Head and Neck Cancer Introduction Page
oropharynx (soft palate, tonsil, base of tongue)
larynx (voice box)
hypopharynx (pyriform sinus, posterior phanryngeal
wall, post-cricoid region)
nasal cavity/paranasal sinuses
paragangliomas (glomus tumors)
Paragangliomas (glomus tumors)
•Signs and Symptoms
Illustration courtesy of Lippincott Williams & Wilkins
Paragangliomas, sometimes called glomus tumors, are uncommon growths that
are closely associated with certain nerves and blood vessels of the head
and neck. They typically grow very slowly and have a large amount of blood
flowing through them. The most common paraganglioma develops on the main
artery of the neck, the carotid artery. They may also develop on vessels
and nerves that are high in the neck, in the area of the undersurface
of the skull. They may even extend into the skull, adjacent to the brain.
A family history can be a risk factor for developing these tumors, and
there may occasionally be more than one of these tumors present in the
head and neck. Paragangliomas are usually benign tumors, but they are
malignant in approximately 10 percent of cases.
Signs and Symptoms
Patients most often first see their doctor with a slowly growing, painless
but throbbing neck mass. Sometimes there may be decreased hearing ability
on one side with an associated throbbing noise (called tinnitus). Hoarseness
of the voice, difficulty swallowing or problems with tongue motion may
Evaluation starts with a thorough history and physical examination performed
by a physician. This will determine the size and location of the tumor
and possible weakness of any nerves involved by a paraganglioma. An ear
examination is included in this evaluation, because it may show tumor
behind the eardrum. Both CT scans (which use X-rays to create a two-dimensional
image of the area), and MRI scans (which use a magnetic field and pulses
of radio wave energy to visualize the detailed anatomy), help to confirm
the diagnosis. These scans also help define the extent of the tumor and
identify any other paragangliomas growing in the neck. Frequently, angiography
(a study showing the blood vessels of the neck) is performed to reveal
the blood supply to these tumors and also to define the circulation to
the brain. Most often, a biopsy of the tumor is not performed prior to
treatment, because it may be lead to unacceptable bleeding.
The treatment of paragangliomas depends on the size and location of the
tumor, the age of the patient, the presence of any nerve weakness, and
evaluation of additional medical problems that the patient may have. Any
tumors undergoing surgery usually require angiography (see Clinical Evaluation).
The blocking of the blood supply to the tumor (known as embolization)
is performed at that time. This facilitates the surgical procedure. If
possible, tumors of the carotid artery (carotid body tumors) and small
tumors of the middle ear (glomus tympanicum) are treated with surgery.
Surgery is also recommended for other paragangliomas (e.g., glomus jugulare,
glomus vagale) in which multiple nerve weaknesses exist. However, radiation
therapy is used if all the nerves are functioning well. Larger tumors
with extensive involvement of the skull base and/or brain are treated
with radiation therapy, which is also suggested for older patients with
medical problems. Radiation therapy is also the treatment of choice in
patients with more than one paraganglioma.
Click Here for more information about radiation oncology treatments for head and neck cancer.
Periodic physical examination of the head and neck is necessary to monitor
the patient after treatment. CT or MRI scans may also be necessary, particularly
if a patient has been treated with radiation therapy.