Spit Tobacco - It's No Game
Secondhand Smoke and Children
Head and Neck Cancer
Fine Needle Aspiration
What Is FNA?
Fine needle aspiration (FNA) is a technique
that allows a biopsy of various bumps and lumps. It allows your
otolaryngologist to retrieve enough tissue for microscopic analysis
and thus make an accurate diagnosis of a number of problems,
such as inflammation or even cancer.
FNA Is Used for Diagnosis In:
Neck lymph nodes
Inside the mouth
Any lump that
can be felt
Why Is It Important?
A mass or lump sometimes indicates a serious
problem, such as a growth or cancer*. While this is not always
the case, the presence of a mass may require FNA for diagnosis.
Your age, sex, and habits, such as smoking and drinking, are
also important factors that help diagnosis of a mass. Symptoms
of ear pain, increased difficulty swallowing, weight loss, or
a history of familial thyroid disorder or of previous skin cancer
(squamous cell carcinoma) may be important as well.
* When found early, most cancers in the head
and neck can be cured with relatively little difficulty. Cure
rates for these cancers are greatly improved if people seek
medical advice as soon as possible. So play it safe. If you
have a lump in your head and neck area, see your otolaryngologist
What Are Some Areas that Can be Biopsied
In This Fashion?
FNA is generally used for diagnosis in areas
such as the neck lymph nodes or for cysts in the neck. The parotid
gland (the mumps gland), thyroid gland, and other areas inside
the mouth or throat can be aspirated as well. Virtually any
lump or bump that can be felt (palpated) can be biopsied using
the FNA technique.
How Is It Done?
Your doctor will insert a small needle into
the mass. Negative pressure is created in the syringe, and as
a result of this pressure difference between the syringe and
the mass, cellular material can be drawn into the syringe. The
needle is moved in a to and fro fashion, obtaining enough material
to make a diagnosis. This procedure is generally accurate and
frequently prevents the patient from having an open, surgical
biopsy, which is more painful and costly. The procedure generally
does not require anesthesia. It is about as painful as drawing
blood from the arm for laboratory testing (venipuncture). In
fact, the needle used for FNA is smaller than that used for
venipuncture. Although not painless, any discomfort associated
with FNA is usually minimal.
What Are the Complications of This Procedure?
No medical procedure is without risks. Due to
the small size of the needle, the chance of spreading a cancer
or finding cancer in the needle path is very small. Other complications
are rare; the most common is bleeding. If bleeding occurs at
all, it is generally seen as a small bruise. Patients who take
aspirin, Advil®, or blood thinners, such as Coumadin®, are more
at risk to bleed. However, the risk is minimal. Infection is
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Spit Tobacco - It's No Game
Sean Marsee of Ada, OK, lifted weights and ran the 400 meter
relay. By the time he was 18 years of age, he had won 28 medals.
To keep his body strong, he did not smoke or drink. But he did
use smokeless tobacco, because he thought it wasn't harmful
to his health.
When oral cancer was discovered, part of Sean's tongue was removed.
But the cancer spread. More surgeries followed, including removal
of his jaw bone. In his last hours, Sean wrote - he could no
longer speak - a plea to his peers; "Don't dip snuff".
He died at age 19.
What Is Spit Tobacco?
There are two forms of spit tobacco: chewing
tobacco and snuff. Chewing tobacco is usually sold as leaf tobacco
(packaged in a pouch) or plug tobacco (in brick form) and both
are put between the cheek and gum. Users keep chewing tobacco
in their mouths for several hours to get a continuous high from
the nicotine in the tobacco.
Snuff is a powdered tobacco (usually sold in
cans) that is put between the lower lip and the gum. Just a
pinch is all that's needed to release the nicotine, which is
then swiftly absorbed into the bloodstream, resulting in a quick
high. Sounds ok, right? Not exactly, keep reading.
What's in Spit Tobacco?
Chemicals. Keep in mind that the spit tobacco
you or your friends are putting into your mouths contains many
chemicals that can have a harmful effect on your health. Here
are a few of the ingredients found in spit tobacco:
Polonium 210 (nuclear waste)
in car batteries)
The chemicals contained in chew or snuff are what make you high.
They also make it very hard to quit. Why? Every time you use
smokeless tobacco your body adjusts to the amount of tobacco
needed to get that high. Then you need a little more tobacco
to get the same feeling. You see, your body gets used to the
chemicals you give it. Pretty soon you'll need more smokeless
tobacco, more often or you'll need stronger spit tobacco to
reach the same level. This process is called addiction.
