Early detection is critical to preventing fatal outcomes. Cancers of the head and neck such as laryngeal cancer can be particularly aggressive. Signs of cancer of the head and neck include changes in the skin, pain, prolonged hoarseness, and sudden loss of voice. If you suffer from any of these symptoms you should see an ENT or head and neck physician immediately.

As many as 20 percent of high school boys and two percent of high school girls continue to use smokeless tobacco, according to the Centers for Disease Control and Prevention. Despite public education campaigns sponsored by medical societies, organized baseball, and individuals, 12 to 14 million American users, one third are under age 21, and more than half of those developed the habit before they were 13. Peer pressure is just one of the reasons for starting the habit. Serious users often graduate from brands that deliver less nicotine to stronger ones. With each use, you need a little more of the drug to get the same feeling.

There has been some progress. The organizer of America’s fastest growing sport, National Association for Stock Car Auto Racing (NASCAR) has dropped its long-time affiliation with Winston tobacco. NASCAR president Mike Helton says a total tobacco ban is “an issue that’s on our radar for next year.”

And there have been setbacks in the fight against smoking tobacco. New marketing campaigns that feature flavored smokeless products have won over new young users. Journalistic coverage of Dr. Brad Rodu and his support of smokeless tobacco as a substitute for cigarettes has diluted the Academy’s “No Smokeless Tobacco Use” message that has been an official campaign for this Academy since 1989. In a November 10, 2005 study; “New Cigarette Brands with Flavors That Appeal to Youth: Tobacco Marketing Strategies; Health Affairs, November/December 2005, Volume 24, number 6, funded by the American Legacy Foundation and the National Cancer Institute noted that candy flavors were also added to smokeless tobacco products, cigars and cigarette rolling papers. “

Gregory Connolly, senior author of the study and a professor of the practice of public health at the Harvard School of Pubic Health noted, “Tobacco companies are using candy-like flavors and high tech delivery devices to turn a blowtorch into a flavored popsicle, misleading millions of youngsters to try a deadly product. Although the study focuses primarily on cigarettes, it noted that the addiction to smokeless tobacco or “chew” is as strong if not stronger than to cigarettes. Additional research has shown that there continues to be substantial evidence that smokeless tobacco is deadly. A December 18, 2003 study by Patricia Richter, Ph.D and Francis Spierto, Ph.D, two CDC researchers released by the Center for the Advancement of Health reported that the most popular brands of smokeless tobacco contain the highest amounts of nicotine that can be readily absorbed by the body. According to Richter, “Consumers need to know that smokeless tobacco products, including loose-leaf and moist snuff, are not safe alternatives to smoking,” Richter says. “The amount of nicotine absorbed per dose from using smokeless tobacco is greater than the amount of nicotine absorbed from smoking one cigarette.

Kicking Tobacco Means Kicking It All

In November 11, 2005 Reuters story, “Oral Tocacco Not Safe Sbustiute for Smoking,” Dr. Stephen Hecht and colleagues from the University of Minnesota Cancer Center in Minneapolis related data from their current research that compared the levels of cancer-causing nitrosamines in popular smokeless tobacco products and medicinal nicotine products such as the nicotine patch, nicotine gum, and nicotine lozenges.

The results “clearly showed that the levels of cancer-causing nitrosamines are far higher in smokeless tobacco products than they are in medicinal nicotine products,” Hecht said during a press briefing. While smokeless tobacco has “demonstrably less carcinogens and toxins than cigarette smoke,” said Hecht, smokeless tobacco still has “remarkably high levels of carcinogenic tobacco-specific nitrosamines — levels that are 100 to 1,000 times higher than in any other consumer product that is designed for oral consumption.” In a separate study, the team evaluated carcinogen biomarker levels in individuals using these products. They had 54 users of popular US smokeless tobacco products use their usual brand for two weeks and then had them switch to either Swedish snus or a nicotine patch for four weeks.

The team found that carcinogen levels in urine were statistically significantly lower after the switch from US-made smokeless tobacco brands to snus or to the nicotine patch. When comparing snus users to patch users, levels of cancer- causing compounds were significantly lower in patch users, indicating that medicinal nicotine is safer than snus, Hecht said. These results conflict with some prior studies that suggested that smokeless tobacco including moist snuff may be a less harmful habit than cigarette smoking because many of the carcinogens in cigarette smoke are either reduced or absent in smokeless tobacco. The bottom line, Dr.Hecht said, is that “smokeless tobacco products are dangerous.”

“The evidence suggests,” he continued, “that smokeless products are in fact a cause of oral cancer and pancreatic cancer in humans. The current evidence does not support smokeless tobacco as a substitute for cigarette smoking.”

It may come as a surprise to you the variety of medical conditions that can lead to voice problems. The most common causes of hoarseness and vocal difficulties are outlined below. If you become hoarse frequently or notice voice change for an extended period of time, please see your Otolaryngologist (Ear, Nose, and Throat doctor) for an evaluation.

Acute Laryngitis

Acute laryngitis is the most common cause of hoarseness and voice loss that starts suddenly. Most cases of acute laryngitis are caused by a viral infection that leads to swelling of the vocal cords. When the vocal cords swell, they vibrate differently, leading to hoarseness. The best treatment for this condition is to stay well hydrated and to rest or reduce your voice use. Serious injury to the vocal cords can result from strenuous voice use during an episode of acute laryngitis. Since most acute laryngitis is caused by a virus, antibiotics are not effective. Bacterial infections of the larynx are much rarer and often are associated with difficulty breathing. Any problems breathing during an illness warrants emergency evaluation.

