A Complete Guide On The Excision Of Carotid Body Tumors

: Admin : 2022-03-10

What Is A Carotid Body Tumor?

A carotid body tumour is also called a chemodectoma or paraganglioma. A carotid body tumour is a growth on the side of the neck in the area where the carotid artery splits off into smaller blood vessels that carry blood to the brain. Human beings have two carotid arteries. One on each side of the neck that supply blood to the front of the brain, which is responsible for thinking, speech, personality, and sensory and motor functions. Carotid body tumours are relatively rare, occur in both men and women, and are most often seen in those who are middle-aged or older. Carotid body tumours also tend to occur in people living at very high altitudes, possibly from the chronic lack of oxygen.

What Are The Signs Of Carotid Body Tumor?

Carotid body tumours (CBTs) can be associated with pain, hoarseness, dysphagia, Horner syndrome, or shoulder drop. As the tumour enlarges and compresses the carotid artery and the surrounding nerves, other symptoms may also be present, such as pain, tongue paresis, hoarseness, Horner syndrome, and dysphagia.

What Are The Symptoms Of Carotid Body Tumors?

Many times, a carotid body tumour does not cause symptoms and is found by the doctor during an exam. The person may be able to feel the tumour, but it is not generally painful. If the tumour becomes large, it can press on the nerves, blood vessels or organs around it. This may cause throat pain, hoarseness, a numb tongue or make it hard to swallow.

A carotid body tumour may not cause any symptoms at first, but it can usually be felt as a slow-growing, painless mass on the side of the neck. As the tumour enlarges, over the course of several years, it may begin to cause symptoms that include:

• Hoarseness
• Difficulty swallowing
• Partial paralysis or numbness in the tongue
• Weakness or pain in the shoulders
• Vision changes, or a drooping eyelid
• High blood pressure or heart palpitations
• A bruit – the distinct whooshing sound of blood pushing past an obstruction

A carotid body tumour is extremely slow-growing and is not an emergency, but anyone with a suspected or diagnosed carotid body tumour should be referred to a cerebrovascular neurosurgeon for evaluation.

 What Causes A Carotid Body Tumor?

In most patients with a carotid body tumour, there is no known cause except for hypoxia which is the chronic oxygen deprivation that may come from living at high altitudes.  In a smaller percentage of patients, there is a family connection.

How Carotid Tumors Are Diagnosed?

The carotid tumours are diagnosed by performing tests. The doctor will closely examine the head and neck to check for signs of a carotid body tumour. The person may need tests, such as:

• Ultrasound – a test that uses a special tool transducer or wand that sends sound waves inside the body to create pictures.
• Magnetic Resonance Imaging (MRI) – a test that uses a large magnet and radio waves to create detailed pictures of the inside of the body.
• Computed Tomography (CT scan) – a special type of X-ray.
• Magnetic Resonance Angiography (MRA) – an MRI that checks for problems with the blood vessels.

What Surgical Treatments Are Available For Carotid Body Tumors?

The surgeons work closely with the ear, nose and throat that is otolaryngology. The surgeons offer patients a multidisciplinary approach to carotid body tumour treatment. The healthcare team will create the best plan of care and give you detailed information about the procedure and recovery.

Surgery for a carotid body tumour involves removing the tumour and repairing any damage to the carotid artery. A procedure called embolization may sometimes be performed before the operation. The surgical procedures are generally very safe, with good outcomes. The surgery takes place in an extremely delicate space, not only near the critical carotid artery that supplies blood to the brain but also very close to the tenth cranial nerve, called the vagus nerve; the facial nerve; and the hypoglossal nerve, which controls the tongue. Only highly skilled neurosurgeons with expertise in this procedure should perform the surgery.

In general, a vascular surgeon will perform a transcatheter embolization and a bypass graft, if needed.

Transcatheter Embolization

Transcatheter embolization is a procedure that reduces blood supply to the tumour. It is done two or three days before surgery. A catheter will be guided through the groin artery into the blood vessels that feed blood to the tumour. Then, medication or a blocking device, such as foam, plastic, metal coil, or glue is used to stop the blood flow to the tumour.

Surgical Removal (Resection)

Most times (60% -70%), the tumour can be removed without the need to repair or remove part of the carotid artery. If the artery does need to be repaired, it may be fixed with a simple suture repair. Sometimes, a more complicated repair is needed, such as creating a patch over a hole made during the tumour removal or replacing a section of the artery with a bypass graft or using another blood vessel to create a new pathway for the blood to flow.

Depending on the size and location of the tumour, the carotid artery may need to be repaired after the resection. Sometimes a simple suturing of the carotid artery is enough, but in other cases removing the tumour creates a hole in the carotid artery that needs to be patched or the damaged section needs to be completely removed. In certain cases, a bypass graft may be done to replace the damaged section.

What To Expect After The Surgery?

After surgery, most people can return to normal activities within three to four weeks. Although, many get back to their daily routines as soon as they feel up to it. During the first few weeks of the recovery, some key things to keep in mind include:

• one might have some soreness in the neck for about two weeks.
• one might need help with preparing meals, housekeeping and shopping.
• one should not drive until the incision is healed.
• one should be prepared to experience some numbness along the jaw and near the earlobe. This is from the incision, but for most people, it goes away in 6 to 12 months.

