The Gale Encyclopedia of Cancer

670 Pages·2001·7.97 MB·English

by  Thackery E.

GALE
The
ENCYCLOPEDIA
of
C
ancer
GALE
The
ENCYCLOPEDIA
of
C
ancer
A GUIDE TO CANCER AND ITS TREATMENTS
V O L U M E
2
L-Z
GENERAL INDEX
ELLEN THACKERY, EDITOR
L
Lactulose see Laxatives place of open surgery) is controversial. The procedure is
being studied to determine if it is as effective as open
Lambert-Eaton syndrome see Eaton-
surgery in complex operations. Laparoscopy is also being
Lambert syndrome investigated as a screening tool for ovarian cancer.
Langerhans cell histiocytosis see Laparoscopy is widely used in procedures for non-
Histiocytosis X cancerous conditions that in the past required open
surgery,such as removal of the appendix (appendecto-
my) and gallbladder removal (cholecystectomy).
Diagnostic procedure
Laparoscopy As a diagnostic procedure,laparoscopy is useful in
taking biopsies of abdominal or pelvic growths,as well
Definition as lymph nodes. It allows the doctor to examine the
abdominal area,including the female organs,appendix,
Laparoscopy is a type of surgical procedure in which
gallbladder,stomach,and the liver.
a small incision is made, usually in the navel, through
which a viewing tube (laparoscope) is inserted. The view- Laparoscopy is used to determine the cause of pelvic
ing tube has a small camera on the eyepiece. This allows pain or gynecological symptoms that cannot be con-
the doctor to examine the abdominal and pelvic organs on firmed by a physical exam or ultrasound. For example,
a video monitor connected to the tube. Other small inci- ovarian cysts, endometriosis, ectopic pregnancy, or
sions can be made to insert instruments to perform proce- blocked fallopian tubes can be diagnosed using this pro-
dures. Laparoscopy can be done to diagnose conditions or cedure. It is an important tool when trying to determine
to perform certain types of operations. It is less invasive the cause of infertility.
than regular open abdominal surgery (laparotomy).
Operative procedure
Purpose While laparoscopic surgery to completely remove
cancerous tumors,surrounding tissues,and lymph nodes
Since the late 1980s,laparoscopy has been a popular
is used on a limited basis,this type of operation is widely
diagnostic and treatment tool. The technique dates back
used in noncancerous conditions that once required open
to 1901,when it was reportedly first used in a gynecolog-
surgery. These conditions include:
ic procedure performed in Russia. In fact,gynecologists
were the first to use laparoscopy to diagnose and treat •Tubal ligation. In this procedure,the fallopian tubes are
conditions relating to the female reproductive organs: sealed or cut to prevent subsequent pregnancies.
uterus,fallopian tubes,and ovaries.
•Ectopic pregnancy. If a fertilized egg becomes embed-
Laparoscopy was first used with cancer patients in ded outside the uterus,usually in the fallopian tube,an
1973. In these first cases,the procedure was used to observe operation must be performed to remove the developing
and biopsythe liver. Laparoscopy plays a role in the diagno- embryo. This often can be done with laparoscopy.
sis,staging,and treatment for a variety of cancers.
•Endometriosis. This is a condition in which tissue from
As of 2001, the use of laparoscopy to completely inside the uterus is found outside the uterus in other
remove cancerous growths and surrounding tissues (in parts of (or on organs within) the pelvic cavity. This can
GALE ENCYCLOPEDIA OF CANCER 565
y •Liver cancer. Laparoscopy is an important tool for
p
o determining if cancer is present in the liver. When a
c
os patient has non-liver cancer,the liver is often checked
r
a to see if the cancer has spread there. Laparoscopy can
p
La 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-
This surgeon is performing a laparoscopic procedure on a ease have surgical procedures to evaluate lymph nodes
patient.(Photo Researchers, Inc.Reproduced by permission.) for cancer. Laparoscopy is sometimes selected over
laparotomy for this procedure. In addition,the spleen
cause cysts to form. Endometriosis is diagnosed with may be removed in patients with Hodgkin’s disease.
laparoscopy,and in some cases the cysts and other tis- Laparoscopy is the standard surgical technique for this
sue can be removed during laparoscopy. procedure,which is called a splenectomy.
•Hysterectomy. This procedure to remove the uterus can, •Prostate cancer. Patients with prostate cancer may
in some cases, be performed using laparoscopy. The have the nearby lymph nodes examined. Laparoscopy
uterus is cut away with the aid of the laparoscopic instru- is an important tool in this procedure.
ments and then the uterus is removed through the vagina.
