Suitable for nursing students

1. Laryngeal Cancer
Presented by:
Ms. Elizabeth M.Sc (N)
Asst. Professor,
Dept of MSN
NNC, GNSU.

4. Introduction
• Cancerof the larynx isamalignant tumor in andaround thelarynx (voicebox).
• Squamouscentercarcinomaisthe mostcommonform of cancerof thelarynx(95%).
• Cancerof the larynxoccursmorefrequently in menthanin women,andit’s mostcommon
inpeoplebetweentheages of 50to 70yearsof age.

6. Risk factors & Causes
• Tobacco and alcohol use
• HPV Infection
• Obesity
• Poor Nutrition
• Genetic
• Occupational exposure
• Male Gender
• Age > 65 year
• Race – African Americans
• GERD

8. Pathophysiology
Inflammation occurs
↑ production of secretion
Obstruction of airway by mucus
Hypoxia, hypercapnia

9. Diagnostic evaluation
• Physical examination: swollen lymph nodes in the neck
• Direct laryngoscopy
• CT and MRI scan
• Biopsy

10. AnIntial assessmentincludesacomplete historyandphysicalexaminationofthehead andneck.
Thisincludesidentification of
• risk factors
• family history
• anyunderlying medicalconditions

11. Treatment
Surgery
Radiation
therapy
Chemotherapy.

12. Laryngectomy - surgicalremovalof partorallofthelarynx
andsurrounding structures

13. Partial Laryngectomy -Aportion of the larynx isremoved, along with onevocalcord
andtumour
Supraglotic Laryngectomy - hyoid bone, glottis and falsecordsareremoved.
Hemilaryngectomy - thethyroidcartilageof thelarynxissplit in the midline of the
neck,andthe portion of the vocal cord is removed
Total Laryngectomy - the laryngeal structures are removed,includingthehyoidbone,
epiglottis,cricoid cartilage,andtwo orthreeringsof thetrachea.

14. Post - Op Care:
• Trachestomy tube care
• Nasogastrictube feeding

15. Radiation Therapy
The goal of radiation therapy is to eradicate the cancer and preserve the function
of thelarynx.
Complications from radiation therapy are acute mucositis, ulceration of the mucous
membranes,Pain, Xerostomia, lossof taste, dysplasia,Fatigue, skin reactions
Later complications may include laryngial necrosis,edemaandfibrosis.

16. Speech Therapy
Esophageal Speech.
To do this, take air in your mouth; trap it in throat, and then let it back out. It is like
what happens when burp. As the air goes out mouth, it makes the upper parts of
esophagus vibrate. esophagus is the tube that goes from mouth to stomach. This
type of speech requires a lot of practice.
https://youtu.be/UTLg-2N4hyw

17. Artificial Larynx can use an electronic device that vibrates when turned on. put the
device against neck or put a small tube in mouth. Many people use this type of
device first. need to practice speaking clearly so others understand. voice will sound
mechanical.

18. Tracheoesophageal Speech
• This is a long-term way to talk after a laryngectomy.
• It is often done during the surgery but can happen later.
• The surgeon makes a hole between airway and esophagus.
• A small valve goes into this hole. breathe air in from the hole in neck and cover
the hole up.
• The air goes through the valve into the esophagus. The esophagus vibrates, and
use that to make sounds through mouth

19. Complication
• Respiratorydistress(hypoxia, airwayobstruction)
• Hemorrhage
• Infection
• Woundbreakdown
• Aspiration

20. Nursing Management
• Expect initial shock and disbelief following the diagnosis of cancer
and traumatizing procedures (disfiguring surgery, colostomy, amputation).
Few patients are fully prepared for the reality of the changes that can occur.
• Provide an open, nonjudgmental environment. Use therapeutic
communication skills of Active-Listening, acknowledgment, and so on.
Promotes and encourages realistic dialogue about feelings and concerns.

21. • Encourage verbalization of thoughts or concerns and accept expressions of
sadness, anger, and rejection. Acknowledge the normality of these feelings.
Patients may feel supported in the expression of feelings by the understanding that
deep and often conflicting emotions are normal and experienced by others in this
difficult situation.

22. • Be aware of mood swings, hostility, and other acting-out behavior. Set limits
on inappropriate behavior, and redirect negative thinking.
Indicators of ineffective coping and need for additional interventions. Preventing
destructive actions enables patients to maintain control and a sense of self-esteem.
• Be aware of debilitating depression. Ask the patient direct questions about
the state of mind.
Studies show that many cancer patients are at high risk for suicide. They are
especially vulnerable when recently diagnosed and discharged from the hospital.

23. • Identify positive aspects of the situation.
The possibility of remission and slow progression of the disease and new therapies can
offer hope for the future.
• Discuss ways patients and SO can plan together for the future. Encourage the setting
of realistic goals.
Having a part in problem-solving and planning can provide a sense of control over
anticipated events.
• Refer to visiting nurse, home health agency as needed, or hospice program, if
appropriate.
Provides support in meeting the physical and emotional needs of the patient and SO, and
can supplement the care family and friends are able to give.

24. • Visit frequently and provide physical contact as appropriate, or provide
frequent phone support as appropriate for the setting. Arrange for a care
provider and support person to stay with the patient as needed.
Helps reduce feelings of isolation and abandonment.
• Reinforce teaching regarding disease process and treatment and provide
information as appropriate about dying. Be honest; do not give false hope
while providing emotional support.
Patients and SO benefit from factual information. Individuals may ask direct
questions about death, and honest answers promote trust and provide reassurance
that correct information will be given.