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% Document Info
\author{aoife}
\pdfinfo{
  /Title (head-and-neck-cancer.pdf)
  /Creator (Cheatography)
  /Author (aoife)
  /Subject (Head \& Neck Cancer Cheat Sheet)
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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Head \& Neck Cancer Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{aoife} via \textcolor{DarkBackground}{\uline{cheatography.com/165126/cs/34591/}}}
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\noindent
\begin{multicols}{3}
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  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}aoife \\
  \uline{cheatography.com/aoife} \\
  \end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 11th October, 2022.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{4}

\begin{tabularx}{3.833cm}{x{1.68217 cm} x{1.75083 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Larynx}}  \tn
% Row 0
\SetRowColor{LightBackground}
what is a larynx and why do i need one? & it protects the airways \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
 & for speaking as the vocal folds are located within the larynx \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
vocal folds & Muscular bands that run lengthwise from front to back of larynx \tn 
% Row Count 11 (+ 4)
% Row 3
\SetRowColor{white}
 & vibrate to produce sound \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{p{0.44629 cm} x{2.98671 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{First normal cells to cancer}}  \tn
% Row 0
\SetRowColor{LightBackground}
\seqsplit{cancer} & refers to uncontrolled, abnormal growth of cells that invade and damage the body's normal tissues \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
 & cells start normal but then change = several mutations = change into a cancer cell \tn 
% Row Count 6 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{- it can start in any cell in the body (organ tissue, skin,bone, muscle blood vessels \& brain tissue) \newline - can form tumours (not all do)  \newline - cancer cells can spread}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Oral and laryngeal Cancer}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{sixth most common type of cancer  \newline % Row Count 1 (+ 1)
➢ more common in men, peak age 60 - 70 years \newline % Row Count 2 (+ 1)
➢ high-risk factors  \newline % Row Count 3 (+ 1)
            ➢ long term smoker  \newline % Row Count 4 (+ 1)
            ➢ alcohol consumption  \newline % Row Count 5 (+ 1)
            ➢ herpes simplex virus% Row Count 6 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Laryngeal Cancer}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{➢ Larynx - 36\% (66\% glottic)  \newline % Row Count 1 (+ 1)
➢ Lymphatic system runs throughout our body \newline % Row Count 2 (+ 1)
               ▪ Part of the immune system → e.g., removes dead cells and protects from invading microorganisms \newline % Row Count 5 (+ 3)
                ▪ Lots of lymph nodes/ glands throughout our body \newline % Row Count 7 (+ 2)
 Particularly more in the neck area \newline % Row Count 8 (+ 1)
➢ Lymph nodes often the first place that cancer cells reach \newline % Row Count 10 (+ 2)
when they break away from a tumour \newline % Row Count 11 (+ 1)
➢ 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% Row Count 15 (+ 4)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{3.833cm}{x{1.0299 cm} x{2.4031 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Surgery vs Radiotherapy vs Chemotherapy}}  \tn
% Row 0
\SetRowColor{LightBackground}
Radiation therapy & → beams of radiation are focused on a specific area in your body \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\seqsplit{Chemotherapy} & → is delivered through an infusion or drugs \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Presenting Signs and Symptoms}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{➢ Nonhealing ulcer \newline % Row Count 1 (+ 1)
➢ Neck lump \newline % Row Count 2 (+ 1)
➢ Pain and/or neuropathic pain (e.g., tumours can cause nerve damage if they grow close to and press on the nerve) \newline % Row Count 5 (+ 3)
➢ Difficulty swallowing (Dysphagia) / Painful swallowing \newline % Row Count 7 (+ 2)
➢ Otalgia (ear pain → nasopharyngeal cancer - see image purple tube) \newline % Row Count 9 (+ 2)
➢ Persistent cough (→ throat cancer) \newline % Row Count 10 (+ 1)
➢ Sore throat \newline % Row Count 11 (+ 1)
