Survivorship Issues: Implications of Head & Neck Cancer - - PowerPoint PPT Presentation

Survivorship Issues: Implications of Head & Neck Cancer Treatment Panel

Moderator: Nicole Messier BSN, RN, OCN, ONN-CG Panelists:

• Philip Schaner, MD – DHMC
• Elise Cushman RD, LD – DHMC
• Michelle Coogan RN – DHMC
• Christina M. Mimikos, DO – Maine Medical Partners
• Zoe Kennedy, MA, CCC-SLP – Voice & Swallowing Center of Maine

Case Study

• 60

60-year-old male le, , 20 PY hx of f cig igarette use (q (quit 20 years prior), , presented wit ith tr trismus x 1 year, , with a 55 lb lb weig ight lo loss

• At

t presentation to otolary ryngology: rig right sid ided neck mass, , palatal mass, , rig right otalgia, , and alt ltered sensation of f th the R oral tongue

• Staging:

CT HN:

• Large mass in the right soft palate / right

lateral oropharyngeal wall. Extension across midline at the soft palate.

• Concern regarding invasion of the mandible
• Right level II and IV adenopathy

Case Study

Treatment:

• Radical tonsillectomy,

, partial glo lossectomy / / palatectomy, , mandibular resection, rig right modified radical neck dis issection

• Pathology:
• pT4N1 squamous cell carcinoma of the soft

palate, 5.1 cm, invasion of mandible, p16 (+), LVSI/PNI (-), margins (+) in bone, 2/6 LN (+). Free flap reconstruction

• Placement of PEG tube immediately after

surgery

• Re-resection of positive margin: no residual

carcinoma

Case Study

Treatment:

• In

Initial adjuvant radiotherapy pla lanned, , but at t th the ti time of f tr treatment pla lanning a g gross recurrence wit ith progressive rig right sid ided adenopathy was evident

• 7 weeks of

f chemoradiotherapy. . Completed 11/2 /2018 MBS 12/27/18:

• 1. Decreased laryngeal elevation and excursion.
• 2. Penetration with nectar thick liquid.
• 3. Deep penetration to the level of the cords from the

vallecular residue after the swallow with thin consistency.

• 4. Large vallecular residue with pudding thick consistency

which does not clear with subsequent swallow, which eventually was coughed up by the patient

Case Study

• Now ~ 1 year out fr

from completion of f radiotherapy: NED

• Lo

Lost his jo job as he could not keep work rking due to post-treatment complications. . Recently found new employment.

• Dysphagia:
• Limited to purees / liquids due to mastication issues
• Has not used G tube since September (not removed yet due to scheduling issues)
• No SLP in St. Johnsbury, transportation to Lebanon challenging