The ENT Specialty Group

Robotic surgery is being commonly used for certain types of throat cancer.
New targeted therapy and immunotherapy is being used for many types of head and neck cancer.

The frequency of follow up is very dependent on what kind of cancer you have and what kind of treatment you receive. It also depends on how far out from treatment you are. The more time that has passed since your treatment finished, the less often you will be seen.

Risks and complications vary tremendously depending on the type of surgery, site and dose of radiation and type of chemotherapy. The specifics will be explained to you by your physicians.

The three primary treatment options for Head and Neck Cancer include: Surgery, Radiation Treatment and Chemotherapy and more recently Immunotherapy. Laser surgery and robotic surgery are used for some head and neck cancers.

The well known causes of Head and Neck Cancer include smoking and alcohol. Another very well recognized cause is human papilloma virus (HPV). HPV vaccine is an extremely effective and important measure to protect against HPV related throat cancer in both men and women.
Exposure to excessive amounts of radiation is a known cause of thyroid cancer.

Besides the examination described above which includes an Ultrasound, blood tests and the Ultrasound guided needle biopsy, your ENT surgeon may discuss other possible tests with you.
There are some very specific and advanced molecular gene tests that can be performed on thyroid nodules. These tests can improve the diagnostic accuracy and precision of thyroid needle biopsies.

The first essential step is to have a thorough examination. Your ENT surgeon will assess your history and perform a complete head and neck examination. That will include examining the skin and lymph nodes in your head and neck region. Your mouth and throat will be assessed with a painless procedure that involves passing a very fine camera into your throat through your nasal passage.

If any abnormal lumps are detected in your neck lymph nodes, parotid gland, submandibular gland or thyroid gland; an ultrasound will be used to see these regions more clearly and will allow your ENT surgeon to perform a fine needle biopsy. This is a very precise and accurate way to achieve a rapid diagnosis.

You may also be sent for special types of xrays, such as a: CT scan, MRI scan or PET/CT scan.

The signs and symptoms of head and neck cancer vary depending on the type and location of the cancer. They can range from a non-healing sore in the mouth, throat or on the skin; to a lump on the side or front of your face or neck. They can be associated with pain in one’s face or throat or may be entirely painless. Head and Neck Cancer may also begin with voice changes or trouble swallowing.

Head and Neck Cancer includes cancers of the mouth, throat, nose and sinuses , thyroid gland, salivary glands (most commonly the parotid gland and submandibular gland) and skin of the head and neck region.

In 9 out of 10 cases, sinus infections will eventually get better on their own, even without antibiotic treatment. Rarely, complications may occur with an acute sinusitis or subsequent to an inadequately treated sinusitis. Infection could spread to surrounding structures such as the eye or even into the brain. More generalized body spread could also concur if the bacteria progresses into the blood stream.

The most expeditious treatment for acute sinusitis would be to start symptomatic therapy such as oral decongestants, nasal saline irrigations, steam inhalation and adequate hydration. Antibiotics may be necessary in some cases.

A sinus infection or acute sinusitis is caused by a bacterial infection. These infective organisms are usually the common bugs that would affect either the sinuses or the upper respiratory tract. They may be similar to the bacteria that may cause pneumonia.

People may try to fight off their symptoms for several days using decongestant medication, analgesics, nasal saline washes and adequate hydration. However, if symptoms are severe or last more than 7 days, it would be wise to consult a physician and perhaps start on antibiotic treatment. It important not to use decongestant medication beyond 3-5 days because of the risk of creating a dependency.

Acute sinusitis (bacterial infection) should not last more than two weeks if properly managed with medication, but can last up to one month. If symptoms last longer than 3 months, chronic sinusitis may be the cause.

Sinus infections can be diagnosed clinically by examining the nose and seeing a purulent looking (coloured discharge) coming from one of the sinus openings. There may be tenderness on palpation of the forehead or cheek area. Sometimes it may be necessary to request a sinus x-ray to confirm the diagnoses.

