Sunday, July 22, 2018
Health

Mayo Clinic Q&A: diagnosing and treating throat cancer; sleep terrors in children

Are there early signs of throat cancer, or is it typically not found until its late stages? How is it treated?

The throat includes several important structures that are relied on every minute of the day and night to breathe, swallow and speak. Unfortunately, cancer can involve any, and sometimes all, of these structures. The symptoms of cancer, how early these symptoms are recognized and how the cancer is treated depend on which structures are involved.

All of the passageway between your tongue and your esophagus can be considered the throat. It includes three main areas. The first is the base of your tongue and tonsils. These, along with the soft palate and upper side walls of the pharynx, are called the oropharynx. Second is the voice box, or larynx. It consists of the epiglottis — a cartilage flap that helps to close your windpipe, or trachea, when you swallow — and the vocal cords. Third is the hypopharynx. That includes the bottom sidewalls and the back of the throat before the opening of the esophagus.

Tumors that occur in these three areas have different symptoms, behave differently and often are treated differently. That's why the areas of the throat are subdivided into separate sections by the head and neck surgeons who diagnose and treat them.

For example, in the oropharynx, most tumors are squamous cell carcinoma. Most are caused by HPV, although smoking and alcohol can play a role in causing some of these tumors. Cancer that occurs in this area, particularly when caused by HPV, grows slowly, usually over a number of months. It often does not cause pain, interfere with swallowing or speaking, or have many other symptoms.

Most people discover cancer in the oropharynx when they notice a mass in their neck that's a result of the cancer spreading to a lymph node. Eighty percent of people with cancer that affects the tonsils and base of tongue are not diagnosed until the cancer moves into the lymph nodes.

This type of cancer responds well to therapy, however, and is highly treatable even in an advanced stage. At Mayo Clinic, most tonsil and base of tongue cancers are treated by removing the cancer and affected lymph nodes with robotic surgery, followed by radiation therapy. This treatment attains excellent outcomes without sacrificing a person's ability to swallow.

When cancer affects the voice box, it often affects speech. People usually notice hoarseness in their voice soon after the cancer starts. Because of that, many cases of this cancer are detected at an early stage. People with hoarseness that lasts for six weeks should get an exam by an otolaryngologist who specializes in head and neck cancer treatment, as early treatment of voice box cancer is much more effective than treatment in the later stages.

Early voice box cancer is treated with surgery — often laser surgery — or radiation therapy. Both are highly effective. If left untreated, voice box cancer can grow and destroy more of the larynx. At that point, treatment usually includes major surgery, along with radiation and chemotherapy — often at great cost to speech and swallowing function.

Finally, cancer of the hypo- pharynx usually involves symptoms such as pain when swallowing and difficulty swallowing solid food. It is most common in people with a long history of tobacco smoking and daily alcohol consumption. This cancer almost always presents in an advanced stage. Treatment is usually a combination of surgery, chemotherapy and radiation therapy.

If you are concerned about the possibility of any of these cancers, or if you notice symptoms that affect your speech or swallowing, make an appointment for an evaluation. The earlier cancer is diagnosed, the better the chances for successful treatment.

Eric Moore, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.

SLEEP TERRORS USUALLY GO AWAY AS CHILD AGES, BUT IN THE MEANTIME ...

My 7-year-old daughter has sleep terrors. What causes this, and when can we expect them to be finished?

It's hard to pinpoint why some children experience sleep terrors and others don't, but fatigue and stress seem to be frequent triggers. Anyone can have a sleep terror, but they are most common in children younger than 12. In most cases, they stop by the time a child reaches middle school or high school.

Sleep terrors, also called night terrors, are occasional episodes of screaming and flailing while a person is still asleep. In some cases, sleep terrors may involve sleepwalking. Although the behavior that happens during a sleep terror can put a child at risk for physical harm from falling or hitting something, a sleep terror itself isn't harmful and doesn't pose any health risks. Most of the time, children don't remember having a sleep terror. Because of that, sleep terrors are usually more upsetting for other members of the household than they are for the child who actually has them.

Sleep terrors tend to run in families. So if a parent had them as a child, then his or her children are at an increased risk for them, too. Sleep terrors are most likely to happen when a child is overtired or feeling a significant amount of stress. Sleeping in new surroundings or in a loud or noisy environment may contribute to sleep terrors. In children, fevers may sometimes trigger a sleep terror.

One of the best steps you can take to help prevent sleep terrors is to make sure your child is well-rested. A regular bedtime routine that is relaxing and doesn't involve any electronics, including cellphones, TV, computers and video games, also can help. Read books together, play a quiet game or spend time talking to help your child wind down before bed. If a child doesn't seem to be able to get enough sleep at night, consider a daytime nap. As much as possible, keep the stress level in your home low, and help your child work through stressful or upsetting situations.

To reduce the risk of a child hurting himself or herself during a sleep terror, create a safe bedroom environment. Place sharp, heavy or fragile objects out of your child's reach at night. Securely lock doors and windows. Put gates across stairways. Children who have sleep terrors shouldn't sleep on the top level of a bunk bed.

When a sleep terror happens, stay with your child until it is finished. If necessary, gently restrain the child from getting out of bed, or lead the child back to bed. Speak softly and calmly. Don't try to wake your child. The phase of sleep during which a sleep terror happens makes it unlikely that a child will respond to attempts to wake him or her.

Shouting or shaking a child during a night terror could make the episode last longer. In most cases, a sleep terror will stop on its own. Never punish a child for having a sleep terror or threaten punishment if it happens again. That only increases a child's stress and could worsen the situation.

Treatment usually isn't necessary for sleep terrors. But if they significantly disrupt your home regularly, make an appointment with your child's health care provider. He or she can help evaluate the situation. In rare cases, a child who has frequent sleep terrors may benefit from an evaluation with a sleep medicine specialist. In most cases, however, sleep terrors fade away as a child ages, without any medical intervention.

Nusheen Ameenuddin, M.D., Community Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minn.

Mayo Clinic Q & A is an educational resource and doesn't replace regular medical care. Email a question to MayoClinicQ[email protected] For more information, visit mayoclinic.org. © 2017 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency LLC. All rights reserved.

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