CONDITIONS

Overviews, Insights and Treatments

CONDITIONS

Overviews, Insights and Treatments

Thyroid Disease

Overview of the Thyroid Gland and Nodules

The thyroid gland is located in the lower neck in front of the trachea. It is butterfly shaped with a right and left lobe. Four parathyroid glands, which regulate calcium metabolism, sit behind the gland.  Other structures near the gland are the esophagus, the voice box, and the nerves to the voice box.

The function of the thyroid gland is to secrete hormones which regulate metabolism.  Thyroid stimulating hormone (TSH) is secreted by the pituitary gland to regulate the thyroid gland. Thyroxine (T4) and Triiodothyronine (T3) are secreted by the thyroid gland which controls the body’s metabolism. It has direct effects on the brain, heart, protein synthesis, and cholesterol, among many other functions.

The thyroid can develop nodules or masses. The majority of thyroid nodules are benign, but some can be cancers. Risk factors for developing thyroid nodules include older age, female gender, radiation exposure, family history, and iodine deficiency, among others.

Overview of Thyroid Cancer

Thyroid cancer has been on the rise with improved technology for detection of and monitoring the thyroid gland. There are different types of thyroid cancer.

Papillary thyroid carcinoma is the most common type of thyroid cancer, which also has the best prognosis. There are different variants within this type of thyroid cancer such as tall cell, columnar cell or hobnail variants.  The other more common types of thyroid cancers include follicular carcinoma, Hürthle cell carcinoma.

Medullary thyroid carcinoma is a less common type of thyroid cancer that arises in a different cell type of the thyroid gland, the parafollicular or C cells. This form commonly can be inherited thus can prompt genetic testing.

Anaplastic thyroid carcinoma is the most rare type of thyroid cancer. This type of cancer is automotically designated as Stage IV because the prognosis can be very poor.

Overview of Goiter

Goiter refers to an enlargement of the thyroid gland that is abnormal. The presence of a goiter does not mean you have thyroid cancer. In fact, most of these are benign causing no symptoms.

Goiter can cause symptoms related to the size. Functions related to swallowing, voice and breathing may be affected. Some patients can experience discomfort in the lower neck as well.

Signs and Symptoms of Thyroid Cancer

The most common sign of a thyroid mass is a lump in the mid-lower neck. In many cases, thyroid masses are found incidentally, meaning they were discovered inadvertently. A patient may have an imaging study such as a CT scan of his or her neck. While evaluating the spine, the thyroid gland is picked up by the scan revealing abnormalities in the thyroid gland.

Symptoms often differ between patients. The following is a list of common signs and symptoms that can warrant an evaluation by a thyroid specialist.

  • Neck mass
  • Swallowing difficulty
  • Change in voice
  • Discomfort in neck
  • Breathing difficulty
Diagnosis and Staging of Thyroid Cancer

To thoroughly evaluate the thyroid gland and the lymph nodes associated, an imaging study is performed. In the case for the thyroid gland, an ultrasound is the best choice. In thyroid ultrasound, an experienced thyroid surgeon has an advantage by knowing the intimate gross anatomy of the thyroid gland. We perform thyroid ultrasounds, being able to monitor thyroid masses as well as being able to perform thyroidectomy surgery.

Other imaging studies may be used depending on the type of thyroid problem.

  • CT (Computed tomography) scan
  • MRI (magnetic resonance imaging) scan
  • PET (positron emission tomography) scan

In addition to monitoring the thyroid gland with ultrasound, our surgeons perform in-clinic fine-needle aspiration (FNA) or needle biopsies leading to more definite diagnoses. Our surgeons will have a thorough discussion with patients before planning any invasive procedures to decrease the number of procedures as well as maximizing education for patients with thyroid problems.

Radioactive iodine update scans may be ordered if the function of the thyroid gland or a particular nodule is in question. These types of scans may also be ordered after surgery to plan for radioactive iodine treatment to help eradicate microscopic cancer cells in the body.

We will order labs including thyroid hormone levels and other related tests based on the type of thyroid problem encountered. Other laboratory tests may also be ordered depending on the medical status of patients. We will also obtain all medical records pertaining to your diagnosis.

After obtaining all tests, we follow the most up to date AJCC (American Joint Committee on Cancer) Cancer Staging System to stage your cancer. We will stay up to date on the most modern philosophies in treating thyroid cancer. The American Thyroid Association (ATA) has guidelines for the treatment of thyroid cancers which we adhere to as well.

Treatment of Thyroid Caner

Regardless of the type of cancer, thyroid cancers are treated with surgery. This can include hemithyroidectomy, total thyroidectomy and different lymph node surgeries depending on the stage of the cancer. Radioactive iodine treatment can be used as an adjuvant or additional therapy after surgery if different criteria are met. Rarely, in the case of very advanced thyroid cancers, radiation therapy and/or chemotherapy can be prescribed.

