Head and Neck Cancer

Endoscopic Laser Surgery of Voice Box Cancer
Neck Masses / Cysts
Treatment of Laryngeal (Voice Box) Cancer
Voice Restoration After Laryngectomy

Endoscopic Laser Surgery of Voice Box Cancer

Endoscopic laser surgery of voice box cancer was introduced in the US by European otolaryngologists.  Dr. Galati was trained during her fellowship by one of the leading experts from Germany.  This procedure has dramatically improved outcomes by shortening hospital stays, avoiding tracheostomies and making swallowing easier.

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Neck Masses / Cysts

State of the art treatment of neck masses including benign tumors of the parotid gland is a regular part of our practice.

Masses may develop in the head and neck, and these may also be called growths, tumors, lumps, and bumps. While some head and neck masses are cancerous, many are not; it is important to see a physician if any abnormal bump or structure persists for more than two weeks. If a cancer is present, earlier detection provides the highest chance of successful treatment.

What Causes Head and Neck Masses?

There are numerous causes of head and neck masses.

• Enlargement of lymph nodes – this is the most common cause of new neck masses. Lymph nodes, which are part of the immune system, can enlarge when the body rallies to fight an infection. When the infection recedes, lymph swelling subsides as well.
• Benign lesions – Benign masses do not spread (metastasize) to surrounding tissue and are not cancerous. Nevertheless, benign masses can be serious if they impact nerves or exert pressure in the head and neck, and are often removed surgically. These include cysts, thyroid masses, vascular masses, salivary gland masses, and others.
• Cancers – Head and neck masses are malignant, or cancerous, if they spread to surrounding tissue. In the head and neck, tumors may be either primary or secondary.

You should see your physician if you experience any of the following symptoms:

• Lump in the neck persisting for more than two weeks, especially if it is not associated with a cold, flu, or other infection. Cancers of the mouth, throat, voice box (larynx), thyroid, and some lymphomas (blood cancers) can appear first as a painless, growing neck lump.
• Change in your voice including hoarseness that persists more than two weeks
• Growth in the mouth
• Swollen tongue
• Blood in the saliva or phlegm
• Swallowing problems
• Changes in the skin – it is important to have a dermatologist or physician examine changes in the skin that could indicate basal cell carcinoma, squamous cell cancer, and malignant melanoma. Skin cancers are associated with prolonged exposure to the sun; most squamous cell cancers occur on the lower lip or ear.
• Persistent ear pain or ear pain while swallowing -- may be a symptom of infection or a growth in the throat

Diagnosing Head and Neck Masses

Examination of some masses may allow a physician to determine their cause based on location, size, and consistency. In other cases, however, additional tests may be required, such as:

• Neurological exam – includes evaluation of eye movements, hearing, sensation, muscular movement, sense of smell, balance and coordination
• MRI – Magnetic Resonance Imaging can clearly show tumors near bones, smaller tumors, and brainstems masses. It uses a magnetic field rather than x-rays (radiation).
• CT Scan – Computed tomography combines a sophisticated x-ray with computer technology. It is less accurate than MRI but can help locate tumors or determine their types, detect swelling or bleeding, and evaluate the effects of treatments. Injections of iodine dye (contrast material) may be used to enhance the visibility of abnormal tissue during CT scans.
• PET (Positron Emission Tomography) and SPECT (Single Photon Emission Tomography) - are useful after diagnosis to help determine the grade of a tumor or to distinguish between cancerous and dead or scar tissue. They involve injection with a radioactive tracer.
• Biopsy – A sample of tissue is taken and examined under a microscope to determine if it is malignant.

Treating Head and Neck Masses

Treatments are determined by the cause of the mass. Benign neck cysts and masses are usually removed by surgical excision. Head and neck cancers may be treated by some combination of radiation therapy, chemotherapy and surgery, depending on their nature. Your surgeon will discuss what treatments are most appropriate for your particular diagnosis.

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Treatment of Laryngeal (Voice Box) Cancer

Our head and neck cancer surgeon will discuss all of the treatments options for your type of cancer.  This can range from radiation therapy, to partial laryngectomy, laser surgery for voice box cancer and total laryngectomy (removal of the vocal cords). 

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Voice Restoration After Laryngectomy

All patients have the ability to talk after total laryngectomy.  Our doctors will help you determine what is the best choice for you.  This might include electro larynx, esophageal speech, or voice prosthesis. 

Voice prosthesis is a simple, short surgical procedure which your doctor can discuss with you before or after your cancer treatment.

The major advantage of the electro larynx is that basic speech is learned quickly by most patients and does not interfere or delay the mastering of other forms of alaryngeal speech.  Furthermore, this form of voice rehabilitation produces a loud voice. 

The major disadvantages of these electromechanical devices is the distinct voice quality.  The voice productions sounds mechanical and even robot-like, distracting the listener’s attention.  The electro larynx requires the use of a handpiece and has a conspicuous appearance.

For  more information on Electro-Larynx, go to www.webwhispers.org/pages/library/electrolarynx.htm.

Esophageal speech is probably the most difficult to master. You will need a speech therapist to help you learn how to force air into to the top of your esophagus and expel it out again through your mouth. This air movement will vibrate the walls of the esophagus and create the "sound" of your voice. There are advantages to this method of speech - you are not battery-dependent and both of your hands are free for other things.

For more information go to www.webwhispers.org/pages/library/esophageal.htm.

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