Head and neck cancer roles and tests

Head and neck cancer

Health care team roles
KEY TERMS Endoscopy is performed by a gastroenterologist with
the assistance of registered nurses. Breath testing can be
Endoscope—A thin, lighted tube with a tiny cam-
administered by a physician or nurse. Venipuncture is
era attached to the end. It allows the doctor to see
performed by a physician, nurse or phlebotomist.
the lining of the esophagus, stomach, and duo-
Serological testing is performed by a clinical laboratory
denum.
scientist, CLS(NCA)/medical technologist, MT(ASCP)
Endoscopy—A procedure that uses an endoscope. or clinical laboratory technician, CLT(NCA)/medical
laboratory technician, MLT(ASCP).
Gastroenterology—The study of the digestive sys-
tem and diseases and disorders affecting it.
Resources
Invasive procedure—A medical procedure that
PERIODICALS
requires entrance of a foreign object into the
Fallone Carlo A., Sander J.O. Veldhuyzen van Zanten, Naoki
human body.
Chiba. “The Urea Breath Test for Helicobacter pylori
Non-invasive procedure—A medical procedure Infection: Taking the Wind Out of the Sails of
that does not require entrance of a foreign object Endoscopy.” Canadian Medical Association Journal
into the human body. (February 8, 2000): 371-2.
Sutton, Fred M. “Diagnosis of H. pylori Infection.” Infectious
Serology—Blood tests.
Medicine 15 no. 5 (1998): 331-336.
Urea—A waste product of the breakdown of pro- Veldhuyzen van Zanten, Sander J. O. “Treating Non-Ulcer
teins. dyspepsia and H. pylori: It Is Economically and
Clinically Sensible But It Won’t Make Most Patients
Better.” British Medical Journal (September 16, 2000).
comfort associated with the procedure, the patient is ORGANIZATIONS
mildly sedated and a topical anesthetic is sprayed in the National Digestive Diseases Information Clearinghouse. 2
throat. Vital signs and history are important to insure that Information Way, Bethesda, MD 20892-3570.
<http//www.niddk.nih.gov>.
the patient does not have a condition that contraindicates
the procedure. An intravenous line is used to instill fluids
Peggy Elaine Browning
and the sedative.
For the breath test, a dose of radiolabeled urea is Hand and arm splints see Upper limb
given orally to the patient. For serological tests,
orthoses
venipuncture is performed using standard precautions for
Haptoglobin test see Plasma protein tests
prevention of exposure to bloodborne pathogens.
HCT see Hematocrit
Aftercare
Following endoscopy, patients should be observed
while recovering from sedating medications for any signs
of GI bleeding or pain and treated accordingly. The
patient should remain under medical supervision until
fully alert. After venipuncture, hemostasis should be Definition
accomplished by applying direct pressure to the puncture
The term head and neck cancers refers to a group of
site.
cancers found in the head and neck region. This includes
tumors found in:
Complications
• The oral cavity (mouth): the lips, the tongue, the teeth,
the gums, the lining inside the lips and cheeks, the floor
Endoscopy may be associated with GI bleeding,
of the mouth (under the tongue), the roof of the mouth,
allergic reaction to medications, and throat or abdominal
and the small area behind the wisdom teeth are all
pain. Rare complications also include perforation of an
included in the oral cavity.
upper GI organ, aspiration of gastric fluid, and phlebitis.
Breath and serological tests are not associated with sig- • The oropharynx: includes the back one-third of the
nificant complications. tongue, the back of the throat, and the tonsils.

