Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin 2 > Head and neck cancer > Flashcards

Head and neck cancer Flashcards

1
Q

What are most type of cancer cells?

A

squamous cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for H&N cancer?

A
  • tobacco
  • alcohol
  • HPV 16
  • weed
  • betel nut chewing (south asia)
  • poor oral hygiene/ ill fitting dentures
  • epstein-barr virus infection
  • environmental or occupational inhalants
  • prolonged sunlight exposure
  • pre-cancerous lesions
  • radiation exposure
  • ancestry/ethnicity
  • diet (intake of preserved/salted foods during childhood)
  • mate (a tea like beverage in SA)
  • GERD
  • weak immune system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the TNM system? (what does it stand for)

A

It’s a staging cancer to determine where it is and the severity:
T: size and extent of the tumour
N: whether cancer cells have spread to nearby lymph nodes and to what extent
M: whether distant metastasis has occured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 4 possible treatments of H&N cancer?

A
  • surgery
  • radiation therapy
  • chemotherapy/immunotherapy
  • research protocols
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 2 tests for swallowing function?

A
  1. MBS/VFSS

2. FEES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 2 things that dysphagia can be associated with?

A

penetration and aspiration (could be silent aspiration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does H&N cancer cause dysphagia?

A
  • disruption of normal anatomy
  • nerve involvement (infiltration of the cranial nerves resulting in reduced sensation and motor function
  • tumour induced pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the symptoms of dysphagia in H&N cancer patients?

A
  • odynophagia/otalgia
  • sensation of food/something caught in throat
  • trismus
  • coughing/choking/gagging when eating
  • drooling/hypersalivation
  • inability to wear dentures
  • difficulty chewing/moving food in mouth
  • inability to control food, liquids or saliva
  • presence of food residue in oral cavity
  • nasal regurgitation of liquids/food
  • need to take time to eat/slow pace
  • need to cut food up into small particle sizes
  • need to drink more with meals to clear food residue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the interventions prior to treatment? (give 6 recommendations)

A
  • may need to be NPO
  • may need EN
  • may be able to continue oral diet
  • may need modifications to facilitate intake/reduce risk of aspiration

Recommendations:

  • high protein, high energy diet with ONS
  • small frequent meals
  • modify food textures/liquid consistencies
  • avoid problematic foods (dry, fibrous, etc)
  • increase moisture content of foods
  • introduce compensatory techniques
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some examples of compensatory techniques?

A
  • short straw and long spoons
  • take time to eat/cut foods in small pieces
  • place food in mouth in a way to bypass the tumour
  • chin tuck, down posture, turn head to affected side
  • effortful swallow, supraglottic swallow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is decannulation?

A

the removal of tracheostomy and closure of opening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a TEP and TEP prothesis?

A

TEP: a fistula between the trachea and esophagus for voice restauration

TEP prothesis: a valve into TEP to keep food out of the trachea but still allows for speech as air can pass by

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the stoma vent?

A

a tube to keep the stoma open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 2 indications for tracheostomy?

A
  1. to bypass an upper airway obstruction due to:
    - tumour obstructing air passage into lungs
    - soft tissue edema due to radiation
    - bilateral vocal cord paralysis in the closed
  2. Prophylactic insertion at time of OR because expect extensive edema of upper respiratory tract and to ensure adequate pulmonary secretions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the impacts of tracheostomy on swallowing?

A
  • increased saliva production
  • decreased mobility of tongue
  • reduced elevation of larynx
  • disordered abductor and adductor laryngeal reflexes
  • desensitization of the oropharynx and larynx as a result of airflow diversion through the tracheostomy tube
  • altered cough mechanism
  • reduced subglottic air pressure
  • increased incidence of aspiration
  • restoring transglottic airflow and subglottic air pressure will improve swallowing function and reduce/eliminate aspiration
  • possible methods of occluding tube
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the passy-muir speaking valve?

