Oral Cancer – Flashcards

4% of naturally occurring cancers

1. tongue 2. floor of mouth

over age 40 2:1 male to female

1. tobacco -pipes=lip cancer -cigarettes=oropharyngeal and laryngeal cancer -snuff dipping/tobacco chewing=cheek and gum cancer 2. alcohol consumption -10x increase in cancer w/heavy alcohol and tobacco usage (also cirrhosis)

1. alcohol and tobacco=drying effect on epithelium (makes it more susceptible) 2. poor oral hygiene 3. ill-fitting prosthetic appliances and dentures 4. spicy food

1. lip 2. anterior floor of mouth 3. lateral floors of mouth 4. tonsils 5. tongue 6. esophagus

1. squamous cell carcinoma 2. lymphoma

1. Leukoplakia -is a precancerous lesion -is a white patch on the epithelium 2. Erythroplakia -oral mucosa transformation -red -precancerous lesion

1. swelling 2. fixation of lump in oral cavity 3. failure of a lesion to heal 4. metastatis (spreading) -most common site is the lymph nodes 5. the more posterior the malignancy, the greater the risk for lymphatic spreading

T= tumor (primary) N= nodal involvement M=Metastasis Ex: T(1) N(0) M(0)=tumor is in early stage and small, no lymph nodes, no metastasis

1. type of tumor 2. extent 3. invasive nature

1. surgical resection -eradicate tumor, thereby obliterate disease -removes entire tumor 2. radiation -reverse or arrest tumor growth 3. chemotherapy is supplementary tx for control of metastatic disease (generally palliative in head/neck cancers) 4. combination with or w/o chemo (laryngeal sparing) 5. Radiation: - is a factor of post-op dysphagia -edema and fibrosis of the tissue (alters mobility) -reduced saliva flow, more dental carries -sores in mouth 6. chemo -gingiva pain, bleeding -mucosa ulcerations -change of taste -xerostemia (reduction of saliva)

-may cause temporary or permanent dysphagia 1. resection -less than 50% of area removed, swallowing won't be severe a. simple resection=one structure is involved b. composite resection=2 or more structures involved 2. extensive surgery -involves neighboring structures -prognosis for swallowing competency decreases

1. primary -suture tissue together 2. flap -used when local tissue isn't sufficient -creates bulk -common donor sites (traps, pecs) 3. skin graft -used when extra bulk is not needed *(in general, the thinner the material, the better)

1. staging of tumor 2. additional therapy (radiation/chemo) 3. what type of tx pt has received

hypernasality

chewing, swallowing, and saliva control

1. articulation 2. swallowing 3. larger resection of tongue=increase in articulation errors

-denervation or scarring a. hypernasality b. nasal regurgitation of food

1. extent of lingual resection 2. MOBILITY of residual tongue 3. type of reconstruction 4. involvement of other structures 5. pt motivation ad ability to adapt 6. skill of rehabilitation team

1. isolated lesion -small resection (results are minimal, no problems) 2. composite resection -persistent swallowing disorder 3. removal of the lip (upper or lower) -persistent drooling -restricted mouth opening -syringe needed to get food into the oral cavity -difficulty w/drinking and eating from a spoon (OT would help w/this)

partial= 1. remove portion of jawbone 2. pts respond well by compensating w/opposite side total= 1. composite resection with -jaw -tongue -neck 2. remove entire jaw 3. pts will be debilitated -poor tongue support -difficulty speaking -difficulty swallowing

partial= 1. small part=good prognosis 2. larger part=more probs total= 1. poor prognosis 2. limited speech output 3. aspirate on own saliva 4. unable to eat or drink liquids 5. larynx may also be removed

1. removal of soft palate -hypernasality and difficulty swallowing 2. rehabilitation=use of an obturator (aides in swallowing) 3. resection of uvula only -VP closure may be possible -minimal difficulties with speech and swallowing

1. either ramus -no difficulties with jaw movement during chewing 2. complete mandibular resection -drooping lip -loss of liquids during feeding -no occlusion relationship -difficulty with chewing -appliances and prosthesis used for reconstruction limited

1. oral preparatory and oral phase of swallow will be impaired 2. no control of oral bolus (piecemeal deglutition) 3. delayed swallow reflex 4. aspiration before swallow

1. propulsion of bolus to hypopharynx becomes disorganized 2. bolus directed down affected side 3. may involve removal of tonsil -nasal regurgitation 4. delayed swallowing reflex 5. pts will have postoperative edema (so they may seem to do better immediately after surgery when there is added mass)

1. can be anterior or lateral 2. problems in oral preparatory stage of swallow and oral transit 3. lateral floor of mouth -tongue may be sutured to floor of mouth on one side -food will remain in lateral gutter

-nasal regurgitation of food -palate may become scarred and immobile

1. reduced labial closure; abnormal hold position 2. reduced lingual control (aspiration before swallow)-esp thin liq 3. delayed pharyngeal swallow (temporary) -so, oral phase impairment can impact pharyngeal phase