G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
1100

• Nasopharynx: includes the area behind the nose. included as a risk factor. A combination of tobacco and

alcohol use increases the risk for oral cancer by six to 15
• Hypopharynx: the lower part of the throat.
times more than for users of either substance alone. In
• The larynx (voice box, located in front of the neck in rare cases, irritation to the lining of the mouth, due to
the region of the Adam’s apple): in the larynx, the can- jagged teeth or ill-fitting dentures, has been known to
cer can occur in any of the three regions—the glottis cause oral cancer. Exposure to asbestos also appears to
(where the vocal cords are); the supraglottis (the area increase the risk of developing laryngeal cancer.
above the glottis), and the subglottis (the area that con-
In the case of lip cancer, just like skin cancer, expo-
nects the glottis to the windpipe).
sure to sun over a prolonged period has been shown to
The most frequently occurring cancers of the head increase the risk. In the Southeast Asian countries (India
and neck area are oral cancers and laryngeal cancers. and Sri Lanka), chewing of betel nut has been associated
Almost half of all the head and neck cancers occur in the with cancer of the lining of the cheek. An increased inci-
oral cavity, and a third are found in the larynx. By defi- dence of nasal cavity cancer has been observed among
nition, the term “head and neck cancers” usually furniture workers, probably due to the inhalation of wood
excludes tumors that occur in the brain. dust. A virus (Epstein-Barr) has also been shown to cause
nasopharyngeal cancer.
Description Head and neck cancers are one of the easiest to
detect. The early signs can be both seen and felt. The
Head and neck cancers involve the respiratory tract
signs and symptoms depend on the location of the cancer:
and the digestive tract, and they interfere with the func-
tions of eating and breathing. Laryngeal cancers affect • Mouth and oral cavity: a sore that does not heal within
speech. Loss of any of these functions is significant. two weeks, unusual bleeding from the teeth or gums, a
Hence, early detection and appropriate treatment of head white or red patch in the mouth, or a lump or thicken-
and neck cancers is of utmost importance. ing in the mouth, throat, or tongue.
Roughly 10% of all cancers are related to the head • Larynx: persistent hoarseness or sore throat, difficulty
and the neck. For cancer of the pharynx and oral cavity, breathing, or pain.
there was an estimated 30,200 new cases in 2000.
• Hypopharynx and oropharynx: difficulty in swallowing
Incidence rates are highest in women and men over age
or chewing food or ear pain.
40, and more than twice as high in men as in women. The
• Nose, sinuses, and nasopharyngeal cavity: pain, bloody
rates of oral cancers and deaths due to this cancer have
discharges from the nose, blocked nose, and frequent
been declining.
sinus infections that do not respond to standard antibi-
Among the major cancers, the survival rate for head
otics.
and neck cancers is one of the poorest. Less than 50% of
When detected early and treated appropriately, head
the patients survive five years or more after initial diag-
and neck cancers have an excellent chance of being cured
nosis. This is because the early signs of head and neck
completely.
cancers are frequently ignored. Hence, when they are
first diagnosed, these types of cancers are often in an
Diagnosis
advanced stage and not very amenable to treatment.
The risk for both oral cancer and laryngeal cancer Specific diagnostic tests used depend on the location
seems to increase with age. Most of the cases occur in of the cancer. The standard tests are:
individuals over 40 years of age, the average age at diag-
nosis being 60. While oral cancer strikes men twice as Physical examination
often as it does women, laryngeal cancer is four times
The first step in diagnosis is a complete and thor-
more common in men than in women. Both diseases are
ough examination of the oral and nasal cavity, using mir-
more common in African Americans than among
rors and other visual aids. The tongue and the back of the
Caucasians.
throat are examined as well. Any suspicious looking
lumps or lesions are examined with fingers (palpation).
Causes and symptoms
In order to look inside the larynx, the doctor may some-
times perform a procedure known as laryngoscopy. In
Although the exact cause for these cancers is
unknown, tobacco is regarded as the single greatest risk indirect laryngoscopy, the doctor looks down the throat
factor: 75–80% of the oral and laryngeal cancer cases with a small, long handled mirror. Sometimes the doctor
occur among smokers. Heavy alcohol use has also been inserts a lighted tube (laryngoscope or a fiberoptic scope)