➢ Hoarse voice (→ glottal) \newline % Row Count 12 (+ 1)
➢ Fever \newline % Row Count 13 (+ 1)
➢ Loss of appetite, weight loss \newline % Row Count 14 (+ 1)
➢ Stridor (→ glottal → abnormal sound produced by turbulent airflow through a partially obstructed airway)% Row Count 17 (+ 3)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Diagnosis}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Combination of history taking, physical examination, imaging and biopsy (a sample of tissue) \newline % Row Count 2 (+ 2)
➢ Imaging – \newline % Row Count 3 (+ 1)
▪ CT (Computed Tomography) \newline % Row Count 4 (+ 1)
▪ a special type of x-ray that gives a highly detailed picture of the organs/body structures \newline % Row Count 6 (+ 2)
▪ MRI (Magnetic Resonance Imaging) \newline % Row Count 7 (+ 1)
▪ use strong magnetic fields, magnetic field gradients, \& radio frequency waves to generate images of the organs in the body \newline % Row Count 10 (+ 3)
▪ PET (positron emission tomography) \newline % Row Count 11 (+ 1)
▪ uses small amounts of radioactive materials, a special camera \& a computer to evaluate organ and tissue functions \newline % Row Count 14 (+ 3)
➢ TNM (Tumour-Node-Metastasis) classification \newline % Row Count 15 (+ 1)
         ▪ T: Size and extension of the tumour → T0 – T4 → Higher = larger tumour \newline % Row Count 17 (+ 2)
         ▪ N: Regional lymph node involvement → N0 – N3 → Higher = distant nodes \newline % Row Count 19 (+ 2)
         ▪ M: Tumor spread → Presence (M1) or absence (M0) of metastases \newline % Row Count 21 (+ 2)
➢ After staging, presented to multidisciplinary team% Row Count 23 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Treatment – Multidisciplinary}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{➢ Decisions made by Head and Neck (H\&N) team – \newline % Row Count 2 (+ 2)
       ▪ Otolaryngologists/H\&N surgeon \newline % Row Count 3 (+ 1)
           ▪ treatment of diseases/ disorders of the ear, nose, throat, \& related structures of the H\&N \newline % Row Count 6 (+ 3)
      ▪ Radiation \& medical oncologists (treat cancer) \newline % Row Count 8 (+ 2)
      ▪ Plastic \& maxillofacial surgeons \newline % Row Count 9 (+ 1)
      ▪ focusing on reconstructive surgery of the H\&N, face, mouth, jaws \newline % Row Count 11 (+ 2)
      ▪ Dentist, prosthodontist \newline % Row Count 12 (+ 1)
      ▪ dental and facial problems that involve restoring missing tooth and jaw structures \newline % Row Count 14 (+ 2)
      ▪ Nursing \newline % Row Count 15 (+ 1)
      ▪ SLP \newline % Row Count 16 (+ 1)
      ▪ Dietician \newline % Row Count 17 (+ 1)
➢ Surgery \newline % Row Count 18 (+ 1)
➢ Radiotherapy \newline % Row Count 19 (+ 1)
➢ Chemotherapy% Row Count 20 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Oral \& Oropharyngeal Cancer}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Affects – \newline % Row Count 1 (+ 1)
▪ Articulation \newline % Row Count 2 (+ 1)
▪ Chewing \newline % Row Count 3 (+ 1)
▪ Swallowing \newline % Row Count 4 (+ 1)
➢ Further depends on any Radiation effects \newline % Row Count 5 (+ 1)
→ may have side effects such as – \newline % Row Count 6 (+ 1)
▪ Soreness (or even open sores) in the mouth or throat \newline % Row Count 8 (+ 2)
▪ Dry mouth \newline % Row Count 9 (+ 1)
▪ Tooth decay \newline % Row Count 10 (+ 1)
▪ Swelling in the gums, throat, or neck \newline % Row Count 11 (+ 1)
▪ Jaw stiffness \newline % Row Count 12 (+ 1)
▪ Trouble swallowing \newline % Row Count 13 (+ 1)
▪ Changes in taste% Row Count 14 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Laryngeal Cancer – Laryngectomy}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Surgical removal of the larynx \newline % Row Count 1 (+ 1)
    ▪ when other therapy is not sufficient, or for advanced cancer, the larynx must be removed \newline % Row Count 3 (+ 2)
➢ Larynx removed → Therefore, complete loss of voice \newline % Row Count 5 (+ 2)
▪ The upper portion of the trachea is brought out to the front of the neck via a stoma \newline % Row Count 7 (+ 2)
▪ Air can no longer pass from lungs into mouth \newline % Row Count 8 (+ 1)
▪ The connection between the mouth and the esophagus preserved% Row Count 10 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Individuals post - laryngectomy must be careful while showering \& washing their hair WHY?  \newline - stoma is a direct pathway to lungs, water entering is a safety risk}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Role of the SLP - laryngectomy}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Facilitate restoration of oral communication \newline % Row Count 1 (+ 1)
