Gale Encyclopedia of Cancer Vol 2 (L Z) pdf

  The GALE ENCYCLOPEDIA of

  

C ancer

  The GALE ENCYCLOPEDIA of

  

C ancer

E L L E N T H A C K E R Y , E D I T O R

  

A GUIDE TO CANCER AND ITS TREATMENTS

  

V O L U M E

L-Z

  

2

  Lactulose see Laxatives Lambert-Eaton syndrome see Eaton-

  Langerhans cell histiocytosis see

  Laparoscopy is a type of surgical procedure in which a small incision is made, usually in the navel, through which a viewing tube (laparoscope) is inserted. The view- ing tube has a small camera on the eyepiece. This allows the doctor to examine the abdominal and pelvic organs on a video monitor connected to the tube. Other small inci- sions can be made to insert instruments to perform proce- dures. Laparoscopy can be done to diagnose conditions or to perform certain types of operations. It is less invasive than regular open abdominal surgery (laparotomy).

  Since the late 1980s, laparoscopy has been a popular diagnostic and treatment tool. The technique dates back to 1901, when it was reportedly first used in a gynecolog- ic procedure performed in Russia. In fact, gynecologists were the first to use laparoscopy to diagnose and treat conditions relating to the female reproductive organs: uterus, fallopian tubes, and ovaries.

• Tubal ligation. In this procedure, the fallopian tubes are sealed or cut to prevent subsequent pregnancies.
• Ectopic pregnancy. If a fertilized egg becomes embed- ded outside the uterus, usually in the fallopian tube, an operation must be performed to remove the developing embryo. This often can be done with laparoscopy.
• Endometriosis. This is a condition in which tissue from inside the uterus is found outside the uterus in other parts of (or on organs within) the pelvic cavity. This can
• Liver cancer. Laparoscopy is an important tool for determining if cancer is present in the liver. When a patient has non-liver cancer, the liver is often checked to see if the cancer has spread there. Laparoscopy can identify up to 90% of malignant lesions that have spread to that organ from a cancer located elsewhere in the body. While computed tomography (CT) can find cancerous lesions that are 0.4 in (10 mm) in size, laparoscopy is capable of locating lesions that are as small as 0.04 in (1 millimeter).
• Pancreatic cancer. Laparoscopy has been used to evalu- ate pancreatic cancer for years. In fact, the first reported use of laparoscopy in the United States was in a case involving pancreatic cancer.
• Esophageal and stomach cancers. Laparoscopy has been found to be more effective than magnetic resonance

  Laparoscopy was first used with cancer patients in 1973. In these first cases, the procedure was used to observe and biopsy the liver. Laparoscopy plays a role in the diagno- sis, staging, and treatment for a variety of cancers.

  As of 2001, the use of laparoscopy to completely remove cancerous growths and surrounding tissues (in place of open surgery) is controversial. The procedure is being studied to determine if it is as effective as open surgery in complex operations. Laparoscopy is also being investigated as a screening tool for ovarian cancer.

  Laparoscopy is widely used in procedures for non- cancerous conditions that in the past required open surgery, such as removal of the appendix (appendecto- my) and gallbladder removal (cholecystectomy).

  Diagnostic procedure As a diagnostic procedure, laparoscopy is useful in taking biopsies of abdominal or pelvic growths, as well as lymph nodes. It allows the doctor to examine the abdominal area, including the female organs, appendix, gallbladder, stomach, and the liver.

  Laparoscopy is used to determine the cause of pelvic pain or gynecological symptoms that cannot be con- firmed by a physical exam or ultrasound. For example, ovarian cysts, endometriosis, ectopic pregnancy, or blocked fallopian tubes can be diagnosed using this pro- cedure. It is an important tool when trying to determine the cause of infertility.

  Operative procedure While laparoscopic surgery to completely remove cancerous tumors, surrounding tissues, and lymph nodes is used on a limited basis, this type of operation is widely used in noncancerous conditions that once required open surgery. These conditions include:

  

L

Lambert syndrome

Histiocytosis X Laparoscopy Definition

Purpose

• Hodgkin’s disease. Some patients with Hodgkin’s dis- ease have surgical procedures to evaluate lymph nodes for cancer. Laparoscopy is sometimes selected over laparotomy for this procedure. In addition, the spleen may be removed in patients with Hodgkin’s disease. Laparoscopy is the standard surgical technique for this procedure, which is called a splenectomy.
• Prostate cancer. Patients with prostate cancer may have the nearby lymph nodes examined. Laparoscopy is an important tool in this procedure.

  cause cysts to form. Endometriosis is diagnosed with laparoscopy, and in some cases the cysts and other tis- sue can be removed during laparoscopy.