1101


through the patient’s nose or mouth. As the tube goes the cancer is completely removed. The amount of normal
tissue removed is minimized using this method.
down the throat, the doctor can observe areas that cannot
be seen by a simple mirror. This procedure is called a Cancers of the nasal cavity are often diagnosed late
direct laryngoscopy. Sometimes patients may be given a because they have no specific symptoms in their early
mild sedative to help them relax, and a local anesthetic to stages, or the symptoms may just resemble chronic
ease any discomfort. sinusitis. Hence, treatment is often complex, involving a
combination of radiotherapy and surgery. Surgery is
Blood tests generally recommended for small tumors. If the cancer
cannot be removed by surgery, then radiotherapy is used
The doctor may order blood or other immunological
alone.
tests. These tests are aimed at detecting antibodies to the
Epstein-Barr virus. Treatment of oropharynx cancers (cancers that are
either in the back of the tongue, the throat, or the tonsils)
Imaging tests generally involves radiation therapy and/or surgery. After
aggressive surgery and radiation, rehabilitation is often
X rays of the mouth, the sinuses, the skull, and the
necessary and is an essential part of the treatment. The
chest region may be required. A computed tomography
patient may experience difficulties with swallowing,
scan (CT scan), a procedure in which a computer takes a
chewing, and speech and may require a team of health
series of x ray pictures of areas inside the body, may be
care workers, including speech therapists, prosthodon-
done. Ultrasonograms (images generated using sound
tists, occupational therapists, etc.
waves) or an MRI (magnetic resonance imaging) a
procedure in which a picture is created using magnets Cancers of the nasopharynx are different from the
linked to a computer), are alternate procedures which a other head and neck cancers in that there does not appear
doctor may have done to get detailed pictures of the areas to be any association between alcohol and tobacco use
inside the body. and the development of the cancer. In addition, the inci-
dence is seen primarily in two age groups: young adults
Biopsy and 50–70 year-olds. The Epstein-Barr virus has been
implicated as the causative agent in most patients. While
When a sore does not heal or a suspicious patch or
80–90% of small tumors are curable by radiation therapy,
lump is seen in the mouth, larynx, nasopharynx, or throat,
advanced tumors that have spread to the bone and cranial
a biopsy may be performed to rule out the possibility of
nerves are difficult to control. Surgery is not very helpful
cancer. The biopsy is the most definitive diagnostic tool
and, hence, is rarely attempted. Radiation remains the
for detecting the cancer. If cancerous cells are detected in
only treatment of choice to treat the cancer that has
the biopsied sample, the doctor may perform more exten-
metastasized (traveled) to the lymph nodes in the neck.
sive tests in order to find whether, and to where, the can-
In the case of cancer of the larynx, radiotherapy is
cer may have spread.
the first choice to treat small lesions. This is done in an
attempt to preserve the voice. If the cancer recurs later,
Treatment
surgery may be attempted. If the cancer is limited to one
The cancers can be treated successfully if diagnosed of the two vocal cords, laser excision surgery is used. In
early. The choice of treatment depends on the size of the order to treat advanced cancers, a combination of surgery
tumor, its location, and whether it has spread to other and radiation therapy is often used. Because the chances
parts of the body. of a cure in the case of advanced laryngeal cancers are
rather low with current therapies, the patient may be
In the case of lip and mouth cancers, sometimes sur-
advised to participate in clinical trials so they may get
gery is performed to remove the cancer. Radiation thera-
access to new experimental drugs and procedures, such
py, which destroys the cancerous cells, is also one of the
as chemotherapy, that are being evaluated.
primary modes of treatment, and may be used alone or in
combination with surgery. If lip surgery is drastic, reha- When only part of the larynx is removed, a relative-
bilitation cosmetic or reconstructive surgery may have to ly slight change in the voice may occur—the patient may
be considered. Some cancers of the lip may be removed sound slightly hoarse. However, in a total laryngectomy,
by Mohs’ surgery, also known micrographic surgery. the entire voice box is removed. The patients then have
Using this method, the surgeon removes the tumor in thin to re-learn to speak using different approaches, such as
slices, examining them immediately under the micro- esophageal speech, tracheo-esophageal (TE) speech, or
scope to look for cancer cells. More slices are taken until by means of an artificial larynx.

