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Head & Neck Cancer Overview (Treatment regimes (Treatment plan options…
Head & Neck Cancer Overview
Aetiology
HPV
Type 16 & 18 responsible for most
Occupational exposure
Smoking
Radiation exposure
Alcohol
Dx and Staging
TNM staging system
Regional lymph nodes
N0
NX
N1, N2, N3
Distant metastasis
M1
M0
MX
Primary tumour
TX
T0
T1,T2,T3
Treatment regimes
Radiation therapy
Chemotherapy
Targeted therapy
Treatment plan options
Dual modality
Triple modality
Single modality
Salvage surgery
Palliative care
Surgery
Multimodality treatment
Increased tx side effect
Increased nutritional risk
Nutritional Implications
Procedure
Radiation therapy
Acute toxicities
Thick saliva
Odynophagia
Mucosititis
Dysphagia
Xerostomia
Dysgeusia
Fatigue
Late toxicities
Dysphagia
Fibrosis
Xerostomia
Trismus
Osteoradionecrosis
Bone death
Larengectomy/ pharyngolaryngectomy
Dysgeusia secondary to reduced smell
Oral diet commenced on free fluids and upgraded as per MDT to soft/full diet
Dysphagia +/- strictures requiring text mod/enteral nut. dependance
Enteral nutrition required post-op until barium swallow
Chemotherapy
Toxicities
Early onset
Anorexia
Fatigue
Diarrhoea
Peripheral neropathy
Nephrotoxicity
Late onset
Hypokaleamia
Hypocalcemia
Hypomagnesia
Ototoxicity
Skin rash (Cetuximab only)
Immediate onset
Thrombocytopenia
Taste & smell alterations
Neutropenia
Oral mucositis
N & V
Nutrition Interventions
Food fortification
Oral nutrition supplements
Texture modification
Grading scale
Unmodified
Texture A - soft
Texture B - minced and moist
Texture C - Puree
Enteral nutrition
When oral intake is not safe or not meeting needs
Long term
(> 4-6 weeks)
Gastrostomy tube
Short term
(4-6 weeks)
Nasogastric tube
Nutritional counselling for symptom mgt