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Ca Larynx 2

Laryngeal carcinoma is cancer that develops in the larynx (voice box). It is usually squamous cell carcinoma. Most cases originate in the glottis and are more common in men ages 60-70 who smoke or drink alcohol. Symptoms include hoarseness, cough, throat pain, and difficulty swallowing. Diagnosis involves laryngoscopy and imaging tests. Treatment options include surgery to remove part or all of the larynx, chemotherapy, radiation therapy, and clinical trials. Nursing focuses on airway clearance, breathing, communication, pain management, and nutrition.

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Kelvin Maikana
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107 views34 pages

Ca Larynx 2

Laryngeal carcinoma is cancer that develops in the larynx (voice box). It is usually squamous cell carcinoma. Most cases originate in the glottis and are more common in men ages 60-70 who smoke or drink alcohol. Symptoms include hoarseness, cough, throat pain, and difficulty swallowing. Diagnosis involves laryngoscopy and imaging tests. Treatment options include surgery to remove part or all of the larynx, chemotherapy, radiation therapy, and clinical trials. Nursing focuses on airway clearance, breathing, communication, pain management, and nutrition.

Uploaded by

Kelvin Maikana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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LARYNGEAL CARCINOMA

RATHEESH R L
cancer of the larynx
• Laryngeal cancer, also known as cancer of the
larynx or laryngeal carcinoma, are
mostly squamous cell carcinomas, reflecting
their origin from the skin of the larynx.
• Cancer can develop in any part of the larynx, but
the cure rate is affected by the location of the
tumor.
• For the purposes of tumor staging, the larynx is
divided into three anatomical regions:
the glottis, supraglottis and the subglottis.
• Most laryngeal cancers originate in the glottis.
Supraglottic cancers are less common, and
subglottic tumours are least frequent.
• Cancer of larynx accounts for approximately
half of all head and neck cancers.
• Cancer of the larynx is most common in
people between the ages of 60 and 70 yrs and
it occurs 4 – 5 times frequently in men than in
women.
RISK FACTORS
• CARCINOGENS:
– Tobacco(smoke)
– Combined effects of alcohol & tobacco
– Asbetos
– Second hand smoke
– Paint fumes
– Wood dust
– Cement dust
– Chemicals
– Tar products
– Mustard gas
– Leather and metals
OTHER FACTORS:
– Straining the voice
– Chronic laryngitis
– Nutritional deficiencies
– History of alcohol abuse
– Familial predisposition
– Age (higher incidence after 60 yrs of age)
– Gender
– Race(african americans)
– Weakend immune system
Clinical manifestations:
• Hoarseness of more than 2 wks duration
occurs in the patient with cancer in the glottic
area because the tumor impedes the action of
vocal cords during speech.
• The voice may sound harsh,raspy and lower in
pitch.
• Patient may complain of a persistent cough or
sore throat and pain and burning in the
throat especially when consuming hot liquids
or citrus juices.
• A lump may be felt in the neck
• Later symptoms include dysphagia
,dyspnea,unilateral nasal obstruction or
discharge,persistent hoarseness,persistent
ulceration& foul breath.
• Cervical lymphadenopathy
• Unintentional weight loss, a general
debilitated state
• Pain radiating to the ear may occur with
metastasis.
Diagnostic findings:
• An initial assessment includes a complete
history and physical examination of the head
and neck
• This identification of risk factors ,family history
and underlying medical conditions.
• An indirect laryngoscopy using a flexible
endoscope,is initially performed in the
otolaryngologists office to visually evaluate
the pharynx,larynx and possible tumor.
• Mobility of the vocal cords is assessed ,if
normal movement is limited ,the growth may
affect muscle,other tissue,and even the
airway.
• The neck and thyroid gland are palpated for
enlarged lymphnodes & enlarged thyroid
gland.
• Diagnostic procedures that may be used
include endoscopy,including virtuaaal
endoscopy,optical imaging and CT.
• If the tumor is suspected on an initial
examination a direct laryngoscopic
examination is performed under local or
general anesathesia to evaluate all cases of
the larynx.
• In some cases intraoperative examination
obtained by direct microscopic visualization
and palpation of the vocal cords may yield a
more accurate diagnosis.
• CT and MRI are used to assess regional
adenopathy of soft tissues & to stage &
determine the extend of a tumor.
• PET scanning may also be used to detect
recurrence of a laryngeal tumor after
treatment.
TREATMENT
• Surgery:
There are many types of surgery for
throat cancer to allow more normal function in
swallowing and speech without a stoma (a
surgically made opening in the neck that allows
breathing).
CORDECTOMY
• Cordectomy is the surgical removal of a cord…
SUPRAGLOTTIC LARYNGECTOMY
• Supraglottic laryngectomy or horizontal
partial laryngectomy is an operation to
remove the epiglottis, false vocal cords, and
superior half of the thyroid cartilage.
HEMILARYNGECTOMY
• Hemilaryngectomy is an operation to remove
the anterior soft parts of the larynx in
continuity with the underlying thyroid
cartilage.
PARTIAL LARYNGECTOMY
• In this surgery the doctor removes part of the
voice box -- one vocal cord, part of a cord, or
the epiglottis
TOTAL LARYNGECTOMY
• A surgical procedure in which the whole voice
box is removed, and the stoma opening into
the larynx is permanent. The patient breathes
through the stoma.
• Chemotherapy:
These are drugs used to shrink
tumors and/or kill cancer cells after surgery
and/or radiation treatment. Chemotherapy is
often used in combination with other therapies.
• Radiation therapy:
it involves placement of
radioactive substance to remove tumor.
• Proton therapy:
This radiation doses using pencil
beam technology directed at the tumor while
preserving nearby healthy tissue
• Targeted therapies:
These drugs are used to stop
the growth of cancer cells by interfering with
proteins and/or other receptors on cancer cells.
• Cancer clinical trials:
This involves the use of
experimental drugs or other methods that may
show promise in survival and/or reduction in
clinical symptoms.
NURSING MANAGEMENT
• Assess respiratory status including rate, pattern,
lung sounds, and cough effectiveness at least
every 4 hours.
• Monitor quantity, color, and odor of secretions.
• Assess vital signs and pain at least every 4 hours.
Administer analgesics as ordered.
• Provide written information as requested.
• Monitor intake, output, and daily weight.
• Arrange dietary consultation to determine caloric
requirements.
• Maintain clear airways and lung sounds.
• Maintain oxygen saturation level greater than
92%.
• Demonstrate interest in providing incision and
stoma care.
• Accept information about potential
communication strategies.
• Communicate effective pain management.
• Maintain appropriate body weight, intake, and
output
NURSING DIAGNOSIS
• Risk for ineffective airway clearance related to
postoperative edema
• Risk for ineffective breathing pattern related
to pain and anxiety
• Disturbed body image related to total
laryngectomy and presence of tracheostomy
stoma
• Impaired verbal communication related to
total laryngectomy
• Pain related to surgical procedure
• Risk for imbalanced nutrition: Less than body
requirements related to difficulty eating after
surgery

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