1102

In esophageal speech, the patients are taught how to Photodynamic therapy (also called PDT, photoradia-

tion therapy, phototherapy, or photochemotherapy) is a
create a new type of voice by forcing air through the
esophagus (food pipe) into the mouth. This method has a treatment for some types of cancer including larynx and
high success rate of approximately 65% and patients are oral cavity.
even able to go back to jobs that require a high level of
Important research is being conducted investigating
verbal communication, such as telephone operators and
new treatments for several head and neck cancers. There
salespersons.
are many new promising treatments and improvements to
In the second approach, TE speech, a small opening current therapies such as:
called a fistula, is created surgically between the trachea
• Tumor growth factors. These hormone-like substances
(breathing tube to the lungs) and the esophagus (tube into
that are naturally occurring in the body typically pro-
the stomach) to carry air into the throat. A small tube,
mote cell growth. Some tumors may grow quickly
known as the “voice prosthesis,” is placed in the opening
because of excessive growth factors. New drugs like C-
of the fistula to keep it open and to prevent food and liq-
225 may help inhibit tumor growth. C-225 targets a
uid from going down into the trachea. In order to talk, the
specific area on the cancer cells’ surface; it may even-
stoma (or the opening made at the base of the neck) must
tually be used to treat other cancers such as colon,
be covered with one’s thumb during exhalation. As the
prostate, bladder, ovarian, and non-small cell lung
air is forced out from the trachea into the esophagus, it
cancer.
vibrates the walls of the esophagus. This produces a
sound that is then modified by the lips and tongue to pro- • New chemotherapy techniques. Intraarterial chemother-
duce normal sounding speech. apy, where drugs are injected into arteries feeding the
cancer, is being tested in combination with radiation
In the third approach, an artificial larynx, a battery
therapy in an attempt to improve their effectiveness.
driven vibrator, is placed on the outside of the throat.
Another new approach uses intralesional chemotherapy
Sound is created as air passes through the stoma (open-
(injecting the drug directly into the tumor). Preliminary
ing made at the base of the neck) and the mouth forms
results have been promising with these new chemother-
words.
apies.
Recent developments have been made with the use
of lasers for treating many types of cancer. Laser therapy • New radiotherapy methods. Studies have been under-
destroys cancer cells by the use of high-intensity light. It way testing the efficacy of new radiation regimens
is often used to relieve symptoms of cancer such as delivering twice-a-day irradiation. Higher cure rates
bleeding or obstruction, particularly when other treat- have been demonstrated.
ments are ineffective. Laser surgery can also treat cancer
• Vaccines may be effective by helping the immune sys-
by shrinking or destroying tumors. Laser surgery is a
tem to recognize and attack the cancer cells.
standard treatment for certain stages of glottis. Although
there are several different kinds of lasers, only the
Prognosis
Carbon dioxide (CO2) laser, Neodymium:yttrium–alu-
minum–garnet (Nd:YAG) laser, and argon laser are wide- Comorbidities (other illnesses) that may be present
ly used in medicine. The CO2 and Nd:YAG lasers are are an important determinant of overall survival in peo-
used to shrink or destroy tumors. Laser surgery is also ple with head and neck cancer.
used to help relieve symptoms caused by cancer (pallia-
tive care) in addition to its use in destroying cancer cells. Oral cavity
Since cancer cannot grow or spread without forming
With early detection and immediate treatment, sur-
new blood vessels, research is being conducted to find
vival rates can be dramatically improved. For lip and oral
ways to stop angiogenesis. Scientists are exploring the
cancer, if detected at its early stages, almost 80% of the
use of natural and synthetic angiogenesis inhibitors, also
patients survive five years or more. However, when diag-
called anti-angiogenesis agents, in anticipation that these
nosed at the advanced stages, the five year survival rate
chemicals will prevent tumor spread by inhibiting new
drops to a mere 18%.
blood vessel formation.
Taxanes are a group of cancer drugs that includes
Nose and sinuses
paclitaxel (Taxol) and docetaxel (Taxotere). Taxanes
inhibit cancer cell growth by arresting cell division. Cancers of the nasal cavity often go undetected until
they reach an advanced stage. If diagnosed at the early
They are also known as antimitotic or antimicrotubule
agents or mitotic inhibitors. stages, the five-year survival rates are 60–70%. However,

