LARYNGEAL CANCER

- malignant tumor of the larynx - malignant ulcerations with underlying infiltration RISK FACTORS 1. cigarette smoking 2.heavy alcohol use and the combined use of tobacco and alcohol 3.Exposure to environmental pollutants 4. Exposure to radiation. 5. straining the voice 6.Gender more common in men 7. Race more prevalent in Afro American 8. Second hand smoke 9. GERD CLINICAL MANIFESTATIONS 1.Persistent hoarseness or sore throat for more than two weeks. 2. Painless neck mass 3. Feeling of lump in the throat 4. Burning sensation in the throat especially when consuming hot or citrus juices. 5. Dysphagia 6. change in voice quality 7. dyspnea 8. weakness and weight loss 9. Hemoptysis 10. foul breath odor DIAGNOSTIC EXAMS 1. Physical exam - swollen lymph nodes 2. LARYNGOSCOPY 3. biopsy of tissues 4. chest radiography 5. CT scan 6. MRI are used for staging

NURSING INTERVENTIONS 1. Place in fowlers position 2. monitor respiratory status 3. Monitor for signs of aspiration of food and fluid. 4. provide respiratory treatments as prescribed. 5. Provide activity as tolerated. 6. Provide high calorie and high protein diet. 7. Administer O2 as prescribed. 8. Provide nutritional support NGT, gastrostomy, jejunostomy tube. 9. Administer analgesic as prescribed. NON SURGICAL INTERVENTIONS 1.Radiation therapy 2. Chemotherapy SURGICAL INTERVENTIONS Partial Laryngectomy is recommended in the early stages of cancer in the glottic area when only one vocal cord is involved Supraglottic Laryngectomy is indicated in the management of early (stage 1) supraglottic and stage II lesions Cordectomy Removal of one or both vocal cords Lymph Node Dissection Thyroidectomy Hemilaryngectomy performed when the tumor extends beyond the vocal cord but is less than 1 cm in size and limited to the subglottic area Total Laryngectomy performed in most advanced stage IV laryngeal cancer MOST COMMON TECHNIQUES OF ALARYNGEAL COMMUNICATION Esophageal speech taught to patient once oral feeding begins 1 week after surgery

Electro Larynx battery powered apparatus projects sound into the oral cavity Tracheoesophageal Puncture most widely used because the speech associated with it most resembles normal speech once the puncture is surgically created and healed, a voice prosthesis is fitted (Blom Singer) over the puncture site NURSING MANAGEMENT PreOp Care Post op Care Observe for hemorrhage and edema in the neck if present. Monitor IV fluids or parenteral nutrition until nutrition is administered via NGT, gastrostomy, or jejunostomy. Assess gag and cough reflexes and the ability to swallow. Provide stoma and laryngectomy care instruct how to clean the incision and provide stoma care. protect the neck from injury Avoid swimming, showering, and using aerosol sprays. Advise the client to wear loose fitting, high collared clothing to cover the stoma. Advise the client to increase humidity in the home. Avoid exposure to infections.

INCIDENCE most common cause of cancer-related death in men second most common in women 1.3 million deaths worldwide annually RISK FACTORS Cigarette smoking Second hand smoke Exposure to environmental pollutants Exposure to occupational pollutants genetic factors radon gas Asbestos air pollution CLINICAL MANIFSETATIONS SUBJECTIVE 1. DYSPNEA 2. CHILLS 3. FATIGUE 4. CHEST PAIN 5. SHOULDER 6. PAIN OBJECTIVE 1. PERSISTENT COUGH 2. CHANGE IN VOICE QUALITY 3. HEMOPTYSIS 4. UNILATERAL WHEEZES 5. WEIGHT LOSS 6. CLUBBING OF FINGERS 7. PLEURAL EFFUSION 8. COIN LESIONS 9. (+) CYSTOLOGIC TEST 10. FEVER 11. DYSPHAGIA 12. HEAD AND NECK EDEMA

LUNG CANCER
Malignant tumor of the lung that may be primary or metastatic MAJOR TYPES Small cell (oat cell) Epidermal (squamous) Adenocarcinoma Carcinoma

13. S/S OF PERICARDIAL EFFUSION DIAGNOSTIC EXAMS 1. CXR 2. CT-SCAN 3. SPUTUM CYTOLOGY 4. FIBEROPTIC BRONCHOSCOPHY 5. FINE NEEDLE ASPIRATION 6. ENDOSCOPY WITH UTZ 7. BONE SCANS 8. LIVER UTZ 9. CT OF THE BRAIN 10. MRI 11. MEDIASTINOSCOPY TREATMENT Nonsurgical SURGERY

1. Explain the potential postoperative need for chest tubes. CHEST TUBE DRAINAGE SYSTEM Post- Op 1. Monitor V/s 2. Assess cardiac and respiratory status, monitor for the presence and absence of lung sounds. 3. maintain the chest drainage system. 4. Assess chest tube insertion site for crepitus ( subcutaneous emphysema)air leak in the system. 5. Check physicians orders regarding client positioning, avoid complete lateral turning. 6. Reduce fatigue by educating the patient in energy conservation techniques NURSING DIAGNOSIS 1. IMPAIRED GAS EXCHANGE 2. INEFFECTIVE AIRWAY CLEARANCE 3. PAIN NURSING MANAGEMENT 1. MONITOR V/S, breathing patterns, BS, tracheal deviation 2. ENCOURAGE COUGHING AND DBE 3. CHANGE POSITION FREQUENTLY 4. POSITION @ AFFECTED SIDE 5. ACCESS POSITION OF TRACHEA 6. IMPROVE DIET 7. TEACH ON ENERGY CONSERVATION AND AIRWAY CLEARANCE TECHNIQUES 8. MANAGE PAIN 9. Monitor pulse oximetry 10. Administer bronchodilators & corticosteroids 11. Provide activity as tolerated, ROM exercises 12. Monitor for bleeding, infection and electrolyte imbalances

Radiation Therapy Chemotherapy Immunotherapy

1. LOBECTOMY 2. WEDGE RESECTION 3. BILOBECTOMY 4. SLEEVE RESECTION 5. PNEUMONECTOMY 6. SEGMENTECTOMY 7. CHEST WALL RESECTION 8. THORACENTESIS

NURSING INTERVENTIONS PRE-OP

HODGKINS LYMPHOMA
Reed-Sternberg (RS) cell cancer of lymph tissue found in the lymph nodes, spleen, liver, bone marrow, and other sites begins when a lymphocyte

9. 10. 11. 12.

INCREASED OR DECREASED WBC NORMAL PLATELET COUNT B symproms IMPAIRED CELLULAR IMMUNITY

DIAGNOSTIC EXAMS  CBC  CXR  Biopsy: CONFIRMATORY! o Excisional o incisional  Bone marrow biopsy  Blood chemistry tests including protein levels, liver function tests, kidney function tests, and uric acid level  CT scans of the chest, abdomen, and pelvis  PETScan  MRI STAGING Factors to consider:
y y y

INCIDENCE  more common in men than women  two peaks of incidence: one in the early 20s and after 50 years of age RISK FACTORS o VIRUSES : HIV, Epstein Barr Virus o Weakened Immune System o Age : among teens and adults aged 15 to 35 years and adults aged 55 years and older o Family History TYPES
 Classical Hodgkin lymphoma  Nodular lymphocyte  

CLINICAL MANIFESTATIONS 1. 2. 3. 4. 5. 6. 7. 8. PAINLESS ENLARGEMENT OF 1 OR MORE LYMPHNODES ON 1 SIDE OF THE NECK (+) MEDIASTINAL MASS PRURITUS PAIN COUGH AND PULMONARY EFFUSION JAUNDICE ABDOMINAL PAIN MILD ANEMIA

The number of lymph nodes that have Hodgkin lymphoma cells. Whether these lymph nodes are on one or both sides of the diaphragm. Whether the disease has spread to the bone marrow, spleen, liver, or lung.

STAGES Stage I: The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or, if the lymphoma cells are not in the lymph nodes, they are in only one part of a tissue or an organ (such as the lung). Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. Or, the lymphoma cells are in one part of a tissue or an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.

Stage III: The lymphoma cells are in lymph nodes above and below the diaphragm. Lymphoma also may be found in one part of a tissue or an organ (such as the liver, lung, or bone) near these lymph node groups. It may also be found in the spleen. Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues. Or, the lymphoma is in an organ (such as the liver, lung, or bone) and in distant lymph nodes. Recurrent: The disease returns after treatment. STAGE A & STAGE B
y y

NON HODGKINS LYMPHOMA

begins when a lymphocyte (usually a B cell) becomes abnormal o The abnormal cell divides to make copies of itself. RISK FACTORS y Weakened Immune System y Certain Viruses: Human immunodeficiency virus, Epstein-Barr virus, Helicobacter pylori, Human T-cell leukemia/lymphoma virus type 1 (HTLV1), Hepatitis C viru y Age: young adults, mostly after 60 y Obesity TYPES

A: no weight loss, drenching night sweats, or fevers. B: weight loss, drenching night sweats, or fevers.

TREATMENT Depends on:

y y y y y y y

Indolent Aggressive

The type of Hodgkin's lymphoma (most people have classic Hodgkin's) The stage (where the disease has spread) Whether the tumor is more than 4 inches (10 cm) wide The patient's age and other medical issues Other factors, including weight loss, night sweats, and fever

CLINICAL MANIFESTATIONS
y y y y y y y

 Stages I and II: radiation therapy, chemotherapy, or both.  Stages III: chemotherapy alone or a combination of radiation therapy and

chemotherapy.
 Stage IV: chemotherapy alone

Swollen, painless lymph nodes in the neck, armpits, or groin Unexplained weight loss Fever Soaking night sweats Coughing, trouble breathing, or chest pain Weakness and tiredness that don't go away Pain, swelling, or a feeling of fullness in the abdomen

DIAGNOSTIC EXAMS: SAME AS HODGKINS Other treatments TREATMENT

 autologous bone marrow transplant  Blood Transfusion: platelet and RBC  Antibiotics to fight infection, especially if a fever occurs

INDOLENT & AGGRESIVE  Chemotherapy  Biologic Therapy Monoclonal Antibodies  Stage or II Radiation Therapy

RECURRENT  High Dose Chemotherapy  Radiation Therapy  Stem Cell Transplantation