The recurrent laryngeal nerves are intimately related to the thyroid gland. These nerves provide the larynx or “voice box” with movement of the muscles that create our voice. As a thyroid surgery specialists, our surgeons ensure proper identification and preservation to these nerves in order to preserve the voice. We use NIM Nerve Monitoring during all thyroid surgeries to increase the safety of patients.

The parathyroid glands are 4 glands that sit behind the thyroid gland. These glands are responsible for the body’s calcium regulation. Without functioning parathyroid glands, the body is unable to regulate the calcium often leading to chronic issues with hypocalcemia or low calcium levels. We ensure proper handling of these glands during thyroid surgery. If any blood flow to a parathyroid gland is compromised, we will re-implant these to ensure proper function.

Thyroid Hormone Replacement and Calcium Supplements

After thyroid surgery, most patients will need to rely on lifelong thyroid replacement therapy. After hemithyroidectomy, most patients will NOT need thyroid hormone supplementation, but 30-40% of patients will require some form of supplementation sometime in his or her life.

In regards to thyroid supplementation after thyroid cancer surgery, different suppressive levels may need to be maintained to prevent any recurrence of cancerous thyroid cells that hide in the body.

After total thyroidectomy, some patients may have temporary low calcium levels with the need to take calcium supplementation and/or calcitriol. Our specialists will work close with you to optimize levels before weaning you off of these calcium related medications.

Parathyroid Disease

Overview of Parathyroid Disease

Parathyroid glands are 4 small glands located behind the thyroid gland in the lower neck. Although they are the size of a grain of rice, these 4 glands control the calcium regulation for the entire body. Parathyroid hormone is secreted and acts on the kidneys, bones and intestines to conserve the calcium in the bloodstream.

Hyperparathyroidism, overactivity of one or more parathyroid glands, results in increased calcium in the blood, increased calcium in the urine and decreased levels in bones. A gland that is overactive and enlarged is called a parathyroid adenoma.  Patients with chronic kidney problems can develop secondary or tertiary hyperparathyroidism.

Signs and Symptoms of Parathyroid Disease

Most patients found with hyperparathyroidism do not have any symptoms, but many patients can be symptomatic because of the dysregulation of calcium. Decreased calcium in bones can cause weaker bones leading to osteoporosis and fractures. Kidney stones can also form at a higher rate because of the increased concentration in the kidneys and urinary system. High levels of calcium in the calcium can lead to many different symptoms including cardiac arrhythmias, altered mood and mental status, depression, fatigue, muscle weakness, aches and pains.

Abnormal parathyroid glands almost never get large enough to notice by the naked eye.

Diagnosis of Parathyroid Disease

In hyperparathyroidism, increased blood calcium levels along with increased parathyroid hormone (PTH) levels are usually diagnostic. Different lab draws including Vitamin D levels, urine calcium levels among other lab tests can help differentiate between primary hyperparathyroidism and other disease leading to increased blood calcium levels.

The following are common imaging studies which can help localize an abnormally enlarged parathyroid gland.

  • Ultrasound of neck
  • Sestamibi scan (Technetium  (99mTc) Sestamibi)
  • SPECT-CT (Single-photon emission CT with CT scanning)
  • 4D-CT scan
  • MRI
Treatment of Parathyroid Disease

The treatment of hyperparathyroidism caused by a parathyroid adenoma is surgical excision. Our surgeons will discuss the benefits of surgery versus waiting depending the patient’s individual health and symptoms.

Skin Cancer

Overview of Skin Cancer

Skin cancer is the most common type of cancer.  There are 3 types of skin cancer that are the most common. Basal cell carcinoma (BCC) is the most common with squamous cell cancer (SCC) being the second most common. Melanoma is not as common as these two mentioned but can be the most dangerous. There are other more rare skin cancers such as merkel cell cancer, adnexal neoplasms and lymphoid neoplasms.

The number one factor that increases the risk of skin cancer is sun exposure. Ultraviolet rays from the sun cause mutations in skin cells that can lead to pre-cancer and eventual cancer formation. The best ways to decrease this risk is wearing protective clothing, avoiding the sun at peak hours and wearing sunscreen that blocks both UVA and UVB rays with SPF of at least 30.

Skin cancer is more common in men and elderly patients. Other factors that increase risk of skin cancer are fairness of skin, living closer to the equator, radiation exposure, smoking, and immunosuppression.

Signs and Symptoms of Skin Cancer

Most commonly, a skin cancer presents itself as an abnormal lesion on the skin.  The following is a list of common signs and symptoms that can warrant an evaluation by a head and neck surgeon.

