Head & Neck Cancer – Flashcards

Includes paranasal sinuses, oral cavity, nasopharynx, oropharynx & larynx

Potential to disrupt breathing, eating, facial appearance, self-image, speech & communication.

-Alcohol & tobacco (synergist effect when used together) -Industrial exposure (chemicals, etc.) -Human papillomavirus (HPV) -Excessive smoked meat ingestion -Poor hygiene (Don't forget the dental health and cardiac connection)

-Early stages produce few to no symptoms. -Anything "sore" or "different" that lasts for more than 2 weeks -> seek help! -Hoarseness - non-remitting, lasting for 3 or more weeks and painless (early sign)- -Later stages may include non-healing ulcer, c/o pain, tenderness; difficulty with chewing, swallowing or speaking; coughing up blood-tinged sputum; enlarged head & neck lymph nodes; unilateral sore throat or otalgia (ear pain); "lump" in throat

-Early stages produce few to no symptoms. -Anything "sore" or "different" that lasts for more than 2 weeks -> seek help! -Hoarseness - non-remitting, lasting for 3 or more weeks and painless (early sign)-

-Later stages may include non-healing ulcer, c/o pain, tenderness; difficulty with chewing, swallowing or speaking; coughing up blood-tinged sputum; enlarged head & neck lymph nodes; unilateral sore throat or otalgia (ear pain); "lump" in throat

-Usually made late (cancer well advanced) -Visualize per scope (Laryngoscopy or Panendoscopy) -Biopsy lesions, x-ray, MRI, CT & PET scan

-Generally based on stage of the disease and TNM staging -If early, lesion may be excised. -If later, radiation, chemo, surgery may be performed.

-Soda and Salt Mouth Rinse ~1/4 teaspoon baking soda ~1/8 teaspoon salt ~1 cup of warm water -Use=pilocarpine hydrochloride (Salagen) for xerostomia - (very costly!!!)

fatigue, dysphagia, hoarseness, skin problems, xerostomia (dry mouth), stomatitis (sores in mouth)

-Nadir - general term for lowest point; body is at lowest immune point (RB, WBC, Plt) -(Most susceptible)

- laryngectomy (total & partial), tracheostomy, oropharyngeal resection & possible reconstruction (may include skin flaps). ---First priority after head/neck surgery is airway maintenance and ventilation.

- removal of tongue - speech deficit

- removal of ½ of tongue - speech deficit

- partial or complete removal of vocal cord

- excision of 1/2 of the larynx (Requires temporary tracheostomy) -Voice is preserved. Is breathy & hoarse.

- removal of false vocal cords & epiglottis -Requires temp. tracheotomy -Voice is preserved. Is breathy and hoarse -High risk for aspiration!!!!!! -Teach supraglottic swallow technique for eating

1. Technique protects upper airway prior to food/liquid bolus arrival 2. Take sip of liquid, hold it on your tongue 3. With mouth closed, take short breath in through nose and bear down (Valsalva maneuver) 4. While holding breath, swallow all at once 5. Cough during exhalation

-(aka neck dissection or radical laryngectomy) -upper airway is separated from throat & esophagus, then trachea is brought out through the skin in the neck and sutured in place, creating a stoma. -Removal/transection of larynx, lymphatic tissue, sternocleidomastoid muscle, IJ vein, mandible, submaxillary gland, spinal accessory nerves & partial thyroidectomy.

1.Normal swallowing - b/c of discontinuity of trachea and espophagus. Can eat after recovers 2.Shoulder drop - d/t 11th cranial nerve (spinal accessory) removal. PT is needed 3.Permanent tracheostomy a.Patent airway? Stoma site? - protruded or retracted, moist/dry, etc. Humidify air/O2 b.Teach about suctioning, sterility, etc. 4.Airway patent? 5.Semi-Fowlers position 6.Frequent suctioning per laryngectomy tube a.Blood-tinged at first, but ↓ over time 7.Hemovac or JP drain - monitor q 4° 8.Drainage normally serosanguineous & should ↓ in volume in 24 ° 9.Humidifier is needed 10.Wash around stoma 3x/day - moist cloth 11.Remove tube and clean daily (just like trach inner cannula cleaning) 12.Can loosely cover stoma - scarf, shirt, crocheted shield, etc. 13.Cover stoma w/ coughing 14.Maintain incr. oral intakes (esp. summer) 15. CO2 monitors in home 16.Smoke alarms in home - can't smell 17. Medi-Alert bracelet - "Neck breather" 18. Swimming is contraindicated 19. Wear plastic collar when showering

-Has normal swallowing -Shoulder drop r/t 11th cranial nerve (spinal accessory) removal. Get PT involved to help with this! -Permanent tracheostomy -Communication deficit post-op - need voice rehabilitation via ST!!! -Teach home care post-op laryngectomy

-(e.g. Blom-Singer) - fistula is made between esophagus & trachea. Valve is placed in tracheal stoma to divert air into the esophagus and out the mouth. Once the puncture is surgically created & has healed, the Blom Singer is fitted over the puncture site. Can also manually block the stoma with the finger and then talk.

- low success rate. Not as popular since 1980's. Basically sound is made with air belching.

- uses vibrations to make voice sounds. Sounds are mechanical/robotic. a. Battery powered device b. Most common

- portion of larynx, along with one vocal cord & the tumor is removed. i. Usually voice preservation with hoarseness ii. Intact airway iii. No difficulty w/ swallowing

-Protect the airway - ventilate appropriately and prevent aspiration -Position in Semi-Fowler's - helps patency of airway secondary to decreased edema -Monitor for bleeding -Drainage tubes - JP or Hemovac -Infection potential -Nutritional needs -Communication needs -Promote positive self-image & self-esteem

1.Careful measurement of output 2.If JP, strip tubing 3.Keep both devices compressed

-Montor temp, CBC, etc. Post-op dressing changes

-Generally TPN or enteral (NGT, gastrostomy tube, etc.)