Learning You Have a Tumor

You or your doctor may have found a tumor (growth) in your mouth or throat. It’s normal to have concerns, and many questions. So find out how your health care team can help-and how important you are to your own recovery. This booklet can show you more.

Concerns About the Future

Finding out you have a tumor is scary. You may wonder what effect it will have on your life. As you and your doctors decide on your treatment, some of your concerns will be resolved. And, moving forward, your health care team can help you learn ways to help yourself.

What Is a Tumor?

A tumor is a mass of abnormal cells. It is either benign (slow growing, not cancerous) or malignant (fast growing, cancerous). Some tumors, especially cancerous ones, can be life-threatening. But most tumors can be treated.

Risk Factors for a Cancerous Tumor

You are more likely to get a tumor of the mouth or throat if you:

  •  Smoke cigarettes, pipes, or cigars
  • Use chewing tobacco or snuff
  • Drink alcohol
  • Take poor care of your teeth
  • Have poor-fitting dentures that irritate your mouth
  • Are exposed to certain industrial chemicals
  • Had a mouth or throat tumor in the past

Working with Your Health Care Team

Your health care team will explain your options and can answer your questions. They’ll work with you during all stages of your treatment. Members of your health care team may include:

  • A primary care physician, a doctor who oversees your health needs
  • A head and neck surgeon, a doctor who performs mouth and throat surgery. He or she may be an otolaryngologist (also called an EN1′), who treats ear, nose, and throat diseases, or a general surgeon, who also performs other kinds of surgery.
  • dentist, a doctor who treats tooth and gum diseases and injuries ·
  • Nurses, who care for you and teach you how to care for yourself
  • An oncologist, a doctor who specializes in treating cancer
  • An anesthesiologist, a doctor who gives medication to prevent pain during and after surgery
  • pathologist, a doctor who identifies diseases by studying cells and tissues with a microscope
  • The radiation team, doctors and therapists who use high energy x-rays to treat diseases
  • Speech pathologists, occupational therapists, and physical therapists, who help you recover after treatment.
  • Dietitians, who help plan your diet during and after treament.

Inside Your Mouth and Throat

Tumors can fmm anywhere in your mouth or throat. A tumor may change how you talk, breathe, chew, or swallow. Learning more about your mouth and throat can help you understand your treatment.

Signs and Symptoms of a Tumor in the Mouth

If you have a mouth tumor, you or your doctor may have noticed one or more of the following:

  • White or red patches on tissues or gums
  • Pain that doesn’t go away
  • A sore that doesn’t heal in a week or two
  • Bleeding that doesn’t stop after a few days
  • A swelling or lump that doesn’t go away
  • Problems with your teeth, dentures, or chewing

Signs and Symptoms of a Tumor in the Throat

If you have a throat tumor, you or your doctor may have noticed one or more of the following:

  • Hoarseness that doesn’t go away
  • Trouble swallowing
  • A lump in your neck
  • Pain that doesn’t go away
  • Aching, pain, or pressure in your ear
  • Persistent coughing with or without bloody sputum

Your Evaluation

To learn more about your tumor and your health, your doctor will evaluate you. Your evaluation includes a history, a physical exam, and some tests. Results of your evaluation help your health care team plan the best treatment for you.

Your Health History

Your doctor will take your health history. During this history, you’re asked about your health problems, your symptoms, and any treatment you’ve already had. Your doctor may refer you to a specialist for more evaluation and treatment.

Your Physical Exam

The physical exam is done in the doctor’s office. Your exam may include indirect laryngoscopy, where a hand-held mirror is used to view the throat. You may also have an endoscopy, where a flexible tube (endoscope) is put into your mouth or nose and sometimes down into your throat. You may have local anesthesia (medication to keep you comfortable) during these exams.

Imaging Tests

You may have one or more imaging tests to give your doctor more information about the tumor. You’ll be told how to prepare for these tests. Some common imaging tests are:

  • An x-ray, a picture of tissues inside the body using high-energy beams
  • A CT (computed tomography) scan, a computer-enhanced x-ray
  • An MRI (magnetic resonance imaging), a test using strong magnets and_computers to form images

Direct Laryngoscopy

For a closer look at your throat, larynx, and other nearby tissues, direct laryngoscopy may be used. During the procedure, a lighted tube called a laryngoscope may be placed into your throat. Direct laryngoscopy may be done in the hospital or in the doctor’s office. If it is done in the hospital, you may receive general anesthesia (medication to help you relax and sleep).

Biopsy

If you have a biopsy, a small sample of your tumor will be removed and studied. This helps show whether or not the tumor is cancerous. The tumor sample may be removed in the doctor’s office or in the hospital. The sample is then studied in a lab. Sometimes a biopsy is done during direct laryngoscopy.

Fine-Needle Aspiration

During fine-needle aspiration (FNA), a very thin needle is inserted into the tumor to remove a tissue sample. This biopsy procedure may be done in the doctor’s office.

