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Flashcards in laryngeal/oral cancer Deck (26):

incidence of laryngeal cancer

2-5x greater in men than women
Trend: instances are on the decline


risk factors of laryngeal cancer

1. Tobacco use: pipes, cigars, cigarettes, and smokeless tobacco
2. Chronic ETOH use
3. Vocal abuse
4. Familial predisposition
5. GERD?


laryngeal cancer patho

Squamous cell carcinoma:
 Often preceded by leukoplakia: (“white plaque”)
 Thick, white, attached patches of plaque (different from thrush)


clinical manifestations of laryngeal cancer

1. Persistent hoarseness (cardinal sign; >2 weeks: immediate referral to physician)
2. Otalgia (ear pain)
3. Dysphagia
4. Advanced disease: dyspnea, hemoptysis


metastasis of laryngeal cancer

1. Rare if tumor confined to vocal cords (limited lymphatic supply)
2. If tumor involves epiglottis, false vocal cords: spreads to deep lymph nodes of neck resulting in dyspnea, dysphagia, cough, enlarged lymph nodes, “lump in throat” with pain that radiates to ear


diagnostics of laryngeal cancer

1. Fiber optic laryngoscopy
2. Barium Swallow (UGI) (Check swallowing, Mets to esophagus)
3. CXR: check for lung mets in advanced disease
4. CT: check for mets to nodes or nearby structures


management of laryngeal cancer

surgical excision or radiotherapy


early stage (T1 or T2) management of laryngeal cancer

Localized to glottis
85-90& cure rate


later stage (T3 or T4) managementof laryngeal cancer

Surgical resection with pre- and/or post-op chemo
Chemo alone is not curative


surgery for laryngeal cancer

supraglottic laryngectomy
total laryngectomy
radical neck dissection


hemilaryngectomy (conservation laryngeal surgery)

1. for stage I or II (glottis)
2. Removal of diseased false cord, one side of thyroid cartilage (half of larynx removed)
3. Variable voice and swelling results
4. No swallowing for 7-10 days
5. May have permanent hoarseness
6. Later: thickened, soft foods to decrease aspiration (no water, juice, coffee, tea, etc.)


supraglottic laryngectomy

1. Removal or epiglottis and diseased tissue
2. Leaves vocal cords intact
3. Normal voice post-op
4. Increased risk of aspiration
5. Often 2-3 weeks before oral feedings started


Both Hemi- and Supraglottic Laryngectomy require:

1. Temporary trach.
2. Speaking is discouraged for several days post-op


total laryngectomy for advanced disease

Removes: removes epiglottis, thyroid cartilage, hyoid bone, cricoid cartilage, 3-4 rings of trachea


total laryngectomy results in

1. Permanent trach
2. Loss of smell (breathing through nose impossible)
3. Loss of voice


radical neck dissection

More extensive removal of structures when risk of metastases due to size/location of tumor
Removes: submandibulary salivary gland, sternocleidomastoid muscle, internal jugular vein, spinal accessory nerve


post-op care for laryngeal cancer

Often in ICU initially
Maintain airway:
1. Position: HOB up 30-45 degrees
2. Trach instead to maintain airway
3. May have for 3-6 months
4. Later: have stoma opening
5. Require meticulous trach care q8hrs
6. Sterile suctioning
7. Trach collar can supply warming and moistening functions


wound care forof laryngeal cancer

1. Often left exposed for assessment
2. Check for edema, drainage (normal drainage, serosanguinous)


check drains (jackson-pratt, hemovac)

1. Must function to prevent hematoma
2. Diffuse oozing of blood (notify doctor)


maintain nutritional needs for laryngeal cancer

1. NG tube for decompression for several days post-op
2. Never manipulate the NG tube; check tube placement often
3. When bowel sounds present, tube feedings are started slowly and advanced


speech rehab

1. For total laryngectomy
2. Electrolarynx: mechanical device uses vibrations to produce sound


tracheoesophageal speech

1. Uses a valve prosthesis
2. Creates fistula between trachea and esophagus; sound produced in esophagus
3. Occludes stoma during speech


body image changes for laryngeal cancer

1. Support Groups: Lost Chord Club or New Voice Club


safety for laryngeal cancer

1. Smoke Alarms
2. Medic Alert Bracelet: neck-breather


airway management and safety for laryngeal cancer

1. Protect stoma during showering to prevent water entry
2. No water sports
3. Stoma covers to warm, moisten, filter air


nursing diagnoses for laryngeal cancer

Anxiety r/t cancer diagnosis
Pain r/t surgical excision
Ineffective airway clearance r/t secretions
Risk for Aspiration r/t removal of epiglottis
Imbalanced nutrition r/t increases BMR from cancer, dysphagia
Impaired verbal communication r/t speech restrictions, permanent tracheostomy
Body Image Disturbance (permanent trach)
Risk for infection