Some people say spit tobacco is ok because there's
no smoke, like a cigarette has. Don't believe them. It's not
a safe alternative to smoking. You just move health problems
from your lungs to your mouth.
Physical and Mental Effects
If you use spit tobacco, here's what
you might have to look forward to:
Cancer. Cancer of the mouth (including the
lip, tongue, and cheek) and throat. Cancers most frequently
occur at the site where tobacco is held in the mouth.
Whoa, what's this? When you hold tobacco in one place in your
mouth, your mouth becomes irritated by the tobacco juice. This
causes a white, leathery like patch to form, and this is called
leukoplakia. These patches can be different in size, shape,
and appearance. They are also considered pre-cancerous. If you
find one in your mouth, see your doctor immediately!
Disease. The constant flow of nicotine into your body
causes many side effects including: increased heart rate, increased
blood pressure, and sometimes irregular heartbeats (this leads
to a greater risk of heart attacks and strokes). Nicotine in
the body also causes constricted blood vessels which can slow
down reaction time and cause dizziness-not a good move if you
and Tooth Disease. Spit tobacco permanently discolors
teeth. Chewing tobacco causes halitosis (BAD BREATH). Its direct
and repeated contact with the gums causes them to recede, which
can cause your teeth to fall out. Spit tobacco contains a lot
of sugar, which when mixed with the plaque on your teeth, forms
acid that eats away at tooth enamel, causes cavities, and chronic
Effects. The really bad breath, discolored teeth, gunk
stuck in your teeth, and constant spitting can have a very negative
effect on your social and love life. An even more serious effect
of spit tobacco is oral cancer, and the surgery for this could
lead to removal of parts of your face, tongue, cheek or lip.
Early Warning Signs
Check your mouth often, looking closely at the
places where you hold the tobacco. See your doctor right away
if you have any of the following:
a sore that bleeds easily and doesn't heal
a lump or thickening
anywhere in your mouth or neck
swelling that doesn't go away
a red or white
patch that doesn't go away
swallowing, or moving your tongue or jaw
Even if you
don't find a problem today, see your doctor or dentist every
three months to have your mouth checked. Your chances for a
cure are higher if oral cancer is found early.
Tips To Quit
You've just read the bad news, but there is
good news. Even though it is very difficult to quit using spit
tobacco, it can be done. Read the following tips to quit for
some helpful ideas to kick the habit. Remember, most people
don't start chewing on their own, so don't try quitting on your
own. Ask for help and positive reinforcement from your support
groups (friends, parents, coaches, teachers, whomever...)
1. Think of reasons why you want to quit. You
may want to quit because:
You don't want to risk getting cancer.
The people around
you find it offensive.
You don't like
having bad breath after chewing and dipping.
You don't want
stained teeth or no teeth.
You don't like
being addicted to nicotine.
You want to
start leading a healthier life.
2. Pick a quit date and throw out all your chewing tobacco and
snuff. Tell yourself out loud every day that you're going to
3. Ask your friends, family, teachers, and coaches
to help you kick the habit by giving you support and encouragement.
Tell friends not to offer you smokeless tobacco. You may want
to ask a friend to quit with you.
4. Ask your doctor about a nicotine chewing
gum tobacco cessation program.
5. Find alternatives to spit tobacco. A few
good examples are sugarless gum, pumpkin or sunflower seeds,
apple slices, raisins, or dried fruit.
6. Find activities to keep your mind off of
spit tobacco. You could ride a bike, talk or write a letter
to a friend, work on a hobby, or listen to music. Exercise can
help relieve tension caused by quitting.
7. Remember that everyone is different, so develop
a personalized plan that works best for you. Set realistic goals
and achieve them.
8. Reward yourself. You could save the money
that would have been spent on spit tobacco products and buy
something nice for yourself.
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Secondhand Smoke and Children
What Is It?
Secondhand smoke is a combination of the smoke
from a burning cigarette and the smoke exhaled by the smoker.
Also known as environmental tobacco smoke (ETS), it can be recognized
easily by its distinctive odor. ETS contaminates the air and
is retained in clothing, curtains and furniture. Many people
find ETS unpleasant, annoying, and irritating to the eyes and
nose. More importantly, it represents a dangerous health hazard.