  • Lesion on the skin
    • Discoloration
    • Raised area
    • Bleeding from lesion
    • Change in size of lesion
  • Pain
  • Numbness
  • Weakness of face
  • Odor from lesion
  • Mass in neck
Diagnosis and Staging of Skin Cancer

The first step to diagnosis is a detailed evaluation from a head and neck surgeon or dermatologist, which includes a history and physical exam. A biopsy should be done if the physician finds the lesion concerning for cancer. The type of cancer will be determined leading to any other imaging or laboratory studies.

If a cancer has been identified, a complete work up will include different radiological tests to determine metastasis or spread to the regional lymph nodes in the neck or other distant organs including the lungs or liver. The following are the most common tests used:

  • CT (computerized tomography) scan
  • Ultrasound
  • MRI (magnetic resonance imaging) scan
  • PET (positron emission tomography) scan
  • CXR (chest x-ray)

Laboratory tests may also be ordered depending on the medical status of patients. We will also obtain all medical records pertaining to your diagnosis.

After obtaining all tests, we follow the most up to date AJCC (American Joint Committee on Cancer) Cancer Staging System to stage your cancer. Staging describes the primary tumor, spread to regional lymph nodes and spread to other organs. We discuss and finalize recommendations for treatment at our Multidisciplinary Head and Neck Tumor Conference.

Treatment of Skin Cancer

Surgery is the preferred treatment for skin cancers. Earlier stage skin cancers can be excised with simple excision of the lesion with a good cuff of normal tissue to ensure total removal. The edges of the tissue removed will be checked by a pathologist to ensure all the cancer is removed at the microscopic level. Bigger surgeries may be needed for more advanced skin cancers including melanoma, merkel cell cancer as well as squamous cell carcinomas that have spread to lymph nodes.

For melanoma, sentinel lymph node biopsies may be performed if the tumor invades pasts a certain depth of skin based on the pathologist’s report.  This is a surgery that is meant to be diagnostic. Before the surgery, a radiologist will inject a radioactive tracer around the lesion. After a certain amount of time has passed, the radiologist will take images to see where the radioactive tracer has traveled to. Using this information, the surgeon will remove the lymph node(s) that the tracer has traveled to. The surgeon uses a gamma probe that can detect radiation during the surgery. These “sentinel” lymph nodes will be studied extensively by the pathologist for staging and prognostic purposes. After the results are collected, a decision will be made for more extensive lymph node removal, radiation therapy, immunotherapy, or no other therapies needing to be administered.

Radiation therapy can be an alternative to surgery for certain types of skin cancers in selected patients. Radiation therapy with or without chemotherapy may also be recommended after surgery if indicated. All cases will be discussed at our Multidisciplinary Head and Neck Tumor Conference with radiation oncologists, medical oncologists, along with other specialties to determine the best modality of treatment.

Oral Cancer

Overview of Oral Cancer

The oral cavity consists of the lips, gums, teeth, inner cheeks, hard and soft palate, floor of mouth, and the front two-thirds of the tongue. Malignant or cancerous cells most commonly start on the mucosal surface of the oral cavity. The most common cancer of the oral cavity is squamous cell carcinoma (SCC). Other cancers can form here as well including minor salivary gland malignancies (See Salivary Gland Cancer, make into link to that page).

Smoking and other forms of oral tobacco use such as chewing tobacco or dipping are the most significant modifiable risk factor for oral cancer. If you use tobacco products, having an increased suspicion of an oral lesion can help spot a pre-cancer or cancer at an earlier stage. Seeing a dentist regularly can also increase the detection of oral cancer.

Signs and Symptoms of Oral Cancer

Symptoms differ between patients. The following is a list of common signs and symptoms that can warrant an evaluation by a head and neck surgeon.

  • Lesion
    • Leukoplakia: a thickened white patch occurring on mucosal membranes.
    • Erythroplakia: an area of reddening or erythema occurring on mucosal membranes.
    • The above mentioned lesions are or can become precancerous and even cancerous.
  • Mass or lump in mouth
  • Ulcer in mouth
  • Bleeding
  • Pain or numbness
    • While cancerous tumors can cause pain, some may not.
  • Difficulty or pain swallowing
  • Pain chewing
  • Change in voice
  • Mass in neck
  • Loose teeth
  • Loose dentures
  • Persistent malodorous breath
  • Weight loss
Diagnosis and Staging of Oral Cancer

The first step to diagnosis is a detailed evaluation from a head and neck surgeon, which includes a history and physical exam. If the suspected area warrants, a simple biopsy can be performed in the clinic under local anesthesia. This will be evaluated by a pathologist and a diagnosis will be determined.

