Laryngeal Cancer

Definition
 Laryngeal cancer may also be called cancer of the larynx or
laryngeal carcinoma.
 Most laryngeal cancers are squamous cell carcinomas, reflecting
their origin from the squamous cells which form the majority of the
laryngeal epithelium.
 Cancer can develop in any part of the larynx, but the cure rate is
affected by the location of the tumour.
 For the purposes of tumour staging, the larynx is divided into three
anatomical regions: the glottis (true vocal cords), the supraglottis
(epiglottis, and false cords); and the subglottis.
Most laryngeal cancers originate in the glottis.
Supraglottic cancers are less common, and
subglottic tumours are least frequent.
Laryngeal cancer may spread by direct
extension to adjacent structures, by metastasis
to regional cervical lymph nodes, or more
distantly, through the blood stream.
Distant metastases to the lung are most
common.
 Incidence
Squamous cell carcinoma is the most common form of
cancer of the larynx (95% )
Occurs in male over 50 , ratio of men to women is 10 :1
Greater predisposition to laryngeal cancer in some
families and in people who smokes heavily or use their
voices excessively.
Incidence is five in 100,000 (12,500 new cases per year) in
the USA.
Each year, about 2,200 people in the U.K. are diagnosed
with laryngeal cancer.
Classification of laryngeal cancer

Supraglotic (false vocal cord) 1/3 of

laryngeal cancer
Glotic (true vocal cord ) 2/3 of
laryngeal cancer occurs
Subglotic (downward extention of disease
from the vocal cord) fewer than 1%
occur
Staging of glotic cancer

Stage O:“Carcinoma in-situ.” Abnormal, but

non-invasive cells found in the top layer of tissue.
Stage I: glotic

Tumor is
confined to
the vocal
cords (glottis),
and the vocal
cords can
move
normally.
Stage II: glotic
Tumor has
spread to the
supraglottis or
subglottis,
and/or the
vocal cords
are unable to
move
normally.
 Stage III
Description
Tumor is confined to the larynx AND:
the tumor has caused a vocal cord to stop moving, AND/OR
the tumor has spread to the space between the glottis and
thyroid cartilage AND/OR
the tumor has spread to the outer layer of the thyroid
cartilage
OR
The cancer has spread to one single lymph node on the
same side of the neck that is 3 cm or less in diameter.
 OR
Stage IVa
Tumor has grown through
Cancer has spread to:
the thyroid cartilage
and/or spread to tissues
beyond the larynx (i.e.
thyroid gland, esophagus,
trachea, neck muscles, or
tongue muscles). Tumor
may or may not have
spread to a single lymph
node on the same side of
the neck that is 3 cm or
less in diameter.
a single lymph node on
same side of the neck
that is between 3 cm and
6 cm in diameter, or
multiple lymph nodes on
same side of the neck
that are less than 6 cm in
diameter, or
multiple lymph nodes on
opposite or both sides of
the neck that are less
than 6 cm in diameter.
Stage Iva:
 Stage IV b
Tumor has grown into the tissue in front of the spine,
has surrounded the carotid artery, or has invaded
the tissues around the trachea close to the lungs.
Tumor may or may not have spread to any number
of lymph nodes in any location.
OR
Cancer has spread to a single lymph node that is
more than 6 cm in diameter.
Stage IVb
Stage Ivc: Cancer has spread to distant
organs or parts of the body, most often the
lungs, liver, or bones.
 Assessment and diagnostic findings
Complete history taking
Physical examination with emphasis on head & neck
An indirect laryngoscope is performed to visually
evaluate the extent of the tumor
Soft tissue x-ray studies
Tomograms ,xenograms, contrast studies & Magnetic
Resonance Imaging (MRI)
Direct laryngoscopic examination under general
anaesthesia
Biopsy test
 Management

Medical management :
Treatment varies with the extent of the
malignancy includes radiation therapy,
chemotherapy
Surgical treatment: laryngectomy , partial
laryngectomy, supraglotic laryngectomy, total
laryngectomy
 Nursing management
Assessment
-The nurse assess the patient for the following symptoms:
hoarseness, sore throat, dyspnea , dysphagia , pain or
burning in throat
-Palpate the neck and throat for swelling
-Asses for voice and ability to hear, see, read and write of
patient
Determine the psychological preparedness of the patient.
Evaluate the patient’s & family’s coping abilities &methods
they used to support preoperatively as well as
postoperatively to them
Nursing Diagnosis

 Anxiety related to the diagnosis of cancer and

impending surgery
 Knowledge deficit related to surgical procedure and
post operative course
 Ineffective airway clearance related to surgical
alteration in the airway
 Impaired verbal communication related to removal of
larynx and edema
 Contd………….
Altered nutrition : less than body requirements related to
swallowing difficulties
Disturbance in body image, self concept and self
esteem related to major neck surgery
Self care deficit related to postoperative care
Potential for noncompliance to rehabilitative program
and home maintenance management
 Planning and Implementation
Goals: the major goals for the patient may include-----
-
Reduction in anxiety
Attainment of adequate level of knowledge
Maintenance of a patent airway
Improvements in communication by use of alternative
method
Contd……………

