Cancer

Papillary thyroid cancer in a gravid woman

July 13, 2014     Darrin V. Bann, PhD; Neerav Goyal, MD, MPH; David Goldenberg, MD, FACS
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All attempts should be made to preserve the recurrent laryngeal nerve with resection of all gross tumor, particularly in cases of known contralateral RLN dysfunction.

Postoperative shoulder function after different types of neck dissection in head and neck cancer

May 7, 2014     Adil Sheikh, MBBS; Hussain Shallwani, MBBS; Shehzad Ghaffar, FCPS, FRCS
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Abstract

Reported complications of neck dissection surgery have included decreases in shoulder muscle power and range of motion, drooping shoulder, and shoulder pain. We conducted a cross-sectional study to assess postoperative shoulder function following three different types of neck dissection surgery that were performed at Aga Khan University Hospital and to determine how various treatment factors and patient characteristics affected postoperative shoulder function. Our study population included 70 patients-51 men and 19 women, aged 18 to 70 years (mean: 48.6 ± 11.6)-who had undergone a total of 92 neck dissections (22 patients underwent bilateral procedures). Patients were assessed by physical examination and questionnaire responses. The physical examination included objective assessments of shoulder muscle power against resistance, active range of motion, maximum possible forward flexion, the length of time needed to repeat active shoulder flexion 5 times, and shoulder abduction. The questionnaire covered shoulder mobility during activities of daily living, the results of physiotherapy (and exercise), postoperative radiation status, and shoulder pain. Of the 92 neck dissections, 17 were selective (18.5%), 64 were modified radical (69.6%), and 11 were radical (12.0%). We found that patients who had undergone a nerve-sparing procedure (i.e., selective neck dissection or a modified radical neck dissection) exhibited significantly better shoulder function than did patients who had undergone radical neck dissections (p < 0.01). In addition, increasing age (p < 0.001) and a history of diabetes (p = 0.003) were associated with worse shoulder function, and postoperative physiotherapy was associated with better shoulder function (p = 0.002). Neither sex, weight, the side of the neck operated on (left or right), the administration of postoperative radiation, the length of time between surgery and shoulder function assessment, comorbidities such as hypertension and ischemic heart disease, nor the status of the level V lymph nodes had any statistically significant association with shoulder function.

Human papillomavirus and tobacco use in tongue base cancers

August 21, 2013     Daniel L. Stoler, PhD; Philip J. Smaldino, MS; Huferesh K. Darbary, PhD; Maureen A. Sullivan, DDS; Saurin R. Popat, MD, MBA; Wesley L. Hicks Jr., MD; Mihai Merzianu, MD; Daniel P. Gaile, PhD; Garth R. Anderson, PhD; and Thom R. Loree, MD, FACS
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Abstract

Human papillomavirus 16 (HPV-16) infection and tobacco use are associated with human oropharyngeal cancers. We conducted a study of the role of HPV and tobacco use in base of the tongue (BOT) cancers. DNA from 34 such cancers was subjected to HPV-16 and HPV-18-specific polymerase chain reaction analysis. Demographic and clinicopathologic data were obtained from each patient's medical record. HPV-16 was detected in 68% of tumors. Tobacco use was the only factor found to be significantly associated with HPV status. Tumors from 100% of patients who had never used tobacco tested positive for HPV, compared with only 56% of those who had ever used tobacco (Fisher exact test, p = 0.024). All tumors were associated with either tobacco use or HPV infection. These findings are consistent with the hypothesis that either tobacco use or HPV infection is necessary to the etiology of BOT tumors, and they suggest that tongue base carcinoma may be prevented by combining HPV vaccination with tobacco avoidance.

Late-onset complications after chemoradiation for head and neck carcinomas

August 21, 2013     Marc I. Surkin, MD, FACS; Sandra A. Schwartz, MS, CCC-SLP; and Deborah A. Markiewicz, MD
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Abstract

Acute complications from chemoradiation for head and neck cancers are relatively common. These can be minor or severe and can have a significant impact on the patient's quality of life. The incidence of late-onset (>5 years after cancer cure) complications is unknown, but the effect on quality of life is just as severe as with acute problems. What makes matters worse is that many of these patients lived years without dysphagia or other issues and were able to resume a normal lifestyle before developing complications. We present 4 cases involving patients with late-onset complications and discuss the need to remain vigilant in follow-up and caring for patients with head and neck cancer.