➢ To do so, must be familiar with – \newline % Row Count 2 (+ 1)
▪ Medical procedures and client status \newline % Row Count 3 (+ 1)
▪ Communicative needs of client \newline % Row Count 4 (+ 1)
▪ Pre-surgery and post-surgery counselling \newline % Row Count 5 (+ 1)
▪ General pattern of adjustment to alaryngeal speech \newline % Row Count 7 (+ 2)
▪ Support groups available \newline % Row Count 8 (+ 1)
Communication post-Laryngectomy \newline % Row Count 9 (+ 1)
Three types of "alaryngeal" communication available – \newline % Row Count 11 (+ 2)
▪ Tracheo-esophageal speech \newline % Row Count 12 (+ 1)
▪ Artificial larynx \newline % Row Count 13 (+ 1)
▪ Esophageal speech \newline % Row Count 14 (+ 1)
➢ Choice of communication means depends on general health, physical and cognitive ability of the client, their needs% Row Count 17 (+ 3)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Electrolarynx}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{➢ Advantages – \newline % Row Count 1 (+ 1)
▪ Can begin within days of surgery \newline % Row Count 2 (+ 1)
▪ Easy to learn \newline % Row Count 3 (+ 1)
▪ Cheaper than tracheoesophageal puncture \newline % Row Count 4 (+ 1)
➢ Disadvantages – \newline % Row Count 5 (+ 1)
▪ Mechanical sounding \newline % Row Count 6 (+ 1)
▪ Monotonous sound \newline % Row Count 7 (+ 1)
▪ Reduced intelligibility - especially in high noise setting% Row Count 9 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Tracheo-esophageal speech}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Voice prosthesis valve \newline % Row Count 1 (+ 1)
1. Surgeon makes a small channel between trachea and esophagus (= tracheo-esophageal puncture) \newline % Row Count 3 (+ 2)
2. A small one-way valve (voice prosthesis) is put into the channel (see image above – arrow) \newline % Row Count 5 (+ 2)
3. Covering stoma with a thumb/ finger and breathing out lets air pass from the lungs through the valve \newline % Row Count 8 (+ 3)
→ Causes throat muscles to vibrate and make a sound \newline % Row Count 10 (+ 2)
→ As with normal speech, you shape the sound into words by moving your lips, cheeks and tongue \newline % Row Count 12 (+ 2)
➢ It can take time to learn how to speak with a voice prosthesis \newline % Row Count 14 (+ 2)
➢ Voice can sound quite natural% Row Count 15 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Artificial larynx ("electrolarynx")}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{➢ Battery causes vibration in a small disc which generates a buzzing sound \newline % Row Count 2 (+ 2)
➢ Often held against the neck \newline % Row Count 3 (+ 1)
➢ Sound passes through tissues into pharynx and mouth where it is shaped into speech  \newline % Row Count 5 (+ 2)
➢ also try to generate a more user-like voice by – \newline % Row Count 7 (+ 2)
▪ generating the vibration patterns from the user's previous recorded voice \newline % Row Count 9 (+ 2)
▪ with dynamic pitch modulation% Row Count 10 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Voice Restoration after Cancer}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Tracheo-esophageal speech} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Artificial larynx} \tn 
% Row Count 2 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Esophageal speech}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Air drawn in to esophagus via the mouth – \newline % Row Count 1 (+ 1)
➢ As the air moves back up from the esophagus, throat muscles vibrate and make a sound \newline % Row Count 3 (+ 2)
➢ Movements of lips, cheeks and tongue shape the sound into words \newline % Row Count 5 (+ 2)
➢ Varying degrees of success (30-62\%)% Row Count 6 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{0.85825 cm} x{2.57475 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Esophageal speech}}  \tn
% Row 0
\SetRowColor{LightBackground}
\seqsplit{Advantages} & No external device or hand use/ not needing any equipment \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & You can learn this as you recover from your laryngectomy \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Disadvantages} & Difficult to learn, a lot of practice \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
 & Small utterances only \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Stoma noise \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}