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Dysphagia Final > Dysphagia Post Laryngectomy > Flashcards

Dysphagia Post Laryngectomy Flashcards

1
Q

Laryngeal cancer occurs in _________ Americans per year & causes _____ deaths.

A

~15,000

4,200 deaths

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2
Q

90% of laryngeal cancers are what type?

A

squamous cell carcinomas.

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3
Q

The etiology of squamous cell carcinomas is mainly related to_____

A

smoking

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4
Q

What can increase the risk of squamous cell carcinomas?

A

Heavy alcohol intake can increase the risk.

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5
Q

Glottic Cancer (involving the glottis (true vf’s)) accounts for approximately what % of the laryngeal cancers?

A

65%

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6
Q

Supraglottic cancer involves:

A

false vf’s, arytenoids, aryepiglottic folds, epiglottis

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7
Q

Supraglottic cancer accounts for what % of the laryngeal cancers?

A

35%

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8
Q

Subglottic cancer accounts for what % of the laryngeal cancers?

A

rare (5%)

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9
Q

What is the risk of second primary tumors, especially if the patients continues smoking and drinking alcohol?

A

has been reported as 25%

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10
Q

The overall 5-year survival of glottic cancer is:

A

85%

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11
Q

The 5 years survival is for stage I glottic cancer:

A

95%

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12
Q

The 5 years survival is for stage II glottic cancer:

A

85%

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13
Q

The 5 years survival is for stage III glottic cancer:

A

60%

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14
Q

The 5 years survival is for stage IV glottic cancer:

A

35%

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15
Q

The overall 5 year survival of supraglottic cancer is:

A

55%

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16
Q

5 year survival of supraglottic cancer for stage I is:

A

65%

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17
Q

5 year survival of supraglottic cancer for stage II:

A

65%

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18
Q

5 year survival of supraglottic cancer for stage III:

A

55%

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19
Q

5 year survival of supraglottic cancer for stage IV:

A

40%

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20
Q

Staging based on (5):

A

1) Location of 1° tumor
2) Tumor size
3) Lymph node involvement
4) Cell type & tumor grade (how close to normal cells)
5) Metastasis

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21
Q

TNM =

A

Primary Tumor (T)

Regional Lymph Nodes (N)

Distant Metastasis (M)

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22
Q

Primary Tumor (T):

A

T1, T2, T3, T4 = Size and/or extent of the primary tumor

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23
Q

TX

A

= Primary tumor cannot be evaluated

24
Q

T0

A

= No evidence of primary tumor

25
Q

Tis

A

= Carcinoma in situ (early cancer that has not spread to neighboring tissue)

26
Q

Regional Lymph Nodes (N)

A

N1, N2, N3 = Involvement of regional lymph nodes (number and/or extent of spread)

27
Q

NX

A

= Regional lymph nodes cannot be evaluated

28
Q

N0

A

= No regional lymph node involvement (no cancer found in the lymph nodes)

29
Q

Distant Metastasis (M)

A

MX, MO, M1

30
Q

MX

A

= Distant metastasis cannot be evaluated

31
Q

M0

A

= No distant metastasis (cancer has not spread to other parts of the body)

32
Q

M1

A

= Distant metastasis (cancer has spread to distant parts of the body)

33
Q

T1 tumor is about the size of a:

A

pea

1cm

34
Q

T2 tumor is about the size of a:

A

peanut

2cm

35
Q

T3 tumor is about the size of a:

A

walnut

4cm

36
Q

T4 tumor is about the size of a:

