Head and Neck Cancer

Question 1

What percentage of head and neck cancers are squamous cell?

Answer 1

90%

Question 2

Risk level for head and neck cancer depends on: (4)

Answer 2

• Daily consumption
• Type
• Toxicity
• Manner of tobacco use

Question 2

Multidisciplinary team

performs and determines the results of imaging including MRI, CT scans, or ultrasound for the diagnosis or post-treatment assessments

Answer 2

Radiologist/Nuclear Medicine Specialist

Question 2

an approach where radiation is administered alone as a curative method (chemotherapy does not apply)

Answer 2

Definitive

Question 2

modified technique with removal of half of the larynx vertically and the upper half of the contralateral larynx, including the ventricle and upper margin of the vocal fold.

Answer 2

subtotal laryngectomy

Question 2

therapeutic compensation

effortful focus on closing the vocal folds during non-phonatory or phonatory tasks

Answer 2

Vocal fold adduction exercises

Question 2

• Involves surgically creating a small puncture through the posterior tracheal wall into the esophagus. A small one-way valve (prosthesis) is inserted into the puncture in order to prevent its spontaneous closure and prevent the aspiration of pharyngoesophageal contents into the trachea

Answer 2

Tracheoesophageal Puncture (TEP)

Question 2

arises from the leanocytic system of the skin or other organs

Answer 2

melanoma

Question 3

Factors affecting post laryngectomy mode of communication selection

Answer 3

• age
• cognitive status
• motor coordination
• personal preferences

Question 4

a type of laryngectomy designed with speech reconstruction in mind

• this surgery typically includes removal of the supraglottic structures including the true and false vocal folds, and the thyroid cartilage including the paraglottic and pre-epiglottic spaces

Answer 4

Supracricoid laryngectomy

Question 5

morbid conditions following the consequences of idsease and could include pain, bleeding, ulcerations to mucosa, bone damage, permanent damage to salivary galnds, chewing difficulty, and/or dysphagia

Answer 5

Sequelae

Question 6

tracheoesophageal speech advantages (3)

Answer 6

• more natural speech
• improved intelligibility
• greater sound duration

Question 7

• The entire larynx is removed
• the hyoid bone is cut from the suprahyoid musculature
• thyroid and cricoid cartilages are removed from the pharyngeal muscles and trachea
• communication is dependent on alaryngeal speech modes

Answer 7

Total laryngectomy

Question 8

develops in the glandular lining of an organ

Answer 8

adenocarcinoma

Question 9

Artificial larynx advantages (4)

Answer 9

• fast and easy way to communicate after surgery
• can be used as a backup to another means of communicating
• battery operated
• volume and pitch control features

Question 10

Voice pathologist’s involvement in electromechanical speech

Answer 10

• selects the most appropriate device
• teaches basic use/care
• assess for neck placement post-healing
• trains the patient to use the device in all communicative settings

Question 11

removal of one ventrical half of the larynx including one false vocal fold, ventricle, true vocal fold, and portion of the thyroid cartilage on the involved side.

Answer 11

hemilaryngectomy

Question 12

Laryngectomy types (5)

Answer 12

• Total laryngectomy
• Partial laryngectomies
  
  • hemilaryngectomy
  • supraglottal laryngectomy
  • supracricoid laryngectomy
  • subtotal laryngectomy

Question 13

Multidisciplinary team

performs any reconstructive surgery that may be necessary after the cancer treatment to lessen the appearance of scarring or removal of structures

Answer 13

Plastic Surgeon

Question 14

Post-laryngectomy communication options (3)

Answer 14

• Artificial/electromechanical
• esophageal
• prosthetic

Question 15

Multidisciplinary Team

studies the stages of the tumor development and the potential involvement of the surrounding tissues or structures

Answer 15

Radiation Oncologist

Question 15

Multidisciplinary team

makes replacements for removed teeth or other oral cavity structures helps in restoring the patient’s comfort, health and appearance

Answer 15

Dental/maxillofacial prosthodontist

Question 15

Multidisciplinary team

a person who has experienced the patient’s situation (or similar) and has adjusted well to it

Answer 15

Laryngectomized Visitor

Question 15

Laryngectomy post surgical counseling

Answer 15

• Readdress psychosocial issues
• encourage participation in support groups
• facilitate socialization
• assist in the emotional recovery
• teach modes of speech

Question 16

Artificial larynx disadvantages (4)

Answer 16

* monopitch/metallic sound * requires clear articulation skills * hand-held device * difficult to use with telephone

Question 17

Multidisciplinary Team examines any tissue that has been removed during the patient’s course of treatment to evaluate it for abnormalities

Answer 17

Pathologist

Question 18

Tracheo-esophageal speech (TEP) Disadvantages

Answer 18

* requires a good seal around the perimeter of the stoma * requires ability to maintain prosthesis * costly: some equipment needs to be replaced daily

Question 19

Multidisciplinary team part of the health care team for postoperative management of medical comorbidities, such as heart disease, diabetes, and high blood pressure