A complete work up will include different radiological tests to determine metastasis or spread to the regional lymph nodes in the neck or other distant organs including the lungs or liver. The following are the most common tests used:

  • CT (computerized tomography) scan
  • Ultrasound
  • MRI (magnetic resonance imaging) scan
  • PET (positron emission tomography) scan
  • CXR (chest x-ray)

Laboratory tests may also be ordered depending on the medical status of patients. We will also obtain all medical records pertaining to your diagnosis.

After obtaining all tests, we follow the most up to date AJCC (American Joint Committee on Cancer) Cancer Staging System to stage your cancer. Staging describes the primary tumor, spread to regional lymph nodes and spread to other organs. We discuss and finalize recommendations for treatment at our Multidisciplinary Head and Neck Tumor Conference.

Treatment of Oral Care

We develop treatment plans on an individual personalized basis. Treatment for oral cavity cancer can involve one or a combination of different treatment modalities. This includes surgical resection, radiation therapy and chemotherapy. Surgery is the usually the first line of therapy that provides the best outcome. Radiation therapy with or without chemotherapy is another option for therapy. Radiation therapy with or without chemotherapy may also be recommended after surgery if indicated. All cases will be discussed at our Multidisciplinary Head and Neck Tumor Conference with radiation oncologists, medical oncologists, along with other specialties to determine the best modality of treatment.

Oropharyngeal Cancer

Overview of Oropharyngeal Cancer

The oropharynx is a portion of the throat that includes the palatine tonsils, base of tongue and soft palate. Malignant or cancerous cells most occur on the mucosal surface of the oropharynx.  The most common cancer of the oral cavity is squamous cell carcinoma (SCC). Other cancers can form here as well including minor salivary gland malignancies (See Salivary Gland Cancer, make into link to that page).

Smoking and other tobacco use were historically the most significant modifiable risk factor for oral cancer. In recent times, there has been an epidemic of human papilloma virus (HPV)-mediated oropharyngeal cancer. The emergence of this disease merited a separate staging section in the American Joint Committee on Cancer (AJCC) 8th Edition Cancer Staging System. The encouraging point about this cancer is that there is a significant better chance of cure and survival than historic head and neck cancer diagnoses.

Our surgeons are trained in contemporary surgical techniques including Transoral Robotic Surgery (TORS). This offers significantly less morbidity than traditional surgical techniques. When surgically indicated, this minimally invasive technique is employed to decrease healing time hospital stay.

Signs and Symptoms of Oropharyngeal Cancer

While the tumor originates most commonly from the tonsils or base of tongue, the first sign can be a neck mass noticed by yourself, your partner or a health professional. If you are an adult and discover a neck mass, a head and neck surgeon can perform tests and determine whether this is cancer or a benign mass.

Symptoms differ between patients. The following is a list of common signs and symptoms that can warrant an evaluation by a head and neck surgeon.

  • Mass or lump in neck
  • Mass or lump in throat
  • Difficulty or pain swallowing
  • Change in voice
  • Ulcer in throat
  • Bleeding
  • Pain or numbness
    • While cancerous tumors can cause pain, some may not.
  • Difficulty breathing
  • Persistent malodorous breath
  • Weight loss
Diagnosis and Staging of Oropharyngeal Cancer

The first step to diagnosis is a detailed evaluation from a head and neck surgeon, which includes a history and physical exam. A fiberoptic flexible laryngoscopy will likely be performed under local anesthesia in clinic to visually evaluate the suspected areas of the throat. This is done in order to see areas the human eye cannot normally see. If the suspected area warrants, a head and neck surgeon may be able to perform a biopsy in clinic or may bring you to the operating room for an exam and biopsy under anesthesia. A biopsy will be evaluated by a pathologist in order to determine whether the mass is benign or malignant and if malignant, which type it is.

A complete work up will include different radiological tests to determine metastasis or spread to the regional lymph nodes in the neck or other distant organs including the lungs or liver. The following are the most common tests used:

  • CT (computerized tomography) scan
  • Ultrasound
  • MRI (magnetic resonance imaging) scan
  • PET (positron emission tomography) scan
  • CXR (chest x-ray)

Laboratory tests may also be ordered depending on the medical status of patients. We will also obtain all medical records pertaining to your diagnosis.

After obtaining all tests, we follow the most up to date AJCC (American Joint Committee on Cancer) Cancer Staging System to stage your cancer. Staging describes the primary tumor, spread to regional lymph nodes and spread to other organs. We discuss and finalize recommendations for treatment at our Multidisciplinary Head and Neck Tumor Conference.

Treatment of Oropharyngeal Cancer

Treatment for oropharyngeal cancer can involve one or a combination of different treatment modalities. This includes surgical resection, radiation therapy and chemotherapy. All oropharyngeal cancer, whether it is HPV-mediated or not, will need to be discussed at our Multidisciplinary Head and Neck Tumor Conference with radiation oncologists, medical oncologists, along with other specialties to determine the best modality of treatment whether it comes in the form of surgery alone or a combination of surgery, radiation therapy and chemotherapy.