• Hysterectomy. This procedure to remove the uterus can, in some cases, be performed using laparoscopy. The uterus is cut away with the aid of the laparoscopic instru- ments and then the uterus is removed through the vagina.
• Ovarian masses. Tumors or cysts in the ovaries can be removed using laparoscopy.
• Appendectomy. This surgery to remove an inflamed appendix required open surgery in the past. It is now routinely performed with laparoscopy.
• Cholecystectomy. Like appendectomy, this procedure to remove the gallbladder used to require open surgery. Now it can be performed with laparoscopy, in some cases.

  In contrast to open abdominal surgery, laparoscopy usually involves less pain, less risk, less scarring, and faster recovery. Because laparoscopy is so much less invasive than traditional abdominal surgery, patients can leave the hospital sooner.

  Cancer staging

  Laparoscopy can be used in determining the spread of certain cancers. Sometimes it is combined with ultra- sound. Although laparoscopy is a useful staging tool, its use depends on a variety of factors, which are considered for each patient. Types of cancers where laparoscopy may be used to determine the spread of the disease include:

  imaging (MRI) or computed tomography (CT) in diag- nosing the spread of cancer from these organs.

  Cancer treatment

  Laparoscopy is sometimes used as part of a pallia- tive cancer treatment. This type of treatment is not a cure, but can often lessen the symptoms. An example is the feeding tube, which cancer patients may have if they are unable to take in food by mouth. The feeding tube provides nutrition directly into the stomach. Inserting the tube with a laparoscopy saves the patient the ordeal of open surgery.

  As with any surgery, patients should notify their physician of any medications they are taking (prescrip- tion, over-the-counter, or herbal) and of any allergies. Precautions vary due to the several different purposes for laparoscopy. Patients should expect to rest for sev- eral days after the procedure, and should set up a com- fortable environment in their home (with items such as pain medication, heating pads, feminine products, comfortable clothing, and food readily accessible) prior to surgery.

  Lapar oscop y This surgeon is performing a laparoscopic procedure on a patient. (Photo Researchers, Inc. Reproduced by permission.)

Precautions

Lapar Description

  Laparoscopy is a surgical procedure that is done in

TO A S K T H E D O C TO R

  the hospital under anesthesia. For diagnosis and biopsy, local anesthesia is sometimes used. In operative proce-

  y

• What is your complication rate? dures, such as abdominal surgery, general anesthesia is required. Before starting the procedure, a catheter is • What is the purpose of this procedure? inserted through the urethra to empty the bladder, and the
• How often do you do laparoscopies? skin of the abdomen is cleaned.
• What type of anesthesia will be used? After the patient is anesthetized, a hollow needle is
• Will a biopsy be taken during the laparoscopy inserted into the abdomen in or near the navel, and car- if anything abnormal is seen? bon dioxide gas is pumped through the needle to expand the abdomen. This allows the surgeon a better view of the • If more surgery is needed, can it be done with a internal organs. The laparoscope is then inserted through laparoscope? this incision to look at the internal organs. The image
• What area will be examined with the from the camera attached to the end of the laparoscope is laparoscope? seen on a video monitor.
• What are the risks? Sometimes, additional small incisions are made to
• How long is the recovery time? insert other instruments that are used to lift the tubes and ovaries for examination or to perform surgical procedures.

  the possibility that it may become apparent that open

Preparation

  surgery is required. Serious complications occur at a rate Patients should not eat or drink after midnight on the of only 0.2%. night before the procedure.

  Rare complications include:

• Hemorrhage

Aftercare

• Inflammation of the abdominal cavity lining After the operation, nurses will check the vital signs
• Abscess of patients who had general anesthesia. If there are no complications, the patient may leave the hospital within
• Problems related to general anesthesia four to eight hours. (Traditional abdominal surgery

  Laparoscopy is generally not used in patients with requires a hospital stay of several days). certain heart or lung conditions, or in those who have There may be some slight pain or throbbing at the inci- some intestinal disorders, such as bowel obstruction. sion sites in the first day or so after the procedure. The gas that is used to expand the abdomen may cause discomfort

Normal results

  under the ribs or in the shoulder for a few days. Depending In diagnostic procedures, normal results would indi- on the reason for the laparoscopy in gynecological proce- cate no abnormalities or disease of the organs or lymph dures, some women may experience some vaginal bleed- nodes that were examined. ing. Many patients can return to work within a week of surgery and most are back to work within two weeks.

