Flashcards in Head and Neck Cancer Deck (43):
What are the 2 primary causes of head and neck cancer?
Smoking and excessive use of alcohol
How can smoking cause cancer?
Tars of tobacco contain carcinogens which cause cancer
How can alcohol cause head and neck cancer?
Causes the enlargement of blood vessels; this tissue change makes the larynx more susceptible to changes in normal tissue
What are 3 other causes of head and neck cancer?
Leukoplakia, dust and other irritants in the environment, and there has been a recent link to the human papilloma virus
What is leukoplakia?
Pre-malignant cells that appear as white patches on the mucous membrane
What are the 3 types of head and neck cancer?
Carcinoma, sarcoma, and melanoma
What type of cancer makes up 90% of all head and neck cancers?
What is carcinoma?
A fast growing cancer that spreads through the lymphatic system
What is sarcoma?
A type of cancer that spreads less rapidly and is slower to metastasize
What is melanoma?
Not as invasive, changing wart or mole; may be serious when ignored
What is sarcoma also known as?
Squamous cell carcinoma
What age does head and neck cancer most likely occur in?
___% of all laryngeal cancer is curable if caught early.
Describe extrinsic laryngeal cancer.
It's the "silent" cancer; first signs include a lump in the neck and an inability to move the base of the tongue. involves pain, and hoarseness may occur later.
Where does intrinsic laryngeal cancer occur?
On the true VF
What do lesions appear as for intrinsic laryngeal cancer?
Regions of elevated nodular or rough surfaces; whitish pink to red in color
What are some symptoms of intrinsic laryngeal cancer?
Hoarseness that lasts more than 2 weeks, dysphagia, neck masses, chronic cough, blood in saliva
What are the 4 most common laryngeal cancer treatment options?
Intra-oral excision, radiation, laryngofissure, and cordectomy
What is intra-oral excision?
Lesion excised through the mouth used with non-extensive lesions
When is radiation used?
For a localized lesion
How is a laryngofissure used?
To open the larynx through thyroid cartilage to excise cancerous tissue
What is a cordectomy?
Removal of one vocal fold
What is TNM staging used for?
It allows a physician to figure out the severity of the cancer, the size of the tumor, and any evidence of the tumor spreading in the regional lymph nodes or whether or not it has metastasized to other areas. It tells us about prognosis and how it should be treated.
What does each letter stand for in TNM staging?
T = tumor
N = nodes
M = metastasis
When is a laryngectomy used?
Used with total involvement of both folds, subglottic extension, fixation of one fold, involvement of the arytenoid cartilage or cancer in the extrinsic larynx
When is a laryngectomy with radical neck dissection necessary?
If the cancer is suspected to have extended into lymphatic tissue of the neck
What anatomical structures are removed in a total laryngectomy?
Everything from above the hyoid to below the cricoid... maybe even a few tracheal rings
What are the two types of partial laryngectomies?
Supraglottic (horizontal) and hemilaryngectomy (vertical)
Describe a supraglottic laryngectomy (horizontal).
Removing the structures above the true VF but the VF are maintained... but swallowing is compromised
Describe a hemilaryngectomy (vertical)
Taking out one half (left or right side) of the larynx, depending on the tumor. Patient has some voice that remains because they have one VF remaining.
What are some of the consequences of a laryngectomy?
Loss of ability to phonate, inability to cough/sneeze, sing, hum, whistle, blow nose... loss of smell and taste. loss of strength in lifting, increased cautions whenever around water.
Why in a total laryngectomy does the patient now have a stoma/why is it necessary?
It allows them to breathe without aspiration because the primary biological purpose of the larynx is to protect the trachea during swallowing.
What are 4 problems for post-op patients?
Air intake, digestive, diminished taste and smell, and many social adjustments
What is alaryngeal speech?
Speech without vocal cords
What are the two options patients have for sound productions who have no larynx?
Pseudoglottis or neuglottis at the opening of the esophagus, or mechanical or electronic sound source.
What is the P-E segment?
The vibratory structure of both esophageal speech and tracheoesophageal speech; primarily composed of the cricopharyngeus and the inferior pharyngeal constrictors
What is the criteria for TEP and voice prosthesis candidates?
Motivated and positive attitude; the physical and mental ability to care for the stoma, prosthesis, and valve; stoma no lower than sternal notch; and the ability to phonate fluently without excessive effort
What is the name of the test we use to hear the quality of the voice and know if the cricopharyngeus is too loose?
What is a myotomy?
A procedure to cut the fibers of the PE segment which loosens it up and allows it to vibrate more easily
Why is it important that the TEP prosthesis has a one way valve?
It prevents aspiration! It stays closed most of the time to close off the airway from swallowing, but opens during more forceful inspiration for speech.
Why is it good to prescribe a laryngectomee with an artificial larynx?
Because they can communicate immediately following their surgery, can use it during an emergency, and they can use it while they're learning another method.
What are the two methods for teaching esophageal speech?
Injection and inhalation