Chronic Laryngitis

Chronic laryngitis is a non-specific term and an underlying cause should be identified. Chronic laryngitis can be caused by acid reflux disease, by exposure to irritating substances such as smoke, and by low grade infections such as yeast infections of the vocal cords in people using inhalers for asthma. Chemotherapy patients or others whose immune system is not working well can get these infections too.

Laryngopharyngeal Reflux Disease (LPRD)

Reflux of stomach juice into the throat can cause a variety of symptoms in the esophagus (swallowing tube) as well as in the throat. Hoarseness (chronic or intermittent), swallowing problems, a lump in the throat sensation, or throat pain are common symptoms of stomach acid irritation of the throat. Please be aware that LPRD can occur without any symptoms of frank heartburn and regurgitation that traditionally accompany gastro esophageal reflux disease (GERD).

Voice Misuse and Overuse

Speaking is a physical task that requires coordination of breathing with the use of several muscle groups. It should come as no surprise that, just like in any other physical task, there are efficient and inefficient ways of using your voice. Excessively loud, prolonged, and/or inefficient voice use can lead to vocal difficulties, just like improper lifting can lead to back injuries. Excessive tension in the neck and laryngeal muscles, along with poor breathing technique during speech leads to vocal fatigue, increased vocal effort, and hoarseness. Voice misuse and overuse puts you at risk for developing benign vocal cord lesions (see below) or a vocal cord hemorrhage.

Common situations that are associated with voice misuse:

  • Speaking in noisy situations
  • Excessive cellular phone use
  • Telephone use with the handset cradled to the shoulder
  • Using inappropriate pitch (too high or too low) when speaking
  • Not using amplification when publicly speaking

Benign Vocal Cord Lesions

Benign non-cancerous growths on the vocal cords are most often caused by voice misuse or overuse, which causes trauma to the vocal cords. These lesions (or “bumps”) on the vocal cord(s) alter vocal cord vibration and lead to hoarseness. The most common vocal cord lesions are nodules, polyps, and cysts. Vocal nodules (also known as nodes or singer’s nodes) are similar to “calluses” of the vocal cords. They occur on both vocal cords opposite each other at the point of maximal wear and tear, and are usually treated with voice therapy to eliminate the vocal trauma that is causing them. Contrary to common myth, vocal nodules are highly treatable and intervention leads to improvement in most cases. Vocal cord polyps and cysts are the other common benign lesions. These are sometimes related to voice misuse or overuse, but can also occur in people who don’t use their voice improperly. These types of problems typically require microsurgical treatment for cure, with voice therapy employed in a combined treatment approach in some cases.

Vocal Cord Hemorrhage

If you experience sudden loss of voice following yelling, shouting, or other strenuous vocal tasks, you may have developed a vocal cord hemorrhage. Vocal cord hemorrhage results when one of the blood vessels on the surface of the vocal cord ruptures and the soft tissues of the vocal cord fill with blood. It is considered a vocal emergency and is treated with absolute voice rest until the hemorrhage resolves. If you lose your voice after strenuous voice use, see your Otolaryngologist as soon as possible.

Vocal Cord Paralysis and Paresis

Hoarseness and other problems can occur related to problems between the nerves and muscles within the voice box or larynx. The most common neurological condition that affects the larynx is a paralysis or weakness of one or both vocal cords. Involvement of both vocal cords is rare and is usually manifested by noisy breathing or difficulty getting enough air while breathing or talking. When one vocal cord is paralyzed or weak, voice is usually the problem rather than breathing. One vocal cord can become paralyzed or weakened (paresis) from a viral infection of the throat, after surgery in the neck or chest, from a tumor or growth along the laryngeal nerves, or for unknown reasons. Vocal cord paralysis typically presents with a soft and breathy voice. Many cases of vocal cord paralysis will recover within several months. In some cases however, the paralysis will be permanent, and may require active treatment to improve the voice. Treatment choice depends on the nature of the vocal cord paralysis, the degree of vocal impairment, and the patient’s vocal needs. While we are not able to make paralyzed vocal cords move again, there are good treatment options for improving the voice. One option includes surgery for unilateral vocal cord paralysis that repositions the vocal cord to improve contact and vibration of the paralyzed vocal cord with the non-paralyzed vocal cord. There are a variety of surgical techniques used to accomplish this. Voice therapy may be used before or after surgical treatment of the paralyzed vocal cords, or it can also be used as the sole treatment. (For more information, see Vocal Cord Paralysis Fact Sheet.)

Laryngeal Cancer

Throat cancer is a very serious condition requiring immediate medical attention. Chronic hoarseness warrants evaluation by an otolaryngologist to rule out laryngeal cancer. It is important to remember that prompt attention to changes in the voice facilitate early diagnosis. Remember to listen to your voice because it might be telling you something. Laryngeal cancer is highly curable if diagnosed in its early stages. (For more information, see Laryngeal Cancer Fact Sheet.)

Laryngeal cancer is not as well known by the general public as some other types of cancer, yet it is not a rare disease. The American Cancer Society estimates that in 2005 almost 10,000 new cases of laryngeal cancer will be diagnosed, and close to 3,800 people will die from laryngeal cancer in the United States. Even for survivors, the consequences of laryngeal cancer can be severe with respect to voice, breathing, or swallowing. It is fundamentally a preventable disease though, since the primary risk factors for laryngeal cancer are associated with modifiable behaviors.

Risk Factors Associated With Laryngeal Cancer

Development of laryngeal cancer is a process that involves many factors, but approximately 90 percent of head and neck cancers occur after exposure to known carcinogens (cancer causing substances). Chief among these factors is tobacco. Over 90 percent of laryngeal cancers are a type of cancer called squamous cell carcinoma (SCCA), and over 95 percent of patients with laryngeal SCCA are smokers. Smoking contributes to cancer development by causing mutations or changes in genes, impairing clearance of carcinogens from the respiratory tract, and decreasing the body’s immune response.

