Module 10 Flashcards
National cancer Institute - COVID
people with blood cancers may be at higher risk of ? and ? from covid than people with solid tumors. That is because people with blood cancers often have abnormal or depleted levels of ?
NCI is conducting a large study of people with cancer who have COVID to learn more about the ? and to help doctors better manage treatment for people with ?
if you had cancer in the past you may also be at higher risk for ?
prolonged infection / death
-immune cells that produce antibodies against the virus
risk factors for covid/ cancer and covid
severe covid
patients with cancer were… included in initial vaccine trials
nearly half the patients with blood cancers did not produce ?
the findings confirm what we have suspected all along which is that immunocompromised people aren’t going to have the same ?
patients in the study had ? leumkemia, lymphomas, multiple myeloma, and other ?
those with B-cell chronic lymphocytic leukemia were the least likely to ?
not
detectable antibodies to the SARS-CoV2 spike protein
immune responses to covid vaccines
B-cell chronic lymphocytic
respond to the vaccine
Changes in cancer patient care:
less ? less ? endoscopy: - - - ...
in-person follow-up visits for cancer surveillance
assessments completed for cancer surveillance during shutdowns:
-head and neck
esophageal
colon
mammograms
Cancer patients the role of SLP: issues with ? -..tumor ...cancedr surgical complications from ? - - -
-
-
comm. and swallowing related to cancedr
-brain tumor
head and neck cancer
surgery for
-lung cancer
-esophageal cancer
-pancreatic cancer
medical complications/ cancer/cancer treatment
-stroke
-head injury
repiratory illness
Head and Neck cancer care: emergency stenting of the TE tract:use of ? size depends on ? normal tract diameter ranges from ? FR:
french sizing system
one increment on french scale equal to ?
red rubber catheter
size of TE tract
16 Fr-22 Fr
french
1/3 millimeter
Head and neck cancer accounts for about .. of all cancers in the US
this year an estimated …. will be diagnosed with head and neck cancer
worldwide an estimated … were diagnosed in 2020
4%
66,470 people
562, 328
Squamous cell cancer: squamous cell cancer: line the ? of ? SCCA is the most common type of ? makes up about .. of head and neck cancers this type of cancer is more common in ?
mucosal surfaces of mouth throat larynx
cancer in head and neck
90%
menn
Risk factors for head and neck cancer:
tobacco?
…products
…refluz
chemicals - - - - -
other factors
tobaccoo products
ethanol products
laryngopharyngeal reflux
chemicals abestos chromium nickel arsenic formaldehyde
ionizing radiation
epstein barr
HPV
.. cancer rates while smoking rates decline
rates of certain orophrayngeal cancers have ? from age ? from …
…increase base of tongue
… increase tonsil
increasing
increased among men and women/ 20-44/ 1973 to 2001
- 1%
- 9%
Increasing incidents of HNSCC
the incidence of some types of ? has been gradually increasing over the past 3 decades
oral, head, and neck squamous cell carcinoma
HPV?
HPV is one of th emost ?
greater than .. strains or genotypes of HPV have been identified , different types known to infect ?
the most visible forms of the virus produce ? on the ?
most HPV’s of this type are very ?
HPV 16
common virus groups affecting skin and mucosal areas of the body
150 strains / different parts of the body
wars (papillomas) on hands, arms, legs, and other areas of skin
very common, harmless, non-cancerous, and treatable
HPV
most HPV infections do not cause ? the immune system ?
if a high risk HPV infection is not controlled by the immune system it can result in ?
cancer/ clears from body
changes within cells that can develop into cancer over time
HPV
there are about.. types of HPV that are considered to be ?
-
these are the same types of HPV associated with ? in females
14/ high risk
hpv 16 and 18
cervical cancer
More about HPV:
a .. virus
16 and 18 associated with ?
in cervicaland oropharyngeal CA, HPV results in ? and abnormal?
DNA
cervical and oropharyngeal CA
inactivation of tumor supressor generes/ duplication of cells induced
HPV prevalence in oral, head and neck cancer:
overall prevalence of HPV in Head and Neck squamous cell carcinoma was estimated at ?
of the HPV positive cancers HPV 16 was the most ?
… of oropharyngeal cancers
… of oral cancers
…of laryngeal cancers
HPV 18 was the next most common, but far less ?
.. of oropharyngeal cancers
… of oral cancers
… of laryngeal cancers
26% prevalent 86.7% 68.2% 69.2%
prevalent
1%
8.0%
3.9%
what is known:
HPV has a strong association with ?
HPV has associations with ?
patients with HPV positive oropharynx tumors:
present at a relatively
do not have
may have better
oropharyngeal squamous cell cancer (particularly tonsil)
oral and laryngeal cancer
younger age
excessive tobacco use
survival rates
Historical LInks to HPV cancer:
1933: identified the first ?
1976: proposed that cervical cancer might be
1983: proposed a link between ?
they noted that .. of cancers in their study contained ? associated ?