Abnormal results Risks

  A diagnostic laparoscopy may reveal cancerous or benign masses or lesions. Abnormal findings include Laparoscopy is a relatively safe procedure, especial- tumors or cysts, infections (such as pelvic inflammatory ly if the physician is experienced in the technique. The disease), cirrhosis, endometriosis, fibroid tumors, or an risk of complication is approximately 1%. accumulation of fluid in the cavity. If a doctor is check-

  The procedure carries a slight risk of puncturing a ing for the spread of cancer, the presence of malignant blood vessel or organ, which could cause blood to seep lesions in areas other than the original site of malignancy into the abdominal cavity. Puncturing the intestines could is an abnormal finding. allow intestinal contents to seep into the cavity. These are

  Endoscopic retrograde cholangiopancre-

  serious complications and major surgery may be required See Also

  atography; Gynecologic cancers; Liver biopsy; Lymph

  to correct the problem. For operative procedures, there is

Description K E Y T E R M S

  The larynx is located where the throat divides into the esophagus and the trachea. The esophagus is the tube

  Biopsy—Microscopic evaluation of a tissue sam-

  that takes food to the stomach. The trachea, or windpipe, ple. The tissue is closely examined for the pres-

  yngeal cancer

  takes air to the lungs. The area where the larynx is locat- ence of abnormal cells. ed is sometimes called the Adam’s apple.

Lar

  Cancer staging—Determining the course and

  The larynx has two main functions. It contains the spread of cancer. vocal cords, cartilage, and small muscles that make up

  Cyst—An abnormal lump or swelling that is filled

  the voice box. When a person speaks, small muscles with fluid or other material. tighten the vocal cords, narrowing the distance between them. As air is exhaled past the tightened vocal cords, it

  Palliative treatment—A type of treatment that

  creates sounds that are formed into speech by the mouth, does not provide a cure, but eases the symptoms. lips, and tongue.

  Tumor—A growth of tissue, benign or malignant,

The second function of the larynx is to allow air to often referred to as a mass

  enter the trachea and to keep food, saliva, and foreign material from entering the lungs. A flap of tissue called the epiglottis covers the trachea each time a person swal- lows. This blocks foreign material from entering the node biopsy; Nutritional support; Tumor grading; Tumor lungs. When not swallowing, the epiglottis retracts, and staging; Ultrasonography air flows into the trachea. During treatment for cancer of the larynx, both of these functions may be lost.

Resources

  Cancers of the larynx develop slowly. About 95% of

  BOOKS

  these cancers develop from thin, flat cells similar to skin Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. cells called squamous epithelial cells. These cells line the The Harvard Guide to Women’s Health.

  Cambridge, MA:

  larynx. Gradually, the squamous epithelial cells begin to Harvard University Press, 1996. change and are replaced with abnormal cells. These

  Cunningham, F. Gary, Paul C. MacDonald, et al. Williams Obstet- rics,

  20th ed. Stamford, CT: Appleton & Lange, 1997. abnormal cells are not cancerous but are pre-malignant Kurtz, Robert C., and Robert J. Ginsberg. “Cancer Diagnosis:

  cells that have the potential to develop into cancer. This

  Endoscopy.” In Cancer: Principles & Practice of Oncolo-

  condition is called dysplasia. Most people with dysplasia gy.

  , edited by Vincent T. DeVita Jr. Philadelphia: Lippin-

  never develop cancer. The condition simply goes away cott, Williams & Wilkins, 2001, 725-27. without any treatment, especially if the person with dys-

  Lefor, Alan T. “Specialized Techniques in Cancer Manage- plasia stops smoking or drinking alcohol. ment.” In Cancer: Principles & Practice of Oncology, 6th ed., edited by Vincent T. DeVita Jr., et al. Philadelphia: The larynx is made up of three parts, the glottis, the Lippincott, Williams & Wilkins, 2001, 739-57.

  supraglottis, and the subglottis. Cancer can start in any of Ryan, Kenneth J., Ross S. Berkowitz, and Robert L. Barbieri. these regions. Treatment and survival rates depend on Kistner’s Gynecology, 6th ed. St. Louis: Mosby, 1997. which parts of the larynx are affected and whether the cancer has spread to neighboring areas of the neck or dis-

  OTHER tant parts of the body.

  Iannitti, David A. “The Role of Laparoscopy in the Manage- ment of Pancreatic Cancer.” Home Journal Library Index.

  The glottis is the middle part of the larynx. It con-

  tains the vocal cords. Cancers that develop on the vocal 1998/v3/e/iannitti/e181-185.htm>. cords are often diagnosed very early because even small vocal cord tumors cause hoarseness. In addition, the

  Carol A. Turkington vocal cords have no connection to the lymphatic system. Rhonda Cloos, R.N.

  This means that cancers on the vocal cord do not spread easily. When confined to the vocal cords without any involvement of other parts of the larynx, the cure rate for this cancer is 75% to 95%.

  The supraglottis is the area above the vocal cords. It

Laryngeal cancer

  contains the epiglottis, which protects the trachea from

Definition

  foreign materials. Cancers that develop in this region are Laryngeal cancer is cancer of the larynx or voice box. usually not found as early as cancers of the glottis

Lar yngeal cancer A pathology photograph of an extracted tumor found on the

  because the symptoms are less distinct. The supraglottis region has many connections to the lymphatic system, so cancers in this region tend to spread easily to the lymph nodes and may spread to other parts of the body (lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection- fighting cells). In 25% to 50% of people with cancer in the supraglottal region, the cancer has already spread to the lymph nodes by the time they are diagnosed. Because of this, survival rates are lower than for cancers that involve only the glottis.

  larynx. (Photograph by William Gage. Custom Medical Stock Photo. Reproduced by permission.)