A

small lime

5cm

37
Q

Tis, N0, M0 = Stage ___

A

Stage 0

38
Q

T1, N0, M0 = Stage ____

A

Stage I

39
Q

T2, N0, M0 = Stage ___

A

Stage II

40
Q

T3, N0, M0 = Stage ___

A

Stage III

41
Q

T3, N1, M0 = Stage ___

A

Stage III

42
Q

T1, N1, M0 = Stage ___

A

Stage III

43
Q

T2, N1, M0 = Stage ___

A

Stage III

44
Q

T4, N0, M0 = Stage ___

A

Stage IVA

45
Q

Any T, N2, M0 = Stage ___

A

Stage IVA

46
Q

T4, N1, M0 = Stage ___

A

Stage IVA

47
Q

Any T, N3, M0 = Stage ___

A

Stage IVB

48
Q

Any T, Any N, M1 = Stage ___

A

Stage IVC

49
Q

Oral cancers can occur where? (5)

A

1) Tongue (glossectomy)
2) Floor of mouth
3) Mandible
4) Maxilla
5) Palate

50
Q

Total laryngectomy includes:

A

1) Removal of the larynx (resection of the hyoid bone, pre-epiglottic space, thyroid cartilage, cricoid cartilage, and one to four tracheal rings)
2) The hypopharyngeal constrictor muscles are sectioned from the lateral edge of the thyroid cartilage and cricoid insertions.
3) After removal of the specimen, the trachea is sutured to the skin of the neck, either in the original skin incision or in a separately made incision.
4) The constrictor muscles are usually reconstructed in the midline to support a one or two layer mucosal closure in a effort to reduce fistula formation

51
Q

Types of Partial Laryngectomy (5)

Possibly with (7)

A

1) supraglottic laryngectomy
2) supracricoid laryngectomy
3) hemilaryngectomy
4) cordectomy
5) subtotal laryngectomy

     Possibly with:

1) total/partial glossectomy
2) neck re/dissection (SCMs, lymph nodes) – radical, modified, simple, composite
3) total/partial mandibulotomy
4) cricohyoidoplexy
5) cricohyoidoepiglottopexy
6) cricopharyngeal myotomy
7) Permanent trachoestomy

52
Q

Dysphagia after Oral Cancer S+S (9):

A

1) Reduced oral sensation
2) Reduced mastication
3) Reduced bolus formation
4) Loss of bolus / drooling
5) Nasal regurgitation
6) Reduced/delayed a-p transport
7) Premature spillage
8) Reduced hyolaryngeal elevation (mandible)
9) Aspiration before swallow

*a lot of these symptoms are from surgery and/or radiation

53
Q

Dysphagia after Partial laryngectomy S+S (7):

A

1) Reduced posterior tongue mvmt
2) Restricted and/or incoordinated pharyngeal constrictor mvmt
3) Slower swallow (oral and/or pharyngeal delays)
4) Poor pulmonary function
5) CP achalasia and/or stricture
6) Decreased laryngeal elevation
7) Recurrence of Cancer (the worst!)

54
Q

Dysphagia after Total laryngectomy S+S (10):

A

1) Tongue weakness
2) Reduced posterior tongue mvmt
3) Restricted pharyngeal constrictor mvmt (weak and hardened)
4) Reduced transit times
5) CP dysfunction (achalasia)
6) Stricture
7) Fistula (esp w/TEP)
8) Abscess
9) Pseudoepiglottis, pseudodiverticulum (extra tissue)
10) Recurrence of Cancer (the worst!!)

55
Q

TEP complications (6):

A

1) Aspiration/leakage of food
2) Aspiration of prosthesis
3) Stenosis
4) Stoma & fistula infection
5) Spasm
6) Migration or fistula enlargement

56
Q

S+S with Radiation Therapy w/ or w/o chemo (8):

A

1) Xerostomia
2) Inflammation (mucositis)
3) Pain
4) Fibrosis (hardening of structures)
5) Reduced taste
6) Loss of appetite
7) Decreased tongue / jaw ROM
8) Reduced pharyngeal constriction (due to fibrosis and weakness)

*often pts are given NG tube to help to get nutrients

57
Q

2 examples of dysphagia problems post trach:

A

CP acalasia

psudoepiglottis

Dysphagia Final (5 decks)

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