2. CANCER OF LARYNX
Cancer of larynx accounts for 2% to 3% of all
malignancies. Squamous cell carcinoma is the
most common malignant tumor of the larynx
arising from the membrane lining the
respiratory tract.
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4.
5. Etiology and risk factors
• Smoking
• Alcohol
• Tobacco chewing
• Occupational exposure to asbestos, wood
dust, mustard gas, petroleum products
• Inhalation of noxious fumes
• Chronic laryngitis
• Voice abuse
• Nutritional deficiency (rivoflavin)
• Age after 60 years
• Gender (more common in men than
woman)
• Low immunity
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13. Regional metastasis size: N classification
N0 – no metastasis
N1 – single ipsilateral lymph node metastasis ≤ 3 cm
N2
a – single ipsilateral lymph node metastasis > 3 cm ≤ 6
cm
b – multiple ipsilateral lymph node metastases ≤ 6 cm
c – bilateral or contralateral lymph node metastases ≤ 6
cm
N3 – lymph node metastases > 6 cm
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15. Clinical manifestation
• Hoarseness of voice
• Persistant cough
• Sore throat
• Throat pain
• Throat burning (when consuming hot liquids or citrus
fruit juice)
• Lump is felt in the neck
• Dysphagia
• Dyspnea
• Unilateral nasal obstruction
• Nasal discharge
• Foul breathing
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18. Diagnostic evaluation
• History taking – family,
environmental, habits
of alcohol, smoking
• Endoscopy
(laryngoscopy)
• CT scan
• MRI
• PET
• Biopsy
19. Medical management
• Chemotherapy – for patient with more advanced
disease, cisplastin based chemotherapy and
radiotherapy protocol have been used. 5 fluorouracil
(5-FU) is also used commonly.
• Radiation therapy – the goal of chemotherapy is to
eradicate the cancer and preserve the function of the
larynx. Radiation therapy can be used preoperativy and
postoperatively. Radiation therapy is combined with
surgery in advanced laryngeal cancer as adjunctive
therapy to surgery or chemotherapy and as palliative
measure.
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21. Surgical management
1. Vocal cord stripping – stripping of vocal cord
is used to treat dysphagia, hyperkeratosis and
leukoplakia. The procedure involves removal
of the mucosa of the edge of the vocal cord
by using an operating microscope.
2. Cordectomy – surgical removal of vocal cord,
is usually performed via transoral laser.
22. 3. Laser surgery – when the tumour size is of
small, small tumours are eradicated with the
use of laser. Microelectrodes are useful for
surgical resection of small tumours of lung.
4. Total laryngectomy results in permanent loss of
the voice and a change in the airway, requiring a
permanent tracheostomy.
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24. 5. Partial laryngectomy – a partial laryngectomy is
often used smaller cancers of larynx (small
tumor). It is recommended in the early stage of
cancer in the glottis area when only one vocal
cord is involved. In this, a portion of the larynx is
removed, along with vocal cord and the tumor, all
other structures remain.
25. 6. Total laryngectomy – in total laryngectomy, the
laryngeal structures are removed, including the
hyroid bone, epiglottis, cricoids cartilage and two
or three rings of trachea.
26. Nursing management (Pre-operative)
1. Risk for aspiration related to surgical removal
of epiglottis and excessive secretion after
surgery.
2. Ineffective airway clearance related to
excessive secretions after surgery
3. Risk for impaired gas exchange related to
excessive secretions after surgery
4. Altered nutrition less than body requirement
related to dysphagia.
27. Swallowing techniques after a partiallarygectomy
• Being with soft or semi solid foods
• Stay with a nurse or swallowing therapist during meals
until you master the technique of swallowing without
choking
• Be patient, learning to swallow again is frustrating
• Follow these steps in sequence –
• Take a deep breath
• Bear down to close the vocal cords
• Place food into your mouth
• Swallow
• Cough to rid the closed cord of accumulated food
particles
• Swallow
• Cough
• Breathe
28. Nursing management of patient after
larygectomy
1. Nutrition – immediately after surgery, the
client’s nutrition is supplemented with tube
feedinds. The client continues to receive tube
feedings until edema has subsided and
suture line healing has occurred. When the
client can swallow saliva, oral feedings can
begin. The diet usually begins with liquid or
semi-soft foods and progresses as healing
occurs.
29. 2. Communication
• Communication – for the first few days after
surgery, the client should communicate by
writing. Even though the client cannot speak,
conversation should still include the client’s
input through nodding and pointing and not
be directed only to others, such as the family.
Avoiding conversation or excessive talking
with client because of difficulty in
communication is demeaning to the client and
leads to frustration.
30. 3. Artificial larynx
• An artificial larynx may me used as
early as 3 to 4 days after surgery.
these battery-operated speech
devices are held alongside the neck
or can be adapted with a plastic
tube that is inserted in the mouth.
The air inside the mouth is vibrated,
and the client articulates as usual.
The speech quality is monotone and
mechanical-souding but intelligible.
31. 4. Esophageal speech
• esophageal speech is a technique
that requires the client to swallow
and hold air in the upper
esophagus. By controlling the flow
of air, the client can pronounce as
many as 6 to 10 words before
stopping to swallow more air. The
voice is deep but is oud and
effective once the technique is
mastered.
32. 5. Tracheoesophagial Puncture (TEP)
❑ It is a surgical technique that also restores speech. A
small puncture is made into the upper tracheostoma to
the cervical esophagus for creation of a fistula. After
the fistula tract has healed, a small one-way valve, or
voice prosthesis, is inserted.
❑ By occlusion of the prosthesis, air can be shunted into
the esophagus and used to produce speech. The TEP
may be done concurrently with a total laryngectomy or
as secondary procedure after healing and radiation
therapy.
❑ These devices require maintenance, therefore only
clients who are highly motivated, who are able to
perform self-care, and who have good manual
dexterity are eligible for this procedure.
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34. SPEECH THERAPY
• To plan postoperative communication strategies
and speech therapy, the speech therapist or
pathologist conduct a preoperative evaluation.
During this time, the nurse discusses with the
patient and family about methods of
communication that will be available in the
immediate post-operative period.
• These include writing, lip speaking and reading,
and communication or word boards. In addition,
a long term postoperative communication plan
for alaryngeal communication is developed.
35. • The important common techniques of
alaryngeal communication are- electrolarynx,
esophageal speech and tracheoesophageal
puncture.
