COMPS: Laryngectomy (O8) & Cancer (O9)

Question 1

History: Who developed the the type of incision used for laryngectomy today? What year?

Answer 1

Von Langenbeck, in 1875.

Question 2

Who performed the first laryngectomy surgery in North America? In what year?

Answer 2

Lange, in 1879

Question 3

How many successful laryngeal transplants in the WORLD have there been?

Answer 3

TWO! And one was performed at UC Davis.

Question 4

What is the “incidence” and “prevalence”?

Answer 4

Incidence- how many NEW cases there are in a given period of time (usually a year).

Prevalence- how many people are living with the disease within a specific period of time.

Question 5

What type of cancer is the biggest killer in the U.S.?

Answer 5

Lung cancer

Question 6

Laryngeal cancer is less than __% of all cancers diagnosed in the U.S. each year, but about __% of all head and neck cancers.

Answer 6

2%, 25%

Question 7

What color does cancer appear on the vocal folds?

Answer 7

white

Question 8

Name some clubs that you could recommend to your laryngectomy patient.

Answer 8

the Lost Chords Club
Whisper Clubs
Look Whose Talking Now

Question 9

In any 24-hour period, roughly __ billion cells die off and are replaced.

Answer 9

3 billion

Question 10

What is “apoptosis”?

What is “metastasis”?

Answer 10

1. planned cell death.
2. when a cell migrates to a place it shouldn’t be and starts to duplicate instead of dying off. Regarding cancer, this is known as ‘spreading.’

Question 11

What is “necrosis”?

Answer 11

cell death due to damage or disease.

Question 12

Cancer is _____ cell life and occurs when there is _____ to a cell’s suicide program (apoptosis).

Answer 12

abnormal; damage

Question 13

What 5 things can cause cancer? (general)

Answer 13

1. Inheritance
2. Chemicals (teratogens)
3. Carcinogens
4. Viruses
5. Radiation

Question 14

What are 4 risk factors for laryngeal cancer?

Answer 14

1. Smoke (esp. tobacco smoke)
2. Alcohol
3. Poor nutrition
4. GERD

Question 15

What are two symptoms of glottic cancer?

Answer 15

1. Hoarseness (1st sign)

2. Persistent cough

Question 16

Most laryngeal cancers begin on the ______ ______.

Answer 16

vocal folds

Question 17

Symptoms of supraglottic cancer (the pharynx, nasopharynx, and oropharynx)

Answer 17

1. sore throat, feeling of painful lump in throat, or cough that does not go away.
2. trouble or pain when swallowing (dysphagia)
3. prolonged/persistent ear pain
4. Dyspnea/stridor (rough, difficult breathing)
5. Unexplained weight loss (general cancer symptom)

Question 18

what does “T” “N” and “M” stand for?

Answer 18

Doctors classify and treat laryngeal cancer based upon 3 primary catetories:

1. T- “tumor,” primary site and size of tumor
2. N- “Node involvement”
3. M- “Metastasis”

Question 19

Define the following:
Tx
T1
T2
T3
T4

Answer 19

Tx: tumor has been identified but cannot yet be assessed. Need a visual eval such as MRI in order to find it.

T1: tumor is in place and is confined, small, and sitting on the structure’s surface.

T2: Tumor is large but still confined, arytenoids still work.

T3: More tissue is involved; tumor has invaded more than the VF tissue and is potentially in the cartilage; arytenoids have stopped working.

T4: Tumor is sizable and has gone through multiple tissue layers; larynx probably immobile. Dysphagia and breathing problems are present.

Question 20

Define the following:

N0
Nx
N1
N2
N3

Answer 20

N0– no lymph node involvement.
Nx– in the nodes, but difficult to assess degree of involvement.
N1– Cancer has spread to the ipsilateral side of lymph nodes in neck (1 or 2 nodes only).
N2– Ipsilateral, BUT larger number and larger tumor in the lymph nodes.
N3– Bilateral spreading to the lymph nodes (both sides of neck)

Question 21

Define the following:
M0
Mx
M1

Answer 21

M0 – none; no spreading (first look in lungs, then brain)
Mx – Likely metastasis but cannot assess it.
M1 – There is most definitely metastasis.

• Metastasis of laryngeal cancer most commonly goes down to the lungs, but can go up to the brain.

Question 22

What are the 4 types of cancer?

Answer 22

1. Carcinoma: occurs in cells that line the surfaces of the body (e.g., digestive tract, laryngeal cancer)
2. Sarcoma: arises in connective tissues (tendons, muscles and bones)
3. Lymphoma: arises in the lymph nodes.
4. Leukemia: blood cancer and the bood-forming systems such as bone marrow.

Question 23

What is “Leukoplakia”?

Answer 23

benign growths of thick, whitish patches on the surface of the vocal folds (precancerous).

Appear as white tissue patches with purplish/reddish edges.

Pts may sound hoarse, low-pitched, breathy, and have reduced vocal loudness.

Question 24

What may leukoplakia turn into? What does treatment involve?

Answer 24

squamous cell carcinoma.

treatment involves a combination of surgery, voice tx, and eliminating exposure to tissue irritants (smoking, alcohol, or vocal abuse).

Question 25

What are the laryngeal cancer treatments? (3)

Answer 25

1. Radiation therapy
2. Surgery
3. Chemotherapy (laryngeal cancer does not respond to chemo, so this is a LAST resort)

Question 26

What are some effects of radiating the larynx?

Answer 26

• makes tissue very stiff, which makes spitting, swallowing, eating, and talking difficult.
• the spine is also irradiated, which affects LMNs and can cause paralysis on the ipsilateral side.
• cataracts
• increased blood pressure due to carotid artery becoming stiff.
• xerostomia
• dysphagia
• speech & esophageal effects

Question 27

What is the most common type of laryngeal cancer?

Answer 27

Squamous Cell Carcinoma

Question 28

Define Tumor grade 1, grade 2, and grade 3.

Answer 28

GRADE 1 (low grade): The cancer cells tend to grow
slowly, look quite similar to normal cells (are ‘well
differentiated’) and are less likely to spread than higher
grades.

GRADE 2 (moderate grade): The cells look more
abnormal and are growing at a slightly quicker rate. 

GRADE 3 (high grade): The cancer cells tend to grow
more quickly, look very abnormal (are ‘poorly
differentiated’) and are more likely to spread than lowgrade cancers.