Head & Neck Cancer: Surgical Treatment
Name at least three structures that may be affected by HNC.
Lips, tongue, floor of mouth, mandible, palate, pharynx, larynx, base of skull
T/F: In all cases, the goal for cancer treatment is to preserve organs.
False! Sometimes the removal of the organ in question is preferable to chemotherapy/radiation treatment.
Tracheotomy is ?
Tracheostomy is ?
Tracheotomy = the surgical procedure that creates an opening in the neck to place a breathing tube
Tracheostomy = the opening itself (called a stoma)
T/F: There is mixed literature regarding the extent to which trach tubes affect swallowing.
True! Results on just how much they affect swallowing are inconclusive.
T/F: It is within the SLP's scope of practice to intubate patients.
False!
Are the following characteristics typical of a malignant or benign tumor?
capsulated, well-differentiated, suffix of "-oma"
BONUS: Name three characteristics of the remaining type of tumor.
benign
(malignant: poorly-differentiated, suffix of "carcinoma" or "sarcoma", non-capsulated, fast-growing, metastasize to other areas, infiltrative)
For HNC patients treated with chemotherapy, dysphagia symptoms tend to be reported how long after treatment?
3 to 6 months after
What does TEP stand for?
tracheoesophageal voice prosthesis
What is decannulation?
Complete removal of the trach tube
What factor of intubation increases possibility of dysphagia?
Time the patient spends being intubated
T/F: Surgery is typically the treatment choice for small cancers, especially oral cancers and early laryngeal cancers.
True!
List three acute and/or long-term radiation effects.
Acute: pain, swelling, mucus production, xerostomia (sensation of dryness orally), mucositis
Long-term: fibrosis, xerostomia
T/F: It is outside of the SLP's scope of practice to monitor and change the tracheoesophageal voice prosthesis.
False! SLPs can and often do both of those things.
Name three parts of a trach tube.
Cuff, fenestration, pilot balloon, speaking valve
Endotracheal intubation (aka intubation) involves placing a tube from the mouth down the _______; placement is guided by a ____________.
trachea, laryngoscope
T/F pt’s with lip tumor/excision have difficulty initiating a __________ _______.
pharyngeal swallow
The most common physiological impairments involved in swallowing for chemotherapy patients are (there are two):
Post-swallow residue and poor base of tongue retraction.
When a speaking valve is attached to a trach, air is inhaled through the valve to the lungs BUT closes on __________.
expiration
Name three indicators that a patient is NOT ready for a trach assessment.
Cuff is up, trach size is 8 or larger, weak cough, no voice, overt signs of aspiration, not tolerating corking (sealing of the trach tube with a cap), poor O2 saturation, confused/disoriented
Which form of intubation is short-term? Which is long-term?
Intubation via mouth = short-term
Intubation via trachea = long-term
What is the difference between supraglottic, partial, and total laryngectomies?
• Supraglottic laryngectomy – removing all structures above the vocal folds
• Partial laryngectomy – remove cancer from a portion the larynx while preserving voice
• Total laryngectomy – total removal of the larynx from its attachments; trachea is diverted out the neck
Why might we as SLPs not recommend a G-tube for a radiation/chemotherapy patient despite the fact that it may be easier for them to get nutrients that way?
If possible, we want the patient to be able to continue practicing eating and swallowing functions so that they don't lose more function from lack of use.
What is a cuff? What is its purpose?
A balloon-like structure that can be inflated or deflated, sitting below the trach curvature on the outer cannula. It maintains air in the subglottic region so that air can be delivered to the lungs.
Which test is sometimes used to assess the possibility of aspiration, but is controversial due to its lack of sensitivity?
Blue dye test
What is the primary issue for speech and swallowing when intubated?
Trauma to the base of tongue, vocal folds, and/or upper esophageal sphincter