Answer 19

Internal medicine

Question 20

usually part of or all of the hyoid and epiglottis, aryepiglottic folds, and false vocal folds are removed

Answer 20

Supraglottic laryngectomy

Question 21

Multidisciplinary team provides counseling to the patient or family to help them cope with issues

Answer 21

Mental health counselor/ social worker/ case manager

Question 22

* a method to warm and filter air via the stoma * involve use of disposable filter cassette that attaches to the stoma with an adhesive base plate, laryngectomy button, or laryngectomy tube * heat and moisture will be absorbed by the filtering mechanism and transferred back to the incoming air * Uses increases in the air temperature and the humidity of air entering the body therebypromoting function of cilia in the lungs

Answer 22

HME Heat and moisture exchange system

Question 23

therapeutic compensation this helps by pushing the epiglottis posteriorly, narrowing the airway entrance

Answer 23

chin down technique

Question 24

Multidisciplinary Team administers chemotherapeutic agents, often used in conjunction with radiation therapy in later stage tumor

Answer 24

Medical Oncologist

Question 25

Multidisciplinary team diagnoses the disease and organizes the treatment plan including the medical management of the condition

Answer 25

Head and neck surgeon

Question 26

Multidisciplinary team evaluates and provides treatment for head and neck cancer patients with short-term and long-term communication needs

Answer 26

Voice Pathologist

Question 27

energy in the form of waves or moving subatomic particles emitted by an atom or other body as it changes from a higher energy state to a lower energy state

Answer 27

Radiation

Question 28

removing part or all of the vocal folds; it can be used to treat very limited or superficial glottic cancers

Answer 28

cordectomy

Question 29

therapeutic compensation rotation to the operated side is used to achieve airway closure; this may be combined with a chin down technique

Answer 29

head rotation technique

Question 30

* Can be produced when the individual transports a small amount (±75 mL) of air from the oral and pharyngeal cavity into the esophagus * The air is redirected back past the PE segment to force vibration of the tissue * Rapid repetition of the air transport can ultimately produce intelligible esophageal speech * The patient then forms this sound into words with the tongue, lips, teeth, and palate

Answer 30

Esophageal speech

Question 31

Role of voice pathologist in total laryngectomy (3)

Answer 31

* presurgical counseling * postsurgical counseling and management * offering modes of communication following total laryngectomy

Question 32

Multidisciplinary team evaluates the patient’s nutritional health prior to and following surgery, radiation, or other intensive treatments

Answer 32

Registered Dietitian

Question 33

an approach which typically follows surgery and enhances the outcome response

Answer 33

Adjuvant

Question 34

* begins in cells of the immune system * many subtypes

Answer 34

Lymphoma

Question 35

Staging of head and neck cancers Tumor (T)

Answer 35

extent of primary tumor

Question 36

Multidisciplinary team works to restore movement or skills that have been impaired due to surgery

Answer 36

Physical/Occupational Therapist

Question 37

Post radiation symptoms (5)

Answer 37

* dental loss * dysphagia * dysphonia * edema * fatigue

Question 38

Two types of TEP prostheses

Answer 38

* Non-Indwelling * Indwelling

Question 39

treatment of a disease by chemicals that kill cells, specifically those of microorganisms or cancer

Answer 39

Chemotherapy

Question 40

head and neck cancers account for what percentage of new cases of cancer in the United States?

Answer 40

3%

Question 41

arises from connective tissue

Answer 41

sarcoma

Question 42

Esophageal speech advantages

Answer 42

* no devices are needed to produce speech * it is possible to produce a normal sounding voice

Question 43

Role of SLP during organ preservation protocols (4)

Answer 43

* perform clinical eval of speech, voice, and swallowing pre-chemo * patient counseling * provide patient with swallow rehab plan and vocal hygiene protocol to minimize side-effects * minimize long term effects on speech and swallowing

Question 44

Esophageal speech disadvantages (4)

Answer 44

* low pitch sound derived rom a controlled belch or burp * difficult to learn * articulation must be clear * reduced length of utterance

Question 45

Staging of head and neck cancers Nodal disease (N)

Answer 45

lymphatic spread; regional metastasis

Question 46

Laryngectomy pre-surgical counseling

Answer 46

* typically conducted two weeks prior to the scheduled surgery date * psychosocial issues are addressed * description of possible swallowing deficits and alterations in anatomy * practice with alternative modes of communication * baseline measures are taken for speech, voice, and swallowing

Question 47

Treatment options for head and neck cancers (4)

Answer 47

* Definitive * concommitant * adjuvant * organ preservation

Question 48

Multidisciplinary team provides personnel care for the patient in all phases of inpatient diagnosis and treatment, and are often involved in case coordination in the outpatient setting

Answer 48

Nurse

Question 49

Multidisciplinary team evaluates, treats, and cares for breathing or respiratory disorders

Answer 49

Respiratory Therapist