laryngeal cancer - contain detailed information of definition, etiology and causes, pathophysiology, management of cancer, nursing management, medical management, patient teaaching, nursing diagnosis, nursing research, complication, diet management.

1. cancer of larynx
PRESENTED BY:-
KAVITA SOREN
ROLL NO.-06
3RD YEAR BASIC B.SC.NURSING
COLLEGE OF NURSING
RIMS, RANCHI

2. Content:- Introduction
 Definition of laryngeal cancer
 Etiology and Risk factors
 Clinical manifestations of laryngeal cancer
 Pathophysiology
 Diagnostic evaluation
 Management of larynx cancer
 Complication of surgery
 Nursing management of laryngectomy
 Patient teaching
 New research done on laryngeal cancer in India
 Nursing diagnosis
 Summary
 Evaluation
 Assignment
 Bibliography

3. Larynx

4.  The larynx, or voice box, is located in the throat. The larynx helps us breathe, speak, and
swallow. The vocal cords, which help us speak, are part of the larynx.
 The larynx is made up mostly of cartilage, a flexible tissue that forms a framework of support.
There are three parts to the larynx:
 The supraglottis, or upper part.
 The glottis, the middle part. This is where the vocal cords are located. The vocal cords open and
close, and allow you to breathe and speak.
 The subglottis, the lower part.
FUNCTIONS OF LARYNX:
 Production of sound
 Speech
 Protection of the lower respiratory tract
 Passage way of air
 Humidifying filtering and warming

5. Introduction:-
Cancer of the larynx is a malignant tumor in and around the
larynx ( voice box). Squamous cell carcinoma is the most
common form of cancer of the larynx. Cancer of larynx
occurs more frequently in men and than in women and it is
most common in people between the ages of 50 and 70
years.
Laryngeal cancer can be classified into three categories :
 Supraglottic ( false vocal cords)
 Glottic ( true vical cords) and
 Subglottic (downward extension of disease from the vocal
cords)

6. Definition:-
Laryngeal cancer is a disease in which malignant
(cancer) cells form in the tissues of the larynx (
Voice Box).
 Laryngeal cancer occurs when cells in the lining
of the throat grow uncontrollably and form
tumors that invade normal tissues and spread to
other part of the body.

8. Etiology and risk factors:-
 Smoking
 Alcohol
 Gastroesophageal reflux disease (GERD)
 Poor nutrition
 Human papiloma virus (HPV)
 Race
 Gender
 Age
 Weakened immune system
 Toxic exposure
 Voice overuse

9. Clinical manifestation:-
 A lump in the neck
 Sore throat
 Persistent cough
 Bad breath
 Respiratory obstruction
 Dysphagia
 Hoarseness and other voice changes
 Stridor
 Fever
 Earache
 Pain in throat reffered to the ear
 Aspiration on swallowing
 Hemoptysis
 Dyspnea

10. Pathophysiology:-

11. Diagnostic evaluation:-
 Medical history
 Physical examination
 Laryngoscopy
 Endoscopic biopsy
 C T Scan
 MRI
 PET
 Chest X-ray
 Fine needle aspiration (FNA)Biopsy

12. Management :-
1. Radiation therapy
2. Chemotherapy
3. Surgery
4. New types of treatment are being tested in clinical trials
1.RADIATION THERAPY:-
Radiation therapy delivers high energy x-rays to the tumor to kill cancer
cells. By focusing the radiation on the cancer cells, the damage to normal
structures can be minimized.

13. 2. CHEMOTHERAPY:-
Chemotherapy is the use of medications to kill or to slow the growth of rapidly multiplying cancer
cells. These medications are often given intravenously (through a needle into a blood vessel)
 Cisplatin and 5-flurouracil are two agents found to be the most effective against larynx cancer.
3. SURGERY:-
Surgery is a common treatment for alll stages of laryngeal cancer.
The following surgical procedure may be used..
 Cordectomy: Surgery to remove the vocal cords only.
 Supraglottic Laryngectomy: Surgery to remove the supraglottis only.
 Hemilaryngectomy: Surgery to remove half of the larynx (Voice Box).
A partial hemilaryngectomy helps keep the patient’s ability to talk.

14.  Partial Laryngectomy: Surgery to remove part of the larynx (Voice
box). A partial laryngectomy helps to keep the patient’s talk ability
talk.
 Total Laryngectomy: Surgery to remove the whole larynx . During
this operation , a hole ( stoma ) is made in the front of the necks to
allow the patient to breathe . This is called a Tracheostomy.
 Thyroidectomy: The removal of all or part of the thyroid gland.
 Laser Surgery: A surgical procedures that usss a laser beam as a
knife to make bloodless cuts in the tissue or to remove a surface
lesion such as a tumor.

