Lecture 7 Additional Etiologies Flashcards
Cancer
•______leading cause of death in the USA
•_____of all men and ______of all women will have some form of cancer.
•Cell growth that is…
.
•Risk factors for head and neck cancer:
Second
Half; 1/3
Out of control
- TOBACCO USE
- HEAVY ALCOHOL USE
- POOR ORAL HYGIENE
- MECHANICAL IRRITATION
Signs and Symptoms
(See Box 6-1 text)
•General warning signs of head & neck cancer:
- Unexplained weight loss
- Fever
- Fatigue
- Pain
Specific symptoms:
- Change in bowel or bladder function
- Sores that do not heal
- Unusual bleeding or discharge
- Thickening or a lump
- Indigestion or difficulty swallowing
- Change in a mole or wart
- Nagging cough or hoarseness
Head and Neck Cancer Treatment Team Members
- Head and Neck surgeon
- Radiation oncologist
- Medical oncologist
- Dentist
- Prosthedontist
- Social worker
- Nutritionist
- Rehabilitation specialists
- Speech-Language Pathologist
- Occupational Therapist
- Physical Therapist
Defining Cancers
(Box 6-4 of Text)
- Benign or malignant
- TNM
- Tumor:
- Nodes:
- Metastasis:
- size of the tumor 0-4
1. Tumor is 2cm or less
2. Tumor is more than 2cm but less than 4cm
3. Tumor is more than 4 cm
4. Tumor invades adjacent structures - lymph nodes involved 0-3
1. Single ipsilateral lymph node. 3cm or less
2. More than 3cm but less than 6 cm
3. Greater than 6cm
spreading 0-1
- No distant metastasis
- Distant metastasis
Surgical treatments:
- Laser surgery:
- Laryngectomy:
- Partial laryngectomy:
- Laryngopharyngectomy:
- Tracheostomy:
- Gastrostomy:
- Neck Dissection:
- Reconstructive surgery:
Laser surgery: using a narrow intense beam of light to remove cancer
Laryngectomy: removal of the entire larynx
Partial laryngectomy: removal of part of the larynx: supraglottic, hemilaryngectomy, supracricoid, vocal cord
Laryngopharyngectomy: removal of larynx and pharynx
Tracheostomy: making a hole in the anterior neck (stoma) into the trachea to establish an airway.
Gastronomy: creating a fistula into the stomach by way of the abdominal wall; often used to place a feeding tube
Neck dissection: removal of lymph nodes and other tissue in the neck considered at risk for metastatic disease
Reconstructive surgery: any surgery that attempts to replace missing anatomy to improve function and/or appearance
Radiation Therapy
- High-energy x-rays to…
- Different types:
- External-beam radiation:
- Intensity-modulated radiation –
- Hyperfractionation:
- internal radiation therapy
to kill cancer cells and shrink tumor.
One-daily, high-beam hits tumor and surrounding tissue
Hits just the tumor
Small dose several times a day
Or brachytherapy. Implanting small pellets or rods containing radioactive material into the cancer or near the cancer site.
Side effects of radiation therapy:
- Redness skin irritation
- Salivary glands change
- Bone pain
- Nausea and vomiting
- Fatigue
- Mouth sores or sore throat
- Dental problems Painful swallowing
- Loss of appetite
Chemo-therapy
- Using ____ to kill cancer cells
- Often have side effects (Box 6-9, page 106):
Drugs
- Fatigue
- Nausea and vomiting
- Hair loss
- Dry mouth
- Loss of appetite
- Reduced sense of taste
- Weakened immune system
- Diarrhea and/or constipation
- Open sores in the mouth/ infection
Surgical management of Head/Neck Cancer
(See Table 6-1, page 107)
- “Majority of head and neck cancer patients have some _____ from cancer or treatments.”
- Glossectomy:
- Palatal resection:
- Anterior/floor of mouth:
- Partial pharyngeal resection:
- Hemilaryngectomy:
- Supraglottic laryngectomy:
- Total laryngectomy:
Dysphagia
Glossectomy: removal of more than 50% of the tongue
Palatial resection: removal of more than 50% of the soft palate. Incomplete velar seal.
