438 Book Quiz 5

Front 1

What are two primary treatment modalities that can be used to manage malignant tumors of the oral cavity? What can they be combined with?

Back 1

1. surgical resection
2. radiotherapy
with or without chemotherapy

Front 2

True or False

While surgery for malignant oral or oropharyngeal cancers often results in deglutition problems, radiation rarely does.

Back 2

False

Either type of treatment can affect deglutition.

Front 3

What are three methods of delivering radiotherapy?

Back 3

1. external beam methods
2. implant into the tumor
3. both

Front 4

What type of tumors are frequently treated with radiotherapy alone or surgery alone?

Back 4

smaller ones

Front 5

What the heck is an organ preservation protocol?

Back 5

Protocol designed to reduce morbidity (functional impact of the treatment) in order to preserve oropharyngeal structure and function.

Front 6

_____ for H&N CA is an adjutant experimental treatment designed to attempt to control regional and metastatic disease, rather than a primary treatment designed to eradicate the tumor itself.

Back 6

Chemotherapy

Front 7

True or False

While chemotherapy is not a primary treatment for H&N CA, many patients have tumor shrinkage during or immediately after a course of chemotherapy that is of significant duration.

Back 7

False

often of short duration

Front 8

What's considered the adjuvant treatment with CA surgery? Why?

Back 8

radiotherapy
Primary is surgery, which eradicates tumor; adjuvant is radiotherapy with controls disease

Front 9

When surgery is used to control tumors in the oral cavity, the general rule is that the malignant tumor must be resected along with a margin of at least _____ of normal tissue.

Back 9

1.5-2cm

Front 10

____ lesions can result in _____ surgeries.

Back 10

very small
large ablative

Front 11

What sorts of structures might be resected during an oral surgery for oral cancer?

Back 11

mandible, floor of mouth, tongue

Front 12

When only one structure is resected, teh surgery is known as a ______

Back 12

simple resection

Front 13

Whe more than one structure or parts of more than one structure are resected during surgery, it is known as a

Back 13

composite resection

Front 14

A composite resection in the oral cavity often includes some part of:

Back 14

the floor of the mouth and the mandible

Front 15

There is one major rule of cancer surgery. No ablative surgical procedure should be compromised _______.

Back 15

because of the desire to maintain the patient's function.

Front 16

Rehabilitation and reconstruction cannot be considered until:

Back 16

the cancer is removed with normal margins.

Front 17

True or False
While resecting the tumor and required margin of tissue, the surgeon should also attend to the problem of reconstruction to maximize functional capacity.

Back 17

False
reconstruction second.

Front 18

When radiotherapy is scheduled as an adjunct to surgery, it is usually given ____ Why?

Back 18

postoperatively after 4-6 weeks
radiotherapy devasculates tissue and makes healing after surgery more difficult.

Front 19

A full course of radio therapy lasts for ____ to a dose of ______

Back 19

5-6 weeks
6K-7K cGy

Front 20

What does the exposed field of radiotherpy usually include?

Back 20

all regional lymph notes.

Front 21

When radiation includes the oral cavity, _______ should be performed prior to initiating radiation treatments because radiotherapy can a devastating effects on ____, causing an increase in the rate of _____ (____)

Back 21

careful dental evaluation
salivary flow
dental disease (caries)

Front 22

Any infected teeth should be removed prior to radiotherapy, because removing them after can put the patient at risk for ______

Back 22

osteoradionecrosis of the mandible

Front 23

Condition after a full course of radiation where portions of the mandible become infected and gradually break from the main body of the mandible to extrude or protrude through the soft tissue, necessitating removal of the infected portions. What's one cause?

Back 23

osteoradionecrosis of the mandible
removal of infected teeth after radiotherapy

Front 24

____ permits comparisons of the results of various treatments across patients with the same tumor (tumor reaction to treatment)

Back 24

Tumor staging

Front 25

Tumor staging for the oral cavity is divided into ____ sites, each staged according to ____, _____, and _____.

Back 25

8
T or tumor size
N or nodal status
M or metastases (presence or absence)

Front 26

Tumor size is assigned a number __ to __, with __ being the smallest and __ being the largest lesion.

