The Gale encyclopedia of cancer pptx

The GALE ENCYCLOPEDIA of C ancer The GALE ENCYCLOPEDIA of C ancer ELLEN THACKERY, EDITOR A GUIDE TO CANCER AND ITS TREATMENTS V OLUME L-Z GENERAL INDEX 2 Lactulose see Laxatives Lambert-Eaton syndrome see Eaton- Lambert syndrome Langerhans cell histiocytosis see Histiocytosis X Laparoscopy Definition 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). Purpose 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. 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: •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 L GALE ENCYCLOPEDIA OF CANCER 565 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: • 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 imaging (MRI) or computed tomography (CT) in diag- nosing the spread of cancer from these organs. • 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. 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. Precautions 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. GALE ENCYCLOPEDIA OF CANCER 566 Laparoscopy This surgeon is performing a laparoscopic procedure on a patient. (Photo Researchers, Inc. Reproduced by permission.) Description Laparoscopy is a surgical procedure that is done in the hospital under anesthesia. For diagnosis and biopsy, local anesthesia is sometimes used. In operative proce- dures, such as abdominal surgery, general anesthesia is required. Before starting the procedure, a catheter is inserted through the urethra to empty the bladder, and the skin of the abdomen is cleaned. After the patient is anesthetized, a hollow needle is inserted into the abdomen in or near the navel, and car- bon dioxide gas is pumped through the needle to expand the abdomen. This allows the surgeon a better view of the internal organs. The laparoscope is then inserted through this incision to look at the internal organs. The image from the camera attached to the end of the laparoscope is seen on a video monitor. Sometimes, additional small incisions are made to insert other instruments that are used to lift the tubes and ovaries for examination or to perform surgical procedures. Preparation Patients should not eat or drink after midnight on the night before the procedure. Aftercare After the operation, nurses will check the vital signs of patients who had general anesthesia. If there are no complications, the patient may leave the hospital within four to eight hours. (Traditional abdominal surgery requires a hospital stay of several days). There may be some slight pain or throbbing at the inci- sion sites in the first day or so after the procedure. The gas that is used to expand the abdomen may cause discomfort under the ribs or in the shoulder for a few days. Depending on the reason for the laparoscopy in gynecological proce- dures, some women may experience some vaginal bleed- ing. Many patients can return to work within a week of surgery and most are back to work within two weeks. Risks Laparoscopy is a relatively safe procedure, especial- ly if the physician is experienced in the technique. The risk of complication is approximately 1%. The procedure carries a slight risk of puncturing a blood vessel or organ, which could cause blood to seep into the abdominal cavity. Puncturing the intestines could allow intestinal contents to seep into the cavity. These are serious complications and major surgery may be required to correct the problem. For operative procedures, there is QUESTIONS TO ASK THE DOCTOR •What is your complication rate? • What is the purpose of this procedure? •How often do you do laparoscopies? • What type of anesthesia will be used? •Will a biopsy be taken during the laparoscopy if anything abnormal is seen? • If more surgery is needed, can it be done with a laparoscope? • What area will be examined with the laparoscope? • What are the risks? •How long is the recovery time? the possibility that it may become apparent that open surgery is required. Serious complications occur at a rate of only 0.2%. Rare complications include: •Hemorrhage • Inflammation of the abdominal cavity lining • Abscess • Problems related to general anesthesia Laparoscopy is generally not used in patients with certain heart or lung conditions, or in those who have some intestinal disorders, such as bowel obstruction. Normal results In diagnostic procedures, normal results would indi- cate no abnormalities or disease of the organs or lymph nodes that were examined. Abnormal results A diagnostic laparoscopy may reveal cancerous or benign masses or lesions. Abnormal findings include tumors or cysts, infections (such as pelvic inflammatory disease), cirrhosis, endometriosis, fibroid tumors, or an accumulation of fluid in the cavity. If a doctor is check- ing for the spread of cancer, the presence