16. 4.New types of treatment are being tested in clinical
trials:-
 Chemoprevention: It is the use of Drugs , Vitamins or other
substances to reduce the risk of developing cancer or reduce
the risk of cancer will reoccur.
 Radiosensitizers: Are the drugs that make tumor cells more
sensitive to radiation therapy.
 Nutrition: Good nutrition is important getting enough calories
and protein to prevent loss , regain strength and rebuild
healthy tissues.

17. Complications of surgery :-
 Salivary fistula
 Hemorrhage
 Hematoma formation
 Stomas stenosis
 Aspiration
Long term complications :-
 Chest infections
 Recurrence of cancer in stoma

18. Nursing management of laryngectomy:-
Pre-operative care:
 Explain the patient that after total laryngectomy the
breathing will occur through a permanent opening made
in the neck and that normal speech will not be possible.
 The patient should meet a speech pathologist before
surgery to learn about options for post operative
rehabilation and speech.
 Assess the anxiety levels of the client and family related to
the diagnosis and proposed surgery.

19. Care of the patient after total
laryngectomy:
1. Provide comfort care and airway management-
 Elevate head of bed 45 degrees.
 Encourage deep breathing every 4 hours.
 Maintain oxygen to tracheostomy collar.
 Assess airway patency every shift as needed.
 Assess vitals- quality, rate of respiration and skin color(pallor , cyanosis)
2. Provide care for suture line and stoma site-
 Assess suture line and stoma site every 4 hours.
 Monitor drain function and output.
 Maintain suction to drain at level ordered.
 Clean the stoma site and suture line with hydrogen peroxide ,
normal saline and dry it with dry gauze.
 Report changes in amount and colour of drainage of air leak.

20. 3. Attention to fluid , food and hygiene needs-
 Monitor hydration and ensure adequate fluid intake to maintain healthy oral mucosa.
 Provide mouth care atleast three times in a day.
 Record intake and output every shift.
 Weigh the patient daily, at the same time and in the same amount of clothing.
 Provide stoma care every shift as needed.
 Assess bowel sounds every shift as needed.
 Record amount, consistency and frequency of stools.
 Assess swallowing ability and provide support when oral diet resumes.
4. Provide support and education for the patient family-
 Assess anxiety level and provide emotional support.
 Assist patient in communicating.
 Provide patient with writing materials or picture board.
 Instruct about use of artificial speech device and encourage its use.

21.  Prepare patient for discharge.
 Begin teaching laryngectomy care.
 Provide information about soft diet.
 Refer the patient to a speech pathologist for voice and speech rehabilitation.
SPEECH REHABILATION
 Tracheoesophageal speech:in this a tracheoesophageal puncture (TEP)is made to create a
tracheoesophageal fistula large enough for insertion of a valve prosthesis.
 Artificial larynx or electro larynx: mechanical device which create natural type of speech.

24. Patient teaching Discharge and home health
care guidelines for patient with laryngeal
cancer:-
 Teach the patient Signs and symptoms of potential complications
and appropriate actions to be taken. Complications include infection
( Wound , Poor Wound healing , Fever , Chills ) , Airway Obstruction
and Tracheostomy stenosis( Noisy respiration , difficulty breathing ,
restlessness, confusion), Vocal straining, Fistula formation and
Ruptured carotid artery (bleeding , hypotension)
 Teach the patient the name , purpose , dosage, schedule, common
side effects and importance of taking all medications.
 Teach the patient appropriate devices and technique to ensure
patent airway and prevent complications . Explore method of
communication that work effectively.
 Encourage the patient to wear medic alert bracelet and necklace,
which identifies him or her as a mouth breather.

25.  Instruct the patient in good oral hygiene practices. If
appropriate , instruct a male client to shave off his beard to
facilitate postoperative care.
 Provide the patient with a list if referrals and support groups
such as visiting nurses.

26. New research done on laryngeal
cancer in India:-
Epidemiological review of laryngeal cancer: An Indian perspective
Done by - Saurabh Bobdey, Aanchal Jain, and Ganesh Balasubramanium (
Indian Society of Medical & Paediatric Oncology)
 Abstract
Background:
Laryngeal cancer is one of the 10 leading causes of cancer in Indian men. The
association of laryngeal cancer and tobacco smoking is well-established, but the
peculiarities such as wide variation of disease distribution and survival, role of tobacco
chewing, indoor air pollution, and dietary factors in laryngeal cancer causation needs to
be understood. In this study, we review the descriptive and observational epidemiology
of laryngeal cancer in India.