DNA virus tumors in mammals
caused by HPV
HPV and head and neck SCCA
40% histological and morphological similarities with HPV / lesions
Most people with HPV do not know they are ? and never develop?
some people find out when they get ?
women may find out when they get an abnormal ?
others may find out when they have developed more serious problems from HPV such as ?
HPV the virus: HPV is so common that almost every person who is sexually active will get HPV at some time if they don’t get?
health problems related to HPV include :
genital warts: before HPV vaccines roughly… women and men affected by genital warts caused by HP V every year
- also about .. in every 100 sexually active adults in US has .. at any given time
cervical cancer: every year nearly .. women in US will be diagnosed andmore than … die from cervical cancer
symptoms
genital warts
Paps
cancer
HPV vaccine
genital warts and cervical cancer
340,000 to 360,000
1 in 100 / genital warts
12,000 women / 4,000
70% of cancers of the oropharynx may be linked to
HPV
Treatment of HPV+ tumors:
HPV positive tumors more ? than HPV negative tumors treated with ?
more rapid tumor ? than HPV negative tumors
why? HPV infected cells are not ? that are repeatedly exposed to ?
need for further ? possibel implications for decreasing ?
these patients are ? what will long term effects of treatment be
radiosensitive / intensity modulated radiotherapy
regression
damaged as severely as cells/ carcinogens
clinical trials / intensity of raidiation
younger
In the US high risk HPVs cause… of all cancers in women and … of all cancers in men
each year there are … new cases of cancer in parts of the body where HPV is often? HPV is estimated to cause about t… of these according to the CDC
worldwide the burden of HPV related cancers is much? high risk hPV causes.. of cancer world-wide, with an estimated … women nd .. men getting HPV-related cancer each year
what is the most common cancers and a leading cause of cancer related deaths in low and middle income countries where screening and treatment of early cervical cell changes are not ?
3%/ 2%
45,000
36,000
greater/ 5% /570,000 women/ 60,000 men
Cervical cancer/ readily available
Smokers with HPV+ tutors have the overall?
worst prognosis of these HPV+ tumors
Sexual transmission of HPV:
Based increase in oropharyngeal cancer incidence behavioural epidemiologists hypothesise that changing ? led to increased ?
several studies indicate that oral HPV infection is ?
D’Souza and colleagues found that individuals with a higher number of sex partners have an ?
sexual behaviours beginning in 1996/ HPV exposure
sexually acquired / increased risk of positive head and neck SCCA
Links to HPV transmission in Head and Neck CA
women with cervical cancer were monitored for occurrence of ?
these women found to be more likely to have a subsequent cancer in ? including:
in husbands of wives with cervical cancer an increased incidence of ? was found
second cancer / head and neck / mouth, oropharynx, hypo pharynx, and larynx
mouth, tongue, oropharynx, hypo pharynx and larynx
HPV transmission:
HPV found in
benign skin warts caused by some types of HPV are transmitted via
research is currently ongoing to determine transmission of ?
saliva, semen, genital secretions
skin to skin contact
of oral HPV infection (still not completely understood)
it is unknown how long it takes to clear ? some hypothesise that they may clear at. faster rate than in other areas due to the presence of ?
oral HPV infections/ lymphoid tissue in the area
Testing for HPV
testing of patients with known SCCA for HP V may improve ?
molecular typing for HPV 16 and EGFR expression may provide important
treatment protocol and provide important prognostic info
prognostic info
HPV has strong association with ?
HPV has associations with
patients with HPV positive oropharynx tumors :
present at
patients typically do not have
may have better
oropharyngeal squamous cell cancer (particularly tonsil)
oral and laryngeal cancer
relatively younger age
excessive tobacco/ETOH use
survival rates
Researchers estimated an average latency period from infection to development of HPV positive orophrayngeal cancer was approximately ?
10 to 30 years
HPV disease onset at younger age:
higher ?
long term treatment effects will be experienced
more potential for ?
radiation therapy may not be an option at a ? if there is a new ? or recurrence of
functional status at time of diagnosis
through a longer life span
socio-economic implications affecting family during prime wage-earning years
later time/ primary tumour or recurrence of cancer
Screening for HPV:
annual ?
screening also exists for
for oral HPV infections: there is currently not an accepted
Pap smear of cervix
anal HPV infections
clinical test that is utilised
Salivary testing for HPV:
how accurate is testing:
if a pt found to be HPV positive how much of predictor is this for oral cancer ?
thus far presence of ? does not ?
variability in saliva make up
HPV in saliva/ establish risk for developing cancer
Oral rinse and gargle sample:
results: oncogenic oral HPV DNA was detected in ? of all adults 20-69
findings showed that men of 50-59 , .. had oncogenic oral HPV, … had oral HPV16 infection
of those only… will develop oropharyngeal cancer in lifetime
screenings based upon oncogenic oral HPV detection would be ?
most groups have low ?
in addition to the large numbers of individuals who would need to be screened to identify prevalent oncogenic oral HPV, the lifetime risk of developing oropharyngeal cancer among those remains?
