2. 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.
3.
4. • 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.
5. • Most laryngeal cancers originate in the glottis.
Supraglottic cancers are less common, and
subglottic tumours are least frequent.
6.
7. • 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.
8. RISK FACTORS
• CARCINOGENS:
– Tobacco(smoke)
– Combined effects of alcohol & tobacco
– Asbetos
– Second hand smoke
– Paint fumes
– Wood dust
– Cement dust
– Chemicals
– Tar products
9. – 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)
11. • 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.
Clinical manifestations:
12. • 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.
13. • Cervical lymphadenopathy
• Unintentional weight loss, a general
debilitated state
• Pain radiating to the ear may occur with
metastasis.
14.
15. • 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.
Diagnostic findings:
16. • 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.
17. • 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.
18. • PET scanning may also be used to detect
recurrence of a laryngeal tumor after
treatment.
19. 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).
21. 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.
22. HEMILARYNGECTOMY
• Hemilaryngectomy is an operation to remove
the anterior soft parts of the larynx in
continuity with the underlying thyroid
cartilage.
23. PARTIAL LARYNGECTOMY
• In this surgery the doctor removes part of the
voice box -- one vocal cord, part of a cord, or
the epiglottis
24. 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.
25. • 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.
27. • Proton therapy:
This radiation doses using pencil
beam technology directed at the tumor while
preserving nearby healthy tissue
28. • Targeted therapies:
These drugs are used to stop
the growth of cancer cells by interfering with
proteins and/or other receptors on cancer cells.
29. • 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.
30. 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.
31. • 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
32. 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
33. • 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