Our surgeons are trained in contemporary surgical techniques including Transoral Robotic Surgery (TORS). This offers significantly less morbidity than traditional surgical techniques. When surgically indicated, this minimally invasive technique is employed to decrease healing time hospital stay.

Laryngeal Cancer

Overview of Laryngeal Cancer

The larynx, also known as the voice box, is a structure in the neck that is responsible for creating a voice and protecting the lungs from solid and liquid food. The larynx has 3 subsites including the supraglottis, glottis and subglottis. Cancers in each of these subsites can different behaviors and patterns of spread. The most common cancer of the hypopharynx  is squamous cell carcinoma (SCC). Other cancers can form here as well including minor salivary gland malignancies (See Salivary Gland Cancer, make into link to that page).  Smoking and other forms of tobacco use are the most significant risk factors for cancer in the hypopharynx.

Signs and Symptoms of Laryngeal Cancer

Because this area of the throat is not visible by just looking into the mouth, no mass in the throat will be visible. The first sign can be hoarseness, trouble swallowing or a neck mass. If you are an adult and have any symptoms, a head and neck surgeon can perform tests and determine whether this is cancer or not.

Symptoms differ between patients. The following is a list of common signs and symptoms that can warrant an evaluation by a head and neck surgeon.

  • Hoarseness
  • Change in voice
  • Difficulty or pain swallowing
  • Pain in neck
  • Cough
  • Coughing blood
  • Difficulty breathing
  • Persistent bad breath
  • Mass or lump in neck
  • Mass or lump in throat
  • Weight loss
Diagnosis of Laryngeal Cancer

The first step to diagnosis is a detailed evaluation from a head and neck surgeon, which includes a history and physical exam. This examination will likely include the use of a flexible fiberoptic laryngoscope which is usually passed through the nose to see deeper into the throat. The surgeon may schedule an examination under anesthesia to obtain a biopsy. This will be evaluated by a pathologist and a diagnosis will be determined.

A complete work up will include different radiological tests to determine metastasis or spread to the regional lymph nodes in the neck or other distant organs including the lungs or liver. The following are the most common tests used:

  • CT (computerized tomography) scan
  • Ultrasound
  • MRI (magnetic resonance imaging) scan
  • PET (positron emission tomography) scan
  • CXR (chest x-ray)

Laboratory tests may also be ordered depending on the medical status of patients. We will also obtain all medical records pertaining to your diagnosis.

After obtaining all tests, we follow the most up to date AJCC (American Joint Committee on Cancer) Cancer Staging System to stage your cancer. Staging describes the primary tumor, spread to regional lymph nodes and spread to other organs. We discuss and finalize recommendations for treatment at our Multidisciplinary Head and Neck Tumor Conference.

Treatment of Laryngeal Cancer

We develop treatment plans on an individual personalized basis. Treatment for hypopharyngeal cancer can involve one or a combination of different treatment modalities. This includes surgical resection, radiation therapy and chemotherapy. There are different types of voice preserving surgeries that head and neck surgical oncologists can perform depending on the patient. All cases will be discussed at our Multidisciplinary Head and Neck Tumor Conference with radiation oncologists, medical oncologists, along with other specialties to determine the best modality of treatment.

Hypopharyngeal Cancer

Overview of Hypopharyngeal Cancer

The hypopharynx consists of the area of the throat from the hyoid bone down to the level of the entrance to the esophagus. This area is below the oropharynx and above the esophagus. Malignant or cancerous cells most commonly start on the mucosal surface of the hypopharynx. The most common cancer of the hypopharynx  is squamous cell carcinoma (SCC). Other cancers can form here as well including minor salivary gland malignancies (See Salivary Gland Cancer, make into link to that page).  Smoking and other forms of tobacco use are the most significant risk factors for cancer in the hypopharynx.

Signs and Symptoms of Hypopharyngeal Cancer

Because this area of the throat is not visible by just looking into the mouth, no mass in the throat will be visible. The first sign can be a neck mass. If you are an adult and discover a neck mass, a head and neck surgeon can perform tests and determine whether this is cancer or a benign mass.

Symptoms differ between patients. The following is a list of common signs and symptoms that can warrant an evaluation by a head and neck surgeon.

  • Mass or lump in neck
  • Mass or lump in throat
  • Difficulty or pain swallowing
  • Change in voice
  • Coughing blood
  • Difficulty breathing
  • Persistent bad breath
  • Weight loss
Diagnosis and Staging of Hypopharyngeal Cancer

The first step to diagnosis is a detailed evaluation from a head and neck surgeon, which includes a history and physical exam. This examination will likely include the use of a flexible fiberoptic laryngoscope which is usually passed through the nose to see deeper into the throat. The surgeon may schedule an examination under anesthesia to obtain a biopsy. This will be evaluated by a pathologist and a diagnosis will be determined.

