Laryngeal cancer – Flashcards

Malignant cells in the tissues of the larynx or voice box Squamous cell carcinoma—most common form (95% of cases) Adenocarcinoma and sarcoma—rare (5% of cases) Intrinsic tumor (located on the true vocal cords; tends not to spread because underlying connective tissues lack lymph nodes) or extrinsic tumor (located on another part of the larynx; tends to spread easily)

Laryngeal cancer is classified by its location: supraglottic (on the false vocal cords) glottic (on the true vocal cords) subglottic (rare downward extension from the vocal cords). supraglottic (on the false vocal cords) glottic (on the true vocal cords) subglottic (rare downward extension from the vocal cords). Malignant cells that proliferate can cause swallowing and breathing impairment. A tumor can decrease mobility of the vocal cords.

Unknown

Smoking Alcoholism Chronic inhalation of noxious fumes, such as paint, diesel and gasoline fumes Exposure to absestos Familial disposition History of gastroesophageal reflux disease Human papillomavirus infection Increasing age High intake of salt-preserved meats and dietary fats Poor oral hygiene; periodontal disease

Laryngeal cancer is the most common cancer of the upper aerodigestive tract (the area including the oral cavity, sinonasal tract, larynx, pyriform sinus, pharynx, and esophagus). It's about two to four times more common in men than in women; however, the incidence is increasing among women who smoke. Laryngeal cancer is three times more common in blacks than in whites. It most commonly occurs in patients ages 60 to 70. (See Understanding laryngeal cancer.)

Increased swallowing difficulty and pain Tracheostomal stenosis Aspiration (after partial laryngectomy) Dysphagia Metastasis Limited neck mobility Loss of upper body strength (after surgery) Wound dehiscence (after surgery) Fistula formation (after surgery)

Weight loss Fatigue Vocal changes noted by patient or family (see Signs and symptoms by location)

Complaints of local throat irritation 2-week history of hoarseness

Hoarseness Sore throat Voice volume reduced to a whisper

Pain radiating to ears Dysphagia Dyspnea

None

None

Possible abnormal movement of vocal cords

Abnormal movement of vocal cords Possible lymphadenopathy

Neck mass or enlarged cervical lymph nodes

Liver function tests rule out metastatic disease.

Xeroradiography, laryngeal tomography, computed tomography, and laryngography confirm the presence of a mass. Chest X-rays rule out metastasis. Bone scans identify possible bone metastasis.

Laryngoscopy with biopsy of multiple specimens establishes a primary diagnosis, determines the extent of the disease, and identifies additional premalignant specimens or second primary tumors.

Biopsy results identify cancer cells.

Radiation therapy for possible early lesions or tumors limited to true vocal cords Speech preservation Speech rehabilitation (when speech preservation is impossible)—esophageal speech, prosthetic devices, or experimental surgical reconstruction of the voice box

Based on treatment options Enteral feeding possibly required

Frequent rest periods

Chemotherapeutic agents such as cisplatin and 5-fluorouracil, docetaxel, carboplatin Opioid analgesics for pain control Nystatin mouth rinses for oral thrush due to radiation therapy

Cordectomy Partial or total laryngectomy with or without neck dissection Supraglottic laryngectomy or total laryngectomy with laryngoplasty Transoral laser microsurgery for precancerous and early lesions

Acute pain Anxiety Disturbed body image Disturbed energy field Impaired gas exchange Impaired skin integrity Impaired swallowing Impaired verbal communication Ineffective airway clearance Ineffective breathing pattern Ineffective coping Ineffective role performance Risk for aspiration Risk for infection

express feelings of increased comfort verbalize feelings of decreased anxiety express positive feelings about body image express an increased sense of well-being maintain adequate ventilation remain free from complications with surgical wounds swallow without coughing or choking use language or an alternative speech method to effectively communicate needs maintain a patent airway maintain an effective breathing pattern demonstrate positive coping mechanisms continue to function in usual roles as much as possible remain free from signs and symptoms of aspiration remain free from signs or symptoms of infection.

Prepare the patient for scheduled treatments, such as radiation therapy or surgery. Provide support. Encourage the patient to verbalize feelings, concerns, and fears. Help the patient develop positive coping strategies, and emphasize positive aspects of the patient's body image. Arrange for patient to meet with a laryngectomee for support prior to surgery if indicated. Assist with establishing a method of communication. Enlist the aid of a speech therapist to assist with meeting the patient's communication needs. Institute aspiration precautions as indicated. Auscultate lung sounds for changes; have suction readily available if patient begins to aspirate. Administer analgesics as ordered to manage pain. Institute measures to minimize the effects of chemotherapy as appropriate. Administer nasogastric or gastrostomy feedings as ordered. Prepare the patient and family physically and psychologically for surgery. Prepare the patient for functional losses (inability to smell, blow his nose, whistle, gargle, sip, or suck on a straw). Encourage patient participation in self-care and decision making to foster feelings of self-esteem and control. Provide frequent mouth care preoperatively and postoperatively. Maintain a patent airway; suction when needed. After total laryngectomy, elevate the head of the bed 30 to 45 degrees and support the back of the neck to prevent tension on sutures and, possibly, wound dehiscence. Provide tracheotomy care as appropriate.

Pain level Coping ability Airway patency Respiratory status Swallowing ability Nutritional status Weight Skin and mucous membrane integrity. (See Recognizing and managing complications of laryngeal surgery.)

Hydration and nutritional status Tracheostomy tube care Use of voice

Laryngectomy tube care Vital signs Postoperative complications (airway obstruction, hemorrhage, carotid artery rupture, and fistula formation) Pain control Nasogastric (NG) tube placement and function Communication methods

Chemotherapeutic drug administration Chemotherapeutic drug preparation and handling Health history interview and physical assessment IV bag preparation IV bolus injection IV catheter insertion Impaired swallowing and aspiration precautions Postoperative care Preoperative care Radiation therapy, external Sputum collection by expectoration Throat specimen collection

disorder; diagnosis; possible underlying risk factors, such as smoking and alcohol abuse; and treatment appropriate oral hygiene practices (before and after partial or total laryngectomy) measures to address adverse effects of radiation therapy, such as pain control and use of nystatin for oral thrush postoperative procedures, such as suctioning, NG tube feeding, and laryngectomy tube care preparation for any functional losses possible speech therapy to assist with communication measures to minimize aspiration tracheostomy care, including site care, tube changes, and suctioning as indicated importance of a well-balanced diet performance of enteral feedings, if indicated cure rate (greater than 90%) with early identification and treatment need for repeat indirect laryngoscopy and complete head and neck examinations for at least 5 years after treatment to detect recurrence need for yearly chest X-rays and liver function tests to rule out metastasis signs and symptoms of complications after surgery, including the need to notify a practitioner if any occur importance of continued follow-up care to evaluate the condition.

Refer the patient to a smoking-cessation or alcohol abuse support group, as necessary. Arrange for rehabilitation measures (including laryngeal speech, esophageal speech, an artificial larynx, and various mechanical devices). Refer the patient to home health care for assistance after discharge. Refer the patient to local resources and support services, such as support groups for laryngectomees.