Partial & Total Laryngectomy/Tumors-Test 2 Flashcards Preview

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Flashcards in Partial & Total Laryngectomy/Tumors-Test 2 Deck (75):
1

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

benign; malignant

2

Intrinsic cancer

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

3

Extrinsic cancer

Tumor developing in some other part of the larynx

4

Leukoplakia

White growth that if not treated can develop into cancer

5

Tumor definition

Abnormal mass of tissue

6

Etiology of benign tumors

Unknown
Believed that most are the result of a chronic inflammatory response

7

When can a Benign tumor occur?

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

8

Where do Benign tumors most often occur?

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

9

Most common symptom of benign laryngeal tumors

Hoarseness

10

Who gets cancer of the larynx

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

11

Predisposition factors to laryngeal cancer

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

12

Who is more likely to get laryngeal cancer?

Ratio of men to women is 7:1
Women are getting it more often due to increasing #s of women smoking, especially in Europe

13

Most common sx of Laryngeal Cancer

Hoarseness
If cancer is intrinsic, hoarseness is an early symptom

14

Prognosis for intrinsic laryngeal cancer:

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

15

Sx's and Extrinsic Laryngeal Cancer

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

16

Locations of Laryngeal Tumors

May occur at 3 sites:
Glottic (on VFs/larynx), supraglottic, subglottic

17

Glottic carcinoma

Most common type of laryngeal cancer

18

Initial symptom of glottic carcinoma

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

19

Supraglottic Carcinoma

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

20

Initial symptoms of Supraglottic Carcinoma

Dysphagia accompanied by pain radiating to ear on speaking and swallowing

21

Subglottic Carcinoma

Develops on the undersurface of the VFs

22

Initial symptoms of Subglottic Carcinoma

Difficulty with breathing

23

Tumor Stages

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

24

TNM: T:

T: Primary tumor
1. Supraglottis
2. Glottis
3. Subglottis

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