Back 26

1 to 4
T1 smallest
T4 largest

Front 27

Metastasis to the nodes in the head and neck is noted by recordin an ___ followed by a ____ representing the ______ thought to be involved in the tumor. This one's easy, folks!

Back 27

N
number
number of nodes

Front 28

To indicated the number of distant metastases, ___ is followed by ____.

Back 28

M
the number of metastases

Front 29

How many nodes involved in a Stage I cancer? How many metastases? T1, T2, T3, or T4?

Back 29

no nodes
no metastases
T1

Front 30

If a cancer is M1, what stages can it be?

Back 30

Stage IV

Front 31

If a cancer is T2, N0, M0, what stage is it?

Back 31

Stage II

Front 32

If a cancer is T2 N1, M0, what stage is it?

Back 32

Stage III

Front 33

If a cancer is T3, N1, M0 what stage is it?

Back 33

Stage III

Front 34

If a cancer is T1, N1, M0, what stage is it?

Back 34

Stage III

Front 35

If a cancer is N2 MO what stage is it?

Back 35

Stage IV

Front 36

If a cancer is N3 MO what stage is it?

Back 36

Stage IV

Front 37

If a cancer is T4 N0 M0 what stage is it?

Back 37

Stage IV

Front 38

What types of lesions (Tumor Stages) are more frequently treated by combined therapies?

Back 38

T3 and T4

Front 39

Combined medical treatment usually includes ____ followed by ____, with ___ also provided sometimes ____ and continuing for some time ____.

Back 39

surgery
radiotherapy
chemotherapy
preoperatively
postoperatively.

Front 40

Can you name six locations in the oral cavity where tumors occur most frequently?

Back 40

1. Hard Palate
2. Soft Palate
3. Base of Tongue
4. Lateral OT margin
5. Alv + lateral Mth flr + tonsil, + AFA Pillar
6. Alv + lateral Mth flr + tonsil, + AFA Pillar + Soft palate

Front 41

True or False

With a larger tumor in the oral cavity, tissue is removed en bloc so that tissues that may contain cancerous cells are taken in continuity and the cancer is not spread by the surgical procedure itself.

Back 41

True

Front 42

Resection of the anterior floor of the mouth and a full section of the anterior mandible frequently reults in ____, which is what?

Back 42

"Andy Gump" appearance
mandible smaller and retracted in relation to maxilla.

Front 43

Smaller tumors on the lateral margin or anterior portion of the OT can often be removed by ___

Back 43

resecting only tongue tissue. Yay!

Front 44

A ___ removes the submandibular lymph notes, the lymph nodes in the neck, and the sternocleidomastoid and omohyoid muscles. When is it done?

Back 44

radical neck dissection
larger tumors of the tongue, any large oral tumor requiring composite resection may do it.

Front 45

What nerve is often sacrificed during a radical neck dissection? Can it be spared?

Back 45

CXI (spinal accessory)
Yes, with a modified radical neck disection

Front 46

True or False

In general, rehabilitation of the patient who has had a partial removal of the soft palate is easier than rehabilitation of the patient with total removal of the velum

Back 46

False, so false.

Total easier than partial.

Front 47

With a _____, the soft tissues remaining are simply pulled together and sutured (used with relatively small resections)

Back 47

primary closure

Front 48

What if the resection of tissues is so large taht there is not sufficient tissue remaining for a primary closure? What then?

Back 48

Surgeon needs to borrow tissue, usually by means of a flap or a graft.

Front 49

____ is a piece of tissue that has been elevated or rased away from its normal site.

Back 49

Flap

Front 50

What are two types of flaps?

Back 50

local (close by)
distal (far away)

Front 51

The ___ consists of skin and subcutaneous tissue that is moved from one part of the body to another, while a pedical or attachment is maintained between it and the body for nourishment.

Back 51

a skin flap

Front 52

_____ includes muscle and overlying skin, and is used when added bulk is needed in closure. This sort of ____ is usually passed beneath the skin to the reconstruction site.

Back 52

myocutaneous distal flap
flap

Front 53

A ____ or ______ transplants tissue from another part of the body into the oral cavity, with veins and arteries anastamosed or attached carefully to blood supply at the site to assure viability of the tissue.