27.  Materials and Methods:
MEDLINE and Web of science electronic database was searched from
January 1995 to December 2013, using the using keywords “laryngeal cancer,
laryngeal cancer outcome, epidemiology, etiological factor and their
corresponding Mesh terms were used in combination like OR, AND.” Two
authors independently selected studies published in English and conducted in
India. A total of 15 studies were found to be relevant and eligible for this review.
 Results:
In India, laryngeal cancer contributes to approximately 3-6% of all cancers
in men. The age-adjusted incidence rate of cancer larynx in males varies widely
among registries, highest is 8.18 per 100,000 in Kamprup Urban District and the
lowest is 1.26 per 100,000 in Nagaland. The 5-year survival for laryngeal cancer
in India is approximately 28%. Indian studies show tobacco, alcohol, long-term
exposure to indoor air pollution, spicy food, and nonvegetarian diet as risk
factors for laryngeal cancer.

28.  Conclusion:
There is wide regional variation in the incidence of laryngeal cancer in India. Survival rates of laryngeal
carcinoma are much lower as compared to other Asian countries. Studies conducted in India to identify
important risk factors of laryngeal cancer are very limited, especially on diet and indoor air pollution. Hence,
more research is required for identifying the etiological factors and development of scientifically sound
laryngeal cancer prevention programs.
 Articles from Indian Journal of Medical and Paediatric Oncology : Official Journal of
Indian Society of Medical & Paediatric Oncology are provided here courtesy of Wolters
Kluwer – Medknow Publications
 REFERENCES
1. Ferlay J, Soerjomataram I, Ervik M, Forman D, Bray F, Dikshit R, et al. Lyon, France: International Agency
for Research on Cancer; 2012. [Last accessed on 2014 May 03]. GLOBOCAN 2012, Cancer Incidence and
Mortality Worldwide in 2012. Available from: http://www.globocan.iarc.fr . [Google Scholar]
2. Three-year Report of Population Based Cancer Registries 2009-2011.Bangalore: National Cancer Registry
Program (ICMR); 2013. ICMR. Individual registry-wise annexure; pp. 92–150. [Google Scholar]
3. Time Trends of Cancer Incidence Rates: 1982-2010. Ch. 4. Bangalore: National Cancer Registry Program
(ICMR); 2013. ICMR. Trends over time for all sites and on selected leading sites of cancer; pp. 19–
130. [Google Scholar]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743184/

29. Nursing diagnosis:-
 Ineffective airway clearance related to altering ability to breath, cough
and swallow.
 Acute pain related to surgical incision and tissue swelling.
 Imapired skin/ tissue integrity related to surgical removal of tissues and
grafting, radiation or chemotherapeutic agents , reduced blood supply
and edema formation.
 Impaired verbal communication related to anatomical deficit removal of
vocal cords.
 Impaired oral mucous membrane related to poor or inadequate oral
hygiene , dehydration or absence of oral intake , decreased saliva
production secondary to radiation or surgical procedure.

30. Summary:-
 Cancer of the larynx is a malignant tumour in and around the larynx (
voice box). Squamous centercarcinoma is the most common form
of cancer of the larynx (95%). Cancerof the larynx occurs more
frequently in men than in women, and it's most common in people
between the ages of 50 to 70 years of age. Most common treatment of
laryngeal cancer is laryngectomy. Other treatments are Radiation
therapy &Chemotherapy .

31. Evaluation:-
 What is cancer of the larynx?
 What is the most common form of laryngeal cancer?
 What gender is most likely to get laryngeal cancer?
 What is the most common treatment for laryngeal cancer?
 What adult age range typically for laryngeal cancer?
 What are the etiologies of laryngeal cancer?
 What are the signs and symptoms of laryngeal cancer?
 What are the 3 functions of larynx?
 What is a total laryngectomy?
 Apart from laryngectomy what other treatments can be used ? (Or
combined with it)

32. Assignment:-
 Write the nursing care plan of the Laryngeal Cancer.

33. Bibliography:-
 Suddarth’s &Brunner;“Textbook of Medical-Surgical Nursing”,twelfth
edition;page no;164-170
 Www. Slideplayer.com
 www.wkipedia.org
 Www.cancer.gov
 www.healthline.com