of malignant lesions in areas other than the original site of malignancy is an abnormal finding. See Also Endoscopic retrograde cholangiopancre- atography; Gynecologic cancers; Liver biopsy; Lymph GALE ENCYCLOPEDIA OF CANCER 567 Laparoscopy node biopsy; Nutritional support; Tumor grading; Tumor staging; Ultrasonography Resources BOOKS Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. The Harvard Guide to Women’s Health. Cambridge, MA: Harvard University Press, 1996. Cunningham, F. Gary, Paul C. MacDonald, et al. Williams Obstet- rics, 20th ed. Stamford, CT:Appleton & Lange, 1997. Kurtz, Robert C., and Robert J. Ginsberg. “Cancer Diagnosis: Endoscopy.” In Cancer: Principles & Practice of Oncolo- gy. , edited by Vincent T. DeVita Jr. Philadelphia: Lippin- cott, Williams & Wilkins, 2001, 725-27. Lefor, Alan T. “Specialized Techniques in Cancer Manage- ment.” In Cancer: Principles & Practice of Oncology, 6th ed., edited by Vincent T. DeVita Jr., et al. Philadelphia: Lippincott, Williams & Wilkins, 2001, 739-57. Ryan, Kenneth J., Ross S. Berkowitz, and Robert L. Barbieri. Kistner’s Gynecology, 6th ed. St. Louis: Mosby, 1997. OTHER Iannitti, David A. “The Role of Laparoscopy in the Manage- ment of Pancreatic Cancer.” Home Journal Library Index. 23 March 2001. 27 June 2001 <http://bioscience.org/ 1998/v3/e/iannitti/e181-185.htm>. Carol A. Turkington Rhonda Cloos, R.N. Laryngeal cancer Definition Laryngeal cancer is cancer of the larynx or voice box. KEY TERMS Biopsy—Microscopic evaluation of a tissue sam- ple. The tissue is closely examined for the pres- ence of abnormal cells. Cancer staging—Determining the course and spread of cancer. Cyst—An abnormal lump or swelling that is filled with fluid or other material. Palliative treatment—A type of treatment that does not provide a cure, but eases the symptoms. Tumor—A growth of tissue, benign or malignant, often referred to as a mass. Description The larynx is located where the throat divides into the esophagus and the trachea. The esophagus is the tube that takes food to the stomach. The trachea, or windpipe, takes air to the lungs. The area where the larynx is locat- ed is sometimes called the Adam’s apple. The larynx has two main functions. It contains the vocal cords, cartilage, and small muscles that make up the voice box. When a person speaks, small muscles tighten the vocal cords, narrowing the distance between them. As air is exhaled past the tightened vocal cords, it creates sounds that are formed into speech by the mouth, lips, and tongue. The second function of the larynx is to allow air to 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 lungs. When not swallowing, the epiglottis retracts, and air flows into the trachea. During treatment for cancer of the larynx, both of these functions may be lost. Cancers of the larynx develop slowly. About 95% of these cancers develop from thin, flat cells similar to skin cells called squamous epithelial cells. These cells line the larynx. Gradually, the squamous epithelial cells begin to change and are replaced with abnormal cells. These abnormal cells are not cancerous but are pre-malignant cells that have the potential to develop into cancer. This condition is called dysplasia. Most people with dysplasia never develop cancer. The condition simply goes away without any treatment, especially if the person with dys- plasia stops smoking or drinking alcohol. The larynx is made up of three parts, the glottis, the supraglottis, and the subglottis. Cancer can start in any of these regions. Treatment and survival rates depend on which parts of the larynx are affected and whether the cancer has spread to neighboring areas of the neck or dis- tant parts of the body. The glottis is the middle part of the larynx. It con- tains the vocal cords. Cancers that develop on the vocal cords are often diagnosed very early because even small vocal cord tumors cause hoarseness. In addition, the vocal cords have no connection to the lymphatic system. 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 contains the epiglottis, which protects the trachea from foreign materials. Cancers that develop in this region are usually not found as early as cancers of the glottis GALE ENCYCLOPEDIA OF CANCER 568 Laryngeal cancer 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. 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. Demographics 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 55. Laryngeal cancer is about 50% more common among African-American men than among other Americans. 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. Causes and symptoms 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. 