CANCER OF THE LARYNX

• Cancer of the larynx is a malignant tumour in and around

the larynx ( voice box). Squamous center carcinoma is the
most common form of cancer of the larynx (95%).
• Cancer of 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.
• Carcinogenes that have been associated with laryngeal
cancer include tobacco (smoke or smokeless and alcohol
and their combined effects, as well as exposure to
asbestos, mustard gas, wood dust, cement dust, tar
products, leather, and metals. Other contributing factors
include straining the voice, chronic laryngitis, nutritional
deficiency (riboflavin) and family predispostions.
Conti
• An Intial assessment includes a complete
history and physical examination of the head
and neck. This includes identification of risk
factors, family history, and any underlying
medical conditions.
 Medical management

Treatment of laryngeal cancers depends on the

staging of the tumor, which includes location,
size, and histology of the tumor and the
presence and extent of cervical lymph node
involvement.
• Treatment options include
Surgery
Radiation therapy and
Chemotherapy.
Patients with early stage disease (stage first or second) can
be treated with either radiation therapy or surgery.
Patients with stage third or fourth or advanced tumours
require a combined treatment modalities approach
consisting of either surgery or radiation therapy or
chemotherapy or all three treatment regimen.
• Surgery and radiation therapy are both
effective methods in the early stages of
cancer of the larynx. Chemotherapy
traditionally has been used for recurrence or
metastasis disease.
 Surgical management

• Surgical management depends largely on the stage of the

disease. The overall goals for the patient include minimizing the
effects of surgery on speech, swallowing, and breathing while
maximizing the cure of the cancer. Complete removal of the
larynx (total Laryngectomy) can provide the desired cure, but it
is also leaves the patient with significant loss of the natural voice
and the need to breathe through an opening (stoma) created in
the lower neck.
Several different types of Laryngectomy (
surgical removal of part or all of the larynx and
surrounding structures) are considered for
patients with more extensive involvement.
• several different types of Laryngectomy (surgical removal
of part or all of the larynx and surrounding structures)
• partial Laryngectomy
• Supraglotic Laryngectomy
• Hemilaryngectomy
• Total Laryngectomy
 Types of surgical therapy

• Partial Laryngectomy ( a partial Laryngectomy is

recommended in the early stages of cancer in the glottic
area only one vocal cord is involved.
• The surgery is associated with a very high cure rate. It may
also performed for recurrence when high dose radiation
has failed. A portion of the larynx is removed, along with
one vocal cord and tumour all structure remain.
 Supraglotic Laryngectomy

• This Is a voice – sparing operation that can be

tailored the supraglotic lesion.
A Supraglotic Laryngectomy is indicated in the
management of early stage first supraglottic and
stage second lesion. The hyoid bone, glottis and
false cords the are removed.
 Hemilaryngectomy

• A Hemilaryngectomy is performed when the tumor

extends beyond the vocal cord but is less than 1 cm in size
and is limited to the subglottic area. It may be used in
stage first glottic lesions.
• In this procedure, the thyroid cartilage of the larynx is split
in the midline of the neck, and the portion of the vocal
cord.
• In this type of surgical therapy patient will have a
trachestomy tube and naso gastric tube in place
for number of days after the surgery.
• The patient is at risk for aspiration
postoperatively. Some changes may occur in the
voice quality.
 Total Laryngectomy

A total Laryngectomy is performed in most advanced stage

4th stage of laryngeal cancers,when the tumors extended
beyond the vocal cords,or for cancer that recurs or persists
after radiation therapy.
In a total Laryngectomy, the laryngeal structures are
removed, including the hyoid bone, epiglottis, cricoid
cartilage, and two or three rings of the trachea.
• A total Laryngectomy results in permanent
loss of the natural voice and a change in the
airway, requiring a permanent trachestomy
 Radiation therapy

• The goal of radiation therapy is to eradicate the cancer and

preserve the function of the larynx.
• The decision to use radiation therapy is based on several factors,
including the staging of the tumor (usually used 1 or 2 stage tumors
as a standard treatment option.) and the patient over all health
status and personal preferences.
• Complications from radiation therapy are a result of
external radiation to the head and neck area, which may
also include the parotid gland, which is responsible for
mucous production. Symptoms may include acute
mucositis, ulceration of the mucous membranes, pain,
Xerostomia (dry mouth) , loss of taste, dysplasia, fatigue,
and skin reactions.. Later complications may include
laryngial necrosis, edema and fibrosis.
 Speech therapy

• The patient who undergoes a Laryngectomy

faces potentially complex and frustrating
communication problems. These are related
to alterations in communication methods.
 Complications

• Respiratory distress (hypoxia, airway obstruction)

• Hemorrhage
• Infection
• Wound break down
• Aspiration
 Nursing management patient undergoing
Laryngectomy… .

• Assessment
The nurse obtains a health history and assess the patient’s physical,
psychological, and spiritual domains.
The health history addresses the following symptoms:hoarseness,
sore throat, dyspnea, dysphagia and pain or burning in the throat.
The physical assessment includes a through head and neck
examination with an emphasis on the patient’s airway.
• The nurse also assess the patient’s general state
of nutrition, including height and weight and
body mass index (BMI) and reviews of laboratory
valves that assist determing the patient
nutritional status (albumin, protein, glucose and
electrolytes.)
 Nursing diagnosis

• Deficient knowledge about the surgical procedure and post operative

course
• Anxiety and depression r/to the diagnosis of cancer and impending
surgery
• Ineffective airway clearance related to excess mucous production
secondary to surgical alterations in the airway.
• Impaired verbal communication related to anatomic deficit secondary to
removal of the larynx and the edema
• Imbalanced nutrition :less than body requirements, related to inability
to ingest Food secondary to swallowing difficulties.
• Disturbed body Image and low self esstem secondary to major neck
surgery, change in appearance, and altered structure and function.
• Self care deficit related to pain, weaknesses, fatigue, musculoskeletal
impairment related to surgical procedures and post operative course.
 Planning and goals

• The major goals for the patient may include attainment

of an adequate level of knowledge, reduction in anxiety,
maintenance of patient airway (patient able to handle
own secretions), Effective use of alternative means of
communication, attainment of optimal levels of nutrition
and hydration., improvement in body Image and self
esteem, improved self care management, and absence of
complications.