Head and Neck Cancer Flashcards
What percentage of head and neck cancers are squamous cell?
90%
Risk level for head and neck cancer depends on: (4)
- Daily consumption
- Type
- Toxicity
- Manner of tobacco use
Multidisciplinary team
performs and determines the results of imaging including MRI, CT scans, or ultrasound for the diagnosis or post-treatment assessments
Radiologist/Nuclear Medicine Specialist
an approach where radiation is administered alone as a curative method (chemotherapy does not apply)
Definitive
modified technique with removal of half of the larynx vertically and the upper half of the contralateral larynx, including the ventricle and upper margin of the vocal fold.
subtotal laryngectomy
therapeutic compensation
effortful focus on closing the vocal folds during non-phonatory or phonatory tasks
Vocal fold adduction exercises
- Involves surgically creating a small puncture through the posterior tracheal wall into the esophagus. A small one-way valve (prosthesis) is inserted into the puncture in order to prevent its spontaneous closure and prevent the aspiration of pharyngoesophageal contents into the trachea
Tracheoesophageal Puncture (TEP)
arises from the leanocytic system of the skin or other organs
melanoma
Factors affecting post laryngectomy mode of communication selection
- age
- cognitive status
- motor coordination
- personal preferences
a type of laryngectomy designed with speech reconstruction in mind
- this surgery typically includes removal of the supraglottic structures including the true and false vocal folds, and the thyroid cartilage including the paraglottic and pre-epiglottic spaces
Supracricoid laryngectomy
morbid conditions following the consequences of idsease and could include pain, bleeding, ulcerations to mucosa, bone damage, permanent damage to salivary galnds, chewing difficulty, and/or dysphagia
Sequelae
tracheoesophageal speech advantages (3)
- more natural speech
- improved intelligibility
- greater sound duration
- The entire larynx is removed
- the hyoid bone is cut from the suprahyoid musculature
- thyroid and cricoid cartilages are removed from the pharyngeal muscles and trachea
- communication is dependent on alaryngeal speech modes
Total laryngectomy
develops in the glandular lining of an organ
adenocarcinoma
Artificial larynx advantages (4)
- fast and easy way to communicate after surgery
- can be used as a backup to another means of communicating
- battery operated
- volume and pitch control features
Voice pathologist’s involvement in electromechanical speech
- selects the most appropriate device
- teaches basic use/care
- assess for neck placement post-healing
- trains the patient to use the device in all communicative settings
removal of one ventrical half of the larynx including one false vocal fold, ventricle, true vocal fold, and portion of the thyroid cartilage on the involved side.
hemilaryngectomy
Laryngectomy types (5)
- Total laryngectomy
- Partial laryngectomies
- hemilaryngectomy
- supraglottal laryngectomy
- supracricoid laryngectomy
- subtotal laryngectomy
Multidisciplinary team
performs any reconstructive surgery that may be necessary after the cancer treatment to lessen the appearance of scarring or removal of structures
Plastic Surgeon
Post-laryngectomy communication options (3)
- Artificial/electromechanical
- esophageal
- prosthetic
Multidisciplinary Team
studies the stages of the tumor development and the potential involvement of the surrounding tissues or structures
Radiation Oncologist
Multidisciplinary team
makes replacements for removed teeth or other oral cavity structures helps in restoring the patient’s comfort, health and appearance
Dental/maxillofacial prosthodontist
Multidisciplinary team
a person who has experienced the patient’s situation (or similar) and has adjusted well to it
Laryngectomized Visitor
Laryngectomy post surgical counseling
- Readdress psychosocial issues
- encourage participation in support groups
- facilitate socialization
- assist in the emotional recovery
- teach modes of speech
Artificial larynx disadvantages (4)
- monopitch/metallic sound
- requires clear articulation skills
- hand-held device
- difficult to use with telephone
Multidisciplinary Team
examines any tissue that has been removed during the patient’s course of treatment to evaluate it for abnormalities
Pathologist
Tracheo-esophageal speech (TEP) Disadvantages
- requires a good seal around the perimeter of the stoma
- requires ability to maintain prosthesis
- costly: some equipment needs to be replaced daily
Multidisciplinary team
part of the health care team for postoperative management of medical comorbidities, such as heart disease, diabetes, and high blood pressure