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. Tumors in the supraglottal region above the vocal cords often cause more, but less distinct symptoms. These include: • 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 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. Diagnosis 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. 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 GALE ENCYCLOPEDIA OF CANCER 569 Laryngeal cancer A pathology photograph of an extracted tumor found on the larynx. (Photograph by William Gage. Custom Medical Stock Photo. Reproduced by permission.) 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. 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: • 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. Treatment team 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. 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. Clinical staging, treatments, and prognosis Staging 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. STAGE I. 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: • Supraglottis: The cancer is only in one area of the supraglottis and the vocal cords can move normally. GALE ENCYCLOPEDIA OF CANCER 570 Laryngeal cancer •Glottis: The cancer is only in the vocal cords and the vocal cords can move normally. • Subglottis: The cancer has not spread outside of the subglottis. STAGE II. The cancer is only in the larynx and has not spread to lymph nodes in the area or to other parts of the body. The exact definition of stage II depends on where the cancer started, as follows: • Supraglottis: The cancer is in more than one area of the supraglottis, but the vocal cords can move normally. •Glottis: The cancer has spread to the supraglottis or the subglottis or both. The vocal cords may or may not be able to move normally. • Subglottis: The cancer has spread to the vocal cords, which may or may not be able to move normally. STAGE III. Either of the following may be true: •The cancer has not spread outside of the larynx, but the vocal cords cannot move normally, or the cancer has spread to tissues next to the larynx. •The cancer has spread to one lymph node on the same side of the neck as the cancer, and the lymph node mea- sures no more than 3 centimeters (just over 1 inch). STAGE IV. Any of the following may be true: •The cancer has spread to tissues around the larynx, such as the pharynx or the tissues in the neck. The lymph nodes in the area may or may not contain cancer. •The cancer has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters (over 2 inches). •The cancer has spread to other parts of the body. RECURRENT. Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the larynx or in another part of the body. Treatment Treatment is based on the stage of the cancer as well as its location and the health of the individual. Generally, there are three types of treatments for cancer of the lar- ynx. These are surgery, radiation, and chemotherapy. They can be used alone or in combination based in the stage of the caner. Getting a second opinion after the can- cer has been staged can be very helpful in sorting out treatment options and should always be considered. SURGERY. The goal of surgery is to cut out the tissue that contains malignant cells. There are several common surgeries to treat laryngeal cancer. QUESTIONS TO ASK THE DOCTOR •What stage is my cancer, and what exactly does that mean? •What are possible treatments for my cancer? •How long will my treatment last? • What are some of the changes in my activities that will occur because of my treatment? •What is daily life like after a laryngectomy? •How will I speak? •I’ve heard about clinical trials using radiation and drugs to treat cancer of the larynx. Where can I find out more about these trials? • What changes in my lifestyle can I make to help improve my chances of beating this cancer? •How often will I have to have check-ups? •What is the likelihood that I will survive this cancer? • Can you suggest any support groups that would be helpful to me or my family? Stage III and stage IV cancers are usually treated with total laryngectomy. This is an operation to remove the entire larynx. Sometimes other tissues around the lar- ynx are also removed. Total laryngectomy removes the vocal cords. Alternate methods of voice communication must be learned with the help of a speech pathologist. Smaller tumors are sometimes treated by partial laryngectomy. The goal is to remove the cancer but save as much of the larynx (and corresponding speech capa- bility) as possible. Very small tumors or cancer in situ are sometimes successfully treated with laser excision surgery. In this type of surgery, a narrowly targeted beam of light from a laser is used to remove the cancer. Advanced cancer (Stages III and IV) that has spread to the lymph nodes often requires an operation