Demographics

  The next step is examination by an otolaryngologist, or ear, nose, and throat (ENT) specialist. This doctor also performs a physical examination, but in addition will

  On the first visit to a doctor for symptoms that suggest laryngeal cancer, the doctor first takes a complete medical history, including family history of cancer and lifestyle information about smoking and alcohol use. The doctor also does a physical examination, paying special attention to the neck region for lumps, tenderness, or swelling.

  Tumors that begin below the vocal cords are rare, but may cause noisy or difficult breathing. All the symp- toms above can also be caused other cancers as well as by less serious illnesses. However, if these symptoms persist, it is important to see a doctor and find their cause, because the earlier cancer treatment begins, the more successful it is.

  Tumors in the supraglottal region above the vocal cords often cause more, but less distinct symptoms. These include:

  The symptoms of laryngeal cancer depend on the location of the tumor. Tumors on the vocal cords are rarely painful, but cause hoarseness. Anyone who is continually hoarse for more than two weeks or who has a cough that does not go away should be checked by a doctor.

  Laryngeal cancer develops when the normal cells lining the larynx are replaced with abnormal cells (dys- plasia) that become malignant and reproduce to form tumors. The development of dysplasia is strongly linked to life-long habits of smoking and heavy use of alcohol. The more a person smokes, the greater the risk of devel- oping laryngeal cancer. It is unusual for someone who does not smoke or drink to develop cancer of the larynx. Occasionally, however, people who inhale asbestos parti- cles, wood dust, paint or industrial chemical fumes over a long period of time develop the disease.

  It is thought that older men are more likely to devel- op laryngeal cancer than women because the two main risk factors for acquiring the disease are lifetime habits of smoking and alcohol abuse. More men smoke and drink more than women, and more African-American men are heavy smokers than other men in the United States. However, as smoking becomes more prevalent among women, it seems likely that more cases of laryn- geal cancer in females will be seen.

  55. Laryngeal cancer is about 50% more common among African-American men than among other Americans.

  About 12,000 new cases of cancer of the larynx develop in the United States each year. Each year, about 3,900 die of the disease. Laryngeal cancer is between four and five times more common in men than in women. Almost all men who develop laryngeal cancer are over age

  The subglottis is the region below the vocal cords. Cancer starting in the subglottis region is rare. When it does, it is usually detected only after it has spread to the vocal cords, where it causes obvious symptoms such as hoarseness. Because the cancer has already begun to spread by the time it is detected, survival rates are gener- ally lower than for cancers in other parts of the larynx.

• persistent sore throat
• pain when swallowing
• difficulty swallowing or frequent choking on food
• bad breath
• lumps in the neck
• persistent ear pain (called referred pain; the source of the pain is not the ear)
• change in voice quality

Causes and symptoms

Diagnosis

  An otolaryngologist and an oncologist (cancer spe- cialist) generally lead the treatment team. They are sup- ported by radiologists to interpret CT and MRI scans, a head and neck surgeon, and nurses with special training in assisting cancer patients.

  Lar yngeal cancer

  also want to look inside the throat at the larynx. Initially, the doctor may spray a local anesthetic on the back of the throat to prevent gagging, then use a long-handled mirror to look at the larynx and vocal cords. This examination is done in the doctor’s office. It may cause gagging but is usually painless.

  A more extensive examination involves a laryn-

  goscopy

  . In a laryngoscopy, a lighted fiberoptic tube called a laryngoscope that contains a tiny camera is inserted through the patient’s nose and mouth and snaked down the throat so that the doctor can see the larynx and surrounding area. This procedure can be done with a sedative and local anesthetic in a doctor’s office. More often, the procedure is done in an outpatient surgery clinic or hospital under general anesthesia. This allows the doc- tor to use tiny clips on the end of the laryngoscope to take biopsies (tissue samples) of any abnormal-looking areas.

Treatment team

  Laryngoscopies are normally painless and take about one hour. Some people find their throat feels scratchy after the procedure. Since laryngoscopies are done under sedation, patients should not drive immedi- ately after the procedure, and should have someone avail- able to take them home. Laryngoscopy is a standard pro- cedure that is covered by insurance.

  The locations of the samples taken during the laryn- goscopy are recorded, and the samples are then sent to the laboratory where they are examined under the micro- scope by a pathologist who specializes in diagnosing dis- eases through cell samples and laboratory tests. It may take several days to get the results. Based on the findings of the pathologist, cancer can be diagnosed and staged.

