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Cancer and Dysphagia
| Term | Definition |
|---|---|
| Hyperplasia | Cell growth out of control |
| Symptoms of Oral Cancer | Lump/thickening of cheek White or red patch on gums/tongue |
| Symptoms of nasal/hypopharyngeal cancer | No early signs |
| Symptoms of supraglottic cancers | Pain on swallow and globus (poss. neck mass) |
| Symptoms of glottic cancers | Hoarseness, stridor, or airway obstruction |
| Symptoms of subglottic cancers | Hoarseness, air way obstruction |
| T | Size and extent of primary tumor |
| N | involvement of cervical lymphatics |
| M | Presence of distant metastases |
| Types of cancer treatment | Surgery Radiology Chemotherapy |
| Side Effects of Tx | Infection/inflammation Saliva issues/xerostomia Pain Dysphagia Psychological (depression) |
| Xerostomia | Perception of dry mouth |
| Primary tumor surgery | Just take it out |
| Laryngectomy | Removing larynx |
| Tracheostomy and Gastrostomy | Done at primary cancer resection, Edema can occur (difficulty breathing) |
| What do you do if edema is expected? | Put in tracheostomy/gastronomy |
| Reconstructive surgery | Fill hole/gap, commonly take skin from underarm |
| 3 Side Effects of Surgery | Swelling in mouth/throat Reduced mobility head/neck Decreased thyroid function |
| Partial glossectomy | Removal of part of tongue, difficulty holding and preparing a bolus |
| Total glossectomy | Whole tongue removal, difficulty moving materials from mouth to pharynx, reduced lingual driving force, pocketing |
| Anterior FOM Deficits from cancer | Reduced labial closure/hold, reduced lingual control, delayed pharyngeal window, few problems if tongue is mobile |
| When are there more issues with tongue movement? | During lateral FOM surgery over anterior FOM |
| Lateral FOM deficits from cancer | Reduced tongue control/bolus hold, reduced chewing ability, aspiration, reduced pharyngeal propulsion |
| When is there worse outcome with lateral FOM function? | When tongue is sutured into deficit |
| Tonsil/Base of tongue deficits from cancer | Reduced lingual control (premature entry of liquids and delayed entry of solids) Delayed pharyngeal swallow Reduced pharyngeal constriction Reduced tongue base retraction Reduced tongue to palate squeeze Nasal regurgitation |
| Deficits from pharyngeal resection | Reduced pharyngeal constriction Premature entry of liquids Reduces force of swallow Reduced clearance (residue = weakness) |
| Deficits from hemilaryngectomy | Reduced airway closure Unilateral pharyngeal weakness |
| Deficits from supraglottic laryngectomy | Reduced closure laryngeal vestibule Reduced airway closure Reduced pharyngeal peristalsis |
| What is the big concern from supraglottic laryngectomy? | Protection airway during closure |
| Main issues with total laryngectomy | Movement and scarring/blockage |
| Two types of stenosis | Anatomic and physiological |
| Anatomic stenosis | Responds to stretching, doesn't let the marshmallow through Structural |
| Physiologic stenosis | Surgery/botox needed, doesn't respond to stretching (because it's a muscle), moves to let marshmallow through eventually, spasm |
| Internal radiotherapy | Surgical implant of radioactive tubes |
| External radiotherapy | Combo with surgery, inflammation is common |
| Radiotherapy | 50-70 Gy, devascualrized tissue, loss of taste, sloughing, mucositis, reduced salivary flow |
| What does devascularization do? | Woody neck, reduced healing abilities |
| Oropharyngeal swallow complications following RT | Bolus deficit Dry mouth Pain Altered taste |
| What should you look for to assess oralphayrngeal swallow dysfunction? | Inefficient swallow |
| What does an inefficient swallow look like? | Multiple swallows Slow |
| Mucosal tissue changes causes | Xerostomia mucositis edema infections |
| Muscle tissue changes causes | Edema fibrosis neuropathy |
| Why is teeth decay associated with radiation? | Radiation takes away saliva, saliva is alkaline which makes things base, lack of salvia means increased acidity in mouth |
| How do you fix increased acidity in mouth? | Baking soda rinse, baking soda is base |
| Example of mechanical obstruction | Anatomic stenosis |
| Trismis | Inability to open jaw due to fibrosis (muscle weakness) |
| When are swallowing problems most common? | Post radiation. Radiation is worse than surgical alone. |
| Why do changes still occur post-radiation? | Still radioactive even months after last treatment |
| How to abnormal cells travel? | Metastasis Via blood Via lymph |
| Radiation leads to | Dry mouth |
| Dry mouth leads to | Acidity |
| Treatment for large tumor | Surgery plus radiotherapy |
| Treatment for small tumor | conservative surgery plus radiotherapy |
| Ectomy | Remove |
| Mucosal tissue treatments | Baking soda gum Ice chips Saliva supplements |
| Muscle tissue treatment | Stretching Exercises |
| Where does natural stenosis occur? | Aortic Arch |
| Stenosis | Stricture |
| Scarring | Fibrosis |
| What causes oropharyngeal dysphagia following radiation? | Mucosal and muscle tissue changes |
| 3 General Cancer Warning Signs | 1) Unexplained weight loss 2) Fever 3) Pain |
| 3 Specific Cancer Warning Signs | 1) Sores don't heal 2) Dysphagia 3) Nagging cough/hoarse |
| Post-radiation issues contributing to dysphagia | 1) Trismus 2) Secretion management (muscle weakness) 3) Xerostomia |
| What can contribute to dysphagia following radiation? | 1) Mucositis 2) Xerostomia 3) Loss of taste/smell |
Created by:
morganmc3
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