called a neck dissection. The goal of a neck dissection is to remove the lymph nodes and prevent the cancer from spreading. There are several forms of neck dissection. A radical neck dissection is the operation that removes the most tissue. Several other operations are sometimes performed because of laryngeal cancer. A tracheotomy is a surgical procedure in which an artificial opening is made in the trachea (windpipe) to allow air into the lungs. This oper- GALE ENCYCLOPEDIA OF CANCER 571 Laryngeal cancer ation is necessary if the larynx is totally removed. A gas- trectomy tube is a feeding tube placed through skin and directly into the stomach. It is used to give nutrition to people who cannot swallow or whose esophagus is blocked by a tumor. People who have a total laryngecto- my usually do not need a gastrectomy tube if their esoph- agus remains intact. RADIATION. Radiation therapy uses high-energy rays, such as x rays or gamma rays, to kill cancer cells. The advantage of radiation therapy is that it preserves the larynx and the ability to speak. The disadvantage is that it may not kill all the cancer cells. Radiation therapy can be used alone in early stage cancers or in combination with surgery. Sometimes it is tried first with the plan that if it fails to cure the cancer, surgery still remains an option. Often, radiation therapy is used after surgery for advanced cancers to kill any cells the surgeon might not have removed. There are two types of radiation therapy. External beam radiation therapy focuses rays from outside the body on the cancerous tissue. This is the most common type of radiation therapy used to treat laryngeal cancer. With internal radiation therapy, also called brachythera- py,radioactive materials are placed directly on the can- cerous tissue. This type of radiation therapy is a much less common treatment for laryngeal cancer. External radiation therapy is given in doses called fractions. A common treatment involves giving fractions five days a week for seven weeks. Clinical trials are underway to determine the benefits of accelerating the delivery of fractions (accelerated fractionation) or divid- ing fractions into smaller doses given more than once a day (hyperfractionation). Side effects of radiation thera- py include dry mouth, sore throat, hoarseness, skin prob- lems, trouble swallowing, and diminished ability to taste. CHEMOTHERAPY. Chemotherapy is the use of drugs to kill cancer cells. Unlike radiation therapy, which is tar- geted to a specific tissue, chemotherapy drugs are either taken by mouth or intravenously (through a vein) and cir- culate throughout the whole body. They are used mainly to treat advanced laryngeal cancer that is inoperable or that has metastasized to a distant site. Chemotherapy is often used after surgery or in combination with radiation therapy. Clinical trials are underway to determine the best combination of treatments for advanced cancer. The two most common chemotherapy drugs used to treat laryngeal cancer are cisplatin and fluorouracil (5- FU). There are many side effects associated with chemotherapy drugs, including nausea and vomiting, loss of appetite (anorexia), hair loss (alopecia), diar- rhea, and mouth sores. Chemotherapy can also damage the blood-producing cells of the bone marrow, which can KEY TERMS Dysplasia—The abnormal change in size, shape or organization of adult cells. Lymph—Clear, slightly yellow fluid carried by a network of thin tubes to every part of the body. Cells that fight infection are carried in the lymph. Lymphatic system—Primary defense against infec- tion in the body. The lymphatic system consists of tissues, organs, and channels (similar to veins) that produce, store, and transport lymph and white blood cells to fight infection. Lymph nodes—Small, bean-shaped collections of tissue found in a lymph vessel. They produce cells and proteins that fight infection, and also filter lymph. Nodes are sometimes called lymph glands. Metastasize—Spread of cells from the original site of the cancer to other parts of the body where sec- ondary tumors are formed. Malignant—Cancerous. Cells tend to reproduce without normal controls on growth and form tumors or invade other tissues. result in low blood cell counts, increased chance of infec- tion, and abnormal bleeding or bruising. Prognosis Cure rates and survival rates can predict group out- comes, but can never precisely predict the outcome for a single individual. However, the earlier laryngeal cancer is discovered and treated, the more likely it will be cured. Cancers found in stage 0 and stage 1 have a 75% to 95% cure rate depending on the site. Late stage cancers that have metastasized have a very poor survival rate, with intermediate stages falling somewhere in between. People who have had laryngeal cancer are at greatest risk for recurrence (having cancer come back), especially in the head and neck, during the first two to three years after treatment. Check-ups during the first year are needed every other month, and four times a year during the sec- ond year. It is rare for laryngeal cancer to recur after five years of being cancer-free. Alternative and complementary therapies Alternative and complementary therapies range from herbal remedies, vitamin supplements, and special diets to spiritual practices, acupuncture, massage, and similar treatments. When these therapies are used in GALE ENCYCLOPEDIA OF CANCER 572 Laryngeal cancer [...]