A complete work up will include different radiological tests to determine metastasis or spread to the regional lymph nodes in the neck or other distant organs including the lungs or liver. The following are the most common tests used:

  • CT (computerized tomography) scan
  • Ultrasound
  • MRI (magnetic resonance imaging) scan
  • PET (positron emission tomography) scan
  • CXR (chest x-ray)

Laboratory tests may also be ordered depending on the medical status of patients. We will also obtain all medical records pertaining to your diagnosis.

After obtaining all tests, we follow the most up to date AJCC (American Joint Committee on Cancer) Cancer Staging System to stage your cancer.  Staging describes the primary tumor, spread to regional lymph nodes and spread to other organs. We discuss and finalize recommendations for treatment at our Multidisciplinary Head and Neck Tumor Conference.

Treatment of Hypopharyngeal Cancer

We develop treatment plans on an individual personalized basis. Treatment for hypopharyngeal cancer can involve one or a combination of different treatment modalities. This includes surgical resection, radiation therapy and chemotherapy. All cases will be discussed at our Multidisciplinary Head and Neck Tumor Conference with radiation oncologists, medical oncologists, along with other specialties to determine the best modality of treatment.

Nasopharyngeal Cancer

Overview of Nasopharyngeal Cancer

The nasopharynx is a portion of the head and neck that is behind the nasal cavity and above the oropharynx.  Nasopharyngeal cancer (NPC) is divided into 3 types based on the WHO criteria: Type 1 is differentiated squamous cell carcinoma, type 2 is nonkeratinizing carcinoma, and type 3 is undifferentiated carcinoma. There are multiple other types of cancers that occur in the nasopharynx including lymphoma, mucosal melanoma and sarcomas.

NPC is less frequent in the United States, while in China and Southeast Asia, NPC is very common, especially type 3. Risk factors include being exposed to the Epstein-Barr virus (EBV) and being of Asian, especially Chinese, ancestry.

Signs and Symptoms of of Nasopharyngeal Cancer

Although the primary tumor originates in the nasopharynx, patients will commonly get evaluated for a neck mass. Many of the symptoms can be related to blockage or bleeding of the mass from behind the nasal cavity.

Symptoms differ between patients. The following is a list of common signs and symptoms that can warrant an evaluation by a head and neck surgeon.

  • Mass or lump in neck
  • Nasal obstruction
  • Loss of smell
  • Alteration of taste
  • Nose bleeds
  • Change in voice
  • Pain or numbness of face
  • Difficulty breathing
  • Malodorous smell
  • Weight loss
Diagnosis and Staging of Nasopharyngeal Cancer

The first step to diagnosis is a detailed evaluation from a head and neck surgeon, which includes a history and physical exam. A nasal endoscopy will likely be performed under local anesthesia in clinic to visually evaluate the suspected areas of the nasopharynx. This is done in order to see areas the human eye cannot normally see. If the suspected area warrants, a head and neck surgeon may be able to perform a biopsy in clinic or may bring you to the operating room for an exam and biopsy under anesthesia. A biopsy will be evaluated by a pathologist in order to determine whether the mass is benign or malignant and if malignant, which type it is.

A complete work up will include different radiological tests to determine metastasis or spread to the regional lymph nodes in the neck or other distant organs including the lungs or liver. The following are the most common tests used:

  • CT (computerized tomography) scan
  • Ultrasound
  • MRI (magnetic resonance imaging) scan
  • PET (positron emission tomography) scan
  • CXR (chest x-ray)

Laboratory tests may also be ordered depending on the medical status of patients. We will also obtain all medical records pertaining to your diagnosis.

After obtaining all tests, we follow the most up to date AJCC (American Joint Committee on Cancer) Cancer Staging System to stage your cancer. Staging describes the primary tumor, spread to regional lymph nodes and spread to other organs. We discuss and finalize recommendations for treatment at our Multidisciplinary Head and Neck Tumor Conference.

Treatment of Nasopharyngeal Cancer

Treatment for nasopharyngeal cancer can involve one or a combination of different treatment modalities. This includes surgical resection, radiation therapy and chemotherapy. In the case for this type of cancer, non-surgical therapies are recommended more often. All cases will be discussed at our Multidisciplinary Head and Neck Tumor Conference with radiation oncologists, medical oncologists, along with other specialties to determine the best modality of treatment.

Sinonasal Cancer

Overview of Sinonasal Cancer

The sinonasal area is made up the nasal cavities on both left and right sides as well as all the paranasal sinuses. The nasal septum is a cartilaginous and bony structure that divides the left and right sides. We have multiple paired sinuses that empty into the nasal cavities. The maxillary sinuses are the biggest sinuses located in our cheeks. The frontal sinuses are approximately in the middle of the forehead area. The ethmoid sinuses are honeycombed shape sinuses that line the front to back of the nasal cavities and are located between our eyes. The sphenoid sinuses are located in the middle of our skull behind the nasal cavities.

