Head and neck cancer

Question 1

What basic human functions can be impacted by head and neck cancer?

Answer 1

speaking, swallowing, and breathing,

Question 2

What is TNM classification? Why is it important?

Answer 2

a system used to classify the presenting stage of cancer. It indicates the patient’s chance of survival and establishes disease status and patient prognosis. It influences treatment options as well.

Question 3

Who are members of the managemet team for HNC?

Answer 3

SLP, radiooncologist, surgeon, nurse, SW, a laryngectomee, respiratory therapist, psychologist, OT, PT, dentist, and ENT

Question 4

What are the medical approaches for laryngeal cancer?

Answer 4

Radiation therapy, chemotherapy, clinical trials, and surgery

Question 5

What are the signs and symptoms of laryngeal cancer?

Answer 5

Chronic bad breath; fatigue; ear pain; trouble breathing; noisy breathing; lump in throat; enlarged lymph node; weight loss; trouble swallowing; sore throat all the time, hoarseness or change in voice

Question 6

What are the surgical options for laryngeal cancer?

Answer 6

composite resection (remove the lining of a part of the laryngeal space; more common with oral cancer); total laryngectomy; partial laryngectomy (cordectomy or removal of vocal cords; supraglottic laryngectomy (; vertical hemilaryngectomy (removal of half or a portion of the larynx); subtotal or supracricoid laryngectomy (removal of 1/2 of the larynx in the vertical direction and a portion from the contralateral side)

Question 7

What is supraglottic laryngectomy?

Answer 7

partial laryngectomy in which removal of parts above the epiglottis, such as epiglottis, pre-epiglottis, and ventricular folds, and may include the hyoid bone; trach tube and NG tube are placed; larynx may be tied to the tongue base to keep it suspended)

Question 8

What is the most common cancer of the upper aeroesophageal tract?

Answer 8

Squamous cell carcinoma cancer

Question 9

What are the goals of tx of laryngeal cancer?

Answer 9

to get rid of the cancer, to make sure the physiology of the larynx still works, and to make sure the person is comfortable with how they look.

Question 10

What are the post-treatment complications related to laryngeal cancer?

Answer 10

loss of upper body strength; aspiration pneumonia, swelling of throat and neck; limited mobility of neck and shoulders; increased or decreased mucus production, psychosocial trauma from surgeries and oher therapies

Question 11

What are other post treatment complications related to laryngeal cancer?

Answer 11

chronic pain; stoma stenosis; osteoradionecrosis; chondroradionecrosis; tissue fibrosis (hardening of tissue); trouble breathing

Question 12

What are the primary medical outcomes?

Answer 12

survival rate (Depends on the presenting stage of cancer); ability of the larynx to function (depends on which part of it was sectioned); pt’s view of their quality of life.

Question 13

What are psychosocial considerations for HNC pts?

Answer 13

financial stress, emotional stress, pain anxiety, depression, acceptability, substance abuse, altered body image, decreased self-esteem, quality of relationships, isolation, fear of recurrence, loss of jobs/economic impact, sexuality, fatigue

Question 14

What are alaryngeal modes of speech?

Answer 14

electrolarynx, tracheoesophageal speech, esophageal speech

Question 15

What is an electrolarynx?

Answer 15

one way to produce speech in lieu of a larynx by vibrating the neck or mouth

Question 16

What are the pros and cons of using an electrolarynx?

Answer 16

Pros: easy to use; can control loudness and pitch; has good intelligibility; electric
Cons: costly (both the device and batteries), requires good articulation skills, voice sounds electric, practice is needed.

Question 17

What is esophageal speech?

Answer 17

esophagus is the source of voice for speech; air is trapped in the PE segment of the UES, causing vibration

Question 18

What are the pros and cons of esophageal speech?

Answer 18

Pros: no electric sound; no outside device needed
Cons: hard to use in noisy places; is not loud enough in noisy places; need excellent articulation skills; hard to learn

Question 19

What is tracheoesophageal speech?

Answer 19

surgical fistula (Tracheoesophageal puncture) is placed between the trachea and esophagus; the air travels from the lungs through the shunt and into the PE segment; the pt must block the stoma with their finger

Question 20

What are the pros and cons of tracheoesophageal speech?

Answer 20

Pros: no external device, easy to learn, flexible loudness and pitch, smooth and fluent across long phrases
Cons: TEP may need to be performed surgically if it was not main procedure; patient must be cognitively sound and dexterous; aspiration may occur due to a poorly placed valve

Question 21

List the different types of clefts.

Answer 21

Cleft lip: isolated unilateral and bilateral; microform; incomplete or complete unilateral or bilateral
Cleft palate: Bifid uvula, submucosal cleft palate, incomple and complete unilateral or bilateral CP
Cleft lip and CP: Unilateral/bilateral CL and CP and alveolar palate; Unilateral/bilateral CL and full palate