Over 4,000 different chemicals have been identified in ETS,
and at least 43 of these chemicals cause cancer.
Is Exposure to Environmental Tobacco
Approximately 26% of adults in the United States
currently smoke cigarettes, and 50 to 67% of children under
five years of age live in homes with at least one adult smoker.
Who Is At Risk?
Although ETS is dangerous to everyone, fetuses,
infants and children are at most risk. This is because ETS can
damage developing organs, such as the lungs and brain.
Its Effect On:
...the Fetus and Newborn
Maternal, fetal, and placental blood flow change
when pregnant women smoke, although the long-term health effects
of these changes are not known. Some studies suggest that smoking
during pregnancy causes birth defects such as cleft lip or palate.
Smoking mothers produce less milk, and their babies have a lower
birth weight. Maternal smoking also is associated with neonatal
death from Sudden Infant Death Syndrome, the major cause of
death in infants between one month and one year of age.
...Children's Lungs and Respiratory
Exposure to ETS decreases lung efficiency and
impairs lung function in children of all ages. It increases
both the frequency and severity of childhood asthma. Secondhand
smoke can aggravate sinusitis, rhinitis, cystic fibrosis, and
chronic respiratory problems such as cough and postnasal drip.
It also increases the number of children's colds and sore throats.
In children under two years of age, ETS exposure increases the
likelihood of bronchitis and pneumonia. In fact, a 1992 study
by the Environmental Protection Agency says ETS causes 150,000
to 300,000 lower respiratory tract infections each year in infants
and children under 18 months of age. These illnesses result
in as many as 15,000 hospitalizations. Children of parents who
smoke half a pack a day or more are at nearly double the risk
of hospitalization for a respiratory illness.
Exposure to ETS increases both the number of
ear infections a child will experience, and the duration of
the illness. Inhaled smoke irritates the eustachian tube, which
connects the back of the nose with the middle ear. This causes
swelling and obstruction which interferes with pressure equalization
in the middle ear, leading to pain, fluid and infection. Ear
infections are the most common cause of children's hearing loss.
When they do not respond to medical treatment, the surgical
insertion of tubes into the ears is often required.
Children of mothers who smoked during pregnancy
are more likely to suffer behavioral problems such as hyperactivity
than children of non-smoking mothers. Modest impairment in school
performance and intellectual achievement have also been demonstrated.
Secondhand Smoke Causes Cancer
have just read how ETS harms the development of your child,
but did you know that your risk of developing cancer from ETS
is about 100 times greater than from outdoor cancer-causing
pollutants? Did you know that ETS causes more than 3,000 non-smokers
to die of lung cancer each year? While these facts are quite
alarming for everyone, you can stop your child's exposure to
secondhand smoke right now.
What Can You Do?
1. Stop smoking, if you do smoke. Consult your
physician for help, if needed. There are many new pharmaceutical
products available to help you quit.
2. If you have household members who smoke, help them stop.
If it is not possible to stop their smoking, ask them, and visitors,
to smoke outside of your home.
3. Do not allow smoking in your car.
4. Be certain that your children's schools and day care facilities
are smoke free.
Acknowledgment is made to the American Academy of Pediatric
Otolaryngology for contributions to this leaflet.
This online publication is also available as
printed leaflets, sold in packages of 100. For an order form,
use our fax-on-demand service (503-402-1374) and request document
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Head and Neck Cancer
More than 55,000 Americans will develop cancer of the head and
neck (most of which is preventable) this year; nearly 13,000
of them will die from it.
Find it early - and be cured
Tobacco is the most preventable cause of these
deaths. In the United States, up to 200,000 people die each
year from smoking-related illnesses. The good news is that this
figure has decreased due to the increasing number of Americans
who have quit smoking. The bad news is that some of these smokers
switched to smokeless or spit tobacco, assuming it is a safe
alternative. This is untrue-they are merely changing the site
of the cancer risk from their lungs to their mouth. While lung
cancer cases are down, cancers in the head & neck appear
to be increasing. Cancer of the head and neck is curable if
caught early. Fortunately, most head and neck cancers produce
early symptoms. You should know the possible warning signs so
you can alert your doctor to your symptoms as soon as possible.
Remember-successful treatment of head and neck cancer can depend
on early detection. Knowing and recognizing the signs of head
and neck cancer can save your life.
