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