Case report: Metastatic small-cell lung carcinoma of the external auditory canal

October 31, 2012     Moshe Hain, MD; Edit Feldberg, MD; and Doron Halperin, MD
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Abstract

We report the case of a 73-year-old man who developed metastatic small-cell lung cancer to the bony external auditory canal (EAC). The patient had only recently been diagnosed with his primary carcinoma. The metastasis presented as a bulky, fleshy, bleeding mass in the right EAC. Biopsy of the metastasis revealed that its histologic characteristics were identical to those of the primary. This case is of interest because this was a unique type of metastasis to the EAC. Although there are reports in the literature of lung cancer and even small-cell cancer metastasizing to the temporal bone, we could find no previously published report of a small-cell lung carcinoma metastasizing to the EAC.

Prostate cancer metastatic to the larynx: A case report

September 7, 2012     Edward E. Katime, MD; Jasvir S. Khurana, MD; Oneida A. Arosarena, MD
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Abstract

Prostate cancer, which is the most common cancer among men, rarely metastasizes to the neck. We report a case of prostatic carcinoma that metastasized to the larynx in a 71-year-old man who presented with hoarseness and shortness of breath. Computed tomography (CT) detected a 2.9 × 3.1 × 2.6-cm mass that extended from the cricoid and arytenoid cartilages into the superior trachea. Findings on histopathology and immunohistochemistry of the laryngeal tumor were consistent with a metastasis of the patient’s earlier prostate cancer. CT of the chest later detected a soft-tissue mass in the right paraspinal area and other thoracic pathology that represented metastatic disease. The patient was treated with palliative radiation therapy. As androgen deprivation therapy continues to increase the life expectancy of prostate cancer patients, detection of distant metastases will likely increase, as well. Urogenital cancer metastatic to the head and neck should be considered in the differential diagnosis of laryngeal masses.

Recurrent pre-B-cell acute lymphoblastic leukemia in the middle ear: A form of granulocytic sarcoma

July 5, 2012     David Manning, MD; Enrique Palacios, MD, FACR; Harold Neitzschman, MD, FACR
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Leukemia of the middle ear easily can be misidentified as acute otitis media or Bell palsy. It occurs most often in children 2 to 5 years of age and in the elderly population.

Voice and swallowing disorders: Functional results and quality of life following supracricoid laryngectomy with cricohyoidoepiglottopexy

September 30, 2009     Juliana Godoy Portas, SLP, Débora dos Santos Queija, SLP, Leonora Pereira Arine, SLP, Alessandra Sampaio Ferreira, SLP, Rogério A. Dedivitis, MD, PhD, Carlos Neutzling Lehn, MD, PhD, and Ana Paula Brandão Barros, SLP, PhD
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Abstract

We conducted a prospective study of 11 patients with laryngeal cancer who underwent supracricoid laryngectomy with cricohyoidoepiglottopexy. Our goal was to evaluate their postoperative voice and swallowing function and to ascertain the impact that surgery had on patient-perceived quality of life. Postoperative assessments were made by auditory perception analyses, objective voice analyses, the Voice Handicap Index questionnaire, the Quality of Life in Swallowing Disorders questionnaire, and videofluoroscopy. Following surgery, 8 patients experienced severe dysphonia and 3 experienced moderate dysphonia. Also, 5 patients experienced mild to severe dysphagia whereas 6 patients experienced normal or near-normal swallowing function. Postoperative acoustic measurements were higher than expected, and spectrographic evaluation revealed the presence of high-grade noise without predominant concentration over the spectrum. Some association with the grade of dysphonia and self-perception of voice handicap was observed. With regard to swallowing, 5 patients (45.5%) showed a decrease in laryngeal remnant elevation and a slight or moderate degree of stasis in the oropharynx. Overall, patients reported good quality of life regarding both voice and swallowing. No relationship between the functional swallowing and the number of preserved arytenoid cartilages was observed.

Adjuvant external-beam radiotherapy in patients with high-risk well-differentiated thyroid cancer

June 30, 2009     Peter V. Chen, MD, MS, Ryan Osborne, MD, Eugene Ahn, MD, Sofia Avitia, MD, Elliot Abemayor, MD, PhD, and Guy Juillard, MD
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Abstract