•Ovarian masses. Tumors or cysts in the ovaries can be
Cancer treatment
removed using laparoscopy.
Laparoscopy is sometimes used as part of a pallia-
•Appendectomy. This surgery to remove an inflamed
tive cancer treatment. This type of treatment is not a
appendix required open surgery in the past. It is now
cure,but can often lessen the symptoms. An example is
routinely performed with laparoscopy.
the feeding tube,which cancer patients may have if they
•Cholecystectomy. Like appendectomy,this procedure are unable to take in food by mouth. The feeding tube
to remove the gallbladder used to require open surgery. provides nutrition directly into the stomach. Inserting
Now it can be performed with laparoscopy, in some the tube with a laparoscopy saves the patient the ordeal
cases. of open surgery.
In contrast to open abdominal surgery,laparoscopy
usually involves less pain, less risk, less scarring, and
Precautions
faster recovery. Because laparoscopy is so much less
invasive than traditional abdominal surgery,patients can As with any surgery, patients should notify their
leave the hospital sooner. physician of any medications they are taking (prescrip-
tion,over-the-counter,or herbal) and of any allergies.
Cancer staging
Precautions vary due to the several different purposes
Laparoscopy can be used in determining the spread for laparoscopy. Patients should expect to rest for sev-
of certain cancers. Sometimes it is combined with ultra- eral days after the procedure,and should set up a com-
sound. Although laparoscopy is a useful staging tool,its fortable environment in their home (with items such as
use depends on a variety of factors,which are considered pain medication, heating pads, feminine products,
for each patient. Types of cancers where laparoscopy may comfortable clothing, and food readily accessible)
be used to determine the spread of the disease include: prior to surgery.
566 GALE ENCYCLOPEDIA OF CANCER
Description L
a
QUESTIONS p
Laparoscopy is a surgical procedure that is done in ar
TO ASK THE DOCTOR o
the hospital under anesthesia. For diagnosis and biopsy, s
c
o
local anesthesia is sometimes used. In operative proce- p
• What is your complication rate? y
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
serious complications and major surgery may be required See Also Endoscopic retrograde cholangiopancre-
to correct the problem. For operative procedures,there is atography; Gynecologic cancers; Liver biopsy; Lymph
GALE ENCYCLOPEDIA OF CANCER 567
r Description
e
c
n KEY TERMS
a The larynx is located where the throat divides into
c
al the esophagus and the trachea. The esophagus is the tube
ge Biopsy—Microscopic evaluation of a tissue sam- that takes food to the stomach. The trachea,or windpipe,
n ple. The tissue is closely examined for the pres-
y takes air to the lungs. The area where the larynx is locat-
Lar ence of abnormal cells. ed is sometimes called the Adam’s apple.
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
Palliative treatment—A type of treatment that them. As air is exhaled past the tightened vocal cords,it
does not provide a cure, but eases the symptoms. creates sounds that are formed into speech by the mouth,
lips,and tongue.
Tumor—A growth of tissue, benign or malignant,
often referred to as a mass. 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-
node biopsy; Nutritional support; Tumor grading; Tumor lows. This blocks foreign material from entering the
staging; Ultrasonography 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.
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.
The Harvard Guide to Women’s Health.Cambridge,MA: cells called squamous epithelial cells. These cells line the
Harvard University Press,1996. larynx. Gradually,the squamous epithelial cells begin to
Cunningham,F. Gary,Paul C. MacDonald,et al. Williams Obstet- change and are replaced with abnormal cells. These
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
OTHER cancer has spread to neighboring areas of the neck or dis-
Iannitti,David A. “The Role of Laparoscopy in the Manage- tant parts of the body.
ment of Pancreatic Cancer.”Home Journal Library Index.
The glottis is the middle part of the larynx. It con-
23 March 2001. 27 June 2001 <http://bioscience.org/
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%.
Laryngeal cancer
The supraglottis is the area above the vocal cords. It
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
568 GALE ENCYCLOPEDIA OF CANCER
because the symptoms are less distinct. The supraglottis L
a
region has many connections to the lymphatic system,so ry
n
cancers in this region tend to spread easily to the lymph g
e
nodes and may spread to other parts of the body (lymph a
nodes are small bean-shaped structures that are found l ca
n
throughout the body; they produce and store infection- c
e
fighting cells). In 25% to 50% of people with cancer in r
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
A pathology photograph of an extracted tumor found on the
vocal cords,where it causes obvious symptoms such as larynx.(Photograph by William Gage.Custom Medical Stock
hoarseness. Because the cancer has already begun to Photo.Reproduced by permission.)
spread by the time it is detected,survival rates are gener-
ally lower than for cancers in other parts of the larynx. 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.
