Dysphagia Disorders Flashcards
What are the main risk factors for Head and Neck Cancer?
Heavy smoking (x20)
Heavy drinking (x5)
Heavy drinking and smoking (x50)
Human Papilloma Virus (25-35% of HNC cancers)
What does a stage 1 cancer mean?
T1 N0 M0
Small tumour that hasn’t spread - good prognosis
What does a stage 2 cancer mean?
T2 N0 M0
Same as a stage 1 but bigger - still treatable
What does a stage 3 cancer mean?
T3 N0 M0 or T1-3 N1 MO
Can be the same as a stage 2 but bigger, or can be smaller but has invaded the lymph nodes. This means it has the ability to invade other organs. This is harder to treat
What does a stage 4 cancer mean?
T4 N0/1 M0
T1-4 N2/3 M0
T any N any M 1
Stage 4 is very hard to treat. It’s more about prolonging life and helping with specific symptoms
What are the 3 categories for HNC treatment?
Surgery (resection and reconstruction)
Radiotherapy
Chemotherapy
Used to be that everyone had surgery and then perhaps either C/R. Now because of organ preservation protocols surgery is not first
What are some of the main side effects of chemotherapy?
Hair loss, fatigue, nausea, kidney failure, abnormal cells (therefore infection is common), mucositis (mucosal infection)
What are some of the side effects radiation?
Devascularisation (death of blood cells), xerostomia, trismus, candidiasis, loss of appetite, nausea, fatigue, odonophagia (pain on swallowing), loss of taste
What is the difference between a swallowing symptom and a swallowing disorder?
Symptom - what someone might describe or what you observe in a person
Disorder - the underlying cause/anatomical or neuromuscular dysfunction
Sometimes a 1-1 relationship between the two but sometimes not
What are some of the common symptoms of dysphagia?
Taking longer to eat, modifications to diet, food in the mouth after eating, food escaping the mouth, weight changes, changes in voice quality, coughing during/after eating, repeated chest infections, eyes watering
What are some of the main pre-feeding difficulties?
Inability to move food to the mouth, difficulty seeing food on the plate due to hemianopia, inability to identify food as food (dementia), not identifying utensils, smelling difficulties (anosmia), impulsive eating
Symptom = food/liquid escaping the lips. What is the possible disorder?
Reduced muscular tone/strength of lips
Symptom = food in lateral sulci after the swallow. Disorder?
Reduced (unilateral right sided) tongue weakness (XII), reduced tone in cheek (VII), reduced sensation (V)
Symptom =Food not chewed adequately. Disorder?
CNV or XII weakness, xerostomia (almost always associated with radiation), TMJ pain, dentition, oral tremor (basal ganglia disorder or idiopathic)
Symptom = unable to propel the bolus posteriorly. Disorder?
CNXII weakness, poor co-ordination or apraxia, glossectomy
Symptom = Coughing after swallow. Disorder?
Reduced BOT/PPW contact, reduced laryngeal elevation
Symptom = coughing during swallow. Disorder?
Reduced vocal fold closure
Disorder = reduced BOT/PPW contact. Possible symptoms?
Reported food sticking in the pharynx
Reported extra swallows
reported need to drink to push food down throat
Coughing after the pharyngeal swallow
Disorder = reduced lip closure (VII). Symptoms?
Food coming out of mouth
Difficulties propelling bolus back in mouth
Saliva leakage
Disorders: reduced unilateral (RS) tongue weakness (XII), reduced tone in cheek (VII), reduced sensation (V) - symptom?
Food residue in right lateral sulci
Disorder: reduced tongue movement (XII - strength, co-ordination, range of movement), reduced sensation (V). Symptom?
Food residue in mouth
Disorders: reduced BOT/PPW contact, reduced oral tongue movements, reduced laryngeal elevation, poor UOS opening, reduced Oro-pharyngeal sensation. Symptom?
Aspiration after swallow
