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Voice > Partial & Total Laryngectomy/Tumors-Test 2 > Flashcards

Partial & Total Laryngectomy/Tumors-Test 2 Flashcards

1
Q

Tumors of the larynx can be divided into ____ & ___ tumors

A

benign; malignant

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2
Q

Intrinsic cancer

A

Tumor developing on the true vocal cord (if it’s inside cartilage)

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3
Q

Extrinsic cancer

A

Tumor developing in some other part of the larynx

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4
Q

Leukoplakia

A

White growth that if not treated can develop into cancer

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5
Q

Tumor definition

A

Abnormal mass of tissue

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6
Q

Etiology of benign tumors

A

Unknown

Believed that most are the result of a chronic inflammatory response

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7
Q

When can a Benign tumor occur?

A

At any age

Most occur in the 35-50 age range, with 70% occurring in males & 30% occurring in females

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8
Q

Where do Benign tumors most often occur?

A

Most frequently on the vocal cords & most are located on the anterior 1/3 of the cord with the least being found on the posterior 1/3

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9
Q

Most common symptom of benign laryngeal tumors

A

Hoarseness

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10
Q

Who gets cancer of the larynx

A

Middle-aged or older men or women with a history of smoking

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11
Q

Predisposition factors to laryngeal cancer

A

Pt factors: excess alcohol & tobacco consumption, presence of a chronic disease state

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12
Q

Who is more likely to get laryngeal cancer?

A

Ratio of men to women is 7:1

Women are getting it more often due to increasing #s of women smoking, especially in Europe

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13
Q

Most common sx of Laryngeal Cancer

A

Hoarseness

If cancer is intrinsic, hoarseness is an early symptom

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14
Q

Prognosis for intrinsic laryngeal cancer:

A

Better than any other site of body since surgical removal of organ is considered a cure

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15
Q

Sx’s and Extrinsic Laryngeal Cancer

A

Does not produce early symptoms because it does not interfere with the voice
Most serious symptom is dyspnea
Might have problems with breathing

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16
Q

Locations of Laryngeal Tumors

A

May occur at 3 sites:

Glottic (on VFs/larynx), supraglottic, subglottic

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17
Q

Glottic carcinoma

A

Most common type of laryngeal cancer

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18
Q

Initial symptom of glottic carcinoma

A

Hoarseness

If it goes undetected & grows to large proportion, laryngeal stridor occurs & airway will become obstructed

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19
Q

Supraglottic Carcinoma

A

Occurs in the pyriform sinuses, the false VFs or ventricular bands, the ventricles, & the aryepiglottic folds

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20
Q

Initial symptoms of Supraglottic Carcinoma

A

Dysphagia accompanied by pain radiating to ear on speaking and swallowing

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21
Q

Subglottic Carcinoma

A

Develops on the undersurface of the VFs

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22
Q

Initial symptoms of Subglottic Carcinoma

A

Difficulty with breathing

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23
Q

Tumor Stages

A

TNM System
T: primary tumor
N: regional lymph nodes
M: distant metastasis

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24
Q

TNM: T:

A

T: Primary tumor

  1. Supraglottis
  2. Glottis
  3. Subglottis
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25
Q

T1s Lesion

A

Pre-invasive carcinoma or a carcinoma in situ (carcinoma encapsulated & hasn’t broken out of basal membrane)
Rarely found
Can be locally excised when found

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26
Q

Carcinoma in Situ

A

Can arise in any part of larynx, but majority occur on true VFs
Lesion is composed of squamous cells
Initial change in this tumor occurs in basal layer of epithelium
Important feature is that neoplastic cells are always confined by basement membrane
Lesion never becomes submucosal
Will usually progress into an invasive cancer through violation of basement membrane

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27
Q

Supraglottis Tumor Stages:

A

T1s: Carcinoma in Situ
T1: Tumor limited to region with normal mobility of structures
T2: Tumor of epiglottis &/or ventricles or ventricular bands & extending to vocal cords without fixation
T3: Tumor limited to larynx w/ fixation &/or destruction or other evidence of deep invasion
T4: Tumor with direct extension beyond larynx, to pyriform sinuses, post-cricoid region, vallecula, or base of tongue
Going posteriorly & upward

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28
Q

Glottis Tumor Stages:

A

T1s: Carcinoma in Situ
T1: Tumor limited to region with normal mobility
T2: Tumor extending to either the subglottic or supraglottic region w/ normal or impaired mobility
T3: Tumor limited to larynx w/ fixation of 1 or both cords
T4: Tumor extending beyond larynx into cartilage, pyriform sinus, post-cricoid region, or skin

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29
Q

Subglottis Tumor Stages:

A

T1s: Carcinoma in Situ
T1: Tumor limited to region with normal mobility
T2: Tumor involving subglottic region & extending to 1 or both cords
T3: Tumor limited to larynx w/ fixation of 1 or both cords
T4: Tumor extending beyond larynx to post-cricoid region, trachea, or skin

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30
Q

Tumor Stages: Lymph Nodes

A 
N: Regional lymph nodes
N0: Regional lymph nodes not palpable
N1: Movable homolateral nodes
N2: Movable contralateral or bilateral nodes
N3: Fixed nodes
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31
Q

Tumor Stages: Metastasis

A

M: Distant metastasis
M0: No evidence of distant metastasis
M1: Distant metastasis present

32
Q

Lymphatic Metastasis

A

If cancer spreads by direct penetration into surrounding tissue with involvement of lymphatic glands

33
Q

Local Metastasis

A

Cancer spreading to the neck & lymph nodes, usually

34
Q

Distant Metastasis

A

Cancer spreading to the lungs, liver, & bone

35
Q

Radiation is preferred only for _____

A

T1N0M0 lesions

36
Q

If zero appears in staging, ____

A

this is lowest # & means it isn’t there (aka no tumor, no lymph nodes, no distant metastasis)

37
Q

In tumor staging, the larger the #, _____

A

the more extensive the tumor

38
Q

What does T3N2M0 mean?

A

Fairly extensive tumor, moveable contralateral lymph nodes, no distant metastasis

39
Q

Treatment options for laryngeal carcinoma

A

Radiation alone
Surgery plus radiation
Surgery plus radiation plus chemotherapy
Chemotherapy

40
Q

If cancer lesion is small, initial course of tx may be _____

A

Radiation
This may shrink the tumor & is the only modality needed
However, voice is much better with surgery than radiation b/c radiation will stiffen VFs

41
Q

Surgical excursion is curative when ____

A

lesion is confined to the mucosa

42
Q

Appearance of squamous cell cancer of larynx

A

Can take on any appearance

It may remain very superficial or it may cause deep invasion

43
Q

Radiation Issues

A

Pt may experience hoarseness, reddening or burning of skin, dry sore throat, & swallowing difficulty during tx
Reddening or burning of skin is painful

44
Q

If radiation alone isn’t successful, it’s called:

A

Radiation failure

45
Q

After radiation failure, Pt will have option of undergoing _____

A

hemi or total laryngectomy

46
Q

If cancer has spread to distant sites, ____ is usually added

A

Chemotherapy; as a palliative measure

47
Q

If tumor is large & the spread is advanced, tx:

A

The only treatment might be chemotherapy alone

48
Q

Laryngeal sparing

A

Don’t do a laryngectomy but do radiation/chemo instead

49
Q

Partial Laryngectomy

A

If lesion is small enough & hasn’t spread, this might be in order
The respiratory, phonatory, & sphincteric functions of larynx are retained

50
Q

Procedures used for Partial Laryngectomy

A

Vertical procedure
Horizontal procedure
Radical neck dissection

51
Q

Radical neck dissection removes:

A

Lymph nodes, sternocleidomastoid muscle, spinal accessory nerve, cervical plexus, strap muscle

52
Q

Supraglottic procedure

A

VFs are not involved & the pt’s voice will remain unimpaired despite probable difficulties w/ swallowing
Some pts choose this to spare voice but they sacrifice eating orally

53
Q

Supraglottic laryngectomy removes:

A

Hyoid bone, epiglottis, aryepiglottic folds, false VFs

Protection during swallow is compromised (epiglottis especially)

54
Q

Lateral Partial Laryngectomy

A

Largyngofissure with cordectomy
Cordectomy is performed with very small, localized tumors in anterior part of VF & on edge of fold
Incision is made through anterior angle of thyroid cartilage
Cord alone is excised in 1 piece w/ a surrounding margin of 1 cm of healthy tissue

55
Q

Hemilaryngectomy

A

Vertico-frontolateral laryngectomy

1 half of larynx is removed

56
Q

What is removed in hemilaryngectomy:

A 
1/2 of thyroid cartilage
Unilateral false vocal fold
Unilateral vocal fold
Unilateral arytenoid
Part of cricoid cartilage
57
Q

After hemilaryngectomy:

A

In place of thyroarytenoid muscle, a substitute VF forms
Healthy fold will pass over midline to meet surgical site & a voice is produced
Voice is hoarse & sounds like voice of an intermediate or abductor type paralyzed vocal fold

58
Q

Voice Tx for Hemilaryngectomy

A

Important after laryngectomy
If substitute cord on excised side doesn’t project toward mid-line & is also immobile, healthy fold on opposite side is trained to pass over midline & compensate for open airway

59
Q

Voice Tx Exercises for Hemilaryngectomy

A

Tensing exercises are recommended as in vocal cord paralysis, however, laryngeal-pharyngeal tension should be tempered
May also help to press sides of thyroid cartilage b/t thumb & finger to emphasize tactile & kinesthetic cues
Practice of strong vowel sounds with hard attack
Voice may become good, but never quite normal & is generally deep & hoarse
Pocket amplifier can be useful to increase vocal volume

60
Q

Improvements Possible from Vocal Exercises

A

Increasing vocal range, practicing scales, speaking phrases on various intonation patterns

61
Q

Total laryngectomy

A

Occurs when laryngeal carcinoma which is not cured by radiation or partial laryngectomy
Trachea & esophagus are now entirely separate (stoma & esophagus)
Trachea is brought forward & sutured to skin of neck & a breathing hole or permanent stoma created for respiration

62
Q

Laryngectomy

A

Surgical procedure

63
Q

Laryngectomee

A

Person receiving surgical procedure

64
Q

Total laryngectomy removes:

A

Hyoid bone, strap muscles, entire larynx, 1-2 tracheal rings

65
Q

Surgical defect in pharyngeal wall and total laryngectomy

A

Closed with cricopharyngeus & inferior middle constrictors to prevent aspiration

66
Q

When radical neck dissection is used

A

If malignant cells have metastasized to lymph glands of neck

67
Q

What happens during radical neck dissection

A

Lymph nodes are removed along with sternocleidomastoid muscle, spinal accessory nerve, cervical plexus, strap muscles, & internal jugular vein

68
Q

Esophageal reconstruction

A

If cancer has spread to cervical esophagus, laryngectomy & esophagectomy may be needed
Removing upper part of esophagus
Pt unable to eat without reconstruction of upper esophagus
Various grafts used to replace esophageal tissue

69
Q

Popular type of esophageal reconstruction today:

A

Jejunal flap: transfer of part of large intestine up to esophagus (will have donor site of incision & extra procedure on larynx) Once the transfer is complete, the patient has a donor site from the second site procedure.
Problems: Jejunum exudes lots of mucus & is more flexible than esophagus; wet gurgly voice

70
Q

Less common esophageal reconstruction

A

Bringing stomach up through thorax to the neck
Not used often very often anymore
Stomach & duodenum are mobilized & transplanted into neck to form a continuous tract between pharynx & stomach

71
Q

Post-laryngectomy complications:

A

Esophageal stenosis or scarring down of the esophagus which interferes with swallowing
Stenosis of tracheostoma interferes with breathing, or development of a fistula at the suture line
With post-laryngectomy, Usually there aren’t swallowing problems; if they do, thinking of scar tissue (red, rubber tube that is swallowed to widen)

72
Q

Specific Swallowing D/O’s in Head/Neck Cancer Population with Hemilaryngectomy:

A

Usually no problems

If extended: Reduced airway closure (aspiration during swallow)

73
Q

Specific Swallowing D/O’s in Head/Neck Cancer Population w/ Supraglottic Laryngectomy

A

Reduced closure of laryngeal vestibule
Reduced laryngeal closure (aspiration during swallow)
Reduced pharyngeal contraction (aspiration after swallow)

74
Q

Specific Swallowing D/O’s in Head/Neck Cancer Population w/ Total Laryngectomy

A

Scar tissue “pseudoepiglottis” at base of tongue

Stricture in pharyngoesophagus

75
Q

Tracheostomy

A

Tube anchors trachea to strap muscles
Limits laryngeal elevation
Relaxation or cricopharyngeus muscle inhibited

Voice (12 decks)

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