Head and Neck Surgery
Otolaryngology – Head and Neck Surgery is often called ENT (for ear, nose, and throat). Patients with tumors of the throat may present to an ENT doctor with many different symptoms.
Persistent hoarseness, difficulty swallowing, or a sore throat that won’t go away after medication are reasons patients see an ENT doctor. Patients with throat tumors sometimes notice blood tinged saliva or even difficulty breathing.
On the first visit, the ENT doctor will take a thorough history and perform a careful exam.
It is helpful for denture wearers not to put adhesive on that day as the ENT doctor will ask the patient to remove the dentures to help the examination. Medical records, x-rays, CAT scans, or MRI scans that have already been done should be brought for the ENT doctor to review.
It is important for patients to bring not only just the reports of x-rays, CAT scans, and MRI scans, but it is important to bring a CD that contains the actual images of the x-rays, CAT scans, MRI scans.
Usually a CD can be picked up from the facility or hospital where the test was done. If someone other than the patient picks up the report and CD, the facility usually asks for a release signed by the actual patient.
There are many hidden areas of the throat that cannot be seen with regular instruments. The ENT doctor may use a fiberoptic endoscope to examine the throat. The fiberoptic endoscope or “scope” is actually passed through the nose and into the throat.
This procedure is done in the office after an anesthetic is sprayed into the nose. The fiberoptic endoscope is a common way of examining the hidden areas of the throat. It usually gives a very good view of the vocal cords and other structures in the lower throat.
Sometimes there may be areas of the throat that need to have a sample or biopsy taken. Biopsies often require a different scope and a short general anesthesia where the patient goes to sleep. At that time the throat can be examined and a sample of the suspicious area can be taken. Usually these types of biopsies are done on an outpatient basis where the patient comes into an outpatient facility early and leaves later in the day.
The throat has many different smaller areas. The ENT doctor categorizes tumors by the specific area of the throat. For example, the pharynx is divided up into the nasopharynx, oropharynx, and the hypopharynx. Each of these areas are then further subdivided. Structures in the oropharynx include the soft palate, uvula, anterior tonsillar pillars, posterior tonsillar pillars, lateral pharyngeal walls, posterior pharyngeal wall, and base of tongue.
The area the tumor is located affects the treatment plan. Tumors of the throat may be treated by several options such as radiation therapy, chemotherapy, or surgical resection. Often a combination of treatments is necessary.
The nearby structures in the neck may develop lumps or tumors. Tumor just means a swelling or lump. To diagnose what a tumor represents may require taking a sample of what’s inside or biopsy. One frequently used biopsy option is called a fine-needle biopsy. A thin needle (often thinner than a needle used to draw blood) is used to remove cells from inside the tumor. These cells are then sent to be analyzed at a pathology lab. Depending on the test results tumors in the neck may require surgical excision.
During surgery care is taken to keep scarring to a minimum. ENT doctors protect important nerves and blood vessels. For example the parotid gland in face and upper neck may develop a tumor. The facial nerve, which controls motion to the face, runs through the parotid gland. During surgery to remove a parotid tumor, the facial nerve is systematically located then carefully monitored and protected to prevent harm to the facial nerve.
Sometimes patients come to the ENT doctor with a lump in the neck. However the lump is actually a metastasis which is cancer that spread to a lymph node in the neck from somewhere else. The most common place that the cancer starts is inside the throat. An ENT doctor will carefully examine the throat and frequently use a scope to find where the problem actually started.
Other tests and scans are also used to help find where the primary tumor is. It is important to find the primary tumor. If the neck mass alone was removed, and the primary tumor was left untreated, the patient would keep developing metastatic cancerous lymph nodes.