Tobacco use is measured in pack-years, where one pack per day for one year is considered one pack-year. Two pack-years is defined as either one pack per day for two years, or two packs per day for one year (Longer terms of pack years are determined using a similar ratio.) Depending upon the number of pack-years smoked, studies have reported that smokers are about 5 to 35 times more likely to develop laryngeal cancer than non-smokers. It does seem that the duration of tobacco exposure is probably more important overall to cancer causing effect, than the intensity of the exposure.

Alcohol is another important risk factor for laryngeal cancer, and acts as a promoter of the cancer causing process. The major clinical significance of alcohol is that it potentiates the effects of tobacco. Magnitude of this effect is between an additive and a multiplicative one. That is, people who smoke and drink alcohol have a combined risk that is greater than the sum of the individual risks. The American Cancer Society recommends that those who drink alcoholic beverages should limit the amount of alcohol they consume, with one drink per day considered a limited alcohol exposure.

Other risk factors for laryngeal cancer include certain viruses, such as human papilloma virus (HPV), and likely acid reflux. Vitamin A and beta-carotene may play a protective role.

Signs and Symptoms of Laryngeal Cancer

Signs and symptoms of laryngeal cancer include: progressive or persistent hoarseness, difficulty swallowing, persistent sore throat or pain with swallowing, difficulty breathing, pain in the ear, or a lump in the neck. Anyone with these signs or symptoms should be evaluated by an Otolaryngologist (Ear, Nose and Throat Doctor). This is particularly important for people with risk factors for laryngeal cancer.

Treatment of Laryngeal Cancer

The primary treatment options for laryngeal cancer include surgery, radiation therapy, chemotherapy, or a combination of these treatments. Remember that this is a preventable disease in the vast majority of cases, because the main risk factors are associated with modifiable behaviors. Do not smoke and do not abuse alcohol!

Tumors or growths in the head and neck region may be divided into those that are benign (not cancerous) and malignant (i.e., cancer). Fortunately, most growths in the head and neck region in children are considered to be benign. These benign growths can be related to infection, inflammation, fluid collections, swellings, or neoplasms (tumors) that are non life-threatening. The malignant growths, on the other hand, may be life-threatening and cause other problems related to their growth and spread. Even the malignant growths in the head and neck are usually treatable.

Benign Tumors

It is very common for children to have enlarged tonsils and adenoids. These are almost always from an infection or inflammation. It is very rare that children develop a cancer, lymphoma, or sarcoma of these areas. When the tonsils, adenoids, or other areas of the mouth or throat remain enlarged or are enlarged on only one side, it is important to have an evaluation by a specialist in ear, nose and throat or otolaryngology-head and neck surgery.

The lymph nodes of the neck region may become enlarged during childhood. Most of the time, this is reactive in nature and related to inflammation or infection. However, if the lymph nodes remain enlarged for a period of time without going away, it is important to have an otolaryngologist-head and neck surgeon evaluate the problem.

Other benign growths in the face and neck include cysts (fluid collection) such as branchial cleft cyst, thyroglossal duct cyst, cystic hygroma, and dermoid cysts. These often require removal due to their continued growth and potential for infection. Growths of blood vessels often are seen in the face and neck and these are often referred to as hemangiomas, vascular malformations, lymphatic and arteriovenous malformations (AVM). Some of these may require removal or treatment depending upon the type and location.

Sinus and Nose Growths

Although most children have nose bleeds and occasional allergies and sinus infection, sometimes tumors of the nose and sinus present with similar symptoms. It is generally recommended that a child with continuous sinus problems or nose bleeds be evaluated by an otolaryngologist-head and neck surgeon to be sure it is not a tumor or other treatable condition.

Non-epithelial neoplasms constitute the majority of sinonasal (sinus) tumors in children and adolescents. Among these, rhabdomyosarcoma (RMS) or undifferentiated sarcoma and non-Hodgkin lymphoma account for the majority of cases. Among head and neck RMS 14 percent arise from the nasal cavity and 10 percent from the paranasal sinuses. Nasopharyngeal carcinoma accounts for one third of the nasopharyngeal neoplasms in children. As is the case in adult patients, it is associated with Epstein-Barr virus (EBV) infection as demonstrated by EBV DNA presence in malignant cells. Less frequently, Ewing’s sarcoma/PNET can present in this location. These tumors have also been described as secondary malignancies following treatment of retinoblastoma and other neoplasms. Esthesioneuroblastoma is a rare sinonasal tumor historically related to Ewing/PNET, although more recently comparative genomic hybridization analysis disputes this relation. Other less common sinonasal tumors presenting in children include hemangioma and hemagiopericitoma, fibroma and fibrosarcoma, malignant fibrous histiocytoma, and desmoid fibromatosis.

Salivary Gland Tumors

There are three paired sets of salivary glands in the head and neck region. These include the ones in front of the ears (parotid), below the jaw (submandibular), and underneath the tongue (sublingual). Additionally, there are numerous very small salivary glands throughout the mouth and throat. Although tumors can arise in these areas, they are rare. Thus, any child with a growth in these areas should be seen by an otolaryngologist-head and neck surgeon.

Thyroid Tumors

The thyroid gland is found in the front of the lower part of the neck just above the chest area but below the Adam’s apple on both sides. Although tumors can arise in this area, they are rare. Thus, any child with a growth in this area should be seen by an otolaryngologist-head and neck surgeon.

