The document provides information about cancer of the larynx (voice box), including its definition, causes, signs and symptoms, diagnostic tests, staging, and treatment options. The main causes are smoking and drinking alcohol. Symptoms depend on the location of the tumor and may include hoarseness, cough, neck mass, difficulty swallowing and breathing. Diagnostic tests include laryngoscopy, CT/MRI scans, and biopsy. Treatment involves surgery such as partial or total laryngectomy, chemotherapy, and radiation therapy. Complications can include airway obstruction, hemorrhage, and fistula formation.

2. GRACIOUS COLLEGE OF NURSING
ABHANPUR RAIPUR
CANCER OF THE LARYNX
PRESENTED BY
OM VERMA
ASSISTANT PROFESSOR

5. INTRODUCTION

6. Con……

7. Con……

8. DEFINATION
• Cancer of the larynx is a malignant tumour in
the larynx (voice box).
According to lippencott
• Cancer of the voice box which is located at
the top of the trachea also called laryngeal
cancer .
According to levis

9. DEFINATION
• Laryngeal cancer is a rare cancer in which
malignant cell grow in the larynx cause by
smoking tobacco and drinking alcohol are
the main cause of laryngeal cancer
According to Brunner and suddarth’s

10. DE….
• It is a define as The cancer of laryngeal
cells. abnormal and uncontrollable of cells
growth in the larynx it is called larynx
cancer
cancer
• According to luckmans

11. ETIOLOGY
• AGE-cancer of the larynx occurs most
often in people over the age of 55
• OCCUPATIONAL- workers exposed to
sulfuric acid and inhaling asbestos fibers .
sulfuric acid and inhaling asbestos fibers .
• HPV – human papilloma-virus

12. SMOKING AND TOBACCO
• Smoking increase the risk of throat cancer
Some of the chemicals contained in
tobacco smoke cause, initiate or promote
cancer. When inhaled, these chemicals
cancer. When inhaled, these chemicals
cause genetic changes in cells of the
throat, which can lead to the
development of throat cancer.

13. EXPOSURE TO ASBESTOS, MUSTARD GAS
This toxic changes in bone marrow cell that
develop in to blood cells ), wood dust,
cements dust, tar products, leather, and
metals.
Other contributing factors include straining
• Other contributing factors include straining
the voice, chronic laryngitis, nutritional
deficiencies (riboflavin), and family
predisposition.

14. TOBACCO ( SMOKING )
• The main way that smoking causes
cancer is by damaging our DNA,
including key genes that protect us
including key genes that protect us
against cancer. Many of the chemicals
found in cigarettes have been shown
to cause DNA damage and lead the
larynx cancer ,

15. ALCOHOL AND THEIR COMBINED
EFFECTS
• Alcohol drinkers tend to have lower
levels of folate, an important vitamin
that helps our cells produce new DNA
that helps our cells produce new DNA
correctly. cancer is more common in
people with low levels of folate in
their blood.

16. • HUMAN PAPILLOMA VIRUS (HPV),
• Commonly known as the virus that causes
genital warts and cervical cancer in women, is
increasing being recognized as a cause of
infections that colonize ( germs) the back of the
mouth (throat), including the tongue base and
mouth (throat), including the tongue base and
tonsils.
• An infection means that germs are in or on the
body and make sick, which results in signs and
symptoms such as fever, pus from a wound, a
high white blood cell count, or pneumonia.

18. CLINICAL
MANIFESTATION
MANIFESTATION

19. The manifestations dependent upon the
location of the tumor:
Glottic tumor
Voice change
Hemoptysis
Dyspnea
Respiratory obstruction
Respiratory obstruction
Dysphasia is a language disorder that affects the
ability to produce and understand spoken language.
Weight loss
Pain
dysphagia ( swallowing difficulties )

20. Supra glottis
Aspiration on swallowing.
Sore throat
Foreign body sensation
Dysphasia ( language disorder marked by
deficiency in the generation of speech, )
deficiency in the generation of speech, )
Neck mass
Hemoptysis
Dyspnea
Pain in the throat referred to the ear

