laryngeal/oral cancer Flashcards
incidence of laryngeal cancer
2-5x greater in men than women
Trend: instances are on the decline
risk factors of laryngeal cancer
- Tobacco use: pipes, cigars, cigarettes, and smokeless tobacco
- Chronic ETOH use
- Vocal abuse
- Familial predisposition
- 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
- Persistent hoarseness (cardinal sign; >2 weeks: immediate referral to physician)
- Otalgia (ear pain)
- Dysphagia
- Advanced disease: dyspnea, hemoptysis
metastasis of laryngeal cancer
- Rare if tumor confined to vocal cords (limited lymphatic supply)
- 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
- Fiber optic laryngoscopy
- Barium Swallow (UGI) (Check swallowing, Mets to esophagus)
- CXR: check for lung mets in advanced disease
- 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
hemilaryngectomy
supraglottic laryngectomy
total laryngectomy
radical neck dissection
hemilaryngectomy (conservation laryngeal surgery)
- for stage I or II (glottis)
- Removal of diseased false cord, one side of thyroid cartilage (half of larynx removed)
- Variable voice and swelling results
- No swallowing for 7-10 days
- May have permanent hoarseness
- Later: thickened, soft foods to decrease aspiration (no water, juice, coffee, tea, etc.)
supraglottic laryngectomy
- Removal or epiglottis and diseased tissue
- Leaves vocal cords intact
- Normal voice post-op
- Increased risk of aspiration
- Often 2-3 weeks before oral feedings started
Both Hemi- and Supraglottic Laryngectomy require:
- 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
- Permanent trach
- Loss of smell (breathing through nose impossible)
- 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
- Often left exposed for assessment
2. Check for edema, drainage (normal drainage, serosanguinous)
check drains (jackson-pratt, hemovac)
- Must function to prevent hematoma
2. Diffuse oozing of blood (notify doctor)
maintain nutritional needs for laryngeal cancer
- NG tube for decompression for several days post-op
- Never manipulate the NG tube; check tube placement often
- When bowel sounds present, tube feedings are started slowly and advanced
speech rehab
- For total laryngectomy
2. Electrolarynx: mechanical device uses vibrations to produce sound
tracheoesophageal speech
- Uses a valve prosthesis
- Creates fistula between trachea and esophagus; sound produced in esophagus
- Occludes stoma during speech
body image changes for laryngeal cancer
- Support Groups: Lost Chord Club or New Voice Club
safety for laryngeal cancer
- Smoke Alarms
2. Medic Alert Bracelet: neck-breather