The thyroid is a butterfly shaped gland located at the base of the throat. It has two lobes separated in the middle by a strip of tissue (the isthmus). The thyroid itself secretes three main hormones: (1) Thyroxine contains iodine, needed for growth and metabolism; (2) Triiodothyronine, similar in function to Thyroxine, effects body size, tissues growth, and function: and (3) Calcitonin, which decreases the concentration of calcium in the blood and increases calcium in the bones. All three of these hormones have an important role in your child’s growth.

Thyroid cancer is the third most common tumor malignancy in children. It occurs six times more often in females than males and shares several characteristics with adult thyroid cancer patients. Surgery is the preferred treatment for this cancer and although the procedure is often uncomplicated, one of the risks of thyroid surgery involves vocal cord paralysis. Consequently, an otolaryngologist-head and neck surgeon should be consulted.

Types of thyroid cancer in children:

Papillary: This form of thyroid cancer occurs in cells that produce thyroid hormones containing iodine. This type, the most common form of thyroid cancer in children, grows very slowly.

Follicular: This type of thyroid cancer also develops in cells that produce thyroid hormones containing iodine. The disease afflicts a slightly older age group and is less common in children. This type of thyroid cancer is more likely to spread to the neck via blood vessels causing the cancer to spread to other parts of the body, making the disease difficult to control.

Medullary: This rare form of thyroid cancer develops in cells that produce calcitonin, a hormone that does not contain iodine. This cancer tends to spread to other parts of the body and constitutes about 5-10 percent of all thyroid malignancies. Medullary thyroid carcinoma (MTC) in the pediatric population is usually associated with multiple endocrine neoplasia type 2 (MEN2), an inherited genetic form of the cancer.

Anaplastic: This is the fastest growing of the thyroid cancers, with extremely abnormal cells that grow and spread rapidly, especially locally in the head and neck region. This form of cancer usually is found in older patients.

Symptoms:

The symptoms of this disease vary. Your child may have a lump in the neck, continuous swollen lymph nodes, a tight or full feeling in the neck, and/or trouble with breathing or swallowing, hoarseness.

Diagnosis:

If any of these symptoms occur, consult your child’s physician for a diagnosis. The diagnosis could consist of a head and neck examination to determine if unusual lumps are present; a blood test to indicate how the thyroid is functioning; a sonography, which uses high-frequency sound waves and a computer to create an image of the thyroid gland; a radioactive iodine scan, which provides information about the thyroid shape and function, identifying areas in the thyroid that do no absorb iodine in the normal way; fine needle biopsy, removal for study of a small part of the tumor; and surgery, where a procedure known as a thyroid lobectomy, necessitates removal of the lobe of the thyroid gland that contains the tumor, for analysis.

Treatments for thyroid cancer:

If the tumor is found to be malignant then surgery is used to remove as much of the tumor as possible either by lobectomy or subtotal thyroidectomy (removal of at least one thyroid lobe and up to a near-total removal of the thyroid gland). If necessary, the otolaryngologist- head and neck surgeon may remove the entire thyroid, in a procedure called a total thyroidectomy. Surgery may be followed by radioactive iodine therapy which destroys cancer cells that are left after surgery and help prevent the disease from returning Thyroid hormone therapy may need to be administered throughout your child’s life when he/she has had surgery to remove the thyroid followed by radioactive iodine treatment to replace normal hormones and slow the growth of cancer cells. If cancer has spread to other parts of the body, chemotherapy, the treatment of disease by means of chemical substances or drugs, may be given. This therapy interferes with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells and shrink tumors. In general, treatment outcomes for this type of cancer in children tend to be excellent. The best outcome is achieved with teenage girls, papillary type cancer, and a tumor localized to the thyroid gland.

Source: National Cancer Institute “Populationbased Outcomes for Pediatric Thyroid Carcinoma,” by Nina L. Shapiro MD, and Neil Bhattacharyya MD, Laryngoscope. 2005 Feb;115(2):337-40.

Rhabdomyosarcoma is a type of a sarcoma, which means a cancer of the bone, soft tissues, or connective tissue. This cancer can occur anywhere in the body but is most often found in the head and neck region, followed by the organs associated with reproduction and urination, and the arms or legs.

More than 90 percent of rhabdomyosarcomas are diagnosed in people under 25 years old; about 60 percent of these cases are diagnosed in children under the age of 10. In the United States, rhabdomyosarcoma strikes approximately five in every one million children each year.

The cause of rhabdomyosarcoma is unknown. Some children with certain birth defects are at increased risk, and some families have a gene mutation that elevates risk. However, the vast majority of children with rhabdomyosarcoma do not have any known risk factors.

Rhabdomyosarcoma Symptoms Depend on Where the Tumor Develops:

The otolaryngologist-head and neck surgeon is the medical specialist that will identify the symptoms of this cancer in the head and neck region. Specifically, when rhabdomyosarcoma affects the eye or eyelid, the result can be a bulging eye, a swollen eyelid or paralysis of the eye muscles. In the sinuses, rhabdomyosarcoma can cause a stuffy nose, and sometimes a nasal discharge that contains pus or blood. In other locations in the head and neck, the most common symptom of a rhabdomyosarcoma near the surface is a painless lump or swelling that gradually gets larger.

When rhabdomyosarcomas develops in the urogenital tract, the consequence can be tumors causing difficulty in urination, blood in the urine, constipation, a lump or mass inside the vagina, vaginal discharge that contains blood and mucus, or a painless enlargement of one side of the scrotum. Rhabdomyosarcoma appears as a lump or swelling, with or without pain, tenderness and redness. In physically active children, the swelling is sometimes mistaken for an injury related to sports or childhood play.

Call your doctor promptly if your child develops any of these symptoms.