Demographics
Tumors in the supraglottal region above the vocal
About 12,000 new cases of cancer of the larynx
cords often cause more, but less distinct symptoms.
develop in the United States each year. Each year,about
These include:
3,900 die of the disease. Laryngeal cancer is between four
and five times more common in men than in women. •persistent sore throat
Almost all men who develop laryngeal cancer are over age •pain when swallowing
55. Laryngeal cancer is about 50% more common among
•difficulty swallowing or frequent choking on food
African-American men than among other Americans.
•bad breath
It is thought that older men are more likely to devel-
op laryngeal cancer than women because the two main •lumps in the neck
risk factors for acquiring the disease are lifetime habits •persistent ear pain (called referred pain; the source of
of smoking and alcohol abuse. More men smoke and the pain is not the ear)
drink more than women, and more African-American
•change in voice quality
men are heavy smokers than other men in the United
States. However, as smoking becomes more prevalent Tumors that begin below the vocal cords are rare,
among women,it seems likely that more cases of laryn- but may cause noisy or difficult breathing. All the symp-
geal cancer in females will be seen. 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
Causes and symptoms
cause, because the earlier cancer treatment begins, the
Laryngeal cancer develops when the normal cells more successful it is.
lining the larynx are replaced with abnormal cells (dys-
plasia) that become malignant and reproduce to form
Diagnosis
tumors. The development of dysplasia is strongly linked
to life-long habits of smoking and heavy use of alcohol. On the first visit to a doctor for symptoms that suggest
The more a person smokes,the greater the risk of devel- laryngeal cancer,the doctor first takes a complete medical
oping laryngeal cancer. It is unusual for someone who history, including family history of cancer and lifestyle
does not smoke or drink to develop cancer of the larynx. information about smoking and alcohol use. The doctor
Occasionally,however,people who inhale asbestos parti- also does a physical examination,paying special attention
cles,wood dust,paint or industrial chemical fumes over to the neck region for lumps,tenderness,or swelling.
a long period of time develop the disease.
The next step is examination by an otolaryngologist,
The symptoms of laryngeal cancer depend on the or ear,nose,and throat (ENT) specialist. This doctor also
location of the tumor. Tumors on the vocal cords are rarely performs a physical examination, but in addition will
GALE ENCYCLOPEDIA OF CANCER 569
r also want to look inside the throat at the larynx. Initially, throat and allows x-ray pictures to be made of the tis-
e
nc the doctor may spray a local anesthetic on the back of the sues lining the throat.
a
c throat to prevent gagging,then use a long-handled mirror
al to look at the larynx and vocal cords. This examination is •Chest x ray. Done to determine if cancer has spread to
e the lungs. Since most people with laryngeal cancer are
ng done in the doctor’s office. It may cause gagging but is smokers,the risk of also having lung cancer or emphy-
y
r usually painless.
a sema is high.
L
A more extensive examination involves a laryn-
•Fine needle aspiration (FNA) biopsy. If any lumps on
goscopy. In a laryngoscopy, a lighted fiberoptic tube
the neck are found, a thin needle is inserted into the
called a laryngoscope that contains a tiny camera is
lump,and some cells are removed for analysis by the
inserted through the patient’s nose and mouth and snaked
pathologist.
down the throat so that the doctor can see the larynx and
•Additional blood and urine tests. These tests do not
surrounding area. This procedure can be done with a
diagnose cancer, but help to determine the patient’s
sedative and local anesthetic in a doctor’s office. More
general health and provide information to determine
often,the procedure is done in an outpatient surgery clinic
which cancer treatments are most appropriate.
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
An otolaryngologist and an oncologist (cancer spe-
about one hour. Some people find their throat feels
cialist) generally lead the treatment team. They are sup-
scratchy after the procedure. Since laryngoscopies are
ported by radiologists to interpret CT and MRI scans,a
done under sedation,patients should not drive immedi-
head and neck surgeon,and nurses with special training
ately after the procedure,and should have someone avail-
in assisting cancer patients.
able to take them home. Laryngoscopy is a standard pro-
A speech pathologist is often involved in treatment,
cedure that is covered by insurance.
