Dysphagia Post Laryngectomy Flashcards
Laryngeal cancer occurs in _________ Americans per year & causes _____ deaths.
~15,000
4,200 deaths
90% of laryngeal cancers are what type?
squamous cell carcinomas.
The etiology of squamous cell carcinomas is mainly related to_____
smoking
What can increase the risk of squamous cell carcinomas?
Heavy alcohol intake can increase the risk.
Glottic Cancer (involving the glottis (true vf’s)) accounts for approximately what % of the laryngeal cancers?
65%
Supraglottic cancer involves:
false vf’s, arytenoids, aryepiglottic folds, epiglottis
Supraglottic cancer accounts for what % of the laryngeal cancers?
35%
Subglottic cancer accounts for what % of the laryngeal cancers?
rare (5%)
What is the risk of second primary tumors, especially if the patients continues smoking and drinking alcohol?
has been reported as 25%
The overall 5-year survival of glottic cancer is:
85%
The 5 years survival is for stage I glottic cancer:
95%
The 5 years survival is for stage II glottic cancer:
85%
The 5 years survival is for stage III glottic cancer:
60%
The 5 years survival is for stage IV glottic cancer:
35%
The overall 5 year survival of supraglottic cancer is:
55%
5 year survival of supraglottic cancer for stage I is:
65%
5 year survival of supraglottic cancer for stage II:
65%
5 year survival of supraglottic cancer for stage III:
55%
5 year survival of supraglottic cancer for stage IV:
40%
Staging based on (5):
1) Location of 1° tumor
2) Tumor size
3) Lymph node involvement
4) Cell type & tumor grade (how close to normal cells)
5) Metastasis
TNM =
Primary Tumor (T)
Regional Lymph Nodes (N)
Distant Metastasis (M)
Primary Tumor (T):
T1, T2, T3, T4 = Size and/or extent of the primary tumor
TX
= Primary tumor cannot be evaluated
T0
= No evidence of primary tumor
Tis
= Carcinoma in situ (early cancer that has not spread to neighboring tissue)
Regional Lymph Nodes (N)
N1, N2, N3 = Involvement of regional lymph nodes (number and/or extent of spread)
NX
= Regional lymph nodes cannot be evaluated
N0
= No regional lymph node involvement (no cancer found in the lymph nodes)
Distant Metastasis (M)
MX, MO, M1
MX
= Distant metastasis cannot be evaluated
M0
= No distant metastasis (cancer has not spread to other parts of the body)
M1
= Distant metastasis (cancer has spread to distant parts of the body)
T1 tumor is about the size of a:
pea
1cm
T2 tumor is about the size of a:
peanut
2cm
T3 tumor is about the size of a:
walnut
4cm
T4 tumor is about the size of a:
small lime
5cm
Tis, N0, M0 = Stage ___
Stage 0
T1, N0, M0 = Stage ____
Stage I
T2, N0, M0 = Stage ___
Stage II
T3, N0, M0 = Stage ___
Stage III
T3, N1, M0 = Stage ___
Stage III
T1, N1, M0 = Stage ___
Stage III
T2, N1, M0 = Stage ___
Stage III
T4, N0, M0 = Stage ___
Stage IVA
Any T, N2, M0 = Stage ___
Stage IVA
T4, N1, M0 = Stage ___
Stage IVA
Any T, N3, M0 = Stage ___
Stage IVB
Any T, Any N, M1 = Stage ___
Stage IVC
Oral cancers can occur where? (5)
1) Tongue (glossectomy)
2) Floor of mouth
3) Mandible
4) Maxilla
5) Palate
Total laryngectomy includes:
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
Types of Partial Laryngectomy (5)
Possibly with (7)
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
Dysphagia after Oral Cancer S+S (9):
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
Dysphagia after Partial laryngectomy S+S (7):
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!)
Dysphagia after Total laryngectomy S+S (10):
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!!)
TEP complications (6):
1) Aspiration/leakage of food
2) Aspiration of prosthesis
3) Stenosis
4) Stoma & fistula infection
5) Spasm
6) Migration or fistula enlargement
S+S with Radiation Therapy w/ or w/o chemo (8):
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
2 examples of dysphagia problems post trach:
CP acalasia
psudoepiglottis