Internal medicine
usually part of or all of the hyoid and epiglottis, aryepiglottic folds, and false vocal folds are removed
Supraglottic laryngectomy
Multidisciplinary team
provides counseling to the patient or family to help them cope with issues
Mental health counselor/ social worker/ case manager
- a method to warm and filter air via the stoma
- involve use of disposable filter cassette that attaches to the stoma with an adhesive base plate, laryngectomy button, or laryngectomy tube
- heat and moisture will be absorbed by the filtering mechanism and transferred back to the incoming air
- Uses increases in the air temperature and the humidity of air entering the body therebypromoting function of cilia in the lungs
HME
Heat and moisture exchange system
therapeutic compensation
this helps by pushing the epiglottis posteriorly, narrowing the airway entrance
chin down technique
Multidisciplinary Team
administers chemotherapeutic agents, often used in conjunction with radiation therapy in later stage tumor
Medical Oncologist
Multidisciplinary team
diagnoses the disease and organizes the treatment plan including the medical management of the condition
Head and neck surgeon
Multidisciplinary team
evaluates and provides treatment for head and neck cancer patients with short-term and long-term communication needs
Voice Pathologist
energy in the form of waves or moving subatomic particles emitted by an atom or other body as it changes from a higher energy state to a lower energy state
Radiation
removing part or all of the vocal folds; it can be used to treat very limited or superficial glottic cancers
cordectomy
therapeutic compensation
rotation to the operated side is used to achieve airway closure; this may be combined with a chin down technique
head rotation technique
- Can be produced when the individual transports a small amount (±75 mL) of air from the oral and pharyngeal cavity into the esophagus
- The air is redirected back past the PE segment to force vibration of the tissue
- Rapid repetition of the air transport can ultimately produce intelligible esophageal speech
- The patient then forms this sound into words with the tongue, lips, teeth, and palate
Esophageal speech
Role of voice pathologist in total laryngectomy (3)
- presurgical counseling
- postsurgical counseling and management
- offering modes of communication following total laryngectomy
Multidisciplinary team
evaluates the patient’s nutritional health prior to and following surgery, radiation, or other intensive treatments
Registered Dietitian
an approach which typically follows surgery and enhances the outcome response
Adjuvant
- begins in cells of the immune system
- many subtypes
Lymphoma
Staging of head and neck cancers
Tumor (T)
extent of primary tumor
Multidisciplinary team
works to restore movement or skills that have been impaired due to surgery
Physical/Occupational Therapist
Post radiation symptoms (5)
- dental loss
- dysphagia
- dysphonia
- edema
- fatigue
Two types of TEP prostheses
- Non-Indwelling
- Indwelling
treatment of a disease by chemicals that kill cells, specifically those of microorganisms or cancer
Chemotherapy
head and neck cancers account for what percentage of new cases of cancer in the United States?
3%
arises from connective tissue
sarcoma
Esophageal speech advantages
- no devices are needed to produce speech
- it is possible to produce a normal sounding voice
Role of SLP during organ preservation protocols (4)
- perform clinical eval of speech, voice, and swallowing pre-chemo
- patient counseling
- provide patient with swallow rehab plan and vocal hygiene protocol to minimize side-effects
- minimize long term effects on speech and swallowing
Esophageal speech disadvantages (4)
- low pitch sound derived rom a controlled belch or burp
- difficult to learn
- articulation must be clear
- reduced length of utterance
Staging of head and neck cancers
Nodal disease (N)
lymphatic spread; regional metastasis
Laryngectomy pre-surgical counseling
- typically conducted two weeks prior to the scheduled surgery date
- psychosocial issues are addressed
- description of possible swallowing deficits and alterations in anatomy
- practice with alternative modes of communication
- baseline measures are taken for speech, voice, and swallowing
Treatment options for head and neck cancers (4)
- Definitive
- concommitant
- adjuvant
- organ preservation
Multidisciplinary team
provides personnel care for the patient in all phases of inpatient diagnosis and treatment, and are often involved in case coordination in the outpatient setting
Nurse
Multidisciplinary team
evaluates, treats, and cares for breathing or respiratory disorders
Respiratory Therapist