3.5%
- 1%
- 7%
challenging
low
Use of saliva testing to detect HPV positive CA recurrence:
HPV DNA can be detected in the saliva of patients after their ?
the presence of HPV predicted cancer recurrence nearly?
blood testing for HPV DNA increased accuracy of predicting recurrence to ?
blood dan saliva testing combined predicted recurrence … of time
cancer treatment
20%
55%
70%
HPV vaccination:
….
a vaccine that is FDA approved to prevent ? with the … types of HPV that most often cause ?
-may also prevent HPV-related cancers of the?
Gardasil 9 has been approved for use in ?females and males aged ? BUT is typically only recommended up to age ?
since 2016 Gardasil 9 has been the only vaccine available in ?
Gardasil 9
infection/ 9 types/ cancers of cervix, vagina, vulva and anus
penis and oropharynx
9-45/ 26
US
Other hPV vaccines not available in US
Gardasil
cervarix
HPV vaccine history:
vaccination for HPV was initiated in mid? for females to prevent cervical cancer ?
vaccination was initiated for males ages 9-26 starting in
2006 (ages 11-12 up to 26)
2009
Current HPV vaccination rates CDC data:
HPV vaccination rates are ?
in 2017: roughly ? of adolescents were up to date on hPV vaccine and … 13-17 years received the first dose to start the vaccine series
still … have not completed the HPV vaccine series and … of adolescents have not received both doses
also fewer adolescents in rural areas, compared with urban areas are getting the ?
increasing
49% (half) / 66%
51%/ 56%
HPV vaccines
Investigation - HPV vaccine and HPV oral infection rates (not cancer)
the researchers analysed most rinse samples from all study participants for the presence of ? including types ? which are covered by Gardasil
the prevalence of oral infection with these four hPV types was > in unvaccinated young adults versus … in vaccinated young adults an … reduction in HPV prevalence
among men, the prevalence of oral infection with the 4 HPV types was ? in unvaccinated and .. in vaccinated
37 HPV types/ 6,11, 16, and 18
- 61%/ 0.11%/ 88%
- 1% and 0.0%
Thinking ahead: future endeavours:
further defining role of ?
determine reliable ? and knowing?
determining the effect of HPV vaccination on ?
determining whether vaccines will have a ? on already ?
HPV in laryngeal and oral cancer
screening tests/ implications of findings
incidence of head and neck cancers in females and males
therapeutic effect / infected pts
preventable public health risks:
head and neck cancer prevention strategies have been a ?
primarily targeting ?
hpv exposure can also be a
target education of ?
public health issue for years
decreaing/eliminating tobacco use
preventable health risk
public
SLP intervention for oropharyngeal cancer: assessment of ? Prior to ? patient ? -what to expect swallowing importance of importance of potential impact of ?
swallowing function / surgery and radiation
education: during and after assessment exercise program maintaining PO intake during tx monitoring size of jaw opening treatment on speech and voice production
Role of SLP during course of HNC Tx: prior to radiation therapy, SLP performs a ? patient ? -explaining changes that could potentially balance... assist with setting ? reduce fears or misconception about ?
clinical eval of speech, voice, swallowing
counseling
A&P of head and neck occur due to tx education with fear realistic expectations process and outcomes associated with radiation
Prior to radiation patient should be provided with
- a .. rehab pan
- … protocol to minimize tx effects
during tx and post treatment recommendations made for -... products how to alleviate sx of ? swallow .. or ?? collaboration with ? establish ? reinforce ? ... and ...
education
swallow
vocal hygiene
saliva substitute products xerostomia strategies or diet modification clinical dietitian regarding supplements swallow exercise schedule/ reinforce swallow exercises/ vocal hygiene and oral care
intervention during tx has been found to … effects on speech and swallowing
prevent or reduce
avoid ?
maintain the ?
-sliding
…
…other
minimise long term effects
formation of fibrosis
trismus
range of motion of oropharynx and larynx through manoeuvres
sliding glissandos
falsetto
mendelsohn
side effects of Radiation: ... .. - impact on function of ? - - ... loss of ? ... changes ot ? ...
mucostitis xerostomia (salivary glands) odynophagia dysphagia (oesophageal lumen) fibrosis soft tissue trismus
Trismus: what I normal MMO men women wat width?
in the head and neck cancer literature MMO of … has been found to be associated with decrease QOL
42.0 -68.0
40.0-57.0mm
3 fingers
35
Prevention/monitoring onset of trismus:
during radiation:
educate patients to complete ? and monitor ?
check ?
educate patients to alert the medical team at first signs of ?
.. ,matters
stretches of jaw daily/ jaw opening
baseline prior to onset of tx
onset of truisms
timematter
Late effects of XRT
late effects of organ preservation become more apparent as the epidemiology and survivorship rates of oropharyngeal cancer change ?
lat effects still somewhat ? and not fully ? late-toxicities from XRT that result in ?
these effects result in significant ? and reduced ? with a significant impact on
-long term means of
in era of HPV associated disease
rare/ understood/ cranial neuropathies
dysphagia / speech and voice function/ QOL
nonfunctional larynx
- tracheostomy
- non-oral nutrition
