Dysphagia Related to Head & Neck Cancer

4%

head & neck cancer account for nearly __% of all cancers in the U.S.

men

head & neck cancer are twice as common among _____

80%

there is an __% survival rate if head & neck cancer is detected early

HPV

_____ has emerged as a major source of new head & neck cancer diagnosis (greater than 70% of HNC diagnosed during the 2000s)

1. oral cavity

2. pharynx

3. larynx

4. paranasal sinuses

5. salivary glands

what 5 areas are affected by H&NC

1. tumor size

2. nodal status

3. presence or absence of metastasis outside the region

what are the 3 components of tumor staging

tumor size

• from 1-4

• T1 smallest, T4 largest

what does the T in TNM stand for

nodal status

• spreading to the lymph nodes in the head/neck is noted by recording N followed by a number representing the number of nodes involved

what does the N in TNM stand for

presence or absence of metastasis outside the region

• noted by recording M followed by a number, indicating the number of regions

what does the M in TNM stand for

1. surgery

2. chemotherapy

3. immunotherapy

4. radiation

what are the 4 ways to treat H&NC

surgery as treatment for H&NC

• laser - can be used to treat early-stage tumor (especially in the larynx)

• resection - removal of tissue, or all or part of an organ

  • if small, the wound may be closed with primary closure (sutures)

  • if large, must use a flap or graft to close the wound

• lymph node dissection - removal of affected lymph nodes

flap

transporting healthy, live tissue from one location of the body to another, with its blood supply intact

graft

transporting skin, without blood supply

chemotherapy as treatment for H&NC

• use of drugs to destroy cancer cells, usually by stopping them from growing, dividing, and making more cells

• patient may receive 1 drug at a time or a combination of drugs

immunotherapy as treatment for H&NC

• uses the body’s natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells

radiation as treatment for H&NC

• high energy x-rays/other particles to destroy cancer cells

  • intensity modulated: type of external-beam used to help target the tumor and reduce damage to nearby healthy cells

larger; T3 and T4

generally, the _____ the tumor, the more aggressive the treatment; T_ and T_ lesions more frequently treated by combined therapies

effects of surgery (depend on type and location)

• voice changes or voice loss

• hearing loss

• swelling (can cause breathing obstruction)

• disfigurement (reconstructive surgery may be recommended)

• pain, stiffness, tightness

early effects of radiotherapy

• xerostomia (oral dryness)

• mucositis (redness, inflammation, may include ulcers)

late effects of radiotherapy (continue long after treatment ends)

• trismus (jaw stiffness)

• decreased muscle bulk - muscles shrink

• fibrosis (stiffness) - fibers are not as pliable as they used to be

oral & oropharyngeal cancer sites

• buccal mucosa

• tongue

• floor of mouth

• mandible

• hard & soft palate

• tonsils

hypopharyngeal & laryngeal cancer sites

• pharyngeal walls

• supraglottic

  • epiglottic

  • arytenoids

  • AE folds

  • false folds

• glottic

  • true vocal folds

  • anterior commissure

• subglottic

  • below vocal folds, above trachea

oral swallowing dysfunctions

• loss of oral control/coordination

  • reduced labial seal

  • reduced mastication

  • reduced bolus control and propulsion

• reduced lingual/palatal seal

• reduced base of tongue force

pharyngeal swallowing dysfunctions

• delayed swallow initiation

• decreased pharyngeal constriction

• decreased hylolaryngeal excursion

  • decreased laryngeal closure

  • decreased UES opening

esophageal swallowing dysfunctions

• esophageal stricture

• esophageal web

  • both cause slow passage to stomach, feeling of things “stuck”, early satiety

• esophageal fistula

  • bolus enters airway - aspiration