A sinus infection usually happens after a common cold or viral process. The symptoms include localised facial or head pain, runny nose with the mucus secretions having a more coloured look to them. There may also be more generalized symptoms of not feeling well.

Sinusitis refers to an infection or inflammation involving the sinus chambers. Every person has 4 sets of sinuses on each side. The term acute sinusitis specifically refers to a bacterial infection of one or more of the sinuses. Chronic sinusitis refers to a condition of long standing inflammation of the sinuses.

At times a biopsy of a thyroid nodule or thyroid lump is indicated to assess for thyroid cancer. The biopsy of the thyroid nodule or thyroid lump is usually performed under ultrasound guidance. An ultrasound guided fine needle aspiration biopsy of a thyroid nodule allows the doctor to see the area that is being sampled. This allows for a more precise biopsy.

The majority of patients treated for thyroid cancer do not have a recurrence. Nevertheless, the prognosis depends on certain specific factors, such as how advanced the cancer was when it was detected, the exact type of malignancy, and the treatment that was given.

Typically patients are seen twice yearly by their specialist for a physical examination and blood tests. In addition to verifying the adequacy of the levothyroxine dosage, the blood is usually tested for tumor markers such as thyroglobulin or calcitonin. If thyroglobulin or calcitonin is detected and is rising it will lead to a search of possible tumor recurrence. General surveillance for tumor recurrence also involves an ultrasound of the thyroid bed and neck. In select cases other tests are necessary such as a whole body scan, a CT scan, or a PET scan.

Yes, clinical follow-up for life is strongly recommended. Although most recurrences are detected within 10 years, sometimes tumors are detected later.

Thyroid cancer is usually treated with surgery, since removal of part or all of the thyroid gland (thyroidectomy) with or without excision of lymph nodes typically offers the best chance of cure.
Radioactive iodine therapy, external beam radiation therapy, chemotherapy and levothyroxine therapy (often prescribed as Synthroid ®) are forms of treatment that are sometimes used following surgery. These forms of treatment, when applied in the appropriate clinical setting, have been shown to reduce the risk of tumor recurrence and improve survival.

The cause of most forms of thyroid cancer is unknown. The most important identifiable risk factor is radiation exposure. A family history of thyroid cancer is also a risk factor for some forms. Certain ethnic groups may be more likely than others to develop thyroid cancer.

When an individual feels a “bump” in their neck at the level of the thyroid gland (where a bow tie is worn) or when a thyroid nodule is detected incidentally during a scan, a workup is often warranted. There are several tests that are commonly performed when thyroid cancer is suspected. Blood tests are usually performed along with an ultrasound to visualize the thyroid tumour. An ultrasound guided fine needle biopsy is then required to get a tissue sample. Sometimes molecular testing is used when the diagnosis is uncertain or when more information is required prior to making management decisions.

Your doctor will typically send you to an endocrinologist, an ENT specialist, or an endocrine surgeon when there is a concern about thyroid cancer.

When you have a concern that you may have thyroid cancer, you should consult your doctor.

Many individuals with thyroid cancer do not have symptoms. Others complain of a “bump” in their neck. Sometimes people complain of voice change or difficulty swallowing, but these symptoms are not specific for thyroid cancer and are caused by many other medical conditions.

Thyroid cancer occurs in men and women of all ages. Nonetheless, it typically affects young adults and middle-aged women. Women are affected more often than men. While some forms of thyroid cancer are inherited, the majority are no

Thyroid nodules (or tumours) are either benign or malignant. The difference between benign and malignant tumours lies in the potential for cancers to spread outside of the thyroid gland to local structures (such as lymph nodes) and distant sites (such as the lungs). Fortunately the spread of thyroid cancer to distant sites is rare.

Common types of thyroid cancer include:

-Papillary thyroid carcinoma

-Follicular thyroid carcinoma

-Hurthle cell thyroid carcinoma

-Medullary thyroid carcinoma

-Anaplastic thyroid carcinoma