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Voice Ch. 9
Laryngeal Cancer Therapy and Management
| Term | Definition |
|---|---|
| Head and Neck Cancers | head and neck cancers include cancers in the lips, mouth, nose, salivary glands, pharynx, and larynx |
| Epidemiology of HNC | 5th most common cancer in the world (4% of all cancers) HPV positive HNCs are more amenable to treatment than HPV negative HNC Alcohol and tobacco increases risk of HNC Over 90% of HNCs fall under squamous cell carcinoma |
| Signs and Symptoms of Laryngeal Cancer | Hoarseness/change in voice that persists over 2wks Enlarged lymph nodes/lump in neck Airway obstruction/diff. breathing/noisy breathing Persistent sore throat or globus sensation Diff. swallow Ear pain, esp. from throat to ear Bad breath Choking |
| Squamous Cell Carcinoma (SCCA) | Squamous cells are thin/flat cells on surface of skin in linings of various organs SCCA is most common cancer of upper aerodigestive tract SCCA spreads in predictable ways depending on site of origin |
| TNM Classification | Tumor staging - most important prognostic indicator T: Tumor location, size, extent N: involvement of regional lymph nodes M: metastasis (has it spread) Numbers combined to stage cancer, higher numbers + increased severity |
| T: Tumor Location | T1: small tumor very localized T4: very large highly invasive tumor |
| N: Involvement of regional lymph nodes | N0: no spread to neck lymph nodes N3: spread to one or more lymph nodes measuring more than 6cm |
| M: Metastasis | M0: No evidence of distant spread M1: distant spread |
| Cancer Staging | Radiographic studies (CT, MRI, PET), operative, and pathologic findings are included in tumor classification and staging Presenting stage is the most important prognostic indicator |
| Stage I | Small tumor (T1), no spread to lymph nodes (N0) and no distant metastasis (M0) |
| Stage II | A tumor with spread to nearby areas (T2), but has not spread to lymph nodes (N0) or to distant parts of the body (M0) |
| Stage III | Any larger tumor (T3), no spread to lymph nodes (N0) or metastasis (M0) Or a smaller tumor (T1, T2), that has spread to regional lymph nodes (N1) but has no sign of distant spread (M0) |
| Stave IVA | Any invasive tumor (T4a) with wither no lymph node involvement (N0) or spread to only a single lymph node (N1), but no metastasis (M0). Also used for any tumor with spread to the lymph nodes (N2) but no metastasis (M0) |
| Stage IVB | any cancer (any T) with extensive spread to lymph nodes (N3), but no metastasis (M0) |
| Stage IVC | Indicates there is evidence of distant spread (any T, any N, M1) |
| Team Management of Laryngeal Cancer | H&N Surgeon Medical Oncologist Radiation Oncologist Anesthesiologist Nurse Dentist Dietician SLP AUD OT PT Respiratory Therapist Social Worker Psychologist/Psychiatrist Laryngectomee |
| Medical Workup Includes | Physical Exam Laryngoscopy Biopsy Imaging studies (x-ray, CT, MRI, bone scans, PET) |
| Medical Approaches to Management | Radiation therapy Chemotherapy Clinical Trials Surgery Combination of above approaches |
| Surgical Options | Total Laryngectomy Partial Laryngectomy (cordectomy, vertical hemilaryngectomy, supraglottic laryngectomy, subtotal laryngectomy) Composite resection |
| Cordectomy | Surgical procedure where part or all of the VFs are removed. Most often, this is performed when a pt has a small tumor on the glottis or VFs |
| Hemilaryngectomy | An operation to remove part of the larynx, but it is going to include modifiers of which specific parts were removed. Think of drawing a vertical line down the larynx. |
| Supraglottic Laryngectomy | Process to remove the supraglottis (everything above the VFs), sometimes referred to as a horizontal laryngectomy |
| Subtotal Laryngectomy | May meet requirements of adequate tumor resection in those that undergo total laryngectomy. Uninvolved column of innervated larynx thats sacrificed in total laryngectomy can be preserved in a subtotal laryngectomy. Removing everything above cricoid cart. |
| Composite resecton | Removal of part of the lining of the mouth and lower jaw |
| Potential Post-Treatment Complications | Trauma Loss of upper body strength Limited mobility: neck/shoulders Tracheostomy Aspiration pneumonia Radiation induced neoplasms of neck Stoma stenosis Pain Breathing diff. Osteoradionecrosis Infections Fistula Necrosis Coughing |
| Medical follow-up | Regular follow-up medical and dental examinations to check for signs of recurring cancer, second primary cancer, and to manage any side effects from treatment |
| Medical Outcomes | 1. Survival rate 2. Pts. functional abilities which are greatly impacted by the amount of tumor resected 3. Pts. perception of their QoL |
| Psychosocial consideration | Acceptability Quality of relationships Financial stress Fatigue Emotional stress Altered body image Depression Job loss Anxiety Decreased self-esteem Substance abuse |
| Alaryngeal speech modes | Artificial larynx: provides vibration when places on pts neck or in the mouth Esophageal speech: uses the esophagus as a sound source Tracheoesophageal speech: directs air from trachea to esophagus so that sound is produced |
| Pneumatic Devices | Piece fits over stoma, small unit inside for sound, and tubing that carries sound to mouth. Sound is shaped by articulators Adv: non-electric sounding, easy to learn, intelligible, inexpensive Dis: bulky, requiere access to stoma, seal hard to main. |
| Electrolarynx | Uses electric power to drive a vibrator that provides a sound source |
| Electrolarynx (oral type) | Adv: easy to use, small, have loudness and pitch controls, less noisy than neck types, provides adequate loudness for noisy places, can be used right after surgery, good intell. Dis: electronic sounding, expensive, ongoing cost for batteries, practice |
| Electrolarynx (neck type) | Adv: easy to use for some, small, loud/pitch controls, can provide adequate loud for noisy places, good intell. can be fitted to use intraorally Dis: electronic sounding, hard for scarring/fibrosis, moderate cost, batteries |
| Esophageal Speech | Sound source in patient's esophagus UES intact and allows air to be trapped within PE segment Adv: non-electric sound, no external device Dis: hard to learn, not loud, gas trapping need good artic skill |
| Techniques for Obtaining Esophageal Air Supply | Injection method - glottal press - glossopharyngeal press inhalation method Swallowing method |
| Tracheoesophageal Speech (TES) | Made possible by surgical fistula &prosthesis Pt occludes stoma after inhaling, then exhales, PE vibrates Ad: non-electric sound, no external device, short learn period, flex. loudness/pitch Dis: TEP needs to be primary procedure, maintenance of valve |
| Tracheostomy Valves | Used in conjunction with TE voice prosthesis Valve is at level of stoma Can be inside the stoma or around it A: hands-free, air humidifier D: needs good seal, physical restrictions, remove for coughing, costly humid. replaced daily |
| TES | Best outcomes for fundamental frequency, max phonation, and intensity Perceptually, TES was reported to be the most pleasant and comprehensible to listeners |
Created by:
jessicawalker
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