Head and Neck cancers Flashcards
Erythroplakia
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
Erythroplakia is how many times more likely malignant than Leukoplakia
17
Treatment/Intervention for Erythroplakia
Excision biopsy
Leukoplakia
white mouth lesions
can be cancerous or pre cancerous
Head and neck cancers are typically what type of cancer
Squamous cell carcinoma
Categories of Head and Neck Cancer
• paranasal sinuses, oral cavity, nasopharynx, oropharynx, and larynx
(Oral, pharynx, and larynx cancers
At what stage are head and neck cancers usually diagnosed
advanced - further debilitating with treatment
RISK FACTORS for head and neck cancers
- 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
CLINICAL MANIFESTATIONS of head and neck cancer
- 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
DIAGNOSTIC STUDIES FOR HEAD AND NECK CANCER
- 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)
TREATMENT OF HEAD AND NECK CANCER
- 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
Two types of oral cancer
• Oral cavity cancer (develops in the mouth)
Oropharyngeal cancer (develops in throat just beyond the mouth)
TREATMENT OF ORAL CANCER
- 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
LARYNX CANCER
• 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
TREATMENT OF LARYNX CANCER
Radation
chemotherapy/targeted therapy
Surgery
- partial laryngectomy
- total laryngectomy
- Radial neck dissection
Radiation therapy as used for laryngeal cancer
elective for localized disease, affecting only on vocal cord or combination therapy
Chemotherapy/targeted therapy
adjunct therapy to help shrink tumor or stages III, IV or combination therapy
Three types of surgical interventions for Laryngeal cancer
- 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
NURSING MANAGEMENT GOALS: of radical neck surgery
- Maintain airway
- Communication
- Adequate nutrition
- Pain management
- Oral hygiene
- Psychological health
Pre-op care and teaching for airway surgery (laryngeal cancer reconstruction)
- 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
post-op care and teaching (neck reconstruction surgeries)
- 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
NURSING MANAGEMENT —-RADIATION THERAPY FOR HEAD AND NECK CANCERS
- 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
NURSING MANAGEMENT —-CHEMOTHERAPY FOR HEAD AND NECK CANCERS:
management of side effects
find this stuff in saunders book??
