ENT: Head and neck cancer

What are the 3 stages of tumours? TNM

What are the lymph nodes? what are they for?

• Lymph nodes are part of the body’s lymph system

• Several groups of nodes (small bean/grape-shaped nodes) positioned around our body in areas such as neck, armpit, groin, chest

• Part of the immune system

• Help to fight infection and inflammation

What are the 5 types of brain tumours? GNAMM

Glioblastoma, Neuroblastoma, Astrocytoma, Meningioma, Metastases

What are the features of the 5 brain tumours: Glioblastoma, Neuroblastoma, Astrocytoma, Meningioma, Metastases

• Glioblastoma – originates from astrocytes in the brain, highly aggressive, mostly found in cerebral hemispheres

• Neuroblastoma – starts from either the adrenal gland or from nervous tissue

• Astrocytoma – originates from astrocytes in the brain, aggressiveness depends on grade, can occur in brain and spinal cord

• Meningioma – within the meninges

• Metastases (e.g from lung Ca, breast Ca) – cancer cells spreading from the original tumour to other parts of the body

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.

Treatment options for cancer?

• Radiotherapy

• Chemotherapy

• Chemoradiation

• Surgery

• Surgery + radiation/ chemotherapy

• Treatments may be curative or palliative

Speech and swallowing can be worse after treatment – radiotherapy can produce more probs before things start to get better

What is Iatrogenesis?

 

Iatrogenesis – the unintentional cause of a health condition during the process of providing healthcare.

Speech and swallowing can be worse after treatment – radiotherapy can produce more probs before things start to get better

Primary closure vs reconstruction?

Common donor sites for flaps

• Radial forearm (inner forearm) (RFFF)

• ALT (antero-lateral thigh) (ALTFF)

• Pectoralis major (chest) (PMPF)

• Scapula (back/shoulder) (SFF)

Donor tissue retains original properties e.g., skin colour, texture, hair growth

Effects of treatment on speech and swallowing: surgery

• Change in anatomy - missing because of surgery or erosion by tumour – additional anatomy e.g., skin flaps on tongue – change in anatomy may then impact the physiology of the swallow or of speech production.

• Loss of function

• Swelling

• Pain

• Tracheostomy

• Psychosocial issues

Describe radiotherapy and its features

• Can be given as a primary treatment or as an adjuvant treatment

• Kills cancerous cells using high-energy radiation; cells then regenerate with healthy tissue

• Also kills off many healthy cells, hence nasty side effects (‘toxicity’)

• Advancements in Radiotherapy (e.g. Intensity modulated radiotherapy – more accurate to site of tumour) have increased accuracy of RT treatment fields, so less healthy surrounding tissue affected.

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

• Effects continue after treatment has stopped

Effects of radiotherapy on speech?

• Mucositis – inflammation and ulceration of the mucus membrane

• Pain

• Erythema – redness of the skin or mucus membrane

• Xerostomia/ altered saliva – “dry mouth”, saliva glands do not produce enough saliva

• Oedema – swelling caused by excess fluid trapped in body’s tissue

• Fatigue

• Fibrosis – scarring of tissue

• Psychosocial issues

Describe chemoradiotherapy and its features

Chemotherapy is the use of cytotoxic drugs to destroy cancer cells

In head and neck cancer, chemotherapy is used:

 In combination with radiotherapy (‘concurrent chemotherapy’)

 Before surgery to shrink a tumour (‘neoadjuvant’ chemotherapy)

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

Chemotherapy is not commonly used on its own as a primary treatment for head & neck cancers

However, is sometimes used alongside RT to increase the sensitivity of the tumour to RT (i.e. Radiosensitiser)

• Usually delivered for one day per week, intravenously (e.g. on chemo day unit)

• Not associated with the hair loss - often accompanied by nausea

• Only usually used with relatively young, fit patients (typically age <60/65 and good performance status (WHO)) as hard to tolerate (heightens RT toxicity)

Effects of chemotherapy on speech

• Fatigue

• Nausea/ vomiting

• Reduced appetite

• Infections

• Sore mouth