During the recovery, one may have different symptoms arise that don’t feel normal or right. one should immediately Call the health care provider if they face Headaches, confusion, numbness or weakness in any part of the body, Problems with the vision, problems speaking, or trouble understanding what others are saying, Trouble swallowing, Chest pain, dizziness, or shortness of breath that does not go away with rest, Coughing up blood or yellow or green mucus, Chills or a fever over 101°F (38.3°C) or a fever that persists even after taking acetaminophen, A red or painful incision, or yellow or green discharge from the incision, Swelling in the legs.

Although a proven surgical technique with high success rates, carotid artery surgery does not cure the cause of the blockage in the arteries. To avoid the arteries becoming narrow again, one might need to take medication, adjust the diet, begin an exercise regimen and make other lifestyle changes, like quitting smoking.

How Rare Is A Carotid Body Tumor?

The incidence of carotid body tumours (CBTs) is less than 1 in 30000. CBTs represent more than half of neck paragangliomas (PGLs), yet are still a very rare cause of neck lumps. Like other paragangliomas, CBTs originate from the neural crest. The most common site is the carotid body.

What Are The Risks Of The Treatment?

Treatment for carotid body tumours is generally very safe with good outcomes. However, all surgery involves risks. One possible complication is stroke, but this is rare and happens in less than 2% of carotid body tumour removals. The risk is highest for patients who have large tumours and need to have vascular repair or replacement.

If the tumour affects the nerves near the carotid artery, such as the vagus nerve, facial nerve or hypoglossal nerve that controls the tongue, part of the nerve may need to be removed. This can cause problems with the affected nerve(s). The risk of nerve problems is higher if the tumour is large, but the overall risk of permanent nerve damage is less than 5%.

If the tumour is cancerous, there is a less than 5% chance it will spread to other areas of the body. The risk of having another carotid body tumour after surgery is 5% to 10%.

 Home Remedies To Recover Post-Surgery Of Carotid Body Tumor

• Supplements and medications: one should strictly adhere to the medications prescribed by the doctor and follow up as and when required.
• Turmeric: This is the king of spices when it comes to dealing with cancer diseases, besides it adding a zesty colour to our food on the platter. Turmeric contains the powerful polyphenol Curcumin that has been clinically proven to retard the growth of cancer cells.
• Fennel: Armed with Phyto-nutrients and antioxidants, cancer cells have nothing but to accept defeat when the spice is fennel. ‘Anethole’, a major constituent of fennel resists and restricts the adhesive and invasive activities of cancer cells. It suppresses the enzymatic regulated activities behind cancer cell multiplication.
• Carrots: Carrots contain several essential nutrients including vitamin K, vitamin A, and antioxidants. Carrots also contain high amounts of beta-carotene, which is responsible for the distinct orange colour. Recent studies reveal that beta-carotene plays a vital role in supporting the immune system and may prevent certain types of cancer.
• Cruciferous vegetables: Cruciferous vegetables, such as broccoli, cauliflower, and kale, contain beneficial nutrients, including vitamin C, vitamin K, and manganese. Cruciferous vegetables also contain sulforaphane, a plant compound with anti-cancer properties. One must add cruciferous vegetables to their diet to get a better lifestyle.
• Rest well:  Sleep problems are more common in people with cancer, even survivors. This can be due to physical changes, side effects of treatment, stress or other reasons. But getting enough sleep is an important part of the recovery. Sleeping gives the mind and body time to rejuvenate and refresh to help one function at the best while you're awake. One should avoid caffeine for at least 8 hours before bedtime. One should stick to a regular sleep schedule and avoid computer or television screens for 1 to 2 hours before bedtime. One must exercise no later than 2 to 3 hours before going to bed.
• Say no to tobacco and Alcohol: Smoking or using chewing tobacco puts one at risk of several types of cancer. Stopping now could reduce the risk of cancer recurrence and also lower your risk of developing a second type of cancer. One should seek help to get rid of smoking and drinking.
• Eat more tomatoes: Research confirms that the antioxidant lycopene, which is in tomatoes, may be more powerful than beta-carotene, alpha-carotene, and vitamin E. Lycopene is a cancer-fighting food associated with protection against certain cancers such as prostate and lung cancer.
• Sip green tea throughout your day: Green tea is a powerful antioxidant and may be an important part of an anti-cancer diet. Green tea, a cancer-fighting food, may be helpful in preventing liver, breast, pancreatic, lung, oesophageal, and skin cancer.
• Berries: Berries are rich in vitamins, minerals, and dietary fibres. Scientists have shown a lot of interest in berries due to their antioxidant properties and potential health benefits. A Trusted Source shows that anthocyanin, which is a compound in blackberries, lowers biomarkers for colon cancer. Another Source demonstrates that the anti-inflammatory effects of blueberries can prevent the growth of tumours.

 Conclusion

Carotid body tumours are not usually cancerous. But they can grow quickly and become large. Because of this, the best treatment is often surgery to remove the tumour. In rare cases, radiation therapy is used. Surgical excision is the treatment of choice for carotid body paragangliomas although radiation therapy is an option for patients who are not ideal candidates for surgery. For tumours that are in intimate contact with carotid arteries, treatment by the vascular surgeon is recommended.