Head and neck cancers

Staging of tumours

System of evaluating the extent of spread of tumours and its cellular mass

0 = carcinoma in situ

1 = localised spread

2 = localised invasion

3 = spread to lymph nodes

4 = metastasis

what is a stage 0 tumour?

carcinoma

N

Node involvement 0 - 3

(lymph nodes in neck)

M

metastasis 0/1

0 = no spread

1 = spread to other lesions in the body

(unusual for head and neck cancers to metastisise)

brain tumours

Cause neurological speech, language and swallowing difficulties. These are not HNC and would be seen by a neuro oncology multi-disciplinary team.

Effects of tumour on speech/ swallowing

- Structural changes to articulators

- Structural changes to resonance chambers

- Structural changes to swallowing mechanism

- Space-occupying lesions may disrupt the breathing/ swallowing/ phonation process

- Pain, appetite, weight, etc.

Surgery

Primary Closure = •Tumour extracted and surrounding tissue pulled across to cover wound.

Reconstruction = •Involves importing tissue, usually containing a blood supply, from a 'donor' site, and 'plumbing' it in to help reconstruct (microscopic anastomosis). (however, • Flaps can 'fail' (die), usually requiring further surgery with new donor tissue)

Common donor sites include

•Radial forearm (inner forearm) (RFFF)

•ALT (antero-lateral thigh) (ALTFF)

•Pectoralis major (chest) (PMPF)

Scapula (back/shoulder) (SFF

Effects of treatment on speech and swallowing: surgery

Change in anatomy

Loss of function

Swelling

Pain

Tracheostomy

Psychosocial issues

Radiotherapy (RT)

•Can be given as a primary treatment or as an adjuvant treatment (in addition to surgery).

•You can only have RT to the same area once.

IMRT = intensity-modulated radiotherapy - more accurate to site of tumour.

•more intense if curative - less intense if palliative.

•Dose measured in Gray (Gy), split into many treatments (fractions, #), e.g. 60Gy in 30# (6 weeks)

Effects of treatment on speech and swallowing: radiotherapy

Mucositis

Pain

Erythema

Xerostomia/ altered saliva

Oedema

Fatigue

Fibrosis

Psychosocial issues

Chemoradiotherapy (CRT)

•Chemotherapy is the use of cytotoxic drugs to destroy cancer cells. (heightens toxicity of RT)

normally an adjunctive treatment for HNC.

-In combination with radiotherapy ('concurrent chemotherapy')

-Before surgery to shrink a tumour ('neoadjuvant' chemotherapy)

-To relieve symptoms and improve quality of life (palliative)

Effects of treatment on speech and swallowing: chemotherapy

Fatigue

Nausea/ vomiting

Reduced appetite

Infections

Sore mouth

-> difficult to motivate ppl to attend and continue treatment.

Xerostomia

Xerostomia is the name for dry mouth (xer- = dry. e.g., xeric)

dysgeusia

taste change

Sialorrhea

hypersalivation or excessive drooling