Cancer of Larynx

Definition
• The cancer of laryngeal cells.
 Classification
• Glottic tumour: tumour in the glottis.
• Sub-glottic tumour: tumour in the sub-glottic
area.
• Supra-glottic tumour: Tumour in the supra-
glottic area.
 Etiology
• Cigarette smoking
• Alcoholism
• Occupational risk factors : asbestos, wound
dust, mustard gas & petroleum products.
• Inhalation of noxious fumes
• Chronic laryngitis and voice abuse
 Pathophysiology
Etiological factors

Carcinoma of the squamous cell lining of the

larynx

Rapid metastasis of the carcinoma, due to

abundant lymphatic vessels, into lymph nodes
and lungs
 Clinical Manifestations
Glottic tumour Supraglottic tumor
• Voice changes • Aspiration on swallowing
• Hoarsness • Persistent unilateral sore
• Hemoptysis throat
• Dyspnoea • Foreign body
• Respiratory obstruction • Dysphagia
• Dysphagia • Weight loss
• Weight loss • Mass in neck
• Pain • Hemoptysis
Supraglottic tumour
• Dyspnoea
• Airway obstruction
• Dysphagia
• Weight loss
• Hemoptysis
 Diagnostic finding
• Physical examination: swollen lymph nodes in
the neck
• Indirect laryngoscopy
• Direct laryngoscopy
• Pan endoscopy
• CT and MRI scan
• Biopsy
 Medical management
• Radiation therapy is given 5 days a week for 5-
8 weeks.
 Surgical Management
• Laser surgery : for vocal cord tumours.
• Partial laryngectomy / Vertical partial
laryngectomy: Removal of half or more of
the larynx
– Supraglottic laryngectomy: for Ca of supraglottis
– Supra-cricoid partial laryngectomy: for confined
transglottic Ca.
• Total laryngectomy: For glottic tumours
• Cervical lymph node dissection / Neck
dissection:
– Radical neck dissection / En Bloc
– Modified radical neck dissection
 Complications of surgery
• Haemorrhage
• Airway obstruction
• Carotid artery rupture
• Fistula formation
 Nursing Management
Partial laryngectomy
– Assess ABG values, pulse oximetry & FiO2 levels
– Semi fowlers to High fowlers position
– Monitor oxygen therapy
– Tracheostomy care and suctioning
– Chest physiotherapy
– Nebulization
 Total laryngectomy
• Nutrition
– Tube feeding
– Start oral feeding with fluids & semi-soft foods
• Communication
– Give pen and paper
– Communication board
– Keep speaking with the client; do not avoid
conversation because it will build up frustration
• Artificial larynx
– Can be used after 3-4 days of surgery
The end