Carotid Body Tumor

Carotid Body Tumor Overview

A carotid body tumor is a rare growth located at the carotid bifurcation, where the common carotid artery in your neck splits into the internal and external carotid arteries. This area contains a small cluster cells known as the carotid body, which monitors levels of oxygen and carbon dioxide in your blood to help regulate breathing.

Carotid body tumors, also known as paragangliomas, are generally slow-growing and are usually benign, meaning they are not cancerous and do not spread to other body parts. However, in a small number of cases, they can be malignant. Carotid body tumors can grow large enough to put pressure on nearby structures in the neck, which may cause symptoms such as a lump in the neck that you can feel, difficulty swallowing, hoarseness, or a change in your voice.

The exact cause of carotid body tumors is not well understood. They are thought to be associated with certain genetic factors, especially in cases where multiple family members are affected. They are most commonly diagnosed in adults between 40 and 60 but can occur in people of all ages.

Carotid body tumor diagnosis typically involves physical examination, imaging studies such as CT scans, MRI, or ultrasound, and sometimes angiography to assess the blood supply to the tumor. Carotid body tumors contain many blood vessels and bleed easily, so your doctor may be reluctant to take a biopsy of the tissue.

Treatment options depend on the location and size of the tumor, whether it’s causing symptoms, and its growth rate. Your doctor may be content to monitor small, asymptomatic tumors without immediate treatment. Surgical removal may be recommended for large or symptomatic tumors. In some cases, particularly if the tumor is difficult to remove surgically or if surgery is not a good option for you, radiation therapy may be a viable alternative treatment approach.

Working with a healthcare team experienced in treating carotid body tumors is essential to determine the best treatment plan for your situation.

About the Carotid Artery

The carotid arteries are major blood vessels in your neck that supply blood to your brain, neck, scalp, and face. There are two carotid arteries – one on each side of your neck – and they are divided into two main parts:

Common Carotid Artery

Each common carotid artery starts from different points in your chest and neck. On the right side, the common carotid artery branches off the brachiocephalic artery, which comes directly from the aorta (the main artery leaving the heart). On the left side, the common carotid artery starts directly from the aorta. These arteries then run upward on either side of the neck.

Internal and External Carotid Arteries

At a certain point in the neck, each common carotid artery divides into two branches:

• The External Carotid Artery: This branch supplies oxygen-rich blood to the face, scalp, skull, and parts of the neck. It has several smaller branches that reach different head and neck areas.
• The Internal Carotid Artery: This branch travels upward into the skull and supplies oxygen-rich blood to the brain. It enters the skull through the carotid canal and then divides further to provide blood to a large portion of the brain.

At the point where the common carotid artery splits into the internal and external branches, there is a small, specialized cluster of cells known as the carotid body. The carotid body acts as a chemoreceptor, monitoring oxygen and carbon dioxide levels in the blood to help regulate breathing. The carotid arteries supply the brain with the necessary oxygen and nutrients. Any interruption in this blood flow, such as from a blockage or narrowing (stenosis), can lead to severe conditions like strokes or transient ischemic attacks (TIAs). That’s why the health of your carotid arteries is so vital to your overall brain health.

Here’s what you might experience if you have a carotid body tumor:

• A Noticeable Lump or Mass: One of the most common signs is feeling a painless, firm lump on one side of your neck, near where the artery divides. This lump may not cause discomfort initially and is often discovered during an examination or imaging study for unrelated reasons.
• Swallowing Difficulties: If the tumor grows large enough, it can press against the esophagus (the tube that connects your mouth and stomach), making swallowing uncomfortable or difficult.
• Voice Changes or Hoarseness: Pressure on the nerves that control your vocal cords, particularly the recurrent laryngeal nerve, can lead to changes in your voice, including hoarseness or a weakened voice.
• Breathing Problems: Sometimes, a large tumor may press against the trachea (windpipe), leading to shortness of breath or difficulty breathing, especially when lying down.
• High Blood Pressure: Rarely, the tumor can interfere with the body’s normal blood pressure regulation, leading to hypertension.
• Pulsatile Tinnitus: Some individuals may experience ringing in the ears that pulses in time with their heartbeat.

Many carotid body tumors are asymptomatic, especially in the early stages, and symptoms typically develop slowly as the tumor grows. If you notice a lump in your neck or experience any of the symptoms mentioned, it’s essential to see a healthcare provider for evaluation. While carotid body tumors are rare, early diagnosis and treatment can help you manage the condition and prevent complications.

• Observation or Watchful Waiting: If the tumor is small, not causing symptoms, and believed to be benign, your doctor might recommend a watch-and-wait approach. This involves regular monitoring with physical exams and imaging tests, like ultrasound, CT scans, or MRIs, to check if the tumor grows or starts causing problems.
• Surgical Removal: Surgery is the primary treatment for carotid body tumors, especially if they’re causing symptoms or growing. The goal is to remove the tumor altogether. However, the surgery can be complex due to the tumor’s location near critical nerves and blood vessels. The risk of complications, such as nerve damage leading to swallowing difficulties, voice changes, or even stroke, varies depending on the tumor’s size and relationship to these structures. An experienced vascular or head and neck surgeon typically performs this surgery.
• Radiation Therapy: In cases where surgery might be too risky due to the size or position of the tumor, or if your health makes surgery too dangerous, radiation therapy may be an option. Radiation can help to control the growth of the tumor. While it’s generally less preferred than surgery, it can benefit certain patients.
• Embolization: Sometimes used before surgery, embolization is a procedure that helps to reduce the tumor’s blood supply, making surgical removal more manageable and safer. It’s not a standalone treatment but can be part of the treatment plan to minimize blood loss during surgery.
• Management of Malignant Tumors: If the carotid body tumor is malignant (cancerous), treatment may also involve a combination of surgery, radiation therapy, and possibly chemotherapy, depending on the extent of the disease and whether it has spread to other parts of the body.

Your healthcare team will consider several factors before recommending a treatment plan, including the tumor’s characteristics, your overall health, and each option’s potential risks and benefits. It’s important to have open and detailed discussions with your doctors about your treatment choices, what each involves, the possible side effects, and the expected outcomes.

Video: Carotid Body Tumor Surgery

#5: Resection of a Left Carotid Body Tumor with Preoperative Embolization

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#151: Left Transcervical Approach for Resection of a Carotid Body Tumor

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#216: Common Carotid Artery to Internal Carotid Artery Interpositional Bypass for En Bloc Resection of a Shamblin Grade III Carotid Body Tumor

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#353: Transcervical Approach for Resection of a Carotid Body Tumor and Carotid Endarterectomy

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