  Once cancer is diagnosed, other tests will probably be done to help determine the exact size and location of the tumors. This information is helpful in determining which treatments are most appropriate. These tests may include:

  A speech pathologist is often involved in treatment, both before surgery to discuss various options for com- munication if the larynx is removed, and after surgery to teach alternate forms of voice communication. A social worker, psychologist, or family counselor may help both the patient and the family meet the changes and chal- lenges that living with laryngeal cancer brings.

  At any point in the process, the patient may want to get a second opinion from another doctor in the same specialty. This is a common practice and does not indi- cate a lack of faith in the original doctor, but simply a desire for more information. Some insurance companies require a second opinion before surgery is done.

• Endoscopy. Similar to a laryngoscopy, this test is done when it appears that cancer may have spread to other areas, such as the esophagus or trachea.
• Computed tomography (CT or CAT) scan. Using x- ray images taken from several angles and computer modeling, CT scans allow parts of the body to be seen as a cross section. This helps locate and size the tumors, and provides information on whether they can be surgi- cally removed.
• Magnetic resonance imaging (MRI). MRI uses mag- nets and radio waves to create more detailed cross-sec- tional scans than computed tomography. This detailed information is needed if surgery on the larynx area is planned.
• Barium swallow. Barium is a substance that, unlike soft tissue, shows up on x rays. Swallowed barium coats the throat and allows x-ray pictures to be made of the tis- sues lining the throat.
• Chest x ray. Done to determine if cancer has spread to the lungs. Since most people with laryngeal cancer are smokers, the risk of also having lung cancer or emphy- sema is high.
• Fine needle aspiration (FNA) biopsy. If any lumps on the neck are found, a thin needle is inserted into the lump, and some cells are removed for analysis by the pathologist.
• Additional blood and urine tests. These tests do not diagnose cancer, but help to determine the patient’s general health and provide information to determine which cancer treatments are most appropriate.

Clinical staging, treatments, and prognosis

  Once cancer of the larynx is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. In can- cer of the larynx, the definitions of the early stages depend on where the cancer started.

  The cancer is only in the area where it started and has not spread to lymph nodes in the area or to other parts of the body. The exact definition of stage I depends on where the cancer started, as follows:

  Staging

• Supraglottis: The cancer is only in one area of the supraglottis and the vocal cords can move normally.

Lar

• Glottis: The cancer is only in the vocal cords and the

  yngeal cancer vocal cords can move normally. QU E S T I O N S

• Subglottis: The cancer has not spread outside of the TO A S K T H E D O C TO R subglottis.
• What stage is my cancer, and what exactly The cancer is only in the larynx and has STAGE II.

  does that mean? not spread to lymph nodes in the area or to other parts of

• What are possible treatments for my cancer? the body. The exact definition of stage II depends on where the cancer started, as follows: • How long will my treatment last?
• What are some of the changes in my activi>Supraglottis: The cancer is in more than one area of the that will occur because of my treatment? supraglottis, but the vocal cords can move normally.
• What is daily life like after a laryngect>Glottis: The cancer has spread to the supraglottis or the subglottis or both. The vocal cords may or may not be
• How will I speak? able to move normally.
• I’ve heard about clinical trials using radia
• Subglottis: The cancer has spread to the vocal cords, and drugs to treat cancer of the larynx. Where which may or may not be able to move normally.

  can I find out more about these trials?

• What changes in my lifestyle can I make to help Either of the following may be true: STAGE III.

  improve my chances of beating this cancer?

• The cancer has not spread outside of the larynx, but the
• How often will I have to have check-ups? vocal cords cannot move normally, or the cancer has spread to tissues next to the larynx.
• What is the likelihood that I will survive this can
• The cancer has spread to one lymph node on the same side of the neck as the cancer, and the lymph node mea-
• Can you suggest any support groups that would sures no more than 3 centimeters (just over 1 inch).

  be helpful to me or my family? Any of the following may be true: STAGE IV.

• The cancer has spread to tissues around the larynx, such as the pharynx or the tissues in the neck. The Stage III and stage IV cancers are usually treated lymph nodes in the area may or may not contain cancer.

  with total laryngectomy. This is an operation to remove the entire larynx. Sometimes other tissues around the lar-

• The cancer has spread to more than one lymph node on ynx are also removed. Total laryngectomy removes the the same side of the neck as the cancer, to lymph nodes vocal cords. Alternate methods of voice communication on one or both sides of the neck, or to any lymph node must be learned with the help of a speech pathologist.

  that measures more than 6 centimeters (over 2 inches).

• The cancer has spread to other parts of the body. Smaller tumors are sometimes treated by partial laryngectomy. The goal is to remove the cancer but save

  Recurrent disease means that the cancer RECURRENT. as much of the larynx (and corresponding speech capa- has come back (recurred) after it has been treated. It may bility) as possible. Very small tumors or cancer in situ are come back in the larynx or in another part of the body. sometimes successfully treated with laser excision surgery. In this type of surgery, a narrowly targeted beam

  Treatment of light from a laser is used to remove the cancer.

