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Head and Neck Cancer

Head and neck cancers are curable if caught early. Fortunately, most of them produce early symptoms. You should know the potential warning signs of head and neck cancer so that you can alert your doctor as soon as possible. Knowing and recognizing the signs 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. Of course, not all lumps are cancer. But a lump could be the first sign of cancer of the mouth, throat, voice box, thyroid gland, salivary glands, or of certain lymphomas and blood cancers. Such lumps are generally painless. Antibiotics may be prescribed as initial treatment for adults with enlarged lymph nodes in the neck under the assumption that an infection may be responsible. If the lump persists, or is enlarging despite antibiotics, further investigation to determine the cause and nature of the enlarged lymph node(s) is important.
  • Change in the Voice  — Most cancers in the voice box cause voice change. An ENT specialist can examine your voice box 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 may be painless. Any sore or swelling in the mouth that does not go away after two weeks should be evaluated by a physician. Your dentist or doctor can determine if a biopsy is needed, and can refer you to an ENT specialist 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 may make swallowing solid foods difficult. 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 see your doctor. 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 skin cancer. 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. 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 typically produces a blue-black or black discoloration of the skin. 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 ENT specialist.

What causes head and neck cancer?

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

Thyroid Disorders and Surgery

Your thyroid gland is one of the endocrine glands that makes hormones to regulate physiological functions in your body, like metabolism. Other endocrine glands are the pancreas, the pituitary, the adrenal glands, and the parathyroid glands.

The thyroid gland is located in the middle of the lower neck, below the larynx, and wraps around the front half of the trachea. It is shaped like a bow tie, just above the collarbones, having two halves which are joined by a small tissue bar. You can't always feel a normal thyroid gland.

What are some different thyroid disorders?

Diseases of the thyroid gland are very common, affecting millions of Americans. The most common thyroid problems are:

  • An overactive gland, called hyperthyroidism (e.g., Graves' disease, toxic adenoma or toxic nodular goiter)
  • An underactive gland, called hypothyroidism (e.g., Hashimoto's thyroiditis)
  • Thyroid enlargement due to overactivity (as in Graves' disease) or from under-activity (as in hypothyroidism). An enlarged thyroid gland is often called a "goiter."

Patients with a family history or who had radiation therapy to the head or neck as children for acne, adenoids, or other reasons are more prone to develop thyroid malignancy.

If you develop significant swelling in your neck or difficulty breathing or swallowing, you should call your surgeon or be seen in the emergency room.

What treatment may be recommended?

Depending on the nature of your condition, treatment may include the following:

Hypothyroidism Treatment:

  • Thyroid hormone replacement pills

Hyperthyroidism Treatment:

  • Medication to block the effects of excessive production of thyroid hormone
  • Radioactive iodine to destroy the thyroid gland
  • Surgical removal of the thyroid gland
Goiters (lumps):

  • A fine needle aspiration biopsy is a safe, relatively painless procedure. With this procedure, a hypodermic needle is passed into the lump, often after administration of local anesthesia into the skin, and tissue fluid samples containing cells are taken. Often several passes with the needle are required. Sometimes ultrasound may be used to guide the needle into the nodule. This test gives the doctor more information on the nature of the lump in your thyroid gland and specifically may help to differentiate a benign from a malignant thyroid mass.
  • Thyroid surgery may be required when:
    • the fine needle aspiration is suggestive of cancer
    • the trachea (windpipe) or esophagus are compressed because both lobes are very large

What is thyroid surgery?

Thyroid surgery is an operation to remove part or all of the thyroid gland. It is performed in the hospital, and general anesthesia is usually required. Typically the operation removes the lobe of the thyroid gland containing the lump and possibly the isthmus. A frozen section (an immediate microscopic reading) may or may not be used to determine if the rest of the thyroid gland should be removed.

Sometimes, based on the result of the frozen section, the surgeon may decide not to remove any additional thyroid tissue, or proceed to remove the entire thyroid gland, and/or other tissue in the neck. This is a decision usually made in the operating room by the surgeon, based on findings at the time of surgery. Your surgeon will discuss these options with you before the procedure.

There may be times when the definite microscopic answer cannot be determined until several days after surgery. If a malignancy is identified in this way, your surgeon may recommend that the remaining lobe of the thyroid be removed at a second procedure. If you have specific questions about thyroid surgery, ask your otolaryngologist.

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