A

it is a one-way valve which attaches to the outside opening of a tracheostomy tube and allows air to pass into the trachea but not out through it

  • exhaled air is directed upwards
  • allows for restoration of normal physiology
  • *DO NOT USE ON A TOTAL LARYNGECTOMY PATIENT
17
Q

What are the impacts of a total laryngectomy on swallowing?

A
  • respiration and deglutition are completely separated -> no risk of aspiration/choking, but food may still get stuck in the newly reconstructed pharynx (neopharynx)
  • aspiration may occur in TEP without prosthesis because there is just a fistula
  • interactions of muscular contraction and pressure generation involved are dramatically altered
  • oral tongue must work more to compensate
18
Q

Which surgeries don’t need extended NPO?

A 
parotidectomy
thyroidectomy
neck dissections - salivary gland transfers
TORS for diagnostic purposes
small lip or oral cavity resections
ear or minor sinus surgery
19
Q

In what cases is EN initiated post-op?

A
  • to bypass extensive soft tissue swelling of upper respiratory tract/temporary tracheostomy
  • to protect surgical anastomosis
  • due to presence of brachytherapy catheters
20
Q

What are the post-op nutrient recommendations?

A

E: MSJ x AF: 1.2-1.3 x SF: 1.3
Pro: 1.3g/kg
Fluids: 1500ml for first 20kg + 15ml for each additional kg

21
Q

What are the 9 factors affecting swallowing post-op?

A
  1. sites of the surgical resection
  2. extent of resection
  3. nature and extent of reconstructive surgery
  4. presence of tracheostomy
  5. post-op brachytherapy: results in edema of tongue
  6. post-op surgeries or radiation therapy to H&N region
  7. overall health prior and post-op
  8. cognitive and emotional state of patient
  9. pain
22
Q

What are the 3 benefits of MBS post-op?

A
  1. to better assess changes in anatomy and physiology of swallow, especially the pharyngeal phase
  2. evidence of penetration/aspiration
  3. to assess benefits of compensatory strategies
23
Q

What are the acute side effects of radiation therapy?

A
  • xerostomia
  • total alterations
  • changes in smell
  • changes in appetite
  • nausea/vomiting
  • reflux
  • increased secretions/thick viscous saliva
  • infections
  • trismus
  • mucositis/ulcerations
  • odynophagia
  • dysphagia
24
Q

Long term effects of XRT?

A
  • xerostomia
  • tasta alterations
  • dental cavities/poor oral health
  • osteoradionecrosis and soft tissue necrosis
  • lymphedema
  • thyroid problems
  • radiation myelopathy
  • vision changes/blindness
  • fibrosis
  • dysphagia
25
Q

What are the goals for the patient post-op? (related to nutritional intervention)

A
  • promote weight gain or maintain weight
  • optimize nutrition and hydration status
  • symptom management
  • promote oral nutrition to favour swallow preservation
  • modify textures and consistencies to facilitate intake and swallow and to prevent aspiration
26
Q

What are the nutritional interventions at the start of treatment?

A
  • conduct nutritional assessment and swallow evaluation
  • avoid alcohol and caffeine, spicy and irritating foods
  • increase fluid intake
  • discuss oral care guidelines and pain control
27
Q

What are the nutritional interventions during treatment?

A
  • need to monitor patients on a weekly basis
  • provide counselling based on the specific symptoms experienced
  • initiate oral nutrition support
  • may need EN to support ONS
  • patient may no longer be able to consume oral nutrition requiring full EN. If no PEG, NGT will be needed
28
Q

What are the nutritional interventions post-treatment?

A
  • follow ups to assess adequacy of intake/monitor weight and provide counselling for transition back to oral diet or progression of diet
  • patients will continue to have sensitivity to acidic and spicy foods as well as alcohol for a period of time
  • if patient was NPO, usually start with pureed foods and liquids
  • patient may be able to discontinue PEG but will require ONS
  • decision to remove PEG depends on ability to meet nutritional requirements with oral intake and medical status

Clin 2 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions