Laryngectomy Exam 1

FML

Growth Regulation

Normal cells are stimulated to divide at a certain rate. Cancer cells divide without the normal signals and grow out of control.

Replicative Senescence

Normal cells are programmed to divide only a certain number of times. Cancer cells mutate and replicate an infinite number of times.

Apoptosis

Normal cells are programmed to self-destruct at a certain point to make way for new cells. Cancer cells mutate and lose this programming, living way longer than they’re supposed to.

Differentiation

Normal cells have specific functions according to their type and maturity. Cancer cells mutate and stop doing their specified job.

Tissue Migration

Cancer cells breakthrough basement membranes of tissues to gain access to blood vessels/lymphatic system.

Angiogenesis

Cancer tissue has the ability to create its own blood supply allowing an exchange of nutrients and waste.

DNA Repair

Cancer cells lose the ability to self-monitor for faulty DNA (p53 mutation) and continue to pass on bad mutations.

Immune Evasion

Cancer cells evade the immune system when it should be flagging them as abnormal.

What happens to cells when they become cancerous?

Mutations occur in cell DNA caused by genetic or epigenetic factors in a series of damaging events.

What important cellular functions become disrupted when cancer occurs?

GRAD

Growth Regulation - Normal cells are stimulated to divide at a certain rate. Cancer cells divide without the normal signals and grow out of control.

Replicative Senescence - Normal cells are programmed to divide only a certain number of times. Cancer cells mutate and replicate an infinite number of times.

 
Apoptosis - Normal cells are programmed to self-destruct at a certain point to make way for new cells. Cancer cells mutate and lose this programming, living way longer than they’re supposed to.

Differentiation - Normal cells have specific functions according to their type and maturity. Cancer cells mutate and stop doing their specified job.

How does that ultimately lead to the development of a cancerous tumor? (What are the steps to cells becoming cancer)

Normal

Dysplasia - pre-cancer

Carcinoma in situ - almost cancer

Invasive cancer - through basement membrane

Metastatic cancer - spread to other areas

What are some of the methods by which cancer spreads throughout the body?

TADI

Tissue Migration - Cancer cells breakthrough basement membranes of tissues to gain access to blood vessels/lymphatic system

Angiogenesis - Cancer tissue has the ability to create its own blood supply allowing an exchange of nutrients and waste.

DNA Repair - Cancer cells lose the ability to self-monitor for faulty DNA (p53 mutation) and continue to pass on bad mutations.

Immune Evasion - Cancer cells evade the immune system when it should be flagging them as abnormal.

Dysplasia

pre-cancerous archetecture

Carcinoma in situ

About to be cancer

Invasive Cancer

Through the basement membrane

Metastatic Cancer

Spreads through lymph or blood vessels to distant areas

Symptoms of H&N CA

WOODPLOGHADRBPTCCP
Weight loss/loss of appetite
Otalgia
Odynophagia
Dysphagia
Persistent Sore Throat
Lump in neck
Oral ulcer that won’t heal
Globus sensation
Hoarseness 3+ weeks
Any visualized lesion
Difficulty breathing
Reduced tongue movement/asymmetry
Bad breath
Poor fitting dentures
Trismus
Cough
Coughing up blood
Pneumonia/bronchitis

What benefits medical professionals achieve from using the TNM classification system?

TESS

Teams can appropriately select treatment modalities

Evaluates efficacy of treatment in comparison of patients with similar prognoses.

Standardizes treatment across different centers

Standardized system for classifying cancer.

Name the types of surgeries for H&N CA.

Laryngectomy (cordectomy, partial, total)

Glossectomy (partial, hemi, near-total, total)

Mandibulectomy (marginal removal, segmental removal, total)

Maxillary Surgery

Oropharyngeal Cancer Surgery (traditional method or TORS)

What is potentially removed in a laryngectomy?

glottis
larynx
hypopharynx
pharynx
upper esophagus

What is potentially removed in a mandibulectomy?

mandible
floor of mouth

What are some functional changes in speech that result from H&N CA surgery?

Speech errors:
- intelligibility
- articulation
- hypernasality
- voicing issues

What are some functional changes in swallowing that result from H&N CA surgery?

Swallowing Issues:
- oral transit
- oral residue
- tongue range of motion and strength
- reduced pharyngeal constriction
- pharyngeal residue
- reduced hyolaryngeal excursion
- reduced airway closure
- reduced VP closure
- aspiration
- decreased sensation

What are the types of grafts and flaps encountered in H&N CA reconstructive surgery?

Secondary Intention - closes defect

Graft - tissue of epidermis, detached from own blood supply, connected to new blood supply

Local flap - retains all or part of original blood supply

Pedicled/Regional flap - Comes from an adjacent part of the body, it stays connected to its original blood supply

Free Flap - two team approach, comes from a further part of the body, disconnect tissue and blood supply, reconnect tissue to new blood supply, improved vascularity and healing.

What are some functional consequences of H&N CA surgeries?

The physiology of the area is going to be permanently altered because reconstructive surgeries rarely restore the physiology.

It improves the look, the anatomy, and restoring some of the lost function.

What might you talk to patients about in the clinic? How could you educate them about what to expect so that they have the knowledge that they need to understand what’s to come and what the role of SLP will be in their treatment plan?

- expected changes in anatomy and physiology
- breathing and protecting the airway
- alaryngeal voice rehabilitation - options
- Post surgical options for communicating (check handwriting/literacy)
- Stoma care
- postoperative pulmonary rehabilitation
- post-op olfaction rehabilitation
- patient and family support

What are some of the acute effects of radiation?

In the Clinic - Acute
- Skin breakdown and “sunburn” (like a blistering sunburn)
- mucositis
- sore mouth/sore throat
- dysphagia and odynophagia (painful swallowing, it can co-occur with dysphagia)
- swollen neck especially submandibular region (lymphedema)
- Opportunistic infections (candida)
- Xerostomia
- Thick, ropy secretions
- Diffuse laryngeal and pharyngeal edema
- Mucositis of the oral cavity and/or pharynx

What are some of the chronic/late effects of radiation?

- firm, hard, “woody” neck
- severely reduced hyolaryngeal elevation - tethering of larynx
- Trismus-reduced jaw opening
- Reduced head/neck mobility
- Chronic lymphedema (often pitting)
- Lingual Atrophy
- “trapdoor effect”
- Osteoradionecrosis
- laryngeal/pharyngeal sensory impairment
- Severe laryngeal/pharyngeal deformity (stenosis, epiglottic deformity)

What are some side effects of chemo?

- Nausea
- Vomiting
- Anorexia (I just don’t feel like eating)
- Fatigue
- Sores in the mouth (mucositis)
- Weakened immunity (more vulnerable to infections and aspiration pneumonia)
- Dehydration -> hypernatremia
- Allergic reactions/skin rashes (may need to delay or stop chemo if bad enough)
- Damage to internal organs
- Ototoxicity
- Neuropathy of extremities
- PROFOUND DISGUST OF FOOD