Dysphagia Post Laryngectomy

Question 1

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

Answer 1

~15,000

4,200 deaths

Question 2

90% of laryngeal cancers are what type?

Answer 2

squamous cell carcinomas.

Question 3

The etiology of squamous cell carcinomas is mainly related to_____

Answer 3

smoking

Question 4

What can increase the risk of squamous cell carcinomas?

Answer 4

Heavy alcohol intake can increase the risk.

Question 5

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

Answer 5

65%

Question 6

Supraglottic cancer involves:

Answer 6

false vf’s, arytenoids, aryepiglottic folds, epiglottis

Question 7

Supraglottic cancer accounts for what % of the laryngeal cancers?

Answer 7

35%

Question 8

Subglottic cancer accounts for what % of the laryngeal cancers?

Answer 8

rare (5%)

Question 9

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

Answer 9

has been reported as 25%

Question 10

The overall 5-year survival of glottic cancer is:

Answer 10

85%

Question 11

The 5 years survival is for stage I glottic cancer:

Answer 11

95%

Question 12

The 5 years survival is for stage II glottic cancer:

Answer 12

85%

Question 13

The 5 years survival is for stage III glottic cancer:

Answer 13

60%

Question 14

The 5 years survival is for stage IV glottic cancer:

Answer 14

35%

Question 15

The overall 5 year survival of supraglottic cancer is:

Answer 15

55%

Question 16

5 year survival of supraglottic cancer for stage I is:

Answer 16

65%

Question 17

5 year survival of supraglottic cancer for stage II:

Answer 17

65%

Question 18

5 year survival of supraglottic cancer for stage III:

Answer 18

55%

Question 19

5 year survival of supraglottic cancer for stage IV:

Answer 19

40%

Question 20

Staging based on (5):

Answer 20

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

Question 21

TNM =

Answer 21

Primary Tumor (T)

Regional Lymph Nodes (N)

Distant Metastasis (M)

Question 22

Primary Tumor (T):

Answer 22

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

Question 23

TX

Answer 23

= Primary tumor cannot be evaluated

Question 24

T0

Answer 24

= No evidence of primary tumor

Question 25

Tis

Answer 25

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

Question 26

Regional Lymph Nodes (N)

Answer 26

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

Question 27

NX

Answer 27

= Regional lymph nodes cannot be evaluated

Question 28

N0

Answer 28

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

Question 29

Distant Metastasis (M)

Answer 29

MX, MO, M1

Question 30

MX

Answer 30

= Distant metastasis cannot be evaluated

Question 31

M0

Answer 31

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

Question 32

M1

Answer 32

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

Question 33

T1 tumor is about the size of a:

Answer 33

pea 1cm

Question 34

T2 tumor is about the size of a:

Answer 34

peanut 2cm

Question 35

T3 tumor is about the size of a:

Answer 35

walnut 4cm

Question 36

T4 tumor is about the size of a:

Answer 36

small lime 5cm

Question 37

Tis, N0, M0 = Stage ___

Answer 37

Stage 0

Question 38

T1, N0, M0 = Stage ____

Answer 38

Stage I

Question 39

T2, N0, M0 = Stage ___

Answer 39

Stage II

Question 40

T3, N0, M0 = Stage ___

Answer 40

Stage III

Question 41

T3, N1, M0 = Stage ___

Answer 41

Stage III

Question 42

T1, N1, M0 = Stage ___

Answer 42

Stage III

Question 43

T2, N1, M0 = Stage ___

Answer 43

Stage III

Question 44

T4, N0, M0 = Stage ___

Answer 44

Stage IVA

Question 45

Any T, N2, M0 = Stage ___

Answer 45

Stage IVA

Question 46

T4, N1, M0 = Stage ___

Answer 46

Stage IVA

Question 47

Any T, N3, M0 = Stage ___

Answer 47

Stage IVB

Question 48

Any T, Any N, M1 = Stage ___

Answer 48

Stage IVC

Question 49

Oral cancers can occur where? (5)

Answer 49

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

Question 50

Total laryngectomy includes:

Answer 50

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

Question 51

Types of Partial Laryngectomy (5) Possibly with (7)

Answer 51

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

Question 52

Dysphagia after Oral Cancer S+S (9):

Answer 52

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

Question 53

Dysphagia after Partial laryngectomy S+S (7):

Answer 53

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!)

Question 54

Dysphagia after Total laryngectomy S+S (10):

Answer 54

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!!)

Question 55

TEP complications (6):

Answer 55

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

Question 56

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

Answer 56

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

Question 57

2 examples of dysphagia problems post trach:

Answer 57

CP acalasia | psudoepiglottis