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chronic > laryngeal/oral cancer > Flashcards

laryngeal/oral cancer Flashcards

1
Q

incidence of laryngeal cancer

A

2-5x greater in men than women

Trend: instances are on the decline

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2
Q

risk factors of laryngeal cancer

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

laryngeal cancer patho

A

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

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4
Q

clinical manifestations of laryngeal cancer

A
  1. Persistent hoarseness (cardinal sign; >2 weeks: immediate referral to physician)
  2. Otalgia (ear pain)
  3. Dysphagia
  4. Advanced disease: dyspnea, hemoptysis
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5
Q

metastasis of laryngeal cancer

A
  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
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6
Q

diagnostics of laryngeal cancer

A
  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
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7
Q

management of laryngeal cancer

A

surgical excision or radiotherapy

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8
Q

early stage (T1 or T2) management of laryngeal cancer

A

Localized to glottis

85-90& cure rate

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9
Q

later stage (T3 or T4) managementof laryngeal cancer

A

Surgical resection with pre- and/or post-op chemo

Chemo alone is not curative

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10
Q

surgery for laryngeal cancer

A

hemilaryngectomy
supraglottic laryngectomy
total laryngectomy
radical neck dissection

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11
Q

hemilaryngectomy (conservation laryngeal surgery)

A
  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.)
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12
Q

supraglottic laryngectomy

A
  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
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13
Q

Both Hemi- and Supraglottic Laryngectomy require:

A
  1. Temporary trach.

2. Speaking is discouraged for several days post-op

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14
Q

total laryngectomy for advanced disease

A

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

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15
Q

total laryngectomy results in

A
  1. Permanent trach
  2. Loss of smell (breathing through nose impossible)
  3. Loss of voice
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16
Q

radical neck dissection

A

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

17
Q

post-op care for laryngeal cancer

A 
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
18
Q

wound care forof laryngeal cancer

A
  1. Often left exposed for assessment

2. Check for edema, drainage (normal drainage, serosanguinous)

19
Q

check drains (jackson-pratt, hemovac)

A
  1. Must function to prevent hematoma

2. Diffuse oozing of blood (notify doctor)

20
Q

maintain nutritional needs for laryngeal cancer

A
  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
21
Q

speech rehab

A
  1. For total laryngectomy

2. Electrolarynx: mechanical device uses vibrations to produce sound

22
Q

tracheoesophageal speech

A
  1. Uses a valve prosthesis
  2. Creates fistula between trachea and esophagus; sound produced in esophagus
  3. Occludes stoma during speech
23
Q

body image changes for laryngeal cancer

A
  1. Support Groups: Lost Chord Club or New Voice Club
24
Q

safety for laryngeal cancer

A
  1. Smoke Alarms

2. Medic Alert Bracelet: neck-breather

25
Q

airway management and safety for laryngeal cancer

A
  1. Protect stoma during showering to prevent water entry
  2. No water sports
  3. Stoma covers to warm, moisten, filter air
26
Q

nursing diagnoses for laryngeal cancer

A

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

chronic (17 decks)

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