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350-T2 > Head and Neck cancers > Flashcards

Head and Neck cancers Flashcards

1
Q

Erythroplakia

A

Pre-malignant condition with red patch or plaque that cannot be rubbed off and cannot be characterized clinically as another disease

Red color due to vascular submucosal tissue shining through under-keratinized mucosa

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2
Q

Erythroplakia is how many times more likely malignant than Leukoplakia

A

17

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3
Q

Treatment/Intervention for Erythroplakia

A

Excision biopsy

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4
Q

Leukoplakia

A

white mouth lesions

can be cancerous or pre cancerous

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5
Q

Head and neck cancers are typically what type of cancer

A

Squamous cell carcinoma

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6
Q

Categories of Head and Neck Cancer

A

• paranasal sinuses, oral cavity, nasopharynx, oropharynx, and larynx
(Oral, pharynx, and larynx cancers

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7
Q

At what stage are head and neck cancers usually diagnosed

A

advanced - further debilitating with treatment

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8
Q

RISK FACTORS for head and neck cancers

A
  • 85% caused by tobacco
  • Alcohol use
  • Advanced age (50 or greater); Males
  • Younger than 50: associated with HPV
  • Poor oral hygiene
  • Sun exposure
  • Occupational exposure: asbestos, cement dust
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9
Q

CLINICAL MANIFESTATIONS of head and neck cancer

A
  • Vary with location of tumor
  • Non-specific: sore throat; sore mouth (does not get better); burning when drinking hot liquids or orange juice
  • Voice changes; lump in throat; enlarged cervical lymph nodes
  • Hoarseness more than 2 weeks
  • Leukoplakia (white patch) or erythroplakia (fiery red patch) on mouth or tongue
  • Ulcer that do not heal: lip or tongue with thickening
  • Change in fit of dentures

LATE:
• Coughing up blood; Increased salivation
• Slurred speech
• Dysphagia; difficulty moving tongue or jaw
• Swelling of neck; toothache; earache
• Difficulty breathing; partially or fully airway obstruction

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10
Q

DIAGNOSTIC STUDIES FOR HEAD AND NECK CANCER

A
  • Early detection – key to survival
  • History and physical examination
  • Pharyngoscopy or laryngoscopy
  • Endoscopy
  • Chest x-ray
  • Barium swallow
  • Biopsy
  • TNM staging
  • Oral exfoliative cytology
  • Toluidine blue test
  • CT; MRI; position emission tomography (PET)
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11
Q

TREATMENT OF HEAD AND NECK CANCER

A
  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Target therapy
  • Combination of modalities
  • Considerations: location of tumor, TNM stage, age and overall health, urgency, residual from treatment
  • Patient’s choice
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12
Q

Two types of oral cancer

A

• Oral cavity cancer (develops in the mouth)

Oropharyngeal cancer (develops in throat just beyond the mouth)

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13
Q

TREATMENT OF ORAL CANCER

A
  • Partial mandibulectomy
  • Hemi glossectomy; glossectomy
  • Resections of buccal mucosa and of the floor of mouth;
  • Radical neck dissection: removal of primary lesion, lymph nodes, sternocleidomastoid muscle, internal jugular vein, mandible, submaxillary gland, spinal accessory nerve: may involve removal of mandible, submaxillary gland, patient of thyroid and parathyroid)
  • Radiation
  • Chemotherapy
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14
Q

LARYNX CANCER

A

• Most common upper respiratory malignancy
• Subglottic: involves the epiglottis and false cords; likely to produce no symptoms until advanced
Glottic – effects true vocal cords; occurs most frequently; produces early symptoms

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15
Q

TREATMENT OF LARYNX CANCER

A

Radation

chemotherapy/targeted therapy

Surgery

  • partial laryngectomy
  • total laryngectomy
  • Radial neck dissection
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16
Q

Radiation therapy as used for laryngeal cancer

A

elective for localized disease, affecting only on vocal cord or combination therapy

17
Q

Chemotherapy/targeted therapy

A

adjunct therapy to help shrink tumor or stages III, IV or combination therapy

18
Q

Three types of surgical interventions for Laryngeal cancer

A
  • Partial laryngectomy – removal of lesion on true cord on one side (with adjoining tissue); early glottis lesions; patient able to talk and have normal airway
  • Total laryngectomy – removal of entire larynx, hyoid bone, pre-epiglottic space, cricoid cartilage, and 3-4 rings of trachea
  • Radial neck dissection – in addition to total laryngectomy; performed when metastasis from larynx is suspected
19
Q

NURSING MANAGEMENT GOALS: of radical neck surgery

A
  • Maintain airway
  • Communication
  • Adequate nutrition
  • Pain management
  • Oral hygiene
  • Psychological health
20
Q

Pre-op care and teaching for airway surgery (laryngeal cancer reconstruction)

A
  • Suctioning
  • Humidification
  • Cough and deep breathing
  • IV fluids
  • Nasogastric tube feeding
  • Tracheostomy or laryngectomy tube
  • Loss of speech;, breathing patterns, and sense of smell
  • Modes of post-op communication – initially post-op (Magic Slates, communication boards, pictures, gestures)
  • Modes of long-term communication - esophageal speech, artificial larynx
21
Q

post-op care and teaching (neck reconstruction surgeries)

A
  • Comfort/pain management
  • Wound care
  • Management of nasogastric tube, if present
  • Advancing diet; nutritional teaching and consult
  • Care of gastrostomy tube, if present
  • Airway management; HOB up
  • Suctioning; humidification
  • Cough and deep breathing
  • Frequent vital signs; risk for hemorrhage
  • Care of dressings, drain, or skin flaps
  • Emphasize oral hygiene
  • Communication methods; devices; speech therapy; reconstruction
  • Home humidification
  • Cough and deep breathing
  • Nutritional teaching for home
  • Smoking sensation; alcohol treatment
  • Teach care at home; involve care giver or family
  • Medic bracelet
  • Electric razor
  • Install smoke and CO2 protectors
  • Stoma care; bathing, couching,
  • Tracheostomy or laryngectomy tube
22
Q

NURSING MANAGEMENT —-RADIATION THERAPY FOR HEAD AND NECK CANCERS

A
  • Dry mouth (xerostomia)
  • Artificial saliva; pilocarpine hydrochloride (Salagen)
  • Sugarless gum; sugarless candies; salt and baking soda rinses
  • Care during treatments (bite blocks, mouth guards, gauze pads
  • Oral mucositis care
  • Management of other side effects
23
Q

NURSING MANAGEMENT —-CHEMOTHERAPY FOR HEAD AND NECK CANCERS:

management of side effects

A

find this stuff in saunders book??

350-T2 (2 decks)

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