What to Expect When you See the Doctor:

After reviewing your child’s symptoms, your doctor will examine your child. Depending on the results of this exam, your doctor may order a regular X-ray as the first test. Computed tomography (CT) scans and magnetic resonance imaging (MRI) might also be needed. If a tumor is found on any of these tests, a small piece of tissue is removed and examined in a laboratory (biopsy).

If the lab tests show signs of a cancerous tumor, your doctor will refer you to a medical center that has the facilities, personnel, and experience to treat childhood cancer. There your child will have more tests to check whether the cancer has spread to the lungs, bones, or elsewhere.

Diagnosis

Once childhood rhabdomyosarcoma is found, more tests will be done to find out if the cancer cells have spread to other parts of the body. This is called staging. Your doctor needs to know how far the cancer has spread to plan treatment.

Treatments:

A rhabdomyosarcoma will continue to grow until it is treated. Without proper treatment, this cancer eventually may spread to the lungs, bone marrow, bones, or lymph nodes. There are treatments for all patients with childhood rhabdomyosarcoma. Three types of treatment are used, most often in combination with each other:

– Surgery

– Chemotherapy (using drugs to kill cancer cells)

– Radiation therapy (using highenergy X-rays or other high-energy rays to kill cancer cells)

Prognosis:

More than 70 percent of children with localized rhabdomyosarcoma enjoy long-term survival. Survival rates depend on initial tumor size, location, appearance under the microscope, how much of the tumor can be removed with surgery, and whether the disease has spread to other parts of the body.

Sources:

emedicine

St. Jude Children’s Research Hospital American Cancer Society

National Cancer Institute

Insight into recognizing symptoms for early detection

  • Early detection of head and neck cancer
  • Symptoms of head and neck cancer
  • and more…

More than 55,000 Americans will develop cancer of the head and neck (most of which is preventable) this year; nearly 13,000 of them will die from it.

Early detection of head and neck cancer

Tobacco use is the most preventable cause of these deaths. In the United States, up to 200,000 people die each year from smoking-related illnesses. The good news is that this figure has decreased due to the increasing number of Americans who have quit smoking. The bad news is that some of these smokers switched to smokeless or spit tobacco, assuming it is a safe alternative. This is untrue. By doing this, they are only changing the site of the cancer risk from their lungs to their mouth. While lung cancer cases are down, cancers in the head and neck appear to be increasing. Cancer of the head and neck is curable if caught early. Fortunately, most head and neck cancers produce early symptoms. You should know the potential warning signs so you can alert your doctor as soon as possible. Remember-successful treatment of head and neck cancer depends on early detection. Knowing and recognizing the signs of head and neck cancer can save your life.

Symptoms of head and neck cancer

A lump in the neck …Cancers that begin in the head or neck usually spread to lymph nodes in the neck before they spread elsewhere. A lump in the neck that lasts more than two weeks should be seen by a physician as soon as possible. Of course, not all lumps are cancer. But a lump (or lumps) in the neck can be the first sign of cancer of the mouth, throat, voicebox (larynx), thyroid gland, or of certain lymphomas and blood cancers. Such lumps are generally painless and continue to enlarge steadily.

Change in the voice …Most cancers in the larynx cause some changes in voice. An otolaryngologist is a head and neck specialist who can examine your vocal cords easily and painlessly. While most voice changes are not caused by cancer, you shouldn’t take chances. If you are hoarse or notice voice changes for more than two weeks, see your doctor.

A growth in the mouth …Most cancers of the mouth or tongue cause a sore or swelling that doesn’t go away. These sores and swellings may be painless unless they become infected. Bleeding may occur, but often not until late in the disease. If an ulcer or swelling is accompanied by lumps in the neck, be concerned. Your dentist or doctor can determine if a biopsy (tissue sample test) is needed and can refer you to a head and neck surgeon who can perform this procedure.

Bringing up blood …This is often caused by something other than cancer. However, tumors in the nose, mouth, throat, or lungs can cause bleeding. If blood appears in your saliva or phlegm for more than a few days, you should see your physician.

Swallowing problems …Cancer of the throat or esophagus (swallowing tube) may make swallowing solid foods difficult. Sometimes liquids can also be troublesome. The food may “stick” at a certain point and then either go through to the stomach or come back up. If you have trouble almost every time you try to swallow something, you should be examined by a physician. Usually a barium swallow x-ray or an esophagoscopy (direct examination of the swallowing tube with a scope) will be performed to find the cause.

Changes in the skin …The most common head and neck cancer is basal cell cancer of the skin. Fortunately, this is rarely serious if treated early. Basal cell cancers appear most often on sun-exposed areas like the forehead, face, and ears, but can occur almost anywhere on the skin. Basal cell cancer often begins as a small, pale patch that enlarges slowly, producing a central “dimple” and eventually an ulcer. Parts of the ulcer may heal, but the major portion remains ulcerated. Some basal cell cancers show color changes. Other kinds of cancer, including squamous cell cancer and malignant melanoma, also occur on the head and neck. Most squamous cell cancers occur on the lower lip and ear. They may look like basal cell cancers and, if caught early and properly treated, usually are not dangerous. If there is a sore on the lip, lower face, or ear that does not heal, consult a physician. Malignant melanoma classically produces dense blue-black or black discolorations of the skin. However, any mole that changes size, color, or begins to bleed may mean trouble. A black or blue-black spot on the face or neck, particularly if it changes size or shape, should be seen as soon as possible by a dermatologist or other physician. 

Persistent earache …Constant pain in or around the ear when you swallow can be a sign of infection or tumor growth in the throat. This is particularly serious if it is associated with difficulty in swallowing, hoarseness or a lump in the neck. These symptoms should be evaluated by an otolaryngologist.