21. • SUBGLOTIC
Airway obstruction
Dysphasia
Weight loss
hemoptysis

22. Con….
• HOARSENESS VOICE of more than 2 weeks’
duration is noted early in the patient with
cancer in the glottic area because the tumor
impedes the action of the vocal cords during
speech
speech
• The voice may sound harsh ( rigid ) , raspy
voice( irritable voice ), and lower in pitch.
• DYSPHAGIA= painful swallowing
• Hemoptysis

23. • The patient may complain of a cough or sore throat
that does not go away and pain and burning in the
throat, especially when consuming hot liquids or
citrus juices.
• A lump( tumour ) may be felt ( feel )in the neck.
• Later symptoms include dysphasia, dyspnea (difficulty
breathing), unilateral (one side )nasal obstruction or
breathing), unilateral (one side )nasal obstruction or
discharge, persistent hoarseness, persistent
ulceration, and foul breath. Cervical lymph
adenopathy (lymph node that enlarge and swelling),
unplanned weight loss, a general debilitated state,
and pain radiating to the ear may occur with
metastasis.

25. PATHOPHYSIOLOGY
Progressive accumulation of genetic alteration
( antioncogene is a gene that protect a cell )
Carcinoma of the
squamous cells lining of
larynx

26. • Sub glottis =T
–T1: limited to subglottis
–T2: extends to vocal cord with normal or
impaired mobility
Staging
• Sub glottis = T
–T1: limited to subglottis
–T2: extends to vocal cord with normal or
impaired mobility (RUNNING)
–T3: limited to larynx vocal cord fixation
impaired mobility
–T3: limited to larynx w/vocal cord fixation
–T4a: invades cricoid or thyroid cartilage, and/or
invades tissues beyond the larynx
–T4b: invades prevertebral space, encases
carotid artery, or invades mediastinal
structures
–T3: limited to larynx vocal cord fixation
–T4a: invades cricoids or thyroid cartilage, and/or
invades tissues beyond the larynx
–T4b: invades prevertebral space, encases carotid
artery, or invades mediastinal structures

27. • Nodes
–Nx: regional Lymph Node can’t be assessed
–N0: no regional node involvements
–N1: single ipsilateral node, ≤ 3 cm
–N2a: single ipsilateral node, > 3 cm, ≤ 6 cm
N2b: multiple ipsilateral nodes, ≤ 6 cm
–N2b: multiple ipsilateral nodes, ≤ 6 cm
–N2c: bilateral (BOTH)or contralateral
(OPPOSITE) nodes, ≤ 6 cm
–N3: node > 6 cm

28. Metastasis
–Mx: unknown
–M0: no distant metastasis
M0:
–M1: distant metastasis

29. DIAGNOSTIC STUDIES

30. DIAGNOSTIC STUDIES
• An initial assessment includes a
complete history and physical
examination of the head and neck.
This will include assessment of risk
factors, family history, and any
factors, family history, and any
underlying medical conditions

31. INDIRECT LARYNGOSCOPY
• The doctor looks down throat using a small
,long handled mirror to check for abnormal
area and see if vocal card move as they
should. doctor may spray a local anesthesia in
should. doctor may spray a local anesthesia in
throat.
• Direct Laryngoscopy: Insertion of the endotracheal
tube by a method of directly visualizing the vocal
cords.

32. DIRECT LARYNGOSCOPY
• The doctor insert a thin, lighted tube
called laryngoscope and direct
visualization of effected part of throat
and vocal card
and vocal card
• ,the doctor can look at area that cannot
be seen with a mirror . A local anesthetic
eases discomfort and prevent gagging.

33. • COMPUTED TOMOGRAPHY AND
MAGNETIC RESONANCE IMAGING
(MRI)
• Are used to assess regional
adenopathy ( large or swelling lymph
adenopathy ( large or swelling lymph
node) and soft tissue and to help
stage and determine the extent of a
tumour.

34. BARIUM SWALLOWS
• A series of x-rays of the esophagus and
stomach .the patient drinks a liquid
that contain barium ( a silver –white
metallic compound ) the liquid coats
metallic compound ) the liquid coats
the esophagus and stomach ,and x-rays
are taken .this procedure is also called
an upper GI series.

