head and neck CA

Question 1

re: how treatment has evolved, what has surpassed surgery in frequency?

Answer 1

RXT: radiation therapy

Question 2

re: how treatment has evolved, assumption is that ______ = better outcomes, but is not always true for swallowing

Answer 2

organ preservation

Question 3

re: how treatment has evolved, when organ is preserved, often times ___ is not

Answer 3

function (of organ)

Question 4

re: how treatment has evolved, the addition of ____ doubles mucosal toxicity

Answer 4

chemotherapy

Question 5

incidence of dysphagia in H&N CA

Answer 5

34%-77% in first 90 days
9%-50% in 2 years
Aspiration= 22%-89% after RXT/chemo

Question 6

early changes (up to 90 days) of radiation side effects

Answer 6

mucositis: pain, edema, ulceration, decreased saliva
swallowing: pain, decreased/thick saliva, taste changes

Question 7

late changes (after 90 days) of radiation side effects

Answer 7

increase in collagen/fibrosis of connective tissue -> loss of elasticity/narrowing of structures

can involve muscle -> muscle necrosis, atrophy

can involve bone, nerve -> this may appear several years later

Question 8

4 more late changes (after 90 days) of radiation side effects (terms)

Answer 8

osteoradionecrosis
trismus
decreased laryngo-pharyngeal sensation
continued xerostomia

Question 9

what we see (in a patient with H&N CA)

Answer 9

edema/lymphedema
structures eroded
decreased hypo laryngeal elevation
decreased CP opening
decreased base of tongue motion
decreased bolus clearance

Question 10

name the term:
abnormal collection of protein-rich fluid in the interstitium resulting from obstruction of lymphatic drainage.
this causes pain, decreased movement, swelling, stiffness.
characterized by puffiness and pitting

Answer 10

lymphedema

Question 11

name the term:
damage to the skin and subcutaneous tissue.
characterized by hardened, stiff, dense tissue

Answer 11

fibrosis

Question 12

treatment of lymphedema and fibrosis: many rehabilitation facilities have lymphedema specialists who treat it with ______

Answer 12

massage

Question 13

treatment of lymphedema and fibrosis: fibrosis is usually treated with a _______. what else is a good option?

Answer 13

deeper massage

myofascial release

Question 14

key concepts:

XRT/chemo ALWAYS hinders ____

Answer 14

swallowing

Question 15

key concepts:

tongue, epiglottis, UES are key in ___

Answer 15

XRT

Question 16

key concepts:

must work with patient before, during, and after _____

Answer 16

XRT/chemo

Question 17

dysphagia may lead to what 2 things?

Answer 17

weight loss and negative effects on swallow function

Question 18

___ may lead to XRT interruption

Answer 18

weight loss

Question 19

XRT interruption leads to _____

Answer 19

decreased survival

Question 20

dysphagia also leads to ____

Answer 20

immune system function

Question 21

3 solutions to dysphagia

Answer 21

shielding
modifying method, manner, composition of intake (KEEP SWALLOWING)
exercises: jaw ROM, active exercises

Question 22

pre-radiation education

Answer 22

perform a clinical swallow eval to see: if ca/tumor causing dysphagia, if they are safe, what baseline is, if they know expectations

Question 23

4 possible side effects of radiation on swallowing

Answer 23

aspiration
GER
pharyngeal residue
xerostomia

Question 24

laryngectomies and dysphagia: oral phase problems

Answer 24

cancers of oral structures
loss of dentition
odynophagia
trismus
xerostomia

Question 25

laryngectomies and dysphagia: oral transit phase problems

Answer 25

cancer of oral structures
effects of surgery for removal of CA (glossectomy)
odynophagia
xerostomia

Question 26

laryngectomies and dysphagia: pharyngeal phase problems

Answer 26

CP may be tight from fibrosis
epiglottis may have been reconstructed
fibrosis
lymphedema
scarring/radiation effects

Question 27

laryngectomies and dysphagia: esophageal phase problems

Answer 27

reflux and other GI issues