland tumors, the mass is often a painless but firm swelling, which may increase in size. These masses are often slow-growing, however the slow speed and almost unnoticeable growth can be deceptive. The lack of pain or discomfort and slow growth are not always a sign of benign tumor. Cancerous tumors are usually painless and slow growing as well. Some patients experience rapid tumor growth or pain and weakness of the facial muscles. These are possible signs of cancerous change.
If you or a physician discovers a mass in your neck, which may or may not be from salivary glands, a consultation with an otolaryngologist (also known as an “ENT” or head and neck surgeon) is necessary. Based on examination, the physician should be able to determine where the tumor has started, by noting the exact location of the mass.
Not all masses or bumps of the major salivary gland are tumors. Benign cysts or obstructive cysts also appear as a mass. Two tests that are useful in determining the nature of the mass are fine needle aspiration biopsy and radiologic imaging, which is often a CT scan. During a fine needle biopsy, an experienced head and neck surgeon inserts a needle, coupled to a syringe, into the mass directly through the skin (not unlike a blood test). The sample of the tumor cells is then sent to a lab for analysis.
A physician may order other imaging or testing. Scans are typically not used to provide a diagnosis but are used to help the surgeon to confirm the exact location of the mass, its size, the solid or cystic nature of the lesion, as well as the extent of the lesion. This is useful information for both diagnosis and treatment planning. Masses are sometimes located outside of but adjacent to the major salivary glands.
Salivary gland tumors are treated by surgical removal. In the case of benign tumors, surgery with complete removal of tumor is the curative treatment and no other treatment (i.e. radiotherapy or chemotherapy) is needed.
In cases where salivary gland tumors are cancerous, surgery is the most effective treatment. However, in some patients, radiation therapy is also recommended. The need for radiation therapy is determined by numerous factors including the exact kind of cancer and its grade, the size of tumor and the location of the tumor.
The thyroid gland, located at the base of your neck, produces hormones that regulate metabolism, heart rate and body temperature. Risk factors for cancer include exposure to radiation (including previous treatment for head and neck cancers), personal or family history of goiter (enlarged thyroid) and certain inherited genetic syndromes.
Symptoms of thyroid cancer include a lump in the neck, changes to the voice, difficulty swallowing, pain in the neck and throat, and swollen lymph nodes in your neck.
Physicians use various means to make a diagnosis of thyroid cancer, including a physical exam, blood tests to measure levels of thyroid stimulating hormone, a fine needle biopsy to examine cells in the thyroid and imaging tests such as a thyroid ultrasound.
A multi-disciplinary team composed of thyroid surgeons, endocrinologists, radiologists and nuclear medicine physicians convene to provide comprehensive thyroid cancer care. Highly-skilled surgeons at GW Hospital perform procedures that can remove the cancer while preserving a patient’s laryngeal nerves and parathyroid glands.
One of these surgeries for select patients with thyroid nodules is a minimally invasive video-assisted thyroidectomy. This procedure involves using an endoscope to remove all or part of the thyroid. By using an endoscope and other special instruments, surgeons can make smaller incisions.