While most of us are familiar with these anatomical structures because of allergies and sinus infections, tumors can form in these areas. Tumors of the nasal cavity and paranasal sinuses are rare and can present at later stages due to the inability to examine these areas easily. Sinonasal cancers make up less than 1% of all cancers and only a small proportion of head and neck cancers.

The most common type of cancer in this part of the body is squamous cell cancer. However, there a myriad of other cancers that occur in this area. These include salivary gland cancers, adenocarcinoima, sinonasal undifferentiated carcinoma, neuroendocrine tumors, esthesioneuroblastoma, sarcomas, lymphomas, cancers that spread from other parts of the body, etc. Most of these cancers occur most commonly in the nasal cavity proper and maxillary sinuses. The rarity and variety of diseases that occur in this area of the head and neck make these diseases difficult to treat.

An increased risk for sinonasal cancers include smoking. Occupational exposure to wood dust increases the risk of adenocarcinoma specifically. Nickel and other heavy metal exposures also increase risk of cancer.

Signs and Symptoms of Sinonasal Cancer

Symptoms differ between patients. The following is a list of common signs and symptoms that can warrant an evaluation by a head and neck surgeon. Many of the symptoms can be related to blockage or bleeding of the mass from inside the nose.

  • Nasal obstruction
  • Loss of smell
  • Alteration of taste
  • Nose bleeds
  • Change in voice
  • Pain or numbness of face
  • Weakness of face
  • Loss or change in vision
  • Double vision
  • Difficulty breathing
  • Malodorous smell
  • Weight loss
  • Loss of appetite
  • Mass or lump in neck
Diagnosis and Staging of Sinonasal Cancer

The first step to diagnosis is a detailed evaluation from a head and neck surgeon, which includes a history and physical exam. A nasal endoscopy will likely be performed under local anesthesia in clinic to visually evaluate the suspected areas inside the nose. This is done in order to see areas the human eye cannot normally see. If the suspected area warrants, a head and neck surgeon may be able to perform a biopsy in clinic or may bring you to the operating room for an exam and biopsy under anesthesia. A biopsy will be evaluated by a pathologist in order to determine whether the mass is benign or malignant and if malignant, which type it is.

A complete work up will include different radiological tests to determine metastasis or spread to the regional lymph nodes in the neck or other distant organs including the lungs or liver. The following are the most common tests used:

  • CT (computerized tomography) scan
  • Ultrasound
  • MRI (magnetic resonance imaging) scan
  • PET (positron emission tomography) scan
  • CXR (chest x-ray)

Laboratory tests may also be ordered depending on the medical status of patients. We will also obtain all medical records pertaining to your diagnosis.

After obtaining all tests, we follow the most up to date AJCC (American Joint Committee on Cancer) Cancer Staging System to stage your cancer. Staging describes the primary tumor, spread to regional lymph nodes and spread to other organs. We discuss and finalize recommendations for treatment at our Multidisciplinary Head and Neck Tumor Conference.

Treatment of Sinonasal Cancer

Treatment for sinonasal cancer can involve one or a combination of different treatment modalities. This includes surgical resection, radiation therapy and chemotherapy. There are a vast number of possible types of benign mass and cancers that occur in the sinonasal area. The type of disease process, as well as different factors specific to each patient, needs to be carefully taken into consideration to develop a treatment plan. All cases will be discussed at our Multidisciplinary Head and Neck Tumor Conference with radiation oncologists, medical oncologists, along with other specialties to determine the best modality of treatment.

Salivary Gland Cancer

Overview of Salivary Cancer

Saliva is important for many functions of the mouth and throat area. Saliva provides moisture for the mouth and helps protects teeth from cavities. It also facilitates speech and swallowing. The human body has hundreds of small salivary glands throughout the mouth, nose, and throat. There are also 3 pairs of larger glands. The parotid glands are the biggest and sit on the side of the face. The submandibular glands sit under the jaw bone and secrete saliva to the area under our tongue. The sublingual glands are the smallest out of the named salivary glands and sit behind the chin area.

Tumors frequently start in one of these larger named glands including the parotid gland and submandibular gland. Most tumors that arise in these larger glands are not cancerous but some can be. Tumors can also start in the smaller minor salivary glands that occupy the space just beneath the mucosa of our mouth and throat.

