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.

•Laryngeal cancer is classified and

treated by its anatomic site. Cancer of

larynx (voice box) may occur on the

glottis (true vocal cords), the supraglotic

structures (below the vocal cord)

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.