Back 53

microvascular free tissue transfer or graft

Front 54

True or False

Innervated grafts or sensate flaps shave been shown to result in postoperative sensation int he oral cavity that is useful in speech or swallowing function.

Back 54

false

Not yet...

Front 55

Oral cancer patients may experience changes in ___, ___, and ____ posttreatment.

Back 55

salivary flow, speech, and swallowing

Front 56

With radiotherapy to the oral cavity, the patient my experience ___, ___, ___, and ____.

Back 56

reduced salivary flow (xerostomia), mucositis, edema, and changes in swallowing

Front 57

____ may be cause dby reduced salivary flow or by intraoral sensory loss

Back 57

swallowign disorders.

Front 58

_____ of the tongue and jaw may be caused by raditation therapy, probably resulting from ___. It can be counteracted with what?

Back 58

Reduced range of motion
fibrosis
an active ROM exercise program completed morning and night

Front 59

Results of studies explorign the relationship between surgical resection and reconstruction fothe oral cavity and speech and swallowing changes postoperatively point toward ___ as providign optimal function in comparison to ___

Back 59

primary closure
distal flaps

Front 60

Often a patient experiences ____ after 4 weeks of radiotherapy

Back 60

a worsening of speech and swallowing problems

Front 61

True or False

Data indicate that at 12 months posttreatment, the oral cancer patient's speech and swallowing function is generally better than at 3 months post treatment.

Back 61

False

It's no better

Front 62

Generally, patients with ____ of the oral tongue resected can benefit from a palatal reshaping (augmentation) prosthesis.

Back 62

50% or more

Front 63

False or True

When surgery involves the TB and lateral PWs, VP closure can be affected in some patients.

Back 63

True

Front 64

In oral and pharyngeal surgery patients, speech and swallowing therapy usually begins when?

Back 64

10-14 days after surgery

Front 65

True or False

Cancer in the oropharyngeal region often affects the tongue base and/or pharyngeal wall.

Back 65

True

Front 66

rehabilitation begins with ____

Back 66

treatment planning

Front 67

True or False

Because of the emotional consequences of oropharyngeal cancer and surgery, patients are rarely capable of participating in treatment decisions.

Back 67

False!

Patient characteristics and preferences are important in treatment selection

Front 68

True or False

Rehabilitative counseling should commence 10-14 days post-operatively.

Back 68

False

Pts should receive rehabilitative counseling prior to initiation oftheir treatment for head and neck cancer

Front 69

Preoperative counceling by the swallowing therapist usually includes what?

Back 69

A swallowing screening, if not MBS, to define any pre-existing swallowing disorders

Front 70

Two reasons for a pretreatment dental consultation:

Back 70

1. ID dental disease
2. ensure preservation of critical teeth needed for prosthetic stabilization

Front 71

An important concept for the patient to learn during treatment and (pretreatment counseling) is that:

Back 71

he or she is in control and responsible for his or her own rehabilitation

Front 72

If the initial treatment is surgical, the rehabilitation tearm should provide additional counseling to the patient and family when?

Back 72

2-3 days postoperatively

Front 73

When does intensive rehabilitation begin postoperatively? How often when inpatient? How often when outpatient?

Back 73

1-2 weeks
daily
weekly

Front 74

True or False

While early and active rehabilitation is helpful, it is not entirely critical to the successful functioning of head and neck cancer patients.

Back 74

False

Front 75

Review of data for a prospective study of 186 oral and oropharyngeal cancer patients treated surgically at 10 major medical centers indicated that ____ of patients received speech and swallowing therapy and ____ received maxillofacial prosthetic intervention. At 3 months posttreatment ____ of patients were lost to follow-up

Back 75

only 50%
less than 10%
50%

Front 76

Two things to know to understand the oral cancer patient's swallowing difficulties

Back 76

1. nature and extent of resection
2. nature of reconstruction

Front 77

In patients who have had less than 50% of their tongue reseected in a surgical procedure, the _____ is the main determinant of the pattern of function.

Back 77

nature of the reconstruction

Front 78

In patients with greater than 50% of the tongue resected, the _____ determine the funcitonal abilities of the patient.

