You are a 2-year graduate of an accredited AGACNP master's program. You are now a certified AGACNP practicing on a very busy inpatient oncology unit.
Your patient is a 45-year-old male with head/neck cancer. This is a new diagnosis, but the patient has lost over 60 pounds in the past 4 months due to dysphagia, malnutrition, and intractable pain. He is currently NPO due to risk of aspiration.
Explore the types of head and neck carcinomas that you will encounter as an AGACNP on this oncology unit. Describe the following and support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.
Malignancy, cytology results, and type of cancer markers, if available.
How this is cancer diagnosed.
The key complications for which you must be watchful.
How you will manage this unique and very difficult patient with regard to pain management, airway, cosmetics, and psychological concerns.
Which nutritional interventions would be important for this patient?
Full Answer Section
- Adenocarcinoma: This type of cancer starts in the glandular tissue of the head and neck. It is the second most common type of head and neck cancer, accounting for about 5% of cases. Adenocarcinoma can develop in the salivary glands, sinuses, and thyroid gland.
- Other types of head and neck cancer include:
- Malignant melanoma: This type of cancer starts in the melanocytes, which are the cells that produce pigment in the skin. Malignant melanoma can develop on the skin of the head and neck, but it is more common on other parts of the body.
- Lymphoma: This type of cancer starts in the lymphocytes, which are a type of white blood cell. Lymphoma can develop in any part of the body, including the head and neck.
- Sarcoma: This type of cancer starts in the connective tissue, such as muscle, bone, or cartilage. Sarcoma is rare in the head and neck, but it can occur.
Malignancy, Cytology Results, and Type of Cancer Markers
The malignancy of a head and neck cancer is determined by the type of cells that are affected and how quickly the cancer is growing. The cytology results, which are the results of a test that looks at cells from the affected area, can also help to determine the malignancy of the cancer.
The type of cancer markers that are present can also help to determine the type of head and neck cancer. Cancer markers are substances that are produced by cancer cells. Some common cancer markers for head and neck cancer include:
- CA 19-9: This cancer marker is often elevated in patients with pancreatic cancer, but it can also be elevated in patients with head and neck cancer.
- SCC antigen: This cancer marker is often elevated in patients with SCC, but it can also be elevated in patients with other types of cancer.
- CEA: This cancer marker is often elevated in patients with colon cancer, but it can also be elevated in patients with head and neck cancer.
How Head and Neck Cancer is Diagnosed
Head and neck cancer is often diagnosed with a biopsy. A biopsy is a procedure in which a small piece of tissue is removed from the affected area and examined under a microscope.
Other tests that may be used to diagnose head and neck cancer include:
- Imaging tests, such as a CT scan or MRI, can be used to look for the extent of the cancer.
- Endoscopy, which is a procedure in which a thin, flexible tube with a camera is inserted into the affected area, can be used to look for the cancer and to take tissue samples.
Key Complications for Which You Must Be Watchful
There are a number of key complications that you must be watchful for in patients with head and neck cancer. These include:
- Pain: Pain is a common symptom of head and neck cancer. It can be caused by the cancer itself, by the treatment, or by both.
- Dysphagia: Dysphagia is difficulty swallowing. It can be caused by the cancer itself, by the treatment, or by both.
- Aspiration: Aspiration is the accidental inhalation of food or liquid into the lungs. It can be a serious complication of head and neck cancer, as it can lead to pneumonia.
- Airway obstruction: Airway obstruction can occur if the cancer grows large enough to block the airway. This is a medical emergency and requires immediate treatment.
- Bleeding: Bleeding can occur from the affected area. It is usually not a serious complication, but it can be alarming for patients and their families.
- Infection: Infection is a risk in any patient who has had surgery or radiation therapy. It is especially important to be watchful for infection in patients with head and neck cancer, as they may have difficulty clearing secretions from the affected area.