35. • NASENDOSCOPY
• It is a procedure used to get a clear
visualization of larynx.
• During the procedure ,a small , flexible tube
with a light and video camera at one end .
• Endoscopy is inserted into one of nostrils and
• Endoscopy is inserted into one of nostrils and
passed down the back of throat .the image
from the endoscopy are displayed on a
monitor .

37. BIOPSY
During a nasendoscopy or
laryngoscopy may used small
instruments to remove a sample of
cells from larynx can be examined
cells from larynx can be examined
for signs of cancer .

38. ULTRASOUND SCAN
Ultrasound scans use high frequency
sound waves to create a picture of a
sound waves to create a picture of a
part of the body. You might have an
ultrasound scan to see if the cancer cells
have spread into lymph nodes close to
larynx

39. MANAGEMENT
MANAGEMENT

40. MEDICAL MANAGEMENT
• Chemotherapy:
Drugs are used to prevent the multiplication
of tumor cells, either by killing or by
preventing cell division
preventing cell division
Systemic chemotherapy
Regional chemotherapy
• Chemoprevention
Drug Isotretinoin used to prevent the
recurrence.

41. Systemic chemotherapy
• Treatment with anticancer drugs that travel through the
blood to cells all over the body.
Regional chemotherapy
• Regional chemotherapy is a method of drug
delivery to a tumor bearing area ( affected part
delivery to a tumor bearing area ( affected part
) through a small catheter placed in the artery supporting
the tumor. This is usually performed without an
operation in the radiology department. By this
method we can deliver a high dose of
chemotherapy to the tumor bearing area.

42. •PHARMACOLOGICAL
MANAGEMENT
MANAGEMENT

43. Chemotherapy
• Carboplatin
• 5- fluorouracil
• Bleomycin
• cisplatin
• cisplatin

44. CON….
• Radiosensiteizers: drugs that make tumor
cells more sensitive to radiation therapy
when used in combination with
chemotherapy, it is more effective
chemotherapy, it is more effective

45. SURGICAL MANAGEMENT
• Laser surgery : for vocal cord tumours.
• Partial laryngectomy / Vertical partial
laryngectomy: Removal of half or more of
the larynx
the larynx

46. Supraglottic laryngectomy: for Ca of
supraglottis
• voice box (larynx) has two bands of muscle
that form the vocal cords. The front of the
voice box is made of cartilage and is
voice box is made of cartilage and is
sometimes called the Adam's apple. During a
supraglottic laryngectomy (sooprah-GLOT-tik
lair-un-JECT-uh-me), a surgeon removes the
top part of your voice box (larynx), near your
vocal cords.

47. Supra-cricoid partial laryngectomy: for
confined transglottic Ca.
• Supraglottic laryngectomy or horizontal
partial laryngectomy is an operation to
partial laryngectomy is an operation to
remove the epiglottis, false vocal cords,
and superior half of the thyroid
cartilage.

48. Con..
• Total laryngectomy: For glottis
tumours
• Cervical lymph node dissection /
• Cervical lymph node dissection /
Neck dissection:
–Radical neck dissection
–Modified radical neck dissection

49. Con..
• Radical neck dissection.
• All the tissue on the side of the neck
from the jawbone to the collarbone is
from the jawbone to the collarbone is
removed. The muscle, nerve, salivary
gland, and major blood vessel in this area
are all removed

50. Con..
• Modified radical neck dissection
• The neck dissection is a surgical procedure
for control of neck lymph node metastasis
from squamous cell carcinoma of the head
from squamous cell carcinoma of the head
and neck. The aim of the procedure is to
remove lymph nodes from one side of the
neck into which cancer cells may have
migrated.

52. Complications of surgery
• Haemorrhage
• Airway obstruction
• Carotid artery rupture
• Fistula formation L.C. Removable esophageal
• Fistula formation L.C. Removable esophageal
stents then lead to an abnormal opening
between organs
• voice abnormalities.

53. Nursing Management
– Assess ABG values, pulse oximetry & FiO2 levels
– Semi fowlers to High fowlers position
– Monitor oxygen therapy
– Tracheostomy care and suctioning
– Tracheostomy care and suctioning
– Chest physiotherapy
– Nebulization