The role of adjuvant external-beam radiation therapy (EBRT) in well-differentiated thyroid cancer is not well delineated. Many clinicians rely solely on iodine 131 (131I) to destroy thyroid remnants following thyroidectomy. However, the lesser uptake of isotope in tumor cells suggests that 131I alone may not be sufficient to eradicate microscopic residual disease when no gross thyroid tissue remains. We conducted a retrospective study to examine the potential benefit of adjuvant EBRT in patients at high risk for microscopic residual disease following thyroidectomy. Between 1973 and 2001, 44 patients with well-differentiated papillary or follicular thyroid cancer were found to have extracapsular extension following thyroidectomy. These patients were divided into 2 groups based on the type of treatment; 11 patients had received adjuvant EBRT (with or without 131I) and 33 patients had not received EBRT (i.e., they received adjuvant 131I only). We reviewed their medical records and compiled data on local recurrence and overall survival (Kaplan-Meier analysis). Despite having a less favorable prognosis, the EBRT group experienced no local recurrences during a mean follow-up of 7.8 years; in contrast, 9 local recurrences were seen in the no-EBRT group. Also, the median survival for patients without a local recurrence was longer than that for those who had failed locally (425 vs. 317 mo). Although our population was not large enough for these differences to achieve statistical significance, our study did show that adjuvant EBRT provided excellent results. We hypothesize that a reciprocal irradiation effect between cancer cells and normal cells may be necessary in order for 131I to be tumoricidal. If so, a patient with microscopic residual disease would not have enough cancer cells to sufficiently concentrate 131I. Because EBRT does not depend on such a mechanism, it may be more effective than 131I in controlling disease in the setting of microscopic disease. Larger studies are needed to validate our results. In the meantime, we believe that adjuvant EBRT should play an important role in the treatment of patients with high-risk well-differentiated thyroid cancer.

Training in the primary prevention and early detection of oral cancer: Pilot study of its impact on clinicians' perceptions and intentions

January 1, 2009     Charles W. LeHew, PhD, Joel B. Epstein, DMD, MSD, Anne Koerber, DDS, PhD, and Linda M. Kaste, DDS, PhD
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Abstract

In this pilot study, we tested a new program for training medical care providers in the primary prevention and early detection of oral cancer. The training program consisted of two modules: (1) oral cancer epidemiology and head and neck examinations for the early detection of oral cancer and (2) assessment and counseling of patients in tobacco cessation. On a pretraining questionnaire, the 8 participating clinicians (3 primary care physicians, 4 ENT nurses, and 1 physician assistant) indicated that they had only a limited awareness of oral cancer, that they generally did not routinely examine asymptomatic patients for oral cancer, and that they engaged in only a limited amount of risk assessment/counseling with their patients. On a post-training questionnaire, they indicated that their training had been well received and would prompt them to increase their efforts to examine their patients for early signs of oral cancer and to counsel them about its risks.

Transthoracic/transcervical approach to cervicothoracic thyroid cancer

September 25, 2008     Sofia Avitia, MD and Ryan F. Osborne, MD, FACS
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Personality changes and the role of counseling in the rehabilitation of patients with laryngeal cancer

July 31, 2008     Deepika Sharma, BSc, Anu N. Nagarkar, PhD, Pankaj Jindal, BSc, Rajinder Kaur, PhD, and Ashok K. Gupta, MS
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Abstract

We conducted a study of 65 adults who had undergone laryngectomy for the treatment of laryngeal cancer. Our goal was to identify any abnormal personality traits in these patients and to assess the effect that psychological counseling might have on correcting these abnormalities and thereby improving postoperative voice rehabilitation. A Personality Trait Inventory (PTI) administered to all patients preoperatively identified 47 patients who had abnormal scores for at least three personality traits. These 47 patients were sent for preoperative psychological counseling, and 3 months following surgery, they underwent a follow-up PTI. At the follow-up assessment, 40 of these patients—32 men and 8 women—still registered abnormal scores for at least three traits. Half of the men and half of the women were randomized to receive 12 sessions of individualized psychological counseling over 6 months in addition to standard speech therapy (group I); the other patients received speech therapy only (group II). A follow-up PTI was administered at the completion of psychological counseling and/or speech therapy (postoperative month 9). Statistical analysis of the data was performed with the paired-samples test. Intragroup analysis of the follow-up PTI results revealed that both groups experienced a significant improvement in activity scores (p < 0.001) compared with their previous PTI results and that group I had significantly better scores for two other PTI traits—cyclothymia (mood swings) and depressive tendency (p < 0.05); neither group showed a significant improvement in dominance scores. Intergroup comparisons revealed that group I's activity and depressive tendency scores were significantly better than those of group II; there was no significant difference between the two groups in cyclothymia and dominance scores. Finally, comparison of results by sex, regardless of group, revealed that men had a significantly higher score for dominance and women had significantly higher scores for depressive tendency, emotional instability, introversion, and social desirability. We conclude that a preoperative personality analysis should be carried out in all patients scheduled for laryngectomy to identify those with personality problems that might benefit from psychological counseling. Correction of these problems should help in the physical, mental, vocational, and social rehabilitation of these patients.

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