Chapter 21: MNT for Head & Neck CA

Question 1

Where do majority of HNC originate? What are majority of HNC types (why kind of carcinomas?)

Answer 1

in the layering of mucosal surfaces

90% are squamous cell carcinomas

Question 2

NHC accounts for what percent of cancer cases in the US? What are the most common risk factors?

Answer 2

3%

alcohol and tobacco use, as well as HPV

Question 3

HNC encompasses what areas of the body?

Answer 3

Oral cavity - lips, tongue, gingiva, buccal mucosa, FOM, hard palate
Salivary glands
Paranasal sinuses
Pharynx
Larynx
Lymph nodes

Question 4

What chemotherapies are most commonly used for NHC?

Answer 4

Bleomycin
Cisplatin
Erbitux
Carboplatin
Taxotere
Gemzar
Ifosfamide (Ifex)
Methotrexate
Taxol
5-FU

Question 5

How many HN patients (%) are treated with a single modality? What modality are those and what stages?

Answer 5

30-40% are treated with either surgery or radiation, usually early stage - 1 or 2 or small tumors with no nodal involvement

Question 6

How many HN patients (%) are treated with a combined modality therapy? What modality are those and what stages?

Answer 6

60% are treated with combo, particularly chemoradiation, locally or regionally advanced disease (III or IV)

Question 7

What is the WHO oral toxicity scale?

Answer 7

Grade 0 – no change over baseline
Grade 1 – Soreness +/- erythema
Grade 2 – Erythema, ulcers and patient can swallow solid food
Grade 3 – Ulcers with extensive erythema; patient cannot swallow solid food
Grade 4 – Musositis so severe that oral alimentation is not possible; patient needs alternative method of feeding

Question 8

What are the key nutritional goal of HNC?

Answer 8

Wt maintenance during and after treatment
Wt maintenance post treatment until the patient is able to consume solid food
successful, break free completion of treatment
minimal, if any, wt loss in overweight/obese patients until patient is fully recovered from treatment and is able to eat without difficulties
Wt maintenance during transitional feedings from enteral nutrition support

Question 9

What are some risk factors identified in support of a prophylactic G-tube placement?

Answer 9

Stage IV tumors
Primary pharyngeal tumors
Combined surgery and radiation
pre-op wt loss of more than 10#

Question 10

Describe the nutritional phases of CRT treatment for HNC

Answer 10

Phase 0: Pretreatment - G-tube not used, assessment completed, HCHP

Phase 1: weeks 1-3 - G-tube not used, HCHP, flush G-tube daily

Phase 2: weeks 3-5 - If G-tube not used: soft/bland foods, oral supplements PRN, flush tube daily
If G-tube used: soft/bland foods, supplements PRN, flush tube daily, Supplemental EN to meet ~50% of needs

Phase 3: weeks 5-7 - If G-tube not used: liquid/pureed foods, oral supplements PRN, flush tube daily
If G-tube used: liquid/pureed foods, supplements PRN, flush tube daily, Supplemental EN to meet >75% of needs

Phase 4: post-CRT - If G-tube not in use: >4-6 weeks post treatment: liquid/pureed foods, oral supplements PRN, meet fluid needs; >6-8 weeks, progress to soft foods, gradual transition to normal diet, remove tube

If G-tube in use: >4-6 weeks post treatment: liquid/pureed foods, supplements PRN, flush tube daily, meet fluid needs, Supplemental EN to meet >75% of needs; >6-8 weeks, progress to soft foods, gradual transition back to normal diet, decrease EN by 1 can/week if wt is stable while increasing PO intake. Remove G-tube if wt stable after 4 weeks of just oral diet