  Treatment is based on the stage of the cancer as well Advanced cancer (Stages III and IV) that has spread as its location and the health of the individual. Generally, to the lymph nodes often requires an operation called a there are three types of treatments for cancer of the lar- neck dissection. The goal of a neck dissection is to ynx. These are surgery, radiation, and chemotherapy. remove the lymph nodes and prevent the cancer from

  They can be used alone or in combination based in the spreading. There are several forms of neck dissection. A stage of the caner. Getting a second opinion after the can-

  radical neck dissection is the operation that removes the

  cer has been staged can be very helpful in sorting out most tissue. treatment options and should always be considered.

  Several other operations are sometimes performed because of laryngeal cancer. A tracheotomy is a surgical

  SURGERY. The goal of surgery is to cut out the tissue

  procedure in which an artificial opening is made in the that contains malignant cells. There are several common trachea (windpipe) to allow air into the lungs. This oper- surgeries to treat laryngeal cancer. ation is necessary if the larynx is totally removed. A gas- trectomy tube is a feeding tube placed through skin and

K E Y T E R M S

  directly into the stomach. It is used to give nutrition to people who cannot swallow or whose esophagus is

  Dysplasia—The abnormal change in size, shape

  blocked by a tumor. People who have a total laryngecto- or organization of adult cells.

  yngeal cancer

  my usually do not need a gastrectomy tube if their esoph-

  Lymph—Clear, slightly yellow fluid carried by a Lar agus remains intact.

  network of thin tubes to every part of the body.

  Radiation therapy uses high-energy RADIATION. Cells that fight infection are carried in the lymph.

  rays, such as x rays or gamma rays, to kill cancer cells.

  Lymphatic system—Primary defense against infec-

  The advantage of radiation therapy is that it preserves the tion in the body. The lymphatic system consists of larynx and the ability to speak. The disadvantage is that it tissues, organs, and channels (similar to veins) that may not kill all the cancer cells. Radiation therapy can be produce, store, and transport lymph and white used alone in early stage cancers or in combination with blood cells to fight infection. surgery. Sometimes it is tried first with the plan that if it

  Lymph nodes—Small, bean-shaped collections of fails to cure the cancer, surgery still remains an option.

  tissue found in a lymph vessel. They produce cells Often, radiation therapy is used after surgery for and proteins that fight infection, and also filter advanced cancers to kill any cells the surgeon might not lymph. Nodes are sometimes called lymph glands. have removed.

  Metastasize—Spread of cells from the original site

  There are two types of radiation therapy. External of the cancer to other parts of the body where sec- beam radiation therapy focuses rays from outside the ondary tumors are formed. body on the cancerous tissue. This is the most common type of radiation therapy used to treat laryngeal cancer.

  Malignant—Cancerous. Cells tend to reproduce

  With internal radiation therapy, also called brachythera- without normal controls on growth and form py, radioactive materials are placed directly on the can- tumors or invade other tissues. cerous tissue. This type of radiation therapy is a much less common treatment for laryngeal cancer.

  External radiation therapy is given in doses called result in low blood cell counts, increased chance of infec- fractions. A common treatment involves giving fractions tion, and abnormal bleeding or bruising. five days a week for seven weeks. Clinical trials are underway to determine the benefits of accelerating the

  Prognosis

  delivery of fractions (accelerated fractionation) or divid- ing fractions into smaller doses given more than once a Cure rates and survival rates can predict group out- day (hyperfractionation). Side effects of radiation thera- comes, but can never precisely predict the outcome for a py include dry mouth, sore throat, hoarseness, skin prob- single individual. However, the earlier laryngeal cancer lems, trouble swallowing, and diminished ability to taste. is discovered and treated, the more likely it will be cured. Chemotherapy is the use of drugs

  CHEMOTHERAPY. Cancers found in stage 0 and stage 1 have a 75% to

  to kill cancer cells. Unlike radiation therapy, which is tar- 95% cure rate depending on the site. Late stage cancers geted to a specific tissue, chemotherapy drugs are either that have metastasized have a very poor survival rate, taken by mouth or intravenously (through a vein) and cir- with intermediate stages falling somewhere in between. culate throughout the whole body. They are used mainly

  People who have had laryngeal cancer are at greatest risk to treat advanced laryngeal cancer that is inoperable or for recurrence (having cancer come back), especially in that has metastasized to a distant site. Chemotherapy is the head and neck, during the first two to three years after often used after surgery or in combination with radiation treatment. Check-ups during the first year are needed therapy. Clinical trials are underway to determine the every other month, and four times a year during the sec- best combination of treatments for advanced cancer. ond year. It is rare for laryngeal cancer to recur after five years of being cancer-free.

