Week 6: Laryngeal Cancer (Upper Respiratory Disorder)

Question 1

Where does Laryngeal Cancer Originate?

Answer 1

originates from the squamous cell that line the larynx and hypopharynx, the part of the pharynx behind the larynx, the entrance to the esophagus

Question 2

How does Laryngeal Cancer Develop?

Answer 2

changes in the squamous cells from irritation, usually from heavy alcohol drinking and smoking, result in the squamous cells becoming precancerous

Question 3

Clinical Manifestations

Answer 3

• hoarseness
• change in the voice that does not go away in 2 weeks (lower-than-usual pitch and raspy and hoarse sounds)
• persistent sore throat
• constant cough
• pain with swallowing
• ear pain that does not go away
• difficulty swallowing
• trouble breathing
• a lump or mass in the neck
• weight loss due to difficulty eating

Question 4

Diagnosis

Answer 4

• starts with completion of a thorough health history (general health information, other medical conditions, onset of symptoms, risk factors, and family history)
• physical examination (neck, thyroid, lymph nodes, and muscle movement of the neck can indicate if tumor growth has invaded these structures)
• endoscopy and imaging
• laryngoscopy
• barium swallow, chest x-ray, CT, MRI, PET scans

Question 5

Diagnosis Procedures

Answer 5

• health history and physical exam

- endoscopy and imaging (barium swallow, laryngoscopy, chest x-ray, CT, MRI, PET)

Question 6

Laryngoscopy

Answer 6

allows for assessment of vocal folds and glottis for the presence of ulcerations, nodules, polyps, strictures, bleeding, or tumors
-may also be performed under general anesthesia, at which samples for biopsies are obtained if needed

Question 7

Barium swallow

Answer 7

evaluates the throat and ability to swallow

Question 8

Chest x-rays for?

Answer 8

obtained to evaluate the lungs for presence of lung cancer

Question 9

CT, MRI, and PET scans are completed for?

Answer 9

to determine the presence of metastasis into the surrounding and distant soft tissues and for regional adenopathy, or lymph node involvement

Question 10

Information Obtained through biopsy and diagnostic imaging

Answer 10

is used for determining the stage of the tumor and disease progression

Question 11

How to determine the stage of cancer

Answer 11

based on size of the tumor, the involvement of the lymph nodes, and whether the cancer has spread to other sites within the body

Question 12

Treatment is based off of?

Answer 12

• stage of disease
• location and size of the tumor
• whether the tumor is a reoccurrence

Question 13

Treatment

Answer 13

• radiation therapy
• surgery
• chemotherapy

Question 14

Radiation Therapy

Answer 14

used to eliminate cancer cells and maintain the structure and function of the larynx
-used to treat small tumors, reduce tumor size prior to surgery, or in patients unable to undergo surgery

Question 15

Side Effects of Radiation Therapy

Answer 15

increased hoarseness, prolonged tissue healing, sore throat, difficulty swallowing, and if salivary glands are involved, dry mouth (xerostomia)

Question 16

Chemotherapy

Answer 16

• used in several ways
• given at the same time as radiation therapy (chemoradiation) to improve effectiveness of radiation therapy
• can be given before radiation therapy to shrink larger tumors and make radiation therapy more effective
• can be given prior to surgery to shrink large tumors that are not easily excised
• used palliatively to help control cancer and relieve symptoms (palliative chemotherapy)

Question 17

Surgical procedures

Answer 17

-laser surgery
-cordectomy
-partial laryngectomy
-total laryngectomy
>goal: remove the tumor and maintain the function of the larynx, speech, swallowing ability, and breathing

Question 18

Cordectomy

Answer 18

removal of part or all of a vocal cord through the use of transoral laser

Question 19

Safety Alert

Answer 19

in patients with a tracheostomy, an obturator and a replacement tracheostomy tube should be kept at the bedside in the event of unexpected dislodgement of the tracheostomy tube.

