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Fine Needle Aspiration
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
Neck cysts
Parotid gland
Thyroid gland
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 right away.

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 rarely seen.


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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.

Sean Marsee before Sean Marsee after















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)
N-Nitrosamines (cancer-causing)
Formaldehyde (embalming fluid)
Nicotine (addictive drug)
Cadium (used in car batteries)
Cyanide
Arsenic
Benzene
Lead (nerve poison)

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.
Leukoplakia. 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!
Heart 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 play sports.
Gum 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 painful sores.
Social 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
soreness or swelling that doesn't go away
a red or white patch that doesn't go away
trouble chewing, 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 quit.

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 Smoke Common?

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 Tracts

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.

...the Ears

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.

...the Brain

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

You 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 1401.


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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 this procedure.

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.

Swallowing problems...

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 physician.

Persistent Earache...

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 Cancer

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 to occur.

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