Here's what you should watch for:
A lump in the neck...
Cancers that begin in the head or neck usually
spread to lymph nodes in the neck before they spread elsewhere.
A lump in the neck that lasts more than two weeks should be
seen by a physician as soon as possible. Of course, not all
lumps are cancer. But a lump (or lumps) in the neck can be the
first sign of cancer of the mouth, throat, voice box (larynx),
thyroid gland, or of certain lymphomas or blood cancers. Such
lumps are generally painless and continue to enlarge steadily.
Change in the voice...
Most cancers in the larynx cause some change
in voice. Any hoarseness or other voice change lasting more
than two weeks should alert you to see your physician. An otolaryngologist
is a head and neck specialist who can examine your vocal cords
easily and painlessly. While most voice changes are not caused
by cancer, you shouldn't take chances. If you are hoarse more
than two weeks, make sure you don't have cancer of the larynx.
See your doctor.
A growth in the mouth...
Most cancers of the mouth or tongue cause a
sore or swelling that doesn't go away. These sores and swellings
may be painless unless they become infected. Bleeding may occur,
but often not until late in the disease. If an ulcer or swelling
is accompanied by lumps in the neck, be very concerned. Your
dentist or doctor can determine if a biopsy (tissue sample test)
is needed and can refer you to a head and neck surgeon to perform
Bringing up blood...
This is often caused by something other than
cancer. However, tumors in the nose, mouth, throat or lungs
can cause bleeding. If blood appears in your saliva or phlegm
for more than a few days, you should see your physician.
Cancer of the throat or esophagus (swallowing
tube) may make swallowing solid foods difficult. Sometimes liquids
can also be troublesome. The food may "stick" at a
certain point and then either go through to the stomach or come
back up. If you have trouble almost every time you try to swallow
something, you should be examined by a physician. Usually a
barium swallow x-ray or an esophagoscopy (direct examination
of the swallowing tube with a telescope) will be performed to
find the cause.
Changes in the skin...
The most common head and neck cancer is basal
cell cancer of the skin. Fortunately, this is rarely a major
problem if treated early. Basal cell cancers appear most often
on sun-exposed areas like the forehead, face, and ears, although
they can occur almost anywhere on the skin. Basal cell cancer
often begins as a small, pale patch that enlarges slowly, producing
a central "dimple" and eventually an ulcer. Parts
of the ulcer may heal, but the major portion remains ulcerated.
Some basal cell cancers show color changes. Other kinds of cancer,
including squamous cell cancer and malignant melanoma, also
occur on the skin of the head and neck. Most squamous cell cancers
occur on the lower lip and ear. They may look like basal cell
cancers and, if caught early and properly treated, usually are
not much more dangerous. If there is a sore on the lip, lower
face, or ear that does not heal, consult a physician. Malignant
melanoma classically produces dense blue-black or black discolorations
of the skin. However, any mole that changes size, color, or
begins to bleed may be trouble. A black or blue-black spot on
the face or neck, particularly if it changes size or shape,
should be seen as soon as possible by a dermatologist or other
Constant pain in or around the ear when you
swallow can be a sign of infection or tumor growth in the throat.
This is particularly serious if it is associated with difficulty
in swallowing, hoarseness or a lump in the neck. These symptoms
are best evaluated by an otolaryngologist.
Identifying High Risk of Head and Neck
As many as 90 percent of head and neck cancers
arise after prolonged exposure to specific factors. Use of tobacco
(cigarettes, cigars, chewing tobacco or snuff) and alcoholic
beverages are closely linked with cancers of the mouth, throat,
voice box and tongue. (In adults who neither smoke nor drink,
cancer of the mouth and throat are nearly nonexistent.) Prolonged
exposure to sunlight is linked with cancer of the lip and is
also an established major cause of skin cancer.
What You Should Do...
All of the symptoms and signs described here
can occur with no cancer present. In fact, many times complaints
of this type will be due to some other condition. But you can't
tell without an examination. So, if they do occur, see your
doctor-and be sure.
REMEMBER: When found early,
most cancers in the head and neck can be cured with relatively
little difficulty. Cure rates for these cancers could be greatly
improved if people would seek medical advice as soon as possible.
So play it safe. If you think you have one of the warning signs
of head and neck cancer, see your doctor right away.
BE SAFE: See your doctor early!
And practice health habits which will make these diseases unlikely
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