Head and Neck Cancer

Question 1

What are the 2 primary causes of head and neck cancer?

Answer 1

Smoking and excessive use of alcohol

Question 2

How can smoking cause cancer?

Answer 2

Tars of tobacco contain carcinogens which cause cancer

Question 3

How can alcohol cause head and neck cancer?

Answer 3

Causes the enlargement of blood vessels; this tissue change makes the larynx more susceptible to changes in normal tissue

Question 4

What are 3 other causes of head and neck cancer?

Answer 4

Leukoplakia, dust and other irritants in the environment, and there has been a recent link to the human papilloma virus

Question 5

What is leukoplakia?

Answer 5

Pre-malignant cells that appear as white patches on the mucous membrane

Question 6

What are the 3 types of head and neck cancer?

Answer 6

Carcinoma, sarcoma, and melanoma

Question 7

What type of cancer makes up 90% of all head and neck cancers?

Answer 7

Sarcoma

Question 8

What is carcinoma?

Answer 8

A fast growing cancer that spreads through the lymphatic system

Question 9

What is sarcoma?

Answer 9

A type of cancer that spreads less rapidly and is slower to metastasize

Question 10

What is melanoma?

Answer 10

Not as invasive, changing wart or mole; may be serious when ignored

Question 11

What is sarcoma also known as?

Answer 11

Squamous cell carcinoma

Question 12

What age does head and neck cancer most likely occur in?

Answer 12

Persons 50-70

Question 13

___% of all laryngeal cancer is curable if caught early.

Answer 13

90

Question 14

Describe extrinsic laryngeal cancer.

Answer 14

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.

Question 15

Where does intrinsic laryngeal cancer occur?

Answer 15

On the true VF

Question 16

What do lesions appear as for intrinsic laryngeal cancer?

Answer 16

Regions of elevated nodular or rough surfaces; whitish pink to red in color

Question 17

What are some symptoms of intrinsic laryngeal cancer?

Answer 17

Hoarseness that lasts more than 2 weeks, dysphagia, neck masses, chronic cough, blood in saliva

Question 18

What are the 4 most common laryngeal cancer treatment options?

Answer 18

Intra-oral excision, radiation, laryngofissure, and cordectomy

Question 19

What is intra-oral excision?

Answer 19

Lesion excised through the mouth used with non-extensive lesions

Question 20

When is radiation used?

Answer 20

For a localized lesion

Question 21

How is a laryngofissure used?

Answer 21

To open the larynx through thyroid cartilage to excise cancerous tissue

Question 22

What is a cordectomy?

Answer 22

Removal of one vocal fold

Question 23

What is TNM staging used for?

Answer 23

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.

Question 24

What does each letter stand for in TNM staging?

Answer 24

T = tumor
N = nodes
M = metastasis

Question 25

When is a laryngectomy used?

Answer 25

Used with total involvement of both folds, subglottic extension, fixation of one fold, involvement of the arytenoid cartilage or cancer in the extrinsic larynx

Question 26

When is a laryngectomy with radical neck dissection necessary?

Answer 26

If the cancer is suspected to have extended into lymphatic tissue of the neck

Question 27

What anatomical structures are removed in a total laryngectomy?

Answer 27

Everything from above the hyoid to below the cricoid... maybe even a few tracheal rings

Question 28

What are the two types of partial laryngectomies?

Answer 28

Supraglottic (horizontal) and hemilaryngectomy (vertical)

Question 29

Describe a supraglottic laryngectomy (horizontal).

Answer 29

Removing the structures above the true VF but the VF are maintained... but swallowing is compromised

Question 30

Describe a hemilaryngectomy (vertical)

Answer 30

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.

Question 31

What are some of the consequences of a laryngectomy?

Answer 31

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.

Question 32

Why in a total laryngectomy does the patient now have a stoma/why is it necessary?

Answer 32

It allows them to breathe without aspiration because the primary biological purpose of the larynx is to protect the trachea during swallowing.

Question 33

What are 4 problems for post-op patients?

Answer 33

Air intake, digestive, diminished taste and smell, and many social adjustments

Question 34

What is alaryngeal speech?

Answer 34

Speech without vocal cords

Question 35

What are the two options patients have for sound productions who have no larynx?

Answer 35

Pseudoglottis or neuglottis at the opening of the esophagus, or mechanical or electronic sound source.

Question 36

What is the P-E segment?

Answer 36

The vibratory structure of both esophageal speech and tracheoesophageal speech; primarily composed of the cricopharyngeus and the inferior pharyngeal constrictors

Question 37

What is the criteria for TEP and voice prosthesis candidates?

Answer 37

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

Question 38

What is the name of the test we use to hear the quality of the voice and know if the cricopharyngeus is too loose?

Answer 38

Insufflation test

Question 39

What is a myotomy?

Answer 39

A procedure to cut the fibers of the PE segment which loosens it up and allows it to vibrate more easily

Question 40

Why is it important that the TEP prosthesis has a one way valve?

Answer 40

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.

Question 41

Why is it good to prescribe a laryngectomee with an artificial larynx?

Answer 41

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.

Question 42

What are the two methods for teaching esophageal speech?

Answer 42

Injection and inhalation

Question 43

What is the preferred method for teaching esophageal speech?

Answer 43

Injection method