Identifying high risk of head and neck cancer

As many as 90 percent of head and neck cancers arise after prolonged exposure to specific factors. Use of tobacco (cigarettes, cigars, chewing tobacco, or snuff) and alcoholic beverages are closely linked with cancers of the mouth, throat, voice box, and tongue. In adults who do not smoke or drink, cancer of the mouth and throat is nearly nonexistent. Prolonged exposure to sunlight is linked with cancer of the lip and is also established as a major cause of skin cancer.

What you should do …All of the symptoms and signs described here can occur with no cancer present. In fact, many times complaints of this type are due to some other condition. But you can’t tell without an examination. So, if they do occur, see your doctor to be sure.

Remember: When found early, most cancers in the head and neck can be cured with little difficulty. Cure rates for these cancers could be greatly improved if people would seek medical advice as soon as possible. Play it safe. If you detect warning signs of head and neck cancer, see your doctor immediately.

Be safe: See your doctor early and practice health habits which help prevent these diseases.

Access to quality healthcare for children is forwarded by the availability of good healthcare information. With this year’s release of a new surgeon general’s report on

secondhand smoke, the following information should beshared with patients.

New Warning on Secondhand Smoke

The Surgeon General released new evidence this year-July 2006-supporting the fact that secondhand smoke, smoke from a burning cigarette and the smoke exhaled by the smoker, represents a dangerous health hazard.

The new report states that there is no risk-free level of secondhand smoke exposure. Although secondhand smoke is dangerous to everyone, fetuses, infants, and children are at most risk. Even brief exposures can be harmful to children. This is because secondhand smoke can damage developing organs, such as the lungs and brain.

Infants and Children Effects and Exposure

Babies of mothers who smoked and those exposed to smoke are more likely to die from Sudden Infant Death Syndrome (SIDS) than babies who are not exposed to smoke.

Babies of mothers who smoked and those exposed to smoke after birth have weaker lungs and thereby increased risk of more health problems.

Children with asthma exposed to secondhand smoke experience more frequent and severe attacks.

Children exposed to secondhand smoke are at increased risk for ear infections and are more likely to need an operation to insert ear tubes for drainage.

Youth and Teens Effects and Exposure

Secondhand smoke exposure causes respiratory symptoms, including cough, phlegm, wheeze, and breathlessness, among school-aged children.

On average, children are exposed to more secondhand smoke than nonsmoking adults.

Statistics

More than 4,000 different chemicals have been identified in secondhand smoke and at least 43 of these chemicals cause cancer.

On average, children are exposed to more secondhand smoke than nonsmoking adults.

Approximately 26 percent of adults in the United States currently smoke cigarettes, and 50 to 67 percent of children less than five years of age live in homes with at least

one adult smoker.

28 percent of high schoolers are exposed to secondhand smoke in their own homes.

A recent study found that 34 percent of teens begin smoking as a result of tobacco company promotional activities.

Among middle school students who were current smokers, 71 percent reported never being asked to show proof of age when buying cigarettes in a store, and 66 percent were not refused purchase because of their age.

Checklist for Protection Against Secondhand Smoke:

Young children

Remember that you are a powerful role model. If you don’t smoke, your children are less likely to smoke.

Make your home and car smoke-free spaces. Put up no-smoking stickers and signs in your home.

Make sure you and your kids aren’t exposed to second-hand smoke at daycare, school, or friends’ homes.

Support businesses and activities that are smoke-free. Let other businesses owners know that you can’t support their businesses until they become 100 percent smoke-free too.

If you can’t find a smoke-free restaurant and must go to one that allows some smoking, ask to sit in the nonsmoking section.

If your asthma or COPD is triggered by smoke, don’t risk it-stay away from any place that allows smoking.

Support laws that restrict smoking.

Youth and Teens

Parents-

Talk to your children about smoking; they’ll be less likely to smoke than if you ignore the problem.

Support tobacco education in the schools and ban all smoking on school grounds, on school buses, and at school-sponsored events for students, school personnel, and visitors.

Ask that schools enforce the policy and consistently administer penalties for violations and that this is communicated in written and oral form to students, staff, and visitors.

Vote for public smoking restrictions as an important component of the social environment that supports healthy behavior, reducing the number of opportunities to smoke, and making smoking less socially acceptable.

Support tax increases on tobacco products so young people cannot afford them.

Teens-

If your friends smoke, ask them in a caring way to quit or at least not to smoke around you.

Peers, siblings, and friends are powerful influences on you and others. Understand that the most common situation for first trying a cigarette is with a friend who already smokes.

Families-

Work together to uphold restrictions on tobacco advertising

and promotions.

Sources and Resources

The Health Consequences of Involuntary Exposure to Tobacco Smoke: Children are Hurt by Secondhand Smoke. A Report of the Surgeon General, U.S. Department of Health and Human Services, 2006; Available at: www.surgeongeneral.gov/library/ secondhandsmoke/factsheets/factsheet2.html.

CDC. Tobacco Use, Access & Exposure to Tobacco Among Middle & High School Students, US 2004 MMWR. Vol. 54(12) April 2005.

American Legacy Foundation. 2004 National Youth Tobacco Survey. 2005

CDC. Cigarette Use Among High School Students – United States, 1991-2003. Morbidity and Mortality Weekly Report 2004; 53(23): 499-502.

King C, Siegel M. The Master Settlement Agreement with the Tobacco Industry and Cigarette Advertising in Magazines. New England Journal of Medicine 2001; 345: 504-511.

Insight into detection, prevention, and treatment

  • What is skin cancer?
  • How is skin cancer diagnosed?
  • Am I at risk for skin cancer?
  • and more…

 

The skin is the largest organ in our body. It provides protection against heat, cold, light, and infection. The skin is made up of two major layers (epidermis and dermis) as well as various types of cells. The top (or outer) layer of the skin-the epidermis-is composed of three types of cells: flat, scaly cells on the surface called squamous cells; round cells called basal cells; and melanocytes, cells that provide skin its color and protect against skin damage. The inner layer of the skin-the dermis-is the layer that contains the nerves, blood vessels, and sweat glands.

