Conservative treatment in head and neck cancer

The incidence of head and neck cancer in Slovenia is increasing, especially inmale population. Late diagnosis, in advanced of disease, influences not onlythe treatment results but also the treatment strategies and modalities: aggressive surgery combined with radiotherapy and reconstructive procedures and chemotherapy in inoperable tumors is therefore indicated too frequently instead of organ sparing treatment. Early detection should be improved, especially in the target population, and all up-to-date diagnostic technology should be employed in centralized multidisciplinary pre-treatment assessment. Good co-operation between surgeons, radio and chemotherapists in planning, performing as well as in evaluating the treatment is also a basic condition for better implementation of organ sparing approaches in head and neck cancer

Voice quality after radiation therapy of early glottic cancer

Radiation therapy is generally accepted as a successful treatment modality forearly glottic cancer offering an acceptable voice quality after the treatment. In order to evaluate objectively the voice quality in irradiated patients and to eliminate the influence of decreasing voice quality as a result of normal aging, the results of the acoustic analysis of voice in 20 patients with early glottic cancer treated with radiation therapy were compared to the results of 20 age-matched volunteers. The results established worse voice quality in the irradiated group but the difference was not significant except in amplitude perturbation quotient which expresses the instability of loudness. In order to identity the factors which could influence the quality of voice after irradiation of the laryngeal carcinoma, the results of laryngoscopy and the biopsy extension, were correlated with theresults of the perceptive voice evaluation and the results of acoustic voice analysis. No significant influence of the stated factors on the voice quality of the patients was established. Only the irregular glottic gap duringphonation indicated to be connected with very hoarse voice. In conclusion, radiation therapy of early glottic cancer results in an abnormal, but still satisfactory voice quality when compared to the voice quality of normal age-matched speakers. The hoarseness is the results of instability of pitch and specifically the instability of amplitude (loudness). The voice quality after the treatment can be influenced by the tumor extension and localization, the sequels of excisional biopsy, and the radiation therapy or functional disorder. All the stated factors are very intermingled and are probably acting together

Sporazumevanje po laringektomiji

Izhodišča. Pri bolnikih z napredovalim rakom grla in spodnjega žrela je kirurška odstranitev grla najbolj primeren način zdravljenja. To zdravljenje pa negativno vpliva na številne pomembne bolnikove funkcije in tudi na govor. Bolniki in metode dela. Po odstranitvi grla je možnih več različnih načinov tvorbe glasu, tako da se vsak laringektomirani bolnik lahko nauči katerega od teh načinov govornega sporazumevanja. Rezultati. Znanih je več različnih, tudielektronskih naprav, ki s pomočjo lastnih baterij proizvajajo zvok. Drugo možnost predstavlja ezofagalni govor, pri katerem se bolnik nauči uporabljati mišični segment na prehodu v zgornji požiralnik kot generator glasu. Kirurško možnost govorne rehabilitacije po laringektomiji pa predstavlja vstavitev proteze v kirurško narejeno fistulo med zgornjim požiralnikom in sapnikom. Proteza usmeri zrak iz pljuč v zgornji požiralnik, glas pa nastane pri prehoduzraka skozi že omenjeni mišični segment. Zaključki. Številni dejavniki vplivajo na izbiro najprimernejšega načina nadomestnega govora pri posameznem bolniku. V Sloveniji največ laringektomiranih bolnikov uporablja ezofagalni govor.Background. Laryngectomy is the mode of treatment of the patients with advanced laryngeal and hypopharyngeal cancer. It affects many important functions, including speech. Patients and methods. Various alaryngeal speech modes are available so that no laryngectomee should be left without a means ofcommunication. Results. There is a variety of artificial devices, including electronic ones that produce their own battery driven sound. Alternatively, the patient can learn a new form of voicing using a muscular segment of the upper esophagus as a source of sound (esophageal speech). A puncture can be created surgically through the esophageal wall and a prosthesis placed in it to divert pulmonary air into the esophagus and through the same muscular segment to produce sound. Conclusions. Many factors influence the choice of analternative to be used with a particular patient. In Slovenia, esophageal speech is the most frequently used alaryngeal speech mode

[Dejavniki, ki vplivajo na rehabilitacijo bolnikov z rakom glave in vratu]

Purpose. The purpose of the prospective study was to identify the factors adversely influencing the post-treatment rehabilitation in patients with head and neck cancer. Patients and methods. One hundred and ten patients with oral cavity, pharyngeal and laryngeal cancer were examined before surgical treatment in order to find unfavorable factors: hearing loss, defective teeth,impaired pulmonary function, and speech disorders. The patients evaluated the success of their rehabilitation 12 months after the treatment. The influence of possible unfavorable factors, tumor site, and type of surgeryon speech, swallowing and reintegration competence was determinated. Results. The site of the tumor and the type of surgery did not influence the quality of rehabilitation in general. Defective teeth influenced the ability of swallowing but not the speech. Hearing loss impaired the patient\u27s reintegration in their home environment. Impaired pulmonary function did not affect patient\u27s speech. Speech was the poorest in laryngectomized patients. However, about two thirds of the patients were satisfied with their capabilityof speech, swallowing and their rehabilitation in general. Conclusions. Early identification of unfavorable factors, and individually planned rehabilitation can ensure a suitable quality of life for patients thathave undergone surgery for head and neck cancer.Namen raziskave. S prospektivno raziskavo so avtorji poskušali ugotoviti, kateri dejavniki negativno vplivajo na rehabilitacijo bolnikov z rakom glave in vratu po končanem zdravljenju. Bolniki in metode dela. Pri 110 bolnikih z rakom ustne votline, žrela in grla so avtorji pred kirurškim zdravljenjem ugotavljali morebitne neugodne dejavnike: naglušnost, pomanjkljivo zobovje, zmanjšano pljučno funkcijo in govorne motnje. Dvanajst mesecev po končanem zdravljenju so bolniki ocenjevali uspešnost rehabilitacije. Avtorji so ugotavljali vpliv naštetih neugodnih dejavnikov, lokalizacije tumorja in vrstekirurškega zdravljenja na bolnikov govor, sposobnost požiranja in reintegracije v domače okolje. Rezultati. Lokalizacija tumorja in vrsta kirurškega zdravljenja nista vplivali na splošno uspešnost rehabilitacije. Pomanjkljivo zobovje je zmanjševalo sposobnost požiranja, ni pa vplivalo na govor. Naglušnost je negativno vplivala na vključevanje bolnika v domače okolje. Zmanjšana pljučna funkcija ni vplivala na bolnikov govor. Govor je bilnajslabši pri laringektomiranih bolnikih. Kljub temu sta bili dve tretjini bolnikov zadovoljni s svojo sposobnostjo govora, požiranja in rehabilitacije po zdravljenju na splošno. Zaključki. Zgodnje odkrivanje neugodnih dejavnikov in individualno načrtovana rehabilitacija lahko omogočita primerno kakovost življenja bolnikov, kirurško zdravljenih zaradi raka glave in vratu