Early symptoms of Head/Neck Cancer

• Hoarseness that lasts >3wk
• Persistent cough
• Sore throat
• pain
• burning
• Lump in neck >3wk

• dysphagia
• dyspnea
• unilateral nasal obstruction
• persistent hoarseness
• persistent ulceration
• foul breath

• weight loss
• debilitation
• lymphadenopathy
• radiation of pain to ear

• Hx
• Physical exam
• laryngoscopic exam
• biopsy - confirms cancer

by the TMN classification

• T - tumor
• N - nodes
• M - metastasis

CT MRI PET are for what ?

Vocal cord nodules are

• benign growths on both vocal cords by vocal abuse
• hard callous like growths
• become larger and stiffer the longer the vocal cord abuse continues

• swelling or bump
• stalk like growth
• blister like lesion
• larger than nodules
• aka polypoid degeneration
• aka Reinke's edema

• surgery
• radiation
• chemo
• combination therapy

1. Health hx (smoking, work)
2. Assess literacy ( have to be able to follow directions)
3. assess family
4. physcial exam
5. biospy

• Impaired oral mucous membrantes
• dental disease
• imbalance nutrition
• disturbed body image
• fear of pain and social isolation
• impaired verbal communication
• risk of infection
• knowledge deficit

• oral mucus membranes
• nutrition
• self image
• pain
• communication
• infection
• knowledge

• radical neck dissection
• modified radical neck dissection

• removal of
• cervical lymph nodes
• sternomastoid muscle
• internal jugular vein
• spinal accessory nerve on one side

• shoulder drop
• poor cosmesis ( neck depression)

• hemorrhage - carotid artery
• chyle fistula - thoracic duct damage, leaking lymphatic fluid
• Nerve injury
• cervical plexus
• spinal accessory nerves
• facial nerve

• partial
• horizontal
• hemi- laryngectomy
• total larygectomy

• Early stage of Cancer in glottic area
• one vocal cord, portion of larynx removed
• High cure rate
• airway intact
• no dysphagia
• voice may change, hoarseness

• aka Supraglottic laryngectomy
• voice sparring
• lesions involving epiglottis, false vocal cords, hyoid bone
• neck dissection of 1 or both sides
• aspiration issues
• must learn to swallow again

Hemilaryngectomy is

• aka vertical
• tumor extends beyond the vocal cords
• half of larynx removed
• not allowed to swallow 7-10 post op
• difficulty swallowing long term problem
• hoarse voice
• airway, swallow intact

• aspiration
• respiratory distress
• infection
• wound breakdown
• hemorrhages
• nutrition

• Tracheoesophageal voice prosthesis

• tube inserted between the trachea and esophagus
• allows air to pass back to mouth to recreate the new voice

1. stoma care
2. tracheostomy care
3. surgical wound care
4. medical alert bracelett
5. activity restrictions
6. shower precautions

• early stage
• reduce size of tumor
• poor surgical risk
• age
• comorbidities
• physical condition

• daily treatments for weeks
• radiation induced fibrosis
• may fail and need surgery

• signs of skin desquamation
• erythma, edema, pain
• neck edema
• tracheostomy tray
• weight loss
• feeding tube

• dehydration
• N/V
• peripheral neuropathy
• mucositis
• neutropenia
• infection