Deciding on Treatment

The treatment you receive depends on the tumor’s size, type, and location, and

whether  it is cancerous. You may be treated with one or more of these options:

  • Surgery
  • Radiation Therapy
  • Chemotherapy

Preparing for Your Treatment

You and your doctor will choose the best treatment for you. Before treatment begins, you can do some things to get ready. Follow your health care team’s instructions. Also be sure to ask any questions you have.

Leading Up to Treatment

In the weeks before treatment, you should do the following:

  • Stop smoking or using tobacco.
  • Have dental work done if your doctor requests it.
  • Tell your doctor if you take any medications, especially aspirin or an anticoagulant (“blood thinner”).
  • If you drink alcoholic beverages, tell your doctor how often and how much you drink.
  • Fill out insurance, consent, and other forms as requested by your doctor.

Preparing for Surgery

Before surgery, prepare by doing the following:

  • Make sure you will be able to arrive at the hospital on time.
  • Ask an adult friend or family member to give you a ride home when you’re ready to leave the hospital.
  • Don’t eat or drink anything after midnight the night before your surgery, even water, candy, or gum. If you eat or drink after midnight, your surgery may be cancelled.
  • If you’ve been told to keep taking a medication, take it with small sips of water.
  • If you feel ill, call your doctor. Your surgery may need to be rescheduled.

If You Have Surgery

Surgery may be done to remove either a benign or a cancerous tumor. Your health care team will let you know what to expect. They’ll also discuss the possible risks and complications of the surgery.

The Surgical Plan

Your surgery may take from a few minutes to several hours. At the start, you’ll receive anesthesia to keep you comfortable. Depending on the size and location of the tumor, surgery can include:

Removing the tumor. If the tumor is benign, you may need no furthertreatment after it’s removed. If the tumor is cancerous, you may also need radiation or chemotherapy.

Helping you breathe while the tumor is removed. To do this, a small hole may be made in the front of your throat. A tracheostomy (trach) tube may be inserted through this hole to help you breathe.

Removing some lymph nodes from your neck if your tumor is cancerous. This procedure (called neck dissection) can help keep the cancer from spreading.

Using tissue from your back or chest to replace tissue removed during the surgery. If necessary, this can help you regain better use of your mouth, throat, or neck after treatment.

Possible Risks and Complications

Some of the possible risks and complications of surgery include:

  • Infection
  • Bleeding
  • Difficulty speaking or swallowing
  • Pain or numbness at the incision site
  • Loss of muscle tone or range of motion in your face, neck, or arm
  • Reduced sense of taste, smell, or feeling
  • Change in appearance

Recovering from Surgery

You may go home the same day as your surgery, or you may need to stay in the hospital longer. These first few days after your surgery can be a challenge. You’ll have lots of help from your health care team. And you’ll learn how to care for yourself once you’re home.

Right After Surgery

An IV (intravenous) line may be in your arm to provide fluids. You may have an air tube in your nose or a trach tube in your throat. You may also have a tube in your stomach to provide food. You may feel tired, confused, or groggy. Your mouth or throat may feel dry or sore. Talking may be hard, so something to write with may be at your bedside.

Before Leaving the Hospital

Your doctors and nurses will check on you after your surgery. They’ll explain what you need to do to recover at home. You may be given medications to take after you leave the hospital. Make sure an adult friend or family member is available to drive you home.

When to Call Your Doctor

Call your doctor right away if you have any of these problems after surgery:

  • Bleeding ot swelling in the mouth or throat
  • Fever over 101 F
  • Vomiting
  • Shortness ofhreath
  • Swelling in the legs and feet
  • Pain that’s not relieved by medication

If You Have a New Airway

If your surgeon has given you a new airway during surgery, it may be in place only a short time while you heal. Or, if your larynx has been removed, you’ll continue breathing through this new airway. In either case, your health care team will help you adjust.

If You Have a Trach Tube

Your trach tube has been chosen to fit well and work right for you. You’ll learn how to keep it clean and clear. Often, a trach tube is needed only a short time. Your surgeon will tell you how long to use the tube. If you don’t need a new airway after surgery, the hole in the front of your throat will close on its own once the tube is no longer needed.

If You Have a Stoma

If your larynx was removed during surgery, you’ll continue to breathe through the hole in your throat. This hole is called a stoma or permanent tracheostomy. You’ll be shown how to care for your stoma. Support groups can help you adjust to having a new airway. And you can return to work, family life, and many of the activities you enjoyed before surgery.

When to Call Your Doctor

Call your doctor right away if you have any of these problems:

  • A red, painful, or bleeding stoma
  • Pain while cleaning your airway
  • Yellow, smelly, bloody, or thick mucus around or inside your stoma
  • Swelling near the trach tube or stoma

If you ever have trouble breathittg, call 9·1·1 (emergency) right away. Tell the dispatcher that you use a trach tube or stoma to breathe.

If You Have Radiation Therapy

During radiation treatment, beams of high energy destroy cancer cells in the tumor. The radiation may come from a machine or from small “seeds” placed in the tumor. Radiation may be used alone or with other treatment.