Anterior/lateral floor of mouth: reduced anterior tongue range. Unable to lateralize tongue.
Partial pharyngeal restriction: reduced pharyngeal wall constriction; delay in the triggering of the swallow
Hemilaryngectomy: unilateral resection, partial airway closure; reduced airway protection
Supraglottic laryngectomy: incomplete posterior tongue movement; delay in bolts propulsion
Total laryngectomy: removal of vibratory source; bolus transport
Effects of Radiation Therapy
(Box 6-10):
- Mucositis
- Xerostomia
- Sensory Changes in taste and smell
- Fibrosis
- Neuropathy
- Stricture
- Odynophagia
- Loss of appetite
- Edema
- Infection
- Dental Changes
Esophageal Disorders
- Not the role of the SLP to treat esophageal dysphagia—refer to _______
- BUT…if problems ________falls within our area of expertise.
- More common for SLP to ________
- Differential Diagnosis: Figure 7-9, pg. 139
gastroenterologist
impact other swallowing issues, (e.g. GERD)
screen esophogeal dysphagia.
Esophageal Disorders
- Esophageal Stenosis- lumen narrows
- Malignant strictures
- Rings and Webs
- Benign Stricture
- Esophageal Diverticulum
- Drug or pill esophagitis
- Gastro-esophageal Reflux Disease (GERD)
- Infections
- Trauma-TE Fistula
- Acute chemical ingestion
- Radiation
- Skin conditions
- Motility disorders
- Zenker’s Diverticulum
Gastroesophageal Reflux Disease
NERD:
tSLERs
- Non-erosive gastroesophageal reflux disease (NERD)
* Transient lower esophageal sphinctor relaxations (tSLERs)
Indications for Artificial Airway
- Upper Airway Obstruction
- Loss or impairment of airway protective reflexes
- Inability to maintain clearance of bronchial secretions
- Need for mechanical ventilatory support
Artificial Airways
- Nasopharyngeal Airway
- Oropharyngeal Airway
- Endotracheal Tube
- Tracheostomy Tube
Complications of Intubation
•Complications can occur during or following intubation as well as a result of ______
Extubation
- Nasal, oral, pharyngeal injuries
- Laryngeal injury
- Subglottic edema
- Tracheal injury
- Laryngospasm
- Reduction in mucociliary transport
Tracheostomy Tubes
- Cricothyroidotomy:Surgical incision directly…
- typically done emergently in cases of
into the anterior aspect of the larynx at the junction of the thyroid and cricoid cartilages
severe airway obstruction; faster procedure “in the field”
Tracheotomy / Tracheostomy
______ is the procedure
_________is the opening
- surgical incision directly into the anterior aspect of the…
- occupies only ____of tracheal space
Tracheotomy
Tracheostomy
trachea through the second or third tracheal ring
2/3
Advantages of Tracheostomy Tubes
- Pulmonary toilet
- Facilitates weaning from mechanical ventilator
- Decreased risk of laryngotracheal injury
- PO nutrition delivery possible
- Options for oral communication
- Improved oral hygiene
- Increased patient comfort
•Disadvantages of Tracheostomy Tubes
- Possible complications: hemorrhage, thyroid injury, laryngeal nerve injury, tracheal stenosis, tracheal granulation, infection, tracheoesophageal fistula, tracheomalacia, pneumothorax, tube obstruction
- Reduced cough efficiency
- Diminished taste & smell
- Dysphagia
- Increased secretions
Why Reduced Cough
- Irritation
- Inspiration
- Compression (intercostals/abdominals)
- Expulsion
- Loss of ability to build-up subglottic pressure = limited expulsion force
Why Diminished Taste & Smell?
- On expiration, air will take___________(tracheostomy tube)
- Thereby reducing…. (nose and mouth)
- Thereby reducing ____
- ~ ___% of taste is dependent upon smell (orthonasal & retronasal)
- Decreased senses of smell and taste = decreased appetite = decreased nutrition = decreased healing!
The path of least resistance
Airflow to the upper airway
Smell
90%