both before surgery to discuss various options for com-
The locations of the samples taken during the laryn- munication if the larynx is removed,and after surgery to
goscopy are recorded,and the samples are then sent to teach alternate forms of voice communication. A social
the laboratory where they are examined under the micro- worker,psychologist,or family counselor may help both
scope by a pathologist who specializes in diagnosing dis- the patient and the family meet the changes and chal-
eases through cell samples and laboratory tests. It may lenges that living with laryngeal cancer brings.
take several days to get the results. Based on the findings
At any point in the process,the patient may want to
of the pathologist,cancer can be diagnosed and staged.
get a second opinion from another doctor in the same
Once cancer is diagnosed,other tests will probably be specialty. This is a common practice and does not indi-
done to help determine the exact size and location of the cate a lack of faith in the original doctor, but simply a
tumors. This information is helpful in determining which desire for more information. Some insurance companies
treatments are most appropriate. These tests may include: 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
Clinical staging, treatments, and prognosis
areas,such as the esophagus or trachea.
Staging
•Computed tomography(CT or CAT) scan. Using x-
ray images taken from several angles and computer Once cancer of the larynx is found,more tests will
modeling,CT scans allow parts of the body to be seen be done to find out if cancer cells have spread to other
as a cross section. This helps locate and size the tumors, parts of the body. This is called staging. A doctor needs
and provides information on whether they can be surgi- to know the stage of the disease to plan treatment. In can-
cally removed. cer of the larynx, the definitions of the early stages
depend on where the cancer started.
•Magnetic resonance imaging (MRI). MRI uses mag-
nets and radio waves to create more detailed cross-sec- STAGE I. The cancer is only in the area where it
tional scans than computed tomography. This detailed started and has not spread to lymph nodes in the area or
information is needed if surgery on the larynx area is to other parts of the body. The exact definition of stage I
planned. depends on where the cancer started,as follows:
•Barium swallow. Barium is a substance that,unlike soft •Supraglottis: The cancer is only in one area of the
tissue,shows up on x rays. Swallowed barium coats the supraglottis and the vocal cords can move normally.
570 GALE ENCYCLOPEDIA OF CANCER
•Glottis:The cancer is only in the vocal cords and the L
a
vocal cords can move normally. QUESTIONS ry
n
TO ASK THE DOCTOR g
•Subglottis: The cancer has not spread outside of the e
a
subglottis. l c
• What stage is my cancer, and what exactly a
n
STAGE II. The cancer is only in the larynx and has does that mean? c
e
not spread to lymph nodes in the area or to other parts of r
• 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?
•Supraglottis:The cancer is in more than one area of the • What are some of the changes in my activities
supraglottis,but the vocal cords can move normally. that will occur because of my treatment?
•Glottis:The cancer has spread to the supraglottis or the • What is daily life like after a laryngectomy?
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 radiation
•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?
STAGE III. Either of the following may be true: • What changes in my lifestyle can I make to help
improve my chances of beating this cancer?
•The cancer has not spread outside of the larynx,but the
vocal cords cannot move normally, or the cancer has • How often will I have to have check-ups?
spread to tissues next to the larynx. • What is the likelihood that I will survive this
•The cancer has spread to one lymph node on the same cancer?
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?
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
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 cancer has spread to more than one lymph node on the entire larynx. Sometimes other tissues around the lar-
the same side of the neck as the cancer,to lymph nodes ynx are also removed. Total laryngectomy removes the
on one or both sides of the neck,or to any lymph node vocal cords. Alternate methods of voice communication
that measures more than 6 centimeters (over 2 inches). must be learned with the help of a speech pathologist.
•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. Recurrent disease means that the cancer
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 dissectionis 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
SURGERY. The goal of surgery is to cut out the tissue because of laryngeal cancer. A tracheotomy is a surgical
that contains malignant cells. There are several common procedure in which an artificial opening is made in the
surgeries to treat laryngeal cancer. trachea (windpipe) to allow air into the lungs. This oper-
GALE ENCYCLOPEDIA OF CANCER 571
r ation is necessary if the larynx is totally removed. A gas-
e
nc trectomy tube is a feeding tube placed through skin and KEY TERMS
a
c directly into the stomach. It is used to give nutrition to
eal people who cannot swallow or whose esophagus is Dysplasia—The abnormal change in size, shape
ng blocked by a tumor. People who have a total laryngecto- or organization of adult cells.
y
r my usually do not need a gastrectomy tube if their esoph-
La agus remains intact. Lymph—Clear, slightly yellow fluid carried by a
network of thin tubes to every part of the body.
RADIATION. Radiation therapyuses high-energy 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. Chemotherapy is the use of drugs 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 cisplatinand 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
572 GALE ENCYCLOPEDIA OF CANCER