Upper and Lower Respiratory Tract Cancers

Question 1

Head and Neck Cancer

Answer 1

tumors of nasal sinuses, nasopharynx, oropharynx, larynx (squamous cell origin)

RF: men >50YO
smoking
ETOH
diet low in fruits and veggies
HPV
sun exposure
industrial carcinogenic
marijuana use
radiation thearpy
poor oral hygiene

Question 2

Head and Neck Cancer: S/O

Answer 2

*varies based on location of cancer
unilateral throat or ear pain
ringing in ears
hoarseness (sx early in laryngeal ca)
globus sensation (lump in throat feeling)
unexplained weight loss 

later sx: pain
dysphagia (at risk for aspiration pneumonia)
decrease tongue movement (slurred speech)
airway sx

Question 3

Head and Neck Cancer: Dx

Answer 3

assess for:

• leukoplakia (white patches), erythroplakia (red patches) in mouth and nose
• lumps
• enlarged lymph nodes

diagnostic tests:

• laryngoscope or nasopharyngoscope
• MRI, CT scan
• Bx
• PET Scan

Question 4

Stages for Head and Neck Cancers

Answer 4

determined by TNM (tumor, node, metastasis)

• stage I or II: potentially curable, treatable w/ one modality (radiation or surgery - larynx sparing)
• stage III or IV: advanced disease, use combo of modalities

treatment modalities = surgery, radiation, chemo, target therapy

Question 5

Head and Neck Cancer Surgeries

Answer 5

vocal cord stripping
laser surgery
cordectomy (partial or full removal of 1 or 2 vocal cords)
partial laryngectomy (one side of larynx removed)
total laryngectomy (larynx, pre-epiglottic region removed and permanent trach placed)
neck resection (feeding tube placed during surgery)

Question 6

Head and Neck Surgery: Post Op Nursing Focus

Answer 6

Airway: edema can compress trachea - semi-fowlers position, suction, secretions may be thick initially - use humidification and increase fluid intake, C&DB, trach care

Wound care: pressure dressing or drains may be in place, serosanguinous drainage should decrease w/in 24 hours.

NG tube: intermittent suction for first 24-48 hours until peristalsis then may use for feedings, take daily weights and labs to evaluate nutritional status

PT: shoulders and neck to prevent frozen shoulders and loss of ROM of neck

Question 7

Speech Therapy voice options for total laryngectomy

Answer 7

electrolarynx: battery powered tube inserted into mouth or device held to neck (artificial larynx)

esophageal speech: sounds made w/ swallowed air

voice prosthesis: fistula between esophagus and trach made and prosthesis placed which can be manipulated by pt fingers

Question 8

Stoma Care

Answer 8

area around stoma cleansed daily w/ moist cloth
humidification
protect from foreign substances
cover when coughing and showering

importance of support groups
monitor for depression

community health nurse and home care set up prior to discharge

Question 9

Lung Cancer

Answer 9

RF: greater than 50YO
hx of smoking (risk of lung ca decreases to that of nonsmoker 10-15 years after quitting)
genetics (EGFR gene may be linked to familial lung ca)

Question 10

Lung Cancer: S/O

Answer 10

often no sx (detected w/ routine chest xray)

sx in late stages:
persistent cough (dry or productive)
hemoptysis
dyspnea or wheezing
chest pain (localized, unilateral)
unilateral wheeze, diminished lung sounds
anorexia
weight loss
fatigue
N/V

Question 11

Lung Cancer: Dx

Answer 11

chest xray
CT or MRI of chest
sputum for cytology (not common as malignant cells are not always present in sputum)
Bx
Bone scan and CT looking for metastasis
MRI and PET scan for staging

Question 12

Lung Cancer: Interventions

Answer 12

surgery (partial or full resection of lung)
radiation
chemo
biologic/targeted therapy