Chapter 21: H&N Cancer

Question 1

T/F: H&N cancer is twice as common in men than women

Answer 1

True

Question 2

What are the 3 parts of the pharynx?

Answer 2

1. Nasopharynx - behind nose
2. Oropharynx - behind mouth
3. Hypopharynx - throat

Question 3

______ is thought to cause ~70% of oropharyngeal cancers

Answer 3

HPV (specifically HPV-16)

Question 4

What are 8 presenting symptoms of H&N cancer

Answer 4

1. Unintended wt loss
2. Pain/difficulty swallowing
3. Loose teeth
4. Sore that won’t heal in mouth
5. Double
6. Foul breath
7. Earache
8. Blood in saliva

Also hoarseness in voice, sore throat that doesn’t improve, persistent nasal congestion, trismus

Question 5

Nutrition, _______ and ______ evaluations are recommended for all H&N patients

Answer 5

Speech
Swallow

Question 6

Nutrition impact symptoms are likely to develop around week _________ of H&N radiation

Answer 6

3

Question 7

Side effects of radiation from H&N cancer that are not typically d/t chemo (5)

Answer 7

Xerostomia, thick secretions/saliva, odynophagia/dysphagia, Anosmia, Thrush

Question 8

________ + ________ treatment regimen for H&N cancer will increase metabolic needs

Answer 8

Cisplatin concurrent w/ radiation

Question 9

Difference between proton beam radiation & intensity modulated radiation, especially w/ H&N cancer

Answer 9

Proton beam radiation uses protons instead of x-rays. These typically have fewer side effects and decrease need for radiation

Question 10

Factors to consider w/ H&N radiation that may increase need for a feeding tube

Answer 10

Bilateral neck radiation
Size of the treatment field

Question 11

How often to manage pt’s weight & NIS for H&N radiation

Answer 11

Weekly

If not possible get nursing involved to help

Question 12

When is laser surgery used for H&N cancer?

Answer 12

Early stage, especially of the larynx

Question 13

What is TORS?

Answer 13

Transoral robotic surgery

Treats oral or throat cancer. Arms of the robot are places inside of the pts mouth

Question 14

ERAS/immunonutrition supplements for H/N cancer post-op?

Answer 14

Recommend both, typically requiring short-term EN

Question 15

Kcal needs may be as high as _______ - _______ kcal/kg after completing a course of cistplatin + radiation

Answer 15

35-40 kcal/kg

Question 16

Weight loss during H&N treatment has been correlated with (4) and may help to determine if they need a feeding tube

Answer 16

1. BMI > 25
2. pharygeal, orocavity, or supraglottic (above) tongue site
3. stage 3 or 4 disease
4. Multimodal treatment regimen

Question 17

Nutrition intervention for patients with HNC cancer should start ___________

Answer 17

Before treatment begins

Question 18

Foods best tolerated w/ taste changes for H&N

Answer 18

Neutral tasting foods high in kcal & protein

Question 19

Foods best tolerated w/ mucositis & thrush (3 components)

Answer 19

Low acid, smooth textured, very moist

Question 20

Some H&N pts may be at risk for aspiration of oral secretions. Critical to receive eval by SLP. 3 signs to monitor for

Answer 20

1. Coughing w/ oral intake
2. “Froggy” voice
3. Fever

Question 21

T/F: Thrush, dysgesusia, xerostomia are both possible short and long term challenges of H&N survivors

Answer 21

TRUE