What is skin cancer?

Skin cancer is a disease in which cancerous (malignant) cells are found in the outer layers of your skin. There are several types of cancer that originate in the skin. The most common types are basal cell carcinoma (70 percent of all skin cancers) and squamous cell carcinoma (20 percent). These types are classified as nonmelanoma skin cancer. Melanoma (5 percent of all skin cancers) is the third type of skin cancer. It is less common than basal cell or squamous cell skin cancer, but potentially much more serious. Other types of skin cancer are rare.

Basal cell carcinoma is the most common type of skin cancer. It typically appears as a small raised bump that has a pearly appearance. It is most commonly seen on areas of the skin that have received excessive sun exposure. These cancers may spread to the skin around the cancer but rarely spread to other parts of the body.

Squamous cell carcinoma is also seen on the areas of the body that have been exposed to excessive sun (nose, lower lip, hands, and forehead). Often this cancer appears as a firm red bump or ulceration of the skin that does not heal. Squamous cell carcinomas can spread to lymph nodes in the area.

Melanoma is a skin cancer (malignancy) that arises from the melanocytes in the skin. Melanocytes are the cells that give color to our skin. These cancers typically arise as pigmented (colored) lesions in the skin with an irregular shape, irregular border, and multiple colors. It is the most harmful of all the skin cancers, because it can spread to other sites in the body. Fortunately, most melanomas have a very high cure rate when identified and treated early.

What causes skin cancer?

Most skin cancers occur on sun-exposed areas of our skin, and there is a lot of scientific evidence to support UV radiation as a causative factor in most types of skin cancer. Family history is also important, particularly in melanoma. The lighter your skin type, the more susceptible you are to UV damage and to skin cancer.

How is skin cancer diagnosed?

The vast majority of skin cancers can be cured if diagnosed and treated early. Aside from protecting your skin from sun damage, it is important to recognize the early signs of skin cancer.

  • Skin sores that do not heal,
  • Bumps or nodules in the skin that are enlarging, and
  • Changes in existing moles (size, texture, color).

If you notice any of the factors listed above, see your doctor right away. If you have a spot or lump on your skin, your doctor may remove the growth and examine the tissue under the microscope. This is called a biopsy. A biopsy can usually be done in the doctor’s office and usually involves numbing the skin with a local anesthetic. Examination of the biopsy under the microscope will tell the doctor if the skin lesion is a cancer (malignancy).

How is skin cancer treated?

There are varieties of treatments available, including surgery, radiation therapy, and chemotherapy, to treat skin cancer. Treatment for skin cancer depends on the type and size of cancer, your age, and your overall health.

Surgery is the most common form of treatment. It generally consists of an office or outpatient procedure to remove the lesion and check edges to make sure all the cancer was removed. In many cases, the site is then repaired with simple stitches. In larger skin cancers, your doctor may take some skin from another body site to cover the wound and promote healing. This is termed skin grafting. In more advanced cases of skin cancer, radiation therapy or chemotherapy (drugs that kill cancer cells) may be used with surgery to improve cure rates.

Am I at risk for skin cancer?

People with any of the factors listed below have a higher risk of developing skin cancer and should be particularly careful about sun exposure.

  • Long-term sun exposure
  • Fair skin (typically blonde or red hair with freckles)
  • Place of residence (increased risk in southern climates)
  • Presence of moles, particularly if there are irregular edges, uneven coloring, or an increase in the size of the mole
  • Family history of skin cancer, particularly melanoma
  • Use of indoor tanning devices
  • Severe sunburns as a child
  • Nonhealing ulcers or nodules in the skin.

How can I lower my risk of skin cancer?

The single most important thing you can do to lower your risk of skin cancer is to avoid direct sun exposure. Sunlight produces ultraviolet (UV) radiation that can directly damage the cells (DNA) of our skin. People who work outdoors are at the highest risk of developing a skin cancer. The sun’s rays are the most powerful between 10 am and 2 pm, so you must be particularly careful during those hours. If you must be out during the day, wear clothing that covers as much of your skin as possible, including a wide-brimmed hat to block the sun from your face, scalp, neck, and ears.

The use of a sunscreen can provide protection against UV radiation. When selecting a sunscreen, choose one with a Sun Protection Factor (SPF) of 15 or more. For people who live in the Southern U.S., a SPF of 30 or greater should be used during summer and when prolonged exposure is anticipated. Sunscreen should be applied before exposure and when the skin is dry. If you will be sweating or swimming, most sunscreens will need to be reapplied. Sunscreen products do not completely block the damaging rays, but they do allow you to be in the sun longer without getting sunburn.

It is also critical to recognize early signs of skin trouble. The best time to do self-examination is after a shower in front of a full-length mirror. Note any moles, birthmarks, and blemishes. Be on the alert for sores that do not heal or new nodules on the skin. Any mole that changes in size, color, or texture should be carefully examined. If you notice anything new or unusual, see your physician right away. If you have a strong family history of skin cancer, particularly melanoma, an annual examination by a physician skilled at diagnosing skin cancer is recommended. Catching skin cancer early can save your life.

Ultraviolet index: What you need to know

The new Ultraviolet (UV) index provides important information to help you plan your outdoor activities and avoid overexposure to the damaging rays of the sun. Developed by the National Weather Service and the Environmental Protection Agency, the UV index is issued daily as a national service.

The UV index gives the next day’s amount of exposure to UV rays. The index predicts UV levels on a 0 to 10+ scale (see chart).