1103


KEY TERMS
Angiogenesis—The formation of blood vessels mouth or nose to examine the larynx and other
around a tumor. areas deep inside the neck.
Biopsy—The surgical removal and microscopic Magnetic resonance imaging (MRI)—A medical
examination of living tissue for diagnostic purposes. procedure used for diagnostic purposes where pic-
tures of areas inside the body can be created using
Chemotherapy—Treatment of cancer with synthet-
a magnet linked to a computer.
ic drugs that destroy the tumor either by inhibiting
the growth of the cancerous cells or by killing the p53 gene—A tumor suppressor gene that typically
cancer cells. inhibits the tumor growth. This gene is often altered
in many types of cancer.
Clinical trials—Highly regulated and carefully con-
trolled patient studies, where either new drugs to Radiation therapy—Treatment using high energy
treat cancer or novel methods of treatment are radiation from x-ray machines, cobalt, radium, or
investigated. other sources.
Computerized tomography scan (CT scan)—A Stoma—When the entire larynx must be surgically
medical procedure where a series of x rays are removed, an opening is surgically created in the
taken and put together by a computer in order to neck so that the windpipe can be brought out to the
form detailed pictures of areas inside the body. neck. This opening is called the stoma
Growth factors—Growth factors or human growth Taxanes—Anticancer drugs that inhibit cancer cell
factors are compounds made by the body that func- growth by arresting cell division. Also known as
tion to regulate cell division and cell survival. Some
antimitotic or antimicrotubule agents or mitotic
growth factors are also produced in the laboratory
inhibitors.
by genetic engineering and are used in biological
Ultrasonogram—A procedure where high-frequen-
therapy. Growth factors are significant because
cy sound waves that cannot be heard by human
they can induce angiogenesis, the formation of
ears are bounced off internal organs and tissues.
blood vessels around a tumor. These growth factors
These sound waves produce a pattern of echoes
also encourage cell proliferation, differentiation,
which are then used by the computer to create
and migration on the surfaces of the endothelial
sonograms, or pictures of areas inside the body.
cells.
X rays—High energy radiation used in high doses,
Laryngoscopy—A medical procedure that uses flex-
either to diagnose or treat disease.
ible, lighted, narrow tubes inserted through the

drugs, the five year survival rate has improved and
if cancers are more advanced, only 10–30% of the
5–40% of the patients survive five years or longer.
patients survive five years or more.

Larynx
Oropharynx
Small cancers of the larynx have an excellent five-
In cancer of the oropharynx, 60–80% of the patients
year survival rate of 75–95%. However, as with most of
survive five years or more if the cancer is detected in the
the head and neck cancers, the survival rates drop dra-
early stages. As the cancer advances, the survival rate
matically as the cancer advances. Only 15–25% of the
drops to 15–30%.
patients survive five years or more after being initially
diagnosed with advanced laryngeal cancer.
Nasopharynx
Advances in detecting head and neck cancer at an
Patients who are diagnosed with early stage cancers early stage are being made. Patients’ prognoses will
that have originated in the nasopharynx have an excellent improve as technological advances are made. Some of
chance of a complete cure (almost 95%). Unfortunately, the research that is being conducted includes DNA muta-
most of the time the patients are in an advanced stage at tions (changes) that occur in genes. Damage to certain
the time of initial diagnosis. With the new chemotherapy DNA can lead to increased growth of abnormal cells and

1104

formation of cancers. Recent studies suggest that tests to and beans. Reducing one’s intake of high-fat food from