There are many different types of cancers that arise in the salivary glands. The World Health Organization has a classification for these many types:

Mucoepidermoid carcinoma

Adenoid cystic carcinoma

Acinic cell carcinoma

Polymorphous adenocarcinoma

Clear cell carcinoma

Basal cell adenocarcinoma

Intraductal carcinoma

Adenocarcinoma, not otherwise specified

Salivary duct carcinoma

Myoepithelial carcinoma

Epithelial-myoepithelial carcinoma

Carcinoma ex pleomorphic adenoma

Secretory carcinoma

Sebaceous adenocarcinoma

Carcinosarcoma

Poorly differentiated carcinoma:

  • Undifferentiated carcinoma
  • Large cell neuroendocrine carcinoma
  • Small cell neuroendocrine carcinoma

Lymphoepithelial carcinoma

Squamous cell carcinoma

Oncocytic carcinoma

Sialoblastoma

Signs and Symptoms of Salivary Cancer

The first sign can be a facial or neck mass. Most of these tumors do not cause any symptoms besides being a mass. Symptoms differ between patients. The following is a list of common signs and symptoms that can warrant an evaluation by a head and neck surgeon.

  • Mass or lump on face
  • Mass or lump on neck
  • Mass or lump in mouth or throat
  • Weakening of face
  • Facial paralysis
  • Numbness in face
  • Pain in head and neck area
  • Difficulty or pain swallowing
  • Difficulty breathing
  • Weight loss
Diagnosis and Staging of Salivary Cancer

The first step to diagnosis is a detailed evaluation from a head and neck surgeon, which includes a history and physical exam. Most of the time, a fine needle aspiration (FNA) biopsy can be done under local anesthesia. This will be evaluated by a pathologist and a diagnosis will be determined. For salivary gland tumors, the accuracy of the diagnosis may not hold as true for other tumors of the head and neck area. For this reason, surgery to excise the mass within the salivary gland may be offered before a definitive diagnosis is made.

If a cancer has been identified, a complete work up will include different radiological tests to determine metastasis or spread to the regional lymph nodes in the neck or other distant organs including the lungs or liver. The following are the most common tests used:

  • CT (computerized tomography) scan
  • Ultrasound
  • MRI (magnetic resonance imaging) scan
  • PET (positron emission tomography) scan
  • CXR (chest x-ray)

Laboratory tests may also be ordered depending on the medical status of patients. We will also obtain all medical records pertaining to your diagnosis.

After obtaining all tests, we follow the most up to date AJCC (American Joint Committee on Cancer) Cancer Staging System to stage your cancer. Staging describes the primary tumor, spread to regional lymph nodes and spread to other organs. We discuss and finalize recommendations for treatment at our Multidisciplinary Head and Neck Tumor Conference.

Treatment of Salivary Cancer

We develop treatment plans on an individual personalized basis. Treatment for salivary gland cancer can involve one or a combination of different treatment modalities. This includes surgical resection, radiation therapy and chemotherapy.

Surgery is the usually the first line of therapy that provides the best outcome. A specialty trained surgeon is very important for the taking out salivary gland tissue because important nerves run through most salivary glands. The facial nerve comes out of the skull and goes through the parotid glands and makes 5 branches supplying all the muscles of the face. The submandibular gland is also associated with one of these branches. The facial nerve and all its branches are carefully monitored and dissected out during the surgery to preserve maximum function.

Radiation therapy with or without chemotherapy is another option for therapy. Radiation therapy with or without chemotherapy may also be recommended after surgery if there are features of the cancer that are worrisome. All cases will be discussed at our Multidisciplinary Head and Neck Tumor Conference with radiation oncologists, medical oncologists, along with other specialties to determine the best modality of treatment.

Ear, Nose and Throat Conditions and Treatments

Sinonasal Disorders
    • Allergies
      • Allergy testing
      • Immunotherapy
        • Subcutaneous Immunotherapy (SCIT)
        • Sublingual Immunotherapy (SLIT)
    • Functional Rhinoplasty
    • Septoplasty
    • Sinus Surgery
      • Polyps
      • Sinusitis
    • Turbinate reduction
Voice and Swallowing Disorders
    • Speech  and Language Pathologists
      • Swallowing therapy
      • Voice therapy
    • Acid Reflux
    • Difficulty Swallowing
    • Hoarseness
    • Tonsillectomy & Adenoidectomy
    • Vocal Fold Masses
    • Zenker’s Diverticulum
Ear and Hearing Disorders
    • Ear Tubes
    • Hearing Loss
      • Hearing testing
      • Hearing aids
Sleep Disorders
    • Obstructive Sleep Apnea
    • Sleep studies
    • Snoring
    • Uvulopalatopharyngoplasty (UPPP)

Head and Neck Reconstructive Surgery

Reconstructive plastic surgery of the head and neck can be the most challenging reconstruction of the body. There are many considerations regarding reconstruction including aesthetics and multiple functions including speaking, chewing, swallowing, breathing, vision and hearing.

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