Back 78

extent of resection AND nature of the reconstruction

Front 79

True or False

The swallowign therapist should as the surgeon for the exact labels for surgical procedures in order to define, in terms of the structures involved, the exact extent of the surgical resection and reconstruction.

Back 79

False

Surgical labels often cover a wide variety of specific resections and reconstructions and can be misleading

Front 80

If the resection is limited to the tongue, the pharyngeal and laryngeal aspects of the swallow are usually ____

Back 80

normal

Front 81

True or False

Pts with less than 50% of tongue resected and reconstruction with primary closure generally have only temporary difficulty swallowing.

Back 81

True

Front 82

With partial tongue resedction, because of edema and changes in tongue movement, pts often have difficulty with what?

Back 82

triggering pg swallow

Front 83

With anterior floor of mouth resection, _____ results in severe difficulties with lingual control and propulsion of the bolus, and mastication. Disruption of ___ contributes significantly to these problems.

Back 83

suturing the tongue into the surgical defect.
mylohyoid support

Front 84

What procedures to use in x-ray and therapy with a partial tongue resection?

Back 84

ROM and bolus control
TTS (early on)
Head up
SGS
reshaping prosthesis
(liquids easier)

Front 85

What procedures to use in therapy with anterior mouth resetion (suturing tongue into surgical defect)

Back 85

OT ROM
positioning food posteriorly
Head up
palatal reshaping prosthesis
mendelsohn and falsetto
dump and swallow
(liquids only)

Front 86

What procedures to use in therapy with anterior mouth resection (tongue flap or graft)

Back 86

ROM
Dental prosthesis
positioning food more posteriorly

Front 87

Patients who have had resection in the lateral floor of the mouth, tonsil, and TB area have potential difficulties with what?

Back 87

both oral and pharyngeal stages of the swallow

Front 88

reduced saliva flow is also called ___ and is a common concurrent factor in ____

Back 88

xerostomia
radiotherapy

Front 89

For a smaller laryngeal tumor, which is better: surgery or radiotherapy?

Back 89

Both show equal cure rates

Front 90

What sorts of medical treatments are used for larger laryngeal tumors (2)?

Back 90

combined treatment: radiotherapy plus surgery or high-dose chemo plus radiation

Front 91

3 areas of the larynx with regard to tumor staging AND percentages of malignant cancers occuring in each one!

Back 91

supraglottic (35%)
glottic (60%)
subglottic (5%)

Front 92

Staging of tumor occurs ___ treatment

Back 92

before

Front 93

True or false

Because of the way in which the lymph system drains in the supraglottic larynx, a tumor of the supraglottic larynx will not spread upward.

Back 93

False

Will not spread downward to the TVF UNLESS the tumor is located at the base of the epiglottis

Front 94

A horizontal or supraglottic laryngectomy is a ___ laryngectomy where the ___, ___, and ___ are removed, leaving the ___, ___, and ___ to protect the airway

Back 94

partial
epiglottis, aryepiglottic folds, and FVF
TB, arytenoids, TVF

Front 95

ROM exercises generally have an effect within gthe first ____ after initiation

Back 95

2-4 weeks

Front 96

True or False

Those pts with good tongue base action who are able to learn the sequence of instructions for the super-supraglottic swallow will be rehabilitated and swallow normally, usually withing 6 months postoperative.y

Back 96

False

1 month

Front 97

How long does it take to acheive a normal swallow with:
a standard supraglottic resection?
A resection including all or part of the arytenoid cartilage?
surgery into the tongue base?

Back 97

1 month (as long as 3-6)
2 months (6-12)
6 months or more

Front 98

In a study of recovery of swallow after partial laryngectomy, patients who had not acheived oral intake _____ took significantly longer to attain oral intake

Back 98

before begining radiotherapy.

Front 99

____ involves removing of one vertical half of the larynx

Back 99

vertical laryngectomy or hemilaryngectomy

Front 100

True or False

Hemilaryngectomies often result in a permanent inabiltiy to acheive full airway closure even though the arytenoid is often left intact, because the TVF, ventricle and FVF are removed.

Back 100

False

Because tissue bulk is reconstructed on the opposite side against which the intact side can attain normal laryngeal closure

Front 101

What to do to help a hemilaryngectomy patient swallow?

Back 101

Head down, rotat to side