... tumor, or neoplasm, that originates in the cells of one of the lips is a cancer of the lip Lip cancer almost always begins in the flat, or squamous, epithelial cells Epithelial cells form coverings (tissues) for the surfaces of the body Skin, for example, has an outer layer of epithelial tissue If a part of the lip is affected by cancer and must be removed by surgery, there will be significant changes in... In the neck, the vagus nerve gives off a paired branch nerve called the recurrent laryngeal nerve The recurrent laryngeal nerves lie in grooves along either side of the trachea (windpipe) between the trachea and the thyroid gland 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. .. The more lip tissue removed, the greater the disturbances to the normal patterns of talking and eating Demographics Nine out of ten cases of lip cancer are diagnosed in people over the age of 45 Age, or the aging process, may G A L E E N C Y C L O P E D I A O F CA N C E R Lip cancers contribute to the way the cancer develops As a line of cells gets older, the genetic material in a cell loses some of. .. R • Is this cancer curable? • What is the stage of the cancer? • What is the likelihood the cancer will recur? • Is there a clinical trial in which I should participate? cers, surgery to remove the cancer or radiation treatment of the affected area is sometimes all that is required to produce a cure Decisions about which method to use depend on many factors, but the size of the tumor and the tolerance... treatment 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 The loss of voice because of laryngeal surgery may be the most traumatic effect of laryngeal cancer Losing the ability to communicate... longer flow into the lungs During this operation, the surgeon removes the larynx through an incision in the neck The surgeon also performs a tracheotomy He makes an artificial opening called a stoma in the front of the neck The upper portion of the trachea is brought to the stoma and secured, making a permanent alternate way for air to get to the lungs The connection between the throat and the esophagus... develop soft tissue sarcomas, careful monitoring may help to ensure early diagnosis and treatment of the disease 583 Leucovorin ORGANIZATIONS KEY TERMS Biopsy The surgical removal and microscopic examination of living tissue for diagnostic purposes Chemotherapy—Treatment of cancer with synthetic drugs that destroy the tumor either by inhibiting the growth of cancerous cells or by killing them American Cancer. .. cells—Flat epithelial cells, which usually make up the outer layer of epithelial tissue, the layer farthest away from the surface the epithelium covers 2.5 million people die from lip cancer each year, or about 112 individuals in the entire U.S population In contrast, cancers in the oral cavity, including on the tongue, cause more than 8,000 deaths in the U.S each year Alternative and complementary therapies... for every patient Often, only specific areas of the TP53 gene, where there is most likely to be a mutation associated with LFS, are analyzed The length of time to receive results depends on the extent of testing that is performed and the laboratory that is used Due to the fact that some of the cancers associated with LFS can occur at very young ages, there is a question as to whether or not genetic... depending on the stage Stage is determined by the size of the tumor, whether the tumor has spread to nearby lymph nodes, whether the tumor has spread elsewhere in the body, and what the cells look like under the microscope Examining the tissue sample under the microscope, using special chemical stains, the pathologist is able to classify tumors as high grade or low grade High-grade tumors have the more . the trachea. During treatment for cancer of the larynx, both of these functions may be lost. Cancers of the larynx develop slowly. About 95% of these cancers. parts of the larynx are affected and whether the cancer has spread to neighboring areas of the neck or dis- tant parts of the body. The glottis is the middle