1. reduced lingual control (aspiration before swallow) 2. delayed pharyngeal swallow (aspiration before swallow) 3. reduced pharyngeal peristalsis (aspiration after swallow) 4. reduced base of tongue retraction 5. if extended to soft palate=nasal regurgitation

-reduced pharyngeal contraction (aspiration after swallow)

-reduced pharyngeal contraction (aspiration after swallow) -delayed pharyngeal contraction (aspiration before swallow)

to preserve swallowing function and maximize functional outcomes at the completion of tx

-base of tongue -pharyngeal musculature -airway protection -laryngeal elevation *practice them in series of 5 reps, 3 x a day as long as able

-continual monitoring of passy-muir valve use and swallowing function through tx -goal is to maintain nutritional status during tx -SLP goal=to maintain oral nutritional status

1. extent of lingual excision 2. mobility of residual tongue 3. presence or absence of teeth 4. type of reconstruction 5. age, hearing, general health, and motivation

1. Physician or nurse identifies patient with potential swallowing and feeding problems 2. Speech-language pathology, occupational therapy, and dietary review chart and assess patient within 24 hours 3. Immediate modifications determined by assessments are implemented 4. Radiographic or videofluroscopic evaluation 5. Team meets at rounds to review patients status and develop a treatment plan 6. Speech Language Pathologist Assesses oral-motor function and swallowing status 7. Recommends, assists and interprets results of videoflurorscopic studies 8. Develops and manages exercises when indicated 9. Determines with physician and dietitian most appropriate feeding method 10. Recommends diet consistency and degree of supervision required 11. Trains patient, staff, and family in compensatory swallowing techniques 12. Performs ongoing determination of swallowing status 13. Assesses influence of language comprehension, ability to follow instructions, mental status, and overall responsiveness on swallowing 14. Recommends aspiration precautions as indicated

Initial Assessment= 1. Observation of how the patient handles his/her own secretions 2. Examination of anatomy, function, and sensory responses 3. Check for cough, gag, and swallow reflex Observe for signs of aspiration 4. Test ability to swallow very small amount of water and applesauce Postoperative swallowing assessment= 1. Swallowing assessment should be done PRIOR to removal of nasogastic tube 2. When results yield a swallow without aspiration and within an acceptable time frame (10 sec or less) nasogastric tube should be removed 3. When swallowing function is disturbed A complete videofluoroscopic modified barium swallow should be done

1. aspiration -if aspirating more than 10% of each bolus, any consistency, should NOT be fed orally 2. time -any pt who takes more than 10 sec to eat every bolus of food (any consistency) is unlikely to maintain adequate nutrition with oral intake alone 3. adequacy of intake -intake is less than 50% for 3 consecutive meals -total calories consumed are not adequate to meet estimated caloric needs after 2 consecutive calories counts (we can recommend calorie count from dietary) -pt has experienced significant weight loss

1. bilabials and labiodental consonants impacted

-minimal probs -lower lip is more important for artic than upper lip

use the less than 50% rule

1. note remaining portion of tongue -ability to move upwards -misarticulation partial glossectomy pretherapy intelligibility -6-24% posttherapy=24-46% total glossectomy pretherapy=0-8% post=18-42%

Questions= 1. What is your full name? 2. Where do you live? (full address) 3. Tell me about your trip to the hospital. 4. Who is your doctor? 5. What is the weather like outside today? Reading 1. Have the patient read Arthur the Rat—stop if unintelligible. Abbreviated phonetic inventory= Nonglossal consonants & vowels 1. Why buy ham? 2. May we have pie? 3. You owe me a fee. 1. Nonglossal consonants & vowels 2. Why buy ham? 3. May we have pie? 4. You owe me a fee. Glossal consonants & vowels 1. I am giving her the little red coats for Nora. Aspirate effect 1. Helen hollers "Hi, Harry, hurry home."

OUTLINE OF TECHNIQUES 1. Initial modification of habitual behaviors -teach telegraphic writing -teach oral rephrasing 2. Listening -identification of sounds -discrimination among similar sounds -recognition of sound variants w/in phonemic limits -monitoring speech of other glossectomies -self-eval of intelligibility 3. Speaking Specifics on Behavior Manipulation -consistency in substitution -Most glossectomees substitute some of the nonglossal for glossal These sounds are generally not produced with: -Differentiation, or Consistency

[v-f] are substituted for [s-z], [d-t], & [ð-θ] [ɾ] (glottal stop) is substituted for [d-t], [g-k] [w] & [a] are substituted for [r] and [ɝ] [j] or [w] for [l] [n] or [ɾ] for [ŋ] Substitutions to Establish Consistency [v-f] substituting only for [ð-θ] [ɾ] only for [g-k] [nɾ] only for [ŋ] [w] only for [ɝ] air puff only for [z-s] [ɜ] only for [ɝ] [j] only for [l]

Velar consonants /k/ & /g/ Velar Fricatives /t / Articulation increases with prosthesis