animal sources is advised. Following the The Dietary
detect p53 gene alterations may allow very early detec-
Guidelines for Americans published by the United States
tion of oral and oropharyngeal tumors. Other substances
Department of Agriculture and Health and Human Services
under investigation that may help early prognosis of can-
can provide a broad overall view of good nutrition.
cers are epidermal growth factor receptor, transforming
growth factor-alpha, and cyclin D1. These dietary guidelines include these seven basic
recommendations:
Using targeted chemoradiation, one clinical study
revealed that statistical projections for overall and can- • Eat a variety of foods.
cer-related five-year survival was 38.8% and 53.6%,
• Control your weight.
respectively for patients with advanced (stage III-IV)
• Eat a low-fat, low-cholesterol diet.
carcinoma of the head and neck.
• Eat plenty of vegetables, fruits, and grains.
Health care team roles • Eat sugar in moderation.
Depending on the diagnosis, disease stage, level of • Use salt in moderation.
nursing care required, and different psychosocial factors, • If you drink alcohol, do so in moderation; no more than
the patient’s health care needs will vary. The care two drinks per day of wine, beer, or spirits.
required is unique to each patient and family. For patients
The Food Guide Pyramid was created by the United
who will be in transitional care, an optimal integration
States Department of Agriculture to help Americans
between inpatient and outpatient care is needed to ensure
choose foods from each food grouping. The food pyra-
the best care possible. Outpatient care includes home
mid, developed by nutritionists, provides a visual guide
care, rehabilitation centers, nursing homes, and hospice
to healthy eating.
care. Health care teams should make the transition from
the different types of inpatient and outpatient care as easy Resources
as possible. Effective communication between profes-
BOOKS
sionals is critical.
Harrison, Louis B., et al., eds. Head and Neck Cancer: A
A dental team with experience in oral oncology, may Multidisciplinary Approach. Philadelphia: Lippincott
reduce the risk of oral complications for patients with Williams & Wilkins Publishers, 1999.
oral cancers. Thawley, Stanley E., et al., eds. Comprehensive Management
of Head and Neck Tumors. 2nd ed. London: W. B.
Saunders Co., 1999.
Prevention
ORGANIZATIONS
Refraining from the use of all tobacco products (cig-
American Association of Oral and Maxillofacial Surgeons.
arettes, cigars, pipe tobacco, chewing tobacco), consum- 9700 W. Bryn Mawr; Rosemont, IL 60018. (800) 467-
ing alcohol in moderation, and practicing good oral 5268. <http://www.aaoms.org>.
hygiene are some of the measures that one can take to American Dietetic Association. 216 W. Jackson Blvd.
prevent head and neck cancers. Since there is an associa- Chicago, IL 60606-6995. (312) 899-0040.
tion between excessive exposure to the sun and lip can- <http://www.eatright.org>.
cer, people who spend a lot of time outdoors in the sun International Association of Laryngectomees (IAL). 7440
should protect themselves from the sun’s harmful rays. North Shadeland Avenue, Suite 100, Indianapolis, IN
Regular physical examinations, or mouth examination by 46250. <http://www.larynxlink.com/welcome.html>.
the patient himself, or by the patient’s doctor or dentist, National Cancer Institute (National Institutes of Health). 9000
Rockville Pike, Bethesda, MD 20892. (800) 422-6237.
can help detect oral cancer in its very early stages.
<http://cancernet.nci.nih.gov>.
Since working with asbestos has been shown to
National Oral Health Information ClearingHouse. 1 NOHIC
increase one’s risk of getting cancer of the larynx, asbestos
Way, Bethesda, MD 20892-3500. (301) 402-7364.
workers should follow safety rules to avoid inhaling <http://www.nohic.nih.gov>.
asbestos fibers. Also, malnutrition and vitamin deficiencies Oral Health Education Foundation, Inc. 5865 Colonist Drive,
have been shown to have some association with an P.O. Box 396, Fairburn, GA 30213. (770) 969-7400.
increased incidence of head and neck cancers. The Support for People with Oral and Head and Neck Cancer
American Cancer Society recommends eating a healthy (SPOHNC). P.O. BOX 53 Locust Valley, NY 11560-
diet, consisting of at least five servings of fruits and veg- 0053. (800) 377-0928. <http://www.spohnc.org>.
etables every day, and six servings of food from other plant
sources such as cereals, breads, grain products, rice, pasta, Crystal Heather Kaczkowski, MSc.

1105

Head and neck cancer roles and tests

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (18)

Andere mochten auch

Andere mochten auch (6)

Ähnlich wie Head and neck cancer roles and tests

Ähnlich wie Head and neck cancer roles and tests (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Head and neck cancer roles and tests