Always take precautions against overexposure, and take special care when the UV index predicts exposure levels of moderate to above (5 to 10+).

Index number Exposure level

0 – 2minimal
3 – 4low
5 – 6moderate
7 – 9high
10+very high

Insight into its physical and mental effects

  • What chemicals are in smokeless tobacco?
  • Who uses smokeless tobacco?
  • Tips for quitting
  • and more…

Three percent of American adults are smokeless tobacco users. They run the same risks of gum disease, heart disease, and addiction as cigarette users, but an even greater risk of oral cancer. Each year about 30,000 Americans are diagnosed with oral and pharyngeal cancers, and more than 8,000 people die of these diseases. Despite the health risks associated with tobacco use, consumers continue to demand the product. In 2001, the five largest tobacco manufacturers spent $236.7 million on smokeless tobacco advertising and promotion.

What is smokeless tobacco?

There are two forms of smokeless tobacco: chewing tobacco and snuff. Chewing tobacco is usually sold as leaf tobacco (packaged in a pouch) or plug tobacco (in brick form). Both are placed between the cheek and gum. Users keep chewing tobacco in their mouths for several hours to get a continuous high from the nicotine in the tobacco.

Snuff is a powdered tobacco (usually sold in cans) that is put between the lower lip and the gum. It is also referred to as “dipping.” Just a pinch is all that’s needed to release the nicotine, which is then swiftly absorbed into the bloodstream, resulting in a quick high.

The chemicals contained in chew or snuff are poisonous and addictive. Every time smokeless tobacco is used, the body adjusts to the amount of tobacco needed to get a high. Consequently, the next time tobacco is used, the body will need a little more tobacco to get the same feeling. Holding an average-sized dip or chew in the mouth for 30 minutes gives the user as much nicotine as smoking four cigarettes.

Is smokeless tobacco less harmful than cigarettes?

In 1986, the U.S. Surgeon General declared that the use of smokeless tobacco “is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous conditions and can lead to nicotine addiction and dependence.” Also since 1991, the National Cancer Institute has recommended that the public avoid the use of all tobacco products due to their high levels of nitrosamines.

In a recent study, cancer researchers found that oral tobacco products including lozenges and moist snuff are not a good alternative to smoking, since the levels of cancer-causing nitrosamines in smokeless tobacco and lozenges are very high. Some smokeless products contain the highest amounts of nicotine that can be readily absorbed by the body.

What are the ingredients in smokeless tobacco?

  • Polonium 210 (nuclear waste)
  • N-Nitrosamines (cancer-causing)
  • Formaldehyde (embalming fluid)
  • Nicotine (addictive drug)
  • Cadmium (used in batteries and nuclear reactor shields)
  • Cyanide ( poisonous compound)
  • Arsenic (poinsonous metallic element)
  • Benzene (used in insecticides and motor fuels)
  • Lead (nerve poison)

Who are the most common smokeless tobacco users?

According to the 2000 National Household Survey on Drug Abuse conducted by the Substance Abuse and Mental Health Services Administration, young adults between the ages of 18-25 are the most common smokeless tobacco users. This trend may be influenced by innovative marketing tactics targeted at a younger audience.

Smokeless tobacco manufacturers are marketing flavored smokeless tobacco. A 2005 American Legacy Foundation and National Cancer Institute study noted, “Tobacco companies are using candy-like flavors and high tech delivery devices to turn a blowtorch into a flavored popsicle, misleading millions of youngsters to try a deadly product.”

What are the physical and mental effects of smokeless tobacco use?

Cancer. Smokeless tobacco is a cancer-causing agent or carcinogen. Cancers are most likely to develop at the site where tobacco is held in the mouth, but it may also include the lips, tongue, cheek, and throat.

Leukoplakia. Smokeless tobacco users may develop a condition in which white spots form on the gums, inside of the cheeks and sometimes tongue. It can be caused by the irritation from the tobacco juice. The disorder can be considered pre-cancerous. Therefore, if a white patch does not heal within one week, a doctor should be consulted.

Heart disease. The stimulating effects of nicotine, an organic compound made out of carbon, hydrogen, nitrogen, and sometimes oxygen, increase the heart rate and blood pressure and may trigger irregular heart beats.

Gum and tooth disease. Smokeless tobacco permanently discolors teeth, causes halitosis (bad breath), and may contribute to tooth loss. Smokeless tobacco contains a lot of sugar which forms and acid that may eat away the tooth enamel causing cavities and mouth sores. Also, its direct and repeated contact with the gums may cause them to recede.

Social effects. Bad breath, discolored teeth.

What are some early warning signs of oral cancer?

  • A sore that bleeds easily and does not heal
  • A lump or thickening anywhere in the mouth or neck
  • Soreness or swelling that does not go away
  • A red or white patch that does not go away
  • Trouble chewing, swallowing, or moving the tongue or jaw

Tips to quit using smokeless tobacco for a lifetime

  • Write down a list of reasons to quit. For example:
  • Don’t want to risk getting cancer.
  • Family members find it offensive.
  • Don’t like having bad breath after chewing and dipping.
  • Don’t want stained teeth or no teeth.
  • Don’t like being addicted to nicotine.
  • Want to start leading a healthier life.

Pick a quit date and throw out all chewing tobacco and snuff. Remember daily of the decision to stop chewing tobacco. Ask friends and family to help stay committed to the decision to quit by giving support and encouragement. Find alternatives to smokeless tobacco, such as sugarless gum, pumpkin or sunflower seeds, apple slices, raisins, or dried fruit. Engage in recreational activities to keep the mind off of smokeless tobacco. Develop a personalized plan that works best; set realistic goals. Reward successes.