Cancer of the Larynx – Flashcards
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larynx
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connects upper airway (trachea) to lower airway, contains the vocal cords
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cancer of the larynx
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smoking main cause, alcohol, absestos, cement dust, voice abuse, nutritional deficiencies
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Cancer in Glottic Area (vocal cords here)
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early signs of horse voice, throat pain, ear pain, coughing, no lymph nodes so rare for it to METS
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Cancer of the Supra Glottic Area
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Eppiglottis here so early signs are aspiration, disphagia, swallowing problems
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Squamous Cell Cancers
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begin as small hard patch
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leukoplacia
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a white patch of squamous cancer cells
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Arrythroplacia
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a red patch of squamous cancer cells
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most common early sign of cancer of the larynx
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persistant horse voice more than 3 weeks
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common late sign of cancer of the larynx
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strider sounds: narrowing of the large airways
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tumor grading
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how anaplastic, virulant and how likely it is to METS
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TNM Stage of tumor
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Tumor size, presence of lymph Node involvement, METS or not
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Indirect Larynostomy
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DX Larynx Cancer visualized in dr. office
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Direct Larynostomy
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fiber optic scope and tissue is biopsied
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radiation therapy to neck jaw area
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must have all dental work done prior because it causes osteonecrosis of the jaw, used if cancer is limited to vocal cords, voice remain normal
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Intensity Modulated Radiation Therapy
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Very high dose radiation with multiple beams converge and take the shape of the tumor and spares healthy tissue
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Neoadjuvent Radiation
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done before surgery to reduce tumor size
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adjuvent radiation
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done after surgery to zap any remaining cancer cells
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pallitive chemo/ radiation
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done to relieve symptoms
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Partial Laryngectomy
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one vocal cord has cancer and is removed, has altered but adequate voice remaining
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Post op Edema after laryngectomey
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need a tracheotomy (artificial airway inserted in trachea)
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Supraglottic Laryngectomy
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above the vocal cords, high risk for aspiration because eppiglotis is removed, need to learn new swallow techniques, trach and feed tube post op
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Hemilarygectomy
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either right or left vocal cord removed, usuable voice, mild swallow problem, trach post op
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Total Laryngectomy
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remove vocal cords, epiglottis, part of trachea, part of thyroid, larynx completely removed. loss of voice, permanent stoma after surgery, cannot SMELL food any longer effects nutrition
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No Swallowing Problem
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can eat immediately after total larynectomy because there is no longer an air connection between upper and lower airway
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complications of total larynectomy surgery
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infection, wound break down, stoma stenosis, fistula formation, difficulty swallowing, speech probblems
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Electrolarynx
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artificial larnyx can speak through it when there is a permanent stoma after total larynectomy
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Espophogeal Speech
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learn to speak through esophogus
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Tracheoesphageal Puncture
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surgically reattach esophagus and trachea with a fistula to get the most normal voice this way
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Pre Op for Partial and Total Larynectomies
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assess communication baseline, teach post op care of trach
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Post Op care in recovery room
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#1 concern: airway. respiratory distress from lots of mucous from major imflammatory response, need suction, HOB 30%, mental status changes, RR and Pulse increases from compensatory reaction, bleeding can block airway
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Thyroidectomy (done with total laryngectomy)
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causes hypocalcemia from removal of parathyroid glands that regulates calcium. s/effects: osteoporosis, spontaneous fractures
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Hypocalcemia
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S/S: too much nerve firing and muscle contractions. numbness, tingling, seizures, bronchospasms, larygospasms can cause osteoporosis, spontaneous fractures
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Hypercalcemia
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muscles don't move well because calcium is a cell membrane stabilizer and controls movement of nerve and muscle cells. It also keeps out too much sodium from getting in and it keeps potassium from getting out.
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Superglotticectomy
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aspiration risk and gets a feeding tube post op, goes home with them
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pt teaching after total larynectomey
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need to humidify air, use mirror to clean and clear secretions, adequate fluids, may need g tube
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Risk for Sepsis
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if mucosa in gut does not get nutrition then you lose the mucosa and the flora (bacteria) translocate and enter the blood
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life with a stoma
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use sterile saline in tubes, bed side humidifier, increase fluids, take mucolytics to thin secretions, use stoma bib, speech therapy, water sports prohibitied
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Mucolytics
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thins secretions; mucomyst (acetycystein),
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anticholinergics
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inhibit action of acetylcholine