  The two most common chemotherapy drugs used to treat laryngeal cancer are cisplatin and fluorouracil (5-

  Alternative and complementary therapies

  FU). There are many side effects associated with chemotherapy drugs, including nausea and vomiting, Alternative and complementary therapies range loss of appetite (anorexia), hair loss (alopecia), diar- from herbal remedies, vitamin supplements, and special

  rhea , and mouth sores. Chemotherapy can also damage diets to spiritual practices, acupuncture, massage, and

  the blood-producing cells of the bone marrow, which can similar treatments. When these therapies are used in

• National Cancer Institute. <http://cancertrials.nci.nih.

  gov> or (800) 4-CANCER.

• National Institutes of Health Clinical Trials. <http:// clinicaltrials.gov> • Center Watch: A Clinical Trials Listing. <http://www.

  Ahmad, I., B.N. Kumar, K. Radford, J. O’Connell, and A.J.Batch. “Surgical Voice Restoration Following Abla- Lar yngeal cancer

  cessation

  See Also Alcohol consumption, Cigarettes, Smoking

  The loss of voice because of laryngeal surgery may be the most traumatic effect of laryngeal cancer. Losing the ability to communicate easily with others can be iso- lating. Support groups and psychological counseling is helpful for both the cancer patient and family members. Many national organizations that support cancer educa- tion can provide information on in-person or on-line sup- port and education groups.

  Not only is one’s health affected, one’s whole life sud- denly revolves around trips to the doctor for cancer treat- ment and adjusting to the side effects of these treatments. This is stressful for both the cancer patient and his or her family members. It is not unusual for family members to feel resentful of the changes that occur in the family, and then feel guilty about feeling resentful.

  By far, the most effective way to prevent laryngeal cancer is not to smoke. Smokers who quit smoking also significantly decrease their risk of developing the dis- ease. Other ways to prevent laryngeal cancer include lim- iting the use of alcohol, eating a well-balanced diet, seek- ing treatment for prolonged heartburn, and avoiding inhaling asbestos and chemical fumes.

  centerwatch.com>

  Current information on what clinical trials are avail- able and where they are being held is available by enter- ing the search term “laryngeal cancer” at the following web sites:

  The selection of clinical trials underway changes frequently. Clinical trials for laryngeal cancer currently focus treating advanced cancers by combining radiation and surgical therapy, radiation and chemotherapy, and different combinations of chemotherapy drugs. Other studies are examining the most effective timing and dura- tion of radiation therapy.

  Clinical trials are government-regulated studies of new treatments and techniques that may prove beneficial in diagnosing or treating a disease. Participation is always voluntary and at no cost to the participant. Clini- cal trials are conducted in three phases. Phase 1 tests the safety of the treatment and looks for harmful side effects. Phase 2 tests the effectiveness of the treatment. Phase 3 compares the treatment to other treatments available for the same condition.

  Chemotherapy brings with it a host of unwanted side effects, many of which disappear after the chemotherapy stops. For example, hair will re-grow, and until it does, a wig can be used. Medications are available to treat nau- sea and vomiting. Side effects such as dry skin are treat- ed symptomatically.

  Cancer treatment, even when successful, has many unwanted side effects. In laryngeal cancer, the biggest side effects are the loss of speech due to total laryngecto- my and the need to breathe through a hole in the neck called a stoma. Several alternative methods of sound pro- duction, both mechanical and learned, are available, and should be discussed with a speech pathologist. Support groups also exist for people who have had their larynx removed. Coping with speech loss and care of the stoma is discussed more extensively in the laryngectomy entry.

  Unlike traditional pharmaceuticals, complementary and alternative therapies are not evaluated by the United States Food and Drug Administration (FDA) for either safety or effectiveness. These therapies may have inter- actions with traditional pharmaceuticals. Patients should be wary of “miracle cures” and notify their doctors if they are using herbal remedies, vitamin supplements or other unprescribed treatments. Alternative and experi- mental treatments normally are not covered by insurance.

  Complementary or alternative therapies are widely used by people with cancer. One large study published in the Journal of Clinical Oncology in July, 2000 found that 83% of all cancer patients studied used some form of com- plementary or alternative medicine as part of their cancer treatment. No specific alternative therapies have been directed toward laryngeal cancer. However, good nutrition and activities that reduce stress and promote a positive view of life have no unwanted side effects and appear to be bene- ficial in boosting the immune system in fighting cancer.

  addition to conventional medicine, they are called com- plementary therapies. When they are used instead of con- ventional medicine, they are called alternative therapies.

Prevention

Coping with cancer treatment

Special concerns Being diagnosed with cancer is a traumatic event

Clinical trials

Resources PERIODICALS

  tive Surgery for Laryngeal and Hypopharyngeal Carcino- ma.” Journal or Laryngology and Otolaryngology 114 (July 2000): 522–5.

