Head & Neck Cancer Cheat Sheet (DRAFT) by aoife

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

➢ 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

➢ 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

➢ 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
▪ SLP
▪ Dietician
➢ Surgery
➢ Radiot­herapy
➢ Chemot­herapy

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

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

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

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

➢ 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

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%)