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Laryngeal Cancer
Etiology?
- smoking
- environmental irritants
- chemicals
- smoking and alcohol
- smoking and asbestos
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Laryngeal cancer:
Typical pt?
Accounts for ___ of all cancers?
50-70% of all laryngeal cancer deaths are associated with ___?
alcohol and smoking incr risk by up to ___?
60 y/o males heavy smoker w/mod alcohol intake
2-5%
smoking
8x's
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Cancer Staging TNM numerical value represents severity
T=?
N=?
M=?
T= location/size of primary tumor
N= involvement of lymph node
M= distant metastasis
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Tumor staging example T1N1M0 means?
T1= tumor is confined to VFs
N1= a single small lymph node involved
M0= no metastasis
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Signs and symptoms laryngeal cancer
Primary symptom?
hoarseness
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Signs and symptoms laryngeal cancer
Additional symptoms?
- stridor
- diff breathing
- pain
- coughin
- coughing up blood
- swallowing problems
- painful swallowing
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Signs and symptoms laryngeal cancer
Signs:?
- lump in neck
- tenderness in laryngeal area
- lack of crepitation
- fullness in CT & TH membrane
- presence of lumps
- lesions of VFs
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Pathophysiology
Arises in ___, usually ___?
Invades __ and destroys ___?
Can invade____ and ___?
epithelium, squamous cell carcinoma
- tissue
- normally functioning cells
- layers of lamina propria
- TA muscle
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Diagnostics
Requires:?
Biopsy and histological analysis
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Diagnostics: Laryngeal cancer
what is seen on videostrob?
- extent of lesion greatly affects VF vibration
- 1. VF appears stiff, immobile
- 2. decreased mucosal wave
- 3. decreased amplitude of vibration
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Acoustic signs:
Acoustics?
Increased freq and intensity perturbations
increased noise levels
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Acoustic signs
Aerodynamics?
- increased airflow
- increased subglottal pressure (Ps)
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Tx Options?
- radiation therapy
- surgery
- surgery and radiation
- chemotherapy
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Laryngectomy
Procedure in which?
can have?
Extent depends on?
Impacts?
all or part of the larynx is excised
Total, hemi, partial, suprglottic
depends on tumor size, location, invasiveness, and spread
communication, swallowing, body image
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Role of SLP
Pre-op consult?
- educate pt regarding surgery
- possible outcomes
- communication options s/p
- address pt concerns
- assess cognitive status
- status of pts hearing
- hand writing
- etc
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Role of SLP post-op consult?
- review pre-op discussion
- assess voice, speech, swallowing
- demo electronic speech aids
- teach use of oral type instrument
- discuss rehab plans
- schedule meeting w/ other laryngectomee pts.
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Alaryngeal Speech? (4)
- pneumatic devices
- electronic
- esophageal speech
- tracheoesphageal speech
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Pneumatic device?
Advantage/dis?
- cup shaped piese fits over the stoma
- small unit w/ reed inside to provide sound
- tubing carries sound to mouth
- Adv: natural sounding, easy to learn, inexpensive
- disadvantage:bulky requires access to stoma (soreness)
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Cooper Rand Electronic speech aid?
Oral device- vibrator delivers vibration to tube which is placed in mouth
sound is delivered to oral cavity and articulated
good post-surgery when neck is healing
$300.00 battery operated
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Electric larynx?
- neck held, battery operated
- switch activated
- pitch and volume control
- easy to use, can use while learning esophageal speech
- some pts prefer this method
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Esophageal speech?
Advantage?
Disadvantage?
- Air is injected from the mouth into esophagus via tongue & pharynx
- As air is expelled the PE segment vibrates creating sound that is articulated in the mouth
Advat: no external devices; sounds more natural; pitch and loudness control; no batteries; both hands are free
- Dis: takes a long time to learn and master
- must have great artic
- not very loud in noise
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Tracheoesphageal puncture-TEP?
is a surgical procedure in which a small puncture is made thru tracheal wall into esophagus
prosthesis is then inserted that acts as a shunt to direct air into the esophagus
air moves thru PE segment, creating sound, and sound travels into pharyns, oral & nasal cavities & is resonated and articulated
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