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Head & Neck Cancer Cheat Sheet (DRAFT) by

Head and Neck Cancer

This is a draft cheat sheet. It is a work in progress and is not finished yet.


what is a larynx and why do i need one?
it protects the airways
for speaking as the vocal folds are located within the larynx
vocal folds
Muscular bands that run lengthwise from front to back of larynx
vibrate to produce sound

First normal cells to cancer

refers to uncont­rolled, abnormal growth of cells that invade and damage the body's normal tissues
cells start normal but then change = several mutations = change into a cancer cell
- it can start in any cell in the body (organ tissue, skin,bone, muscle blood vessels & brain tissue)
- can form tumours (not all do)
- cancer cells can spread

Oral and laryngeal Cancer

sixth most common type of cancer
➢ more common in men, peak age 60 - 70 years
➢ high-risk factors
➢ long term smoker
➢ alcohol consum­ption
➢ herpes simplex virus

Laryngeal Cancer

➢ Larynx - 36% (66% glottic)
➢ Lymphatic system runs throughout our body
▪ Part of the immune system → e.g., removes dead cells and protects from invading microo­rga­nisms
▪ Lots of lymph nodes/ glands throughout our body
Partic­ularly more in the neck area
➢ Lymph nodes often the first place that cancer cells reach
when they break away from a tumour

➢ Because there are lots of lymph glands in the neck the cancer cells are likely to invade them so that is why cancer is most common in the laryngeal level

Surgery vs Radiot­herapy vs Chemot­herapy

Radiation therapy
→ beams of radiation are focused on a specific area in your body
→ is delivered through an infusion or drugs

Presenting Signs and Symptoms

➢ Nonhealing ulcer
➢ Neck lump
➢ Pain and/or neurop­athic pain (e.g., tumours can cause nerve damage if they grow close to and press on the nerve)
➢ Difficulty swallowing (Dysph­agia) / Painful swallowing
➢ Otalgia (ear pain → nasoph­ary­ngeal cancer - see image purple tube)
➢ Persistent cough (→ throat cancer)
➢ Sore throat
➢ Hoarse voice (→ glottal)
➢ Fever
➢ Loss of appetite, weight loss
➢ Stridor (→ glottal → abnormal sound produced by turbulent airflow through a partially obstructed airway)


Combin­ation of history taking, physical examin­ation, imaging and biopsy (a sample of tissue)
➢ Imaging –
▪ CT (Computed Tomogr­aphy)
▪ a special type of x-ray that gives a highly detailed picture of the organs­/body structures
▪ MRI (Magnetic Resonance Imaging)
▪ use strong magnetic fields, magnetic field gradients, & radio frequency waves to generate images of the organs in the body
▪ PET (positron emission tomogr­aphy)
▪ uses small amounts of radioa­ctive materials, a special camera & a computer to evaluate organ and tissue functions
➢ TNM (Tumou­r-N­ode­-Me­tas­tasis) classi­fic­ation
▪ T: Size and extension of the tumour → T0 – T4 → Higher = larger tumour
▪ N: Regional lymph node involv­ement → N0 – N3 → Higher = distant nodes
▪ M: Tumor spread → Presence (M1) or absence (M0) of metastases
➢ After staging, presented to multid­isc­ipl­inary team

Treatment – Multid­isc­ipl­inary

➢ Decisions made by Head and Neck (H&N) team –
▪ Otolar­yng­olo­gis­ts/­H&N surgeon
▪ treatment of diseases/ disorders of the ear, nose, throat, & related structures of the H&N
▪ Radiation & medical oncolo­gists (treat cancer)
▪ Plastic & maxill­ofacial surgeons
▪ focusing on recons­tru­ctive surgery of the H&N, face, mouth, jaws
▪ Dentist, prosth­odo­ntist
▪ dental and facial problems that involve restoring missing tooth and jaw structures
▪ Nursing
▪ Dietician
➢ Surgery
➢ Radiot­herapy
➢ Chemot­herapy

Oral & Oropha­ryngeal Cancer

Affects –
▪ Articu­lation
▪ Chewing
▪ Swallowing

➢ Further depends on any Radiation effects
→ may have side effects such as –
▪ Soreness (or even open sores) in the mouth or throat
▪ Dry mouth
▪ Tooth decay
▪ Swelling in the gums, throat, or neck
▪ Jaw stiffness
▪ Trouble swallowing
▪ Changes in taste

Laryngeal Cancer – Laryng­ectomy

Surgical removal of the larynx
▪ when other therapy is not suffic­ient, or for advanced cancer, the larynx must be removed

➢ Larynx removed → Therefore, complete loss of voice
▪ The upper portion of the trachea is brought out to the front of the neck via a stoma
▪ Air can no longer pass from lungs into mouth
▪ The connection between the mouth and the esophagus preserved
Indivi­duals post - laryng­ectomy must be careful while showering & washing their hair WHY?
- stoma is a direct pathway to lungs, water entering is a safety risk

Role of the SLP - laryng­ectomy

Facilitate restor­ation of oral commun­ication
➢ To do so, must be familiar with –
▪ Medical procedures and client status
▪ Commun­icative needs of client
▪ Pre-su­rgery and post-s­urgery counse­lling
▪ General pattern of adjustment to alaryngeal speech
▪ Support groups available

Commun­ication post-L­ary­nge­ctomy
Three types of “alary­ngeal” commun­ication available –
▪ Trache­o-e­sop­hageal speech
▪ Artificial larynx
▪ Esophageal speech
➢ Choice of commun­ication means depends on general health, physical and cognitive ability of the client, their needs


➢ Advantages –
▪ Can begin within days of surgery
▪ Easy to learn
▪ Cheaper than trache­oes­oph­ageal puncture

➢ Disadv­antages –
▪ Mechanical sounding
▪ Monotonous sound
▪ Reduced intell­igi­bility - especially in high noise setting

Trache­o-e­sop­hageal speech

Voice prosthesis valve
1. Surgeon makes a small channel between trachea and esophagus (= trache­o-e­sop­hageal puncture)
2. A small one-way valve (voice prosth­esis) is put into the channel (see image above – arrow)
3. Covering stoma with a thumb/ finger and breathing out lets air pass from the lungs through the valve
→ Causes throat muscles to vibrate and make a sound
→ As with normal speech, you shape the sound into words by moving your lips, cheeks and tongue
➢ It can take time to learn how to speak with a voice prosthesis
➢ Voice can sound quite natural

Artificial larynx (“elec­tro­lar­ynx”)

➢ Battery causes vibration in a small disc which generates a buzzing sound
➢ Often held against the neck
➢ Sound passes through tissues into pharynx and mouth where it is shaped into speech
➢ also try to generate a more user-like voice by –
▪ generating the vibration patterns from the user‘s previous recorded voice
▪ with dynamic pitch modulation

Voice Restor­ation after Cancer

Trache­o-e­sop­hageal speech
Artificial larynx

Esophageal speech

Air drawn in to esophagus via the mouth –
➢ As the air moves back up from the esophagus, throat muscles vibrate and make a sound
➢ Movements of lips, cheeks and tongue shape the sound into words
➢ Varying degrees of success (30-62%)

Esophageal speech

No external device or hand use/ not needing any equipment
You can learn this as you recover from your laryng­ectomy
Difficult to learn, a lot of practice
Small utterances only
Stoma noise