Attainment of optimal level of nutrition &

hydration
Improvement in body image &self-esteem
Adherence to rehabilitative program
Home maintenance management
Prevention of complications
 Preoperative nursing intervention
Patient education: the diagnosis of cancer of the larynx
is associated with preconceived notions & fears.
Give information to client & family about complication
of operative procedure as well as its outcomes eg after
laryngectomy there is loss of voice , ability to sing ,
laugh or whistle will be lost.
Needs for rehabilitative care and availability of
rehabilitative center.
Contd………..
Teach about deep breathing and coughing
exercise pre &post operatively.
Reducing anxiety and depression : any patient
undergoing surgery may have many fears and
so many queries regarding surgery of malignant
tumor i.e. Will the surgeon be able to remove all
of the tumor? Is it cancer? Will I die? Will I ever
speak again? etc,. Therefore the psychological
preparation of the patient is important.
 Post operative nursing intervention
1.Maintaining a patent airway : position the patient in semi-
fowler’s or fowler’s position after recovery from
anaesthesia.
Avoid medication that cause respiratory depression.
Observed for restlessness , labored breathing , increased
pulse rate , because these suggest respiratory or
circulatory problems.
Encourage turn , cough & take deep breath , suctioning
may necessary.
Early ambulation is also encourage to prevent atelectasis
and pneumonia.
Contd…………….
2. Promoting communication & speech
Rehabilitation : Magic slate is often
used for communication e.g. use of
picture, word , phrase board or hand
signals if can not write with patient of
voice loss.
 Contd………….
Alternative to the call bell, such as a hand bell may be
required.
These above system is very time consuming to write or
communicate through gesture. Patient may angry or
become impatient when not understood, the nurse must
be patient & understand of such feelings.
Esophageal speech : it should be started to teach when
the patient is able to compress air into the esophagus
and expel it.
 Contd….
This can be taught once the patient begins
oral feeding or 1 week postoperatively.
The patient first develops the ability to belch
and to do so an hour after eating . This
technique is practiced repeatedly .Later this
conscious actions is transformed into simple
explosions of air from the esophagus for
speech purposes.
 Contd………………
If esophageal speech is not successful, an
electric larynx may be used for
communication.
This apparatus projects sound into the oral
cavity.
When words are formed by the mouth , the
sound from the electric larynx becomes words
that can be heard. The voice that is produced
is obviously not a normal voice, but the patient
is able to communicate with relative ease.
 Cont………….
Another form of communication is
tracheoesophageal puncture (TEP).
In this method the voice is restored by diverting
air , which travels from the lungs through a
puncture in the posterior wall of the trachea, into
the esophagus , and out of the mouth. Once the
puncture is surgically created & has healed , a
voice prosthesis is fitted over the puncture site.
To prevent airway obstruction , the prosthesis is
removed & cleaned when mucus builds up.
Promoting adequate nutrition
Till 10 to 14 days the patient may not be
permitted to eat or drink . Alternate
sources of nutrition & hydration include
intravenous fluids, enteral feedings
through a nasogastric tube ,& total
parental nutrition.
Once the patient is ready to eat orally
start to give thick fluid i.e. gelatin, will be
easy to swallow.
Contd………….
The patient is instructed to avoid
sweet foods , which increases
salivation and suppress the appetite.
Solid foods are introduced as
tolerated.
The patient is instructed to rinse the
mouth with warm water or mouth
wash & to brush the teeth frequently.
Promoting self-esteem

Disfiguring surgery &an altered communication

pattern are a threat to a patient’s self concept,
self esteem, and body image.
A positive approach is important when caring
for the patient.
The patient is encouraged to express any
negative feelings about the changes brought
by surgery.
Monitoring and managing potential
complications
Respiratory complication
Bleeding
Infection
 Patient education and home care
advice
The nurse has an important role in rehabilitation of the
laryngectomy patient .The patient will learn a variety of
self-care behaviors.
Tracheostomy & stomal care : The patient needs specific
information about how to expect from the tracheostomy.
There will increase cough and amount of mucus through
this opening. Mucus membrane will be dry so adequate
humidification should be provided through nebulizer. To
prevent from stomal drying should apply oil free
lubrication.
Contd……..

Changes in taste and smell: there is diminished

sense of taste and smell for a period of time
after surgery. Because breathing occurs directly
into the trachea. However in time the patient
usually accommodates to this problem and
olfactory sensation adapts
Contd…

Hygienic measures: special precautions need to

be taken in a shower to prevent water from
entering the stoma. Swimming is not
recommended. Barbers and beauticians need
to be cautioned so that hair sprays, loose hair,
powder do not get near the stoma because
these substances can block or irritate the
trachea and possibly cause infection.
 Contd…
Recreation measures: recreation and exercise are
important. Golf, bowling, card and computer games
and walking can be enjoyed safely.
Homecare and safety measures: the nurse encourage
the person to have regular physical examination and
to seek advice concerning any problem. Avoid air
conditioning at first to prevent cold air from irritating
the airway. Advice to carry proper identification card
and first aid personal in contact.