Cancer of the Larynx
Objectives:
Describe the Medical management of Laryngeal Cancer;
Formulate nursing diagnosis for clients with Laryngeal cancer.
Develop Nursing intervention for clients with Laryngeal Cancer;
Define and Describe what is Atelectasis.
Cancer of the Larynx
It is a malignant tumor in the larynx (voice box).
It is usually a primary cancer and can spread to the lungs, liver, or lymph nodes.
Cancer of the Larynx
Areas where malignant growth occur:
Glottic area (vocal cords)
Supraglottic area (area above the glottis or vocal cords, including epiglottis)
Subglottis (area below the glottis or vocal cords to the cricoid)
Clinical Manifestations
Assessment
Complete history and physical examination of the head and neck (assessment of risk factors,
family history, and any underlying medical conditions)
Diagnostic Test
Laryngoscopy examination and biopsy
CT Scan
MRI
Medical Management
Surgery
Radiation therapy and
Chemotherapy.
Speech therapy
Surgical Management
Partial laryngectomy
Supraglottic laryngectomy
Hemilaryngectomy
Total laryngectomy
1. Partial laryngectomy (laryngofissure– thyrotomy)
Recommended in the early stages of cancer in the glottic area when only one vocal cord is
involved.
Portion of the larynx is removed, along with one vocal cord and the tumor
2. Supraglottic laryngectomy
Indicated in the management of early (stage I) supraglottic and stage II lesions.
Hyoid bone, glottis, and false cords are removed. The true vocal cords, cricoid cartilage, and
trachea remain intact.
Supraglottic laryngectomy
Advantage:
Preserves the voice, even though the quality of the voice may change.
Major problem:
High risk for recurrence of the cancer;
3. Hemilaryngectomy
Performed when the tumor extends beyond the vocal cord but is less than 1 cm in size and
is limited to the subglottic area.
4. Total Laryngectomy
Performed in the most advanced stage IV laryngeal cancer, when the tumor extends beyond
the vocal cords, or for recurrent or persistent cancer following radiation therapy.
the laryngeal structures are removed, including the hyoid bone, epiglottis, cricoid cartilage,
and two or three rings of the trachea.
The tongue, pharyngeal walls, and trachea are preserved.
2. Radiation Therapy
To eradicate the cancer and preserve the function of the larynx.
Stage I&II.
Nursing Responsibilities: Radiation Therapy
External Radiation Therapy
Monitor for adverse effects: skin changes, such as blanching, erythema, desquamation,
sloughing, or hemorrhage; ulcerations of mucous membranes; nausea and vomiting,
diarrhea, or gastrointestinal bleeding.
Identify and record any medications that the client will be taking during the radiation
treatment.
Monitor white blood cell counts and platelet counts for significant decreases.
Nursing Responsibilities: Radiation Therapy
External Radiation Therapy (Client and Family Teaching)
Wash the skin that is marked as the radiation site only with plain water, no soap; do not
apply deodorant, lotions, medications, perfume, or talcum powder to the site during the
treatment period.
Do not rub, scratch, or scrub treated skin areas. If necessary, use only an electric razor to
shave the treated area.
Nursing Responsibilities: Radiation Therapy
External Radiation Therapy (Client and Family Teaching)
Apply neither heat nor cold (e.g., heating pad or ice pack) to the treatment site.
Inspect the skin for damage or serious changes, and report these to the radiologist or
physician.
Nursing Responsibilities: Radiation Therapy
External Radiation Therapy (Client and Family Teaching)
Protect skin from sun exposure during treatment and for at least 1 year after radiation
therapy is discontinued. Cover skin with protective clothing during treatment; once
radiation is discontinued, use sun-blocking agents with a sun protection factor (SPF) of at
least 15.
Internal Radiation Therapy
Place the client in a private room.
Limit visits to 10 to 30 minutes, and have visitors sit at least 6 feet from the client.
Monitor for side effects such as burning sensations, excessive perspiration, chills and fever,
nausea and vomiting, or diarrhea.
Assess for fistulas or necrosis of adjacent tissues.
While a temporary implant is in place, stay in bed and rest quietly to avoid dislodging the
implant.
For outpatient treatments, avoid close contact with others until treatment has been
discontinued.
If the radiologist indicates the need for such measures, dispose of excretory materials in
special containers or in a toilet not used by others.
Carry out daily activities as able; get extra rest if feeling fatigued.
Eat a balanced diet; frequent, small meals often are better tolerated.
3. Speech Therapy
Writing
Lip speaking and
Communication or word boards.
3. Speech Therapy (Post Operative Communication)
Alaryngeal communication
Esophageal speech
Artificial larynx (electrolarynx), and
Tracheoesophageal puncture.
Esophageal Speech
The patient needs the ability to compress air into the esophagus and expel it, setting off a
vibration of the pharyngeal esophageal segment.
Patient learns to belch and is reminded to do so an hour after eating.
Later, this conscious belching action is transformed into simple explosions of air from the
esophagus for speech purposes. the speech therapist works with the patient in an attempt
to make speech intelligible and as close to normal as possible.
Electric Larynx
Battery-powered apparatus projects sound into the oral cavity.
When the mouth forms words (articulated), the sounds from the electric larynx become
audible words.
Tracheoesophageal Puncture
A valve is placed in the tracheal stoma to divert air into the esophagus and out of the
mouth.
Once the puncture is surgically created and has healed, a voice prosthesis (Blom–Singer) is
fitted over the puncture site.
NURSING PROCESS: THE PATIENT UNDERGOING LARYNGECTOMY
Assessment
Diagnosis
Nursing diagnoses based on all the assessment data.
Planning and Goals
Nursing Interventions
Evaluation
Expected patient outcomes
Nursing Diagnosis
Acute pain related to surgical procedure
Impaired verbal communication related to loss of vocal cords
Risk for imbalanced nutrition, less than body requirements related to absence of oral.
Impaired swallowing related to edema or laryngectomy tube.
Grieving related to loss of voice
Disturbed body image related to change in body structure and function
