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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
T1s Lesion
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
26
Carcinoma in Situ
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
27
Supraglottis Tumor Stages:
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
28
Glottis Tumor Stages:
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
29
Subglottis Tumor Stages:
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
30
Tumor Stages: Lymph Nodes
``` N: Regional lymph nodes N0: Regional lymph nodes not palpable N1: Movable homolateral nodes N2: Movable contralateral or bilateral nodes N3: Fixed nodes ```
31
Tumor Stages: Metastasis
M: Distant metastasis M0: No evidence of distant metastasis M1: Distant metastasis present
32
Lymphatic Metastasis
If cancer spreads by direct penetration into surrounding tissue with involvement of lymphatic glands
33
Local Metastasis
Cancer spreading to the neck & lymph nodes, usually
34
Distant Metastasis
Cancer spreading to the lungs, liver, & bone
35
Radiation is preferred only for _____
T1N0M0 lesions
36
If zero appears in staging, ____
this is lowest # & means it isn't there (aka no tumor, no lymph nodes, no distant metastasis)
37
In tumor staging, the larger the #, _____
the more extensive the tumor
38
What does T3N2M0 mean?
Fairly extensive tumor, moveable contralateral lymph nodes, no distant metastasis
39
Treatment options for laryngeal carcinoma
Radiation alone Surgery plus radiation Surgery plus radiation plus chemotherapy Chemotherapy
40
If cancer lesion is small, initial course of tx may be _____
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
Surgical excursion is curative when ____
lesion is confined to the mucosa
42
Appearance of squamous cell cancer of larynx
Can take on any appearance | It may remain very superficial or it may cause deep invasion
43
Radiation Issues
Pt may experience hoarseness, reddening or burning of skin, dry sore throat, & swallowing difficulty during tx Reddening or burning of skin is painful
44
If radiation alone isn't successful, it's called:
Radiation failure
45
After radiation failure, Pt will have option of undergoing _____
hemi or total laryngectomy
46
If cancer has spread to distant sites, ____ is usually added
Chemotherapy; as a palliative measure
47
If tumor is large & the spread is advanced, tx:
The only treatment might be chemotherapy alone
48
Laryngeal sparing
Don't do a laryngectomy but do radiation/chemo instead
49
Partial Laryngectomy
If lesion is small enough & hasn't spread, this might be in order The respiratory, phonatory, & sphincteric functions of larynx are retained
50
Procedures used for Partial Laryngectomy
Vertical procedure Horizontal procedure Radical neck dissection
51
Radical neck dissection removes:
Lymph nodes, sternocleidomastoid muscle, spinal accessory nerve, cervical plexus, strap muscle
52
Supraglottic procedure
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
Supraglottic laryngectomy removes:
Hyoid bone, epiglottis, aryepiglottic folds, false VFs | Protection during swallow is compromised (epiglottis especially)
54
Lateral Partial Laryngectomy
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
Hemilaryngectomy
Vertico-frontolateral laryngectomy | 1 half of larynx is removed
56
What is removed in hemilaryngectomy:
``` 1/2 of thyroid cartilage Unilateral false vocal fold Unilateral vocal fold Unilateral arytenoid Part of cricoid cartilage ```
57
After hemilaryngectomy:
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
Voice Tx for Hemilaryngectomy
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
Voice Tx Exercises for Hemilaryngectomy
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
Improvements Possible from Vocal Exercises
Increasing vocal range, practicing scales, speaking phrases on various intonation patterns
61
Total laryngectomy
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
Laryngectomy
Surgical procedure
63
Laryngectomee
Person receiving surgical procedure
64
Total laryngectomy removes:
Hyoid bone, strap muscles, entire larynx, 1-2 tracheal rings
65
Surgical defect in pharyngeal wall and total laryngectomy
Closed with cricopharyngeus & inferior middle constrictors to prevent aspiration
66
When radical neck dissection is used
If malignant cells have metastasized to lymph glands of neck
67
What happens during radical neck dissection
Lymph nodes are removed along with sternocleidomastoid muscle, spinal accessory nerve, cervical plexus, strap muscles, & internal jugular vein
68
Esophageal reconstruction
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
Popular type of esophageal reconstruction today:
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
Less common esophageal reconstruction
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
Post-laryngectomy complications:
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
Specific Swallowing D/O's in Head/Neck Cancer Population with Hemilaryngectomy:
Usually no problems | If extended: Reduced airway closure (aspiration during swallow)
73
Specific Swallowing D/O's in Head/Neck Cancer Population w/ Supraglottic Laryngectomy
Reduced closure of laryngeal vestibule Reduced laryngeal closure (aspiration during swallow) Reduced pharyngeal contraction (aspiration after swallow)
74
Specific Swallowing D/O's in Head/Neck Cancer Population w/ Total Laryngectomy
Scar tissue "pseudoepiglottis" at base of tongue | Stricture in pharyngoesophagus
75
Tracheostomy
Tube anchors trachea to strap muscles Limits laryngeal elevation Relaxation or cricopharyngeus muscle inhibited

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