Head and Neck Cancer

Question 1

Definition of head and neck cancer

Answer 1

• tumours from epithelial lining of aerodigestive tract
• oral cavity, larynx, pharynx, paranasal sinuses, salivary glands
• squamous cell
• risk factors: smoking, alcohol

Question 2

Risk factors for H and N cancers

Answer 2

• Smoking
• ETOH
• HPV
• EBC
• mucosal irritation (dentures, roughened dental edges)

Question 3

Social issues unique to Hand N cancers

Answer 3

• disfigurement
• body image
• social interactions
• speaking, eating disruption
• financial issues - patients cannot work

Question 4

Swallowing assessment in head and neck cancers

Answer 4

*

Question 5

Dysphagia/odynopahgia from radiation

Answer 5

• Acute radiation toxicities 4-12 weeks:
  
  • mucositis
  • tissue edema
  • xerostomia
  • hyperviscous secretions
• Late effects of radiation
  
  • decreased tongue retraction
  • decreased laryngeal elevation
  • decreased epiglottic inversion
  • decreased wall motion
  • aspiration

Question 6

PEG tubes for dysphagia

Answer 6

• nutritional support
• disuse atrophy in swallowing can occur
• temporary PEG: patient should still continue to swallow or physio to maintain pharyngeal function
• advance diet as quickly as possible

Question 7

Voice concerns

Answer 7

• surgery, radiation
• CN IX or X involvement
• Soft breathy voice, laryngeal paralysis

Question 8

Communication rehab

Answer 8

• artificial larynx
• esophageal speech (physical therapy)
• trachea-esophageal tract one way valve to produce sound

Question 9

Airway concerns in Head and neck cancers

Answer 9

• sonourous mouth breathing
  
  • obstruction at base of tongue
  • nasal trumpet, upright positioning
• Stridor
  
  • fixed laryngotracheal obstructoin
  • tracheostomy?
• Anxiety/agitation/confusion
  
  • hyerpcarbia
  • laryngoscopy

Question 10

Auditory dysfunction

Answer 10

• chemo/radiation
• sensorineural hearing loss
• hearing aids

Question 11

Dermatitis

Answer 11

• common with radiation
• 2-3 weeks after therapy and lasts 2-4 weeks
• erythema, edema, blistering, ulceration, sloughing
• atrophy
• pigmentation
• telangectasias
• hair loss

Question 12

Common lab abnormalities in head and neck cancers

Answer 12

• Anemia
• hypothyroidism
  
  • radiation and lobectomy from tumour resection

Question 13

Lymphedema

Answer 13

• common in head and neck
• can lead to fibrosis and impaired ROM
• Manual lymphatic drainage
• compression garments
• Lymphedema therapists

Question 14

Osteonecrosis in head and neck cancer

Answer 14

• mandible
• from radiation
• depends on dentition (edentulous most common)
• pre-radiation dental treatment
• avoid alcohol, good oral hygiene