Dysphagia and Head & Neck Cancer Flashcards
exam 2
What are some risk factors for head and neck cancer?
Tobacco
Alcohol
HPV in oropharyngeal cancers
Epstein-Barr virus in nasopharyngeal cancers
Poor oral hygiene
Poor nutrition – Vitamin A and B deficiency
GERD in pharyngeal cancers
What does the most recent research support when it comes to treating a cancerous tumor?
The most recent research supports:
Primary chemotherapy to shrink the tumor
Surgical removal with wide margins
Followed by radiation therapy to address remaining cells in the environment.
What are the three purposes of a preoperative conference?
Preoperative conference to:
- Discuss outcome options (PEG placed pre, peri or post op?)
- Conduct clinical swallow evaluation because chances are the patients are already experiencing changes in swallowing.
- Conduct videofluoroscopic swallow evaluation with or without postural or compensatory techniques.
Why do we do a preoperative conference?
To get a baseline
What are some side effects of surgical removal?
Decreased movement.
Scar tissue formation.
Wound Dehiscence (a surgical complication in which a wound ruptures along a surgical incision.)
A decreased sensation at the suture/graft site.
Presence of tracheostomy (hole in the neck for breathing).
What is a TEP?
Tracheo-Esophageal Puncture/Prothesis. It’s the oneway prosthesis used in patients with a trach who desire to speak again. Must be replaced every 3-4 months or when the client senses aspiration.
Describe Fibrosis.
he formation of excess fibrous connective tissue (hardening/stiffening) in an organ or tissue in a reparative or reactive process. If in response to injury, it is called scarring.
List some side effects of Radiation Therapy.
Tissue:
Changes the nature of the tissues by reducing blood supply which damages small nerve endings in the region, Tissue necrosis (death), Fibrosis (tissue hardening)
Nausea
Irritation to skin
Damages the salivary glands causing xerostomia (dry mouth)
Peripheral neuropathies
MOVEMENT:
Reduces RANGE/SPEED OF MOTION
Reduces flexibility of the pharyngeal and laryngeal structures
Reduced synchrony of movement, larynx excursion and airway closure for instance.
SENSATION:
Reduces sensation of the bolus volume and UES width opening
What is Xerostomia?
Xerostomia is defined as dry mouth resulting from reduced or absent saliva flow.
What are some side effects of Chemotherapy?
Nausea – poor tolerance to food, loss of appetite
Occasional mucositis: painful inflammation and ulceration of the mucous membranes lining the digestive tract.
Hair loss
Xerostomia (dry mouth)
Infections of oral cavity
REDUCED MOVEMENTS:
Reduced strength and coordination of the anterior tongue.
Reduced posterior movement of the base of tongue to the posterior pharyngeal wall
Reduced laryngeal elevation
Reduced airway closure.
What is the demographic that lip cancer usually is seen in? What are the primary risk factors?
Occur mostly in men- 55 to 65 years old.
Alcohol and tobacco are the primary risk factors.
(Patients usually have poor oral and dental hygiene)
How does lip cancer usually present initially?
Usually present as non-healing ulcers – Pain in advanced stages.
What is the treatment for lip cancers?
Lip cancer is treated with radiation mostly – especially if initial stages.
Carcinoma in-situ and early lesions of the lip may also be surgically removed.
What will be some dysphagia symptoms for those with lip cancer?
Mostly oral stage deficits – Labial seal, oral bolus control.
May affect other structures because of radiation effects.
Describe the location of floor of the mouth cancers.
Anterior surface on either side of the midline.
They can spread to bone and tongue.
Approximately 30% of these cancers involve the sub-maxillary nodes.
What are some symptoms for those with cancer on the floor of their mouth?
Mostly oral stage deficits – Oral bolus control. Can affect other related physiological processes – hyoid excursion and UES opening.
May affect other structures because of radiation effects.
