Head and Neck Cancer Flashcards
Tumor Classification
TNM system. Numbers used to categorize tumors.
What is the “T” in TNM
tumor size and extension into neighboring tissue.
What is the “N” in TNM
nodes. How far or if cancer spread into lymph nodes
What is the M in TNM
Spread of cancer to other organ systems within the body
What is typical course of treatment
surgery.
When does speech and swallow therapy begin after surgery?
10-14 days post
When does Radiation and Chemo begin?
4-6 weeks post.
When do functions begin to deteriorate during radiation?
Swallowing function dleclines 4 weeks in. Overall health also declines. Many drop out at this time. HOME PROGRAMS IMPORTANT HERE BECAUSE EVEN IF TOO SICK TO COME TO THERAPY CAN DO SOME THINGS AT HOME. Then can come back when feel better.
What is important in pre-tretment counseling
Establish baseline of function.
Preliminary swallow screen of VFSS for pre and post surgery comparison.
Dental consultation for removing parts of jaw or teeth.
Psychosocial assessment- assess how well will adjust after surgery.
What’s the purpose of pre-treatment counsleing
Reduce patient and families fear
Don’t try to provide exact details of post-treatment function.
Explain speech and swallowing impact
Assure them the team will be avilable to improve post treatment function
Explain patient will be responsible for their own rehab
When does post treatment intervention start
2-3 days post.
PRovide counseling to patient and family.
1-2 weeks post: healing is progressing so re-evaluate patient and begin rehab
How do we do a swallow re-ealuation
VFSS
Continue rehab through radiation therapy. IF too sick encourage ROM excercises as much as possible.
What’s a primary closure
soft tissues remaining in the area sutured together to cloe defect.
Used with small resections.
Can’t be used if natural tension in tissues would be too great, which would reopen wound
What’s a Flap Reconstruction
Tissue elevated away from its normal site.
One portion attached to donor site, so blood flow to flap until healing is complete
Other portion is attached to the defect area.
What is a graft?
usually from a part of your body that can easily grow skin.
move tissue from distal part of body to oral cavity.
Attaceh arteries and veins in donor tissue to arteries and veins in defect area to provide blood supply.
What is Post-treatment surgery dependent on
surgical site and extent of surgery and type of resection.
primary closure=best function
What do we need to read if we’re treating patients who’ve had surgery
detailed description of surgery and resection, include exact structures were involved. In surgical report in patient chart!
What is a partial glossectomy?
removal of <50% of tongue.
Difficulty with bolus hold and prep for swallow
What is a partial glossectomy?
removal of <50% of tongue.
Difficulty with bolus hold and prep for swallow
What is total glossectomy?
remove >50% of tongue.
Difficulty moving material from oral caity.
Reduced tongue driving force
REduced pharyngeal clearance
What happens with Anterior/Lateral Floor of Mouth Resection?
reduced anteriror tongue range
inability to lateralize tongue
REDUCED HYOLARYNGEAL excursion
Reduced UES opening
What’s a palatal resection?
Remove >50% of soft palate
incomplete VP closure=nasal regurtitation
What does a base of tongue resection impact?
difficulty with bolus control, reduced driving force for bolus (tongue base retraction)
Delayed swallow trigger
What’s a supraglottic laryngectomy (horizontal laryngectomy) used for?
Small lesions involving supraglottic structures; epiglottis, aryepiglottic folds, ventricular folds
Remove all/part of: hyoid, epiglottis, aryepiglottic folds and false v folds.
NO VALLECULAE, SMALL PYRIFORM SINUS
What surgery is done if cancer extends below the false folds?
Sill only take 1/2 laryngeal ventricle and not touch vocal folds.
Can be extended to include base of tongue.
Can be extended down to include part of one vocal fold.
What is the reconstruction life if the cancer extends below the false folds?
Remaining laryngeal structures are raised and tucked under tongue base.
Treatment for supraglottic laryngectomies
If not cognitively able to learn a sequence of instructions, should not receive a supraglottic laryngectomy
When is hemi laryngectomy
take right or left side of larynx to treat unilateral tumors in larnyx. Vertical laryngectomy
What is removed during hemi laryngectomy?
remove 1/2 larynx vertically. False fold, thyroid cartilage. Leave arytenoid cartilage, hyoid, epigltottis
What is reconstruction like after hemi-laryngectomy?
tissue bulk reconstrcuted using strap muscles so intact side can impact reconstruction to provide airway closure. Usually few swallowing problems.
Treatment strategies for Hemilaryngectomies
Chin down- pushes epiglottis posterior and protect airway more
Chin down with head reotation to damaged side
May only need to use these during first few weeks post s
Treatment strategies for Hemilaryngectomies
Chin down- pushes epiglottis posterior and protect airway more
Chin down with head reotation to damaged side
MAy only need to use these during first few weeks post op
What’s swallowing like post hemilaryngectomy
Don’t aspirate since airway separated from GI tract.
If not eating pre-surgerly level within 2 mos of surgerey, do VFSS
If eating fine and number of years later, has onset of dysphagia, refer back to surgeon. Cancer may have come back
What are some pseudoepiglottic problems?
After hemilaryngectomy. Pseudoepiglottis is fold of tissue at tongue base.
Due to surgical reconstrction.
Must be examined durign swalowing since contraction of pharyngeal constrictors causes pocket to enlarge allowing food to collect.
CAn prevent materaial from making it into esophagus.
How is pseudoepiglottis treated
surgical removal
What are complications of scar tissue strictues following total laryngectomy?
narrows esophagus, preventic large or thick material from getting into esophagus.
Dilation-needs to be repeated regulalry
Pharyngealesophageal myotomy-cut muscles of cricopharngeus to release stricture
What are swallowing problems that can occur when a pharyngectomy or esophagectomy were performed and reconstructed with a distal flap, stomach pull up or jejunal grafy?
food may flow back into mouth and nose
Treat with head rotation or neck extension postures.
What are complications of radiation?
fibrosis photosensitivity mucositis reduced taste intraoral sensory loss xerostomia trismus
What is mucositis
inflmattion of mucus membranes. (mouth pharynx, larynx, esophagus, entire GI tract covered in them)
What is effect of mucositis?
Incredibly painful, so stop eating and drinking.
How to treat mucositis?
Reduce radiation dose. If severe enough, may have to stop radiation treatment.
What is Trismus
tonic contraction of muscles of mastication.
Treat with digital massage and ROM excercises
What is the trajectory of dysphagia over time following radiation?
Swallow problems can contineu to develop over months and years after radiation due to fibrosis.
Treat with ROM excercises for jaw, tongue, lanrynx before beginning radiation. Continue them during and after radiation.
May need to do them for rest of life.
What is fibrosis?
Scarring on skin or oral tissues. Caused by damage to small blood vessels in field of radiation,
muscle fiber changes to connective tissue,
can continue to happen even years after radiation complete,
more present in chemoradiaton than radiation alone
What does fibrosis do?
reduce ROM of tongue and jaw.
If pharynx radiated, reduced pharyngeal contraction, tongue base retraction, laryngeal elevation
How to treat fibrosis?
Treat with swallow maneuvers
What is photosensitivity
if the treatment is close to the eyes can cause blurred vision, pain in the eyes, cataracts
Treatment for photosensitivity
Can use preservative-free tears
What is swallowing function after supraglottic laryngectomies?
Learn to close airway by retracting tongue base to touch arytenoid cartilage as it tips forward.
Reduced laryngeal elevation since part/all of hyoid removed.
Reduced sensation
Reduced cough reflex due to SLN damage