K E Y T E R M S

  ORGANIZATIONS American Cancer Society. National Headquarters, 1599 Clifton Rd. NE, Atlanta, GA 30329. 800 (ACS)-2345. <http:// www.cancer.org> National Cancer Institute. Cancer Information Service. Bldg.

  Lar yngeal ner ve palsy

  Some normal variation in the location of the recur- rent laryngeal nerve occurs among individuals. Occa- sionally the nerves are not located exactly where the sur-

  Once the recurrent laryngeal nerve is damaged, there is no specific treatment to heal it. With time, most cases of recurrent laryngeal palsy improve on their own. In the event of severe damage, the larynx may be so paralyzed that air cannot flow past it into the lungs. When this hap- pens, an emergency tracheotomy must be performed to save the patient’s life. A tracheotomy is a surgical proce- dure to make an artificial opening in the trachea (wind- pipe) to allow air to bypass the larynx and enter the lungs. If paralysis of the larynx is temporary, the tra- cheotomy hole can be surgically closed when it is no longer needed.

  Laryngeal nerve palsy can also occur from causes unrelated to thyroid surgery. These include damage to either the vagus nerve or the laryngeal nerve, due to tumors in the neck and chest or diseases in the chest such as aortic aneurysms. Both tumors and aneurysms press on the nerve, and the pressure causes damage.

  Laryngeal nerve palsy is an uncommon side effect of surgery to remove the thyroid gland (thyroidectomy). It occurs in 1% to 2% of operations for total thyroidectomy to treat cancer, and less often when only part of the thyroid is removed. Damage can occur to either one or both branches of the nerve, and it can be temporary or permanent. Most people experience only transient laryngeal nerve palsy and recover their normal voice within a few weeks.

  When the recurrent laryngeal nerve is damaged, the movements of the larynx are reduced. This causes voice weakness, hoarseness, or sometimes the complete loss of voice. The changes may be temporary or permanent. In rare life-threatening cases of damage, the larynx is para- lyzed to the extent that air cannot enter the lungs.

  that regulate the body’s metabolism. It is shaped like a flying bat with its wings outstretched and lies over the windpipe in the front of the neck.

  Aortic aneurysm—The ballooning of a weak spot in the aorta (the major heart artery). Thyroid gland—A gland that produces hormones

  The recurrent laryngeal nerve controls movement of the larynx. The larynx is located where the throat divides into the esophagus, a tube that takes food to the stomach, and the trachea (windpipe) that takes air to the lungs. The larynx contains the apparatus for voice production: the vocal cords, and the muscles and ligaments that move the vocal cords. It also controls the flow of air into the lungs.

  The vagus nerve is one of 12 cranial nerves that con- nect the brain to other organs in the body. It runs from the brain to the large intestine. In the neck, the vagus nerve gives off a paired branch nerve called the recurrent laryn- geal nerve. The recurrent laryngeal nerves lie in grooves along either side of the trachea (windpipe) between the trachea and the thyroid gland.

  Laryngeal nerve palsy is damage to the recurrent laryngeal nerve (or less commonly the vagus nerve) that results in paralysis of the larynx (voice box). Paralysis may be temporary or permanent. Damage to the recur- rent laryngeal nerve is most likely to occur during surgery on the thyroid gland to treat cancer of the thy- roid. Laryngeal nerve palsy is also called recurrent laryn- geal nerve damage.

  Tish Davidson, A.M.

  OTHER “What you Need to Know About Cancer of the Larynx.” Can- cerNet November 2000. 19 July 2001 <http://www. cancernet.nci.nih.gov> “Laryngeal Cancer.” CancerNet 19 July 2001 <http://www. graylab. ac.uk/cancernet/201519.html#3_STAGE EXPLANATION>

  31, Room 10A19, 9000 Rockville Pike, Bethesda, MD 20892. (800) 4-CANCER. <http://www.nci.nih.gov/ cancerinfo/index.html> National Cancer Institute Office of Cancer Complementary and Alternative Medicine. <http://occam.nci.nih.gov> National Center for Complementary and Alternative Medicine. P. O. Box 8218, Silver Spring, MD 20907-8281. (888) 644-6226. <http://nccam.nih.gov>

Causes

Laryngeal nerve palsy Description

Treatments

  geon expects to find them. Choosing a board certified head and neck surgeon who has had a lot of experience with thyroid operations is the best way to prevent laryn- geal nerve palsy.

Precautions

  Laryngectomy is done only after cancer of the lar- ynx has been diagnosed by a series of tests that allow the otolaryngologist (a specialist often called an ear, nose, and throat doctor) to look into the throat and take tissue samples (biopsies) to confirm and stage the cancer. Peo- ple need to be in good general health to undergo a laryn- gectomy, and will have standard pre-operative blood work and tests to make sure they are able to safely with- stand the operation.

  Lar yngectom y

Description

Resources PERIODICALS

  A person undergoing a laryngectomy spends several days in intensive care (ICU) and receives intravenous