Study Notes on Head and Neck Cancer and Dysphagia

Overview of Head and Neck Cancer

  • Definition: Malignant tumors categorized into 44 stages, involving the nasal/oral cavity, pharynx, or larynx glands.
  • Nature: Typically primary, though occasionally secondary (ASHA, 2021).
  • Symptoms: Dysphagia, weight loss, neck lumps, and vocal changes.
  • Treatment Factors: Determined by cancer stage and patient general health.

Primary Treatment Options

  • Surgery: Removal of tumor and surrounding tissue; often requires reconstruction and alters chewing, swallowing, and speech.
  • Radiation Therapy: Uses high-energy x-rays. Causes tissue stiffness (fibrosis), mucosal damage, dysphagia, dry mouth, and loss of taste.
  • Chemotherapy: Drugs used to stop cell division; often combined with radiation to avoid a total laryngectomy.

Dysphagia in Head and Neck Cancer

  • Causes: Oral/throat surgery, Glossectomy, Laryngectomy, and Radiation therapy.
  • Common Symptoms: Multiple swallows, wet voice quality, coughing/choking, pain, and dry mouth.

Mann Assessment of Swallowing Ability (MASA-C)

An assessment tool evaluating multiple domains including:

  • Behavioral/Cognitive: Alertness, cooperation, auditory comprehension.
  • Respiratory: Rate and independence of control.
  • Oral/Motor: Dysphasia, Dyspraxia, Dysarthria, saliva control, lip seal, and tongue strength/coordination.
  • Swallow Function: Bolus clearance, oral transit (noting delays > 10 sec10\,sec, > 5 sec5\,sec, or > 1 sec1\,sec), cough reflex, and pharyngeal phase response.

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

  • Anatomical Findings: Pharyngeal tumors, narrowing of the pharyngeal cavity, and swelling of the epiglottis or larynx.
  • Physiological Findings: Aspiration of thin liquids and pharyngeal residue of solids (Groher & Crary, 2016).

Prophylactic and Specialized Interventions

  • Prophylactic Swallowing Exercises: Implemented prior to and during chemo/radiation to maintain swallowing ability and improve quality of life.
  • Feeding Devices: Glossectomy spoons and the TheraBite device for trismus.
  • Sensory Interaction: Sour taste may improve pharyngeal transit (Umeno, 2008).

Targeted Therapy Strategies

  • Impaired Bolus Transport: Head-tilt back, Effortful swallow, isometric tongue exercises, and Mendelsohn maneuver.
  • Reduced Airway Protection: Chin-tuck, head-turn, Supraglottic swallow, Super-supraglottic swallow, and surgical medialization of vocal folds.
  • Radiation Side Effects: Flavored gum or water spritzers for Xerostomia; frequent liquid use during meals; PEG tube preference over NG tube.