Planning for Treatment

You and your radiation team will meet to plan your treatment. You may need to have dental work done before starting treatment. The team will decide how best to position you and direct the energy beams. You may be fitted with a flexible mask to wear during the sessions. Because you may have several radiation sessions over many weeks, be sure to plan for extra help at home and work during your treatment period.

During Treatment

First, a therapist will prepare you for treatment. Then he or she leaves the room. You’ll need to lie as still as you can. During treatment, a large machine sends x-ray beams into the tumor site and nearby affected tissues. This is called local treatment. You’ll hear the equipment working, but you won’t feel the radiation on your skin .

Possible Side Effects of Radiation Therapy

Radiation may affect the normal tissue near the cancer cells. This may cause side effects. These don’t mean that the cancer is worse or that the therapy isn’t working. Ask your health care team how to mange these or other side effects:

  • Weight loss
  • Dry, itchy, red, darkening, or peeling skin
  • Fungal infections in the mouth
  • Sore in the mouth
  • Eating difficulties
  • Loss of or decrease taste
  • Dry mouth or thick saliva
  • Dental cavities
  • Fatigue

If You Have Chemotherapy

During chemotherapy (also called chemo), one or more medications travel through your bloodstream. When they reach the tumor, these medications kill cancer cells. You may receive chemo by itself or with other treatment.

Planning for Treatment

Chemo affects your entire body. This is called systemic treatment. You may receive chemo many times over a few months, with breaks of several days between treatments. Your treatment schedule depends on what type of chemo medications you receive. Talk with your health care team about how to plan and prepare for chemo treatments.

During Treatment

Chemo is most often given by IV infusion (through a tube placed in a vein). It can also be given by pill or by a shot. Sometimes it is sent right into the tumor site. You may receive chemo at your doctor’s office, at a clinic, at a hospital, or from a portable pump that you wear.

Possible Side Effects of Chemotherapy

Chemotherapy may cause side effects anywhere in the body. Side effects don’t mean that the cancer is worse or that the therapy isn’t working. Ask your health care team how to manage these or other side effects:

  • Nausea or vomiting
  • Hair loss
  • Bleeding
  • Weakened immune system
  • Mouth sores
  • Dry mouth
  • Sinus or other infections
  • Anemia
  • Diarrhea or constipation
  • Numbness

Adjusting After Treatment

Treatment for a tumor may change the way you speak, chew, or eat. If so, your health care team will show you new ways to do these important tasks. Family, friends, and other people you trust can also help you adjust.

Help with Daily Tasks

Surgery to remove a tumor may make simple tasks harder to do for a while. If needed, your therapists can help you relearn how to chew or swallow food.  If you have a stoma or a feeding tube, your health care team will show you how to care for it. If you have dentures, you may need to get new ones. And you may need to practice moving muscles in your neck or face. Members of your health care team can help. If you need help at home, ask them about home nurses and health aides. A dietitian can work with you to plan healthy meals after treatment.

Help with Speaking

If you have your larynx removed, it will change the way you speak. But you can learn to speak again. A speech pathologist can help you use one or more of the following

  • An electrolarnyx, a device like a microphone that you hold up to your throat when you want to talk
  • Esophageal speech, which creates speech using air forced up from your esophagus
  • voice prosthesis, a special valve placed inside your throat to help you speak. The procedure to place the valve is called a tracheoesophageal puncture (TEP).

Following Up

In the future, you may need more exams, x-rays, tests, or treatment. So be sure to follow up with your health care team as directed. It’s also important to do what you can to improve your health. Talk with your health care team about what lies ahead.

Improving Your Life

Now is the time to take control of your health. Cancer can recur, but you can do a lot to keep it from coming back. If you haven’t stopped smoking or using tobacco, stop now. If you drink alcohol, ask your doctor how to cut back. Take good care of your teeth and gums. Eat well, exercise, and get plenty of sleep. Your lifestyle choices can help keep you healthy. Talk to your health care team about what else you can do.

Looking Ahead

Life after treatment for a tumor can be a challenge. At first, how you look or speak may concern or depress you. If you had cancer, you may be afraid that the cancer might come back. But you can find ways to cope. Therapists and counselors can do a lot for you. Look to your family, friends, clergy, and support groups for more help.

Getting Support

The groups below can give you more information and support. To find out more, contact:

American Cancer Society (ACS)

1-800-ACS-2345 (1-800-227-2345)

www.cancer.org

Cancer Information Service (CIS)

(National Cancer Institute)

1-800-4-CANCER (1-800-422-6237)

www.nci.nih.gov

American Academy of Otolaryngology – Head and Neck Surgery

1-703-836-4444

www.entnet.org

International Association of Laryngectomees (IAL) (“Lost Chord” or “New Voice” clubs)

1-757-888-0324

www.larynxlink.com

National Coalition for Cancer Survivorship (NCCS)

1-877-NCCS-YES (1-877-622-7937)

www.cansearch.org

Support for People with Oral and Head and Neck Cancer (SPOHNC)

1-516-759-5333

www.spohnc.org

The Yul Brynner Head and Neck Foundation

1-843-792-8299

www.yulbrynnerfoundation.com