• ensure that the tube is secured in place with cloth tracheostomy ties or a Velcro tracheostomy tube holder
• a suctioning unit and suctioning supplies should be at the bedside

Question 20

Partial Laryngectomy

Answer 20

remove part of the larynx in the early stages of laryngeal cancer

• removal of part of the larynx, only one vocal cord, and the tumor
• preservation of the voice, which may be slightly altered or hoarse, is achieved because of the remaining structures
• retain normal breathing and swallowing ability
• temporary tracheostomy may be required to protect the airway

Question 21

Total Laryngectomy

Answer 21

complete removal of the larynx

• in advance stages of laryngeal cancer where the cancer has spread beyond the vocal cords, a total laryngectomy is a curative procedure
• the larynx and several rings of the trachea are removed
• swallowing ability will remain normal
• results in inability to speak
• creation of tracheostomy is required for breathing and because of the risk of aspiration of foods and fluids after removal of epiglottis

Question 22

Nursing Care

Answer 22

• assess a complete review of risk factors (smoking, alcohol use, and occupational exposure to chemicals)
• review symptoms/ complaints (hoarseness, earache, sore throat lasting several weeks)
• skin/ vocal/ swallowing assessment (red, tender, peeling skin can result from radiation therapy. radiation therapy may also cause worsening hoarseness and difficulty swallowing)
• laboratory assessments; electrolytes, WBC, and platelet count (patients on chemotherapy may have alterations in electrolytes, can also become immunosuppressed, resulting in neutropenia; platelet counts may decrease, resulting in bleeding risk)

Question 23

Nursing Care: For Post-Operative

Answer 23

• assess vital signs (decreased blood pressure may occur with blood loss, increased HR due to hypovolemia or pain)
• assess oxygenation status (edema and increased secretions may cause SOB and decreased oxygenation)
• assess patency of tracheostomy (bleeding or edema may occur postoperatively, impairing patency of tracheostomy)
• monitor weight, nutritional intake, and calorie count (swallowing impairment postoperatively may impact adequate nutritional intake)
• administer chemotherapy as ordered
• institute bleeding precautions
• institute aspiration precautions
• provide means for communication
• nutritional consultation (placement of a gastric or percutaneous esophageal gastrostomy tube may be required)

Question 24

Tracheostomy care

Answer 24

• use of humidified oxygen via a tach collar
• pulmonary hygiene such as turning, coughing, deep breathing and mobility
• suctioning equipment
• replacement tracheostomy tube and obturator at bedside
• tracheostomy care twice daily (TID) and as needed
• management of oral secretions with yankauer suction tip

Question 25

Client Education

Answer 25

• disease management
• tracheostomy management
• radiation therapy care; skin oral and throat care
• nutrition management
• chemotherapy management
• communication management

Question 26

Client Education: Radiation therapy care; Skin

Answer 26

Skin: avoid heating pad, ice pack, lotions or powders, sun exposure, extremes of temperature, and abrasive activities; shaving at radiation site; do not rub, scratch, or scrub at site; wear loose fitting, soft clothing at site; use mild soap

Question 27

Client Education: Radiation therapy care; Oral

Answer 27

-use a soft-bristle toothbrush and brush and floss after each meal and at bedtime; suck on hard candy or chewing gum; examine oral cavity for signs of infection ,ulcerations, or bleeding

Question 28

Client Education: Radiation Therapy care; Throat

Answer 28

• limit voice use, eat soft foods, drink plenty of fluids; sucking on ice chips or use of saline gargling may decrease discomfort
• use of throat sprays or mouthwashes that contain a local anesthetic prescribed by the provider may assist in relieving the sore throat

Question 29

Client Education: Nutritional Management

Answer 29

-easy-to-eat, soft, non-spicy, non-acid containing foods; small-frequent feedings; liquid nutritional supplements may be added

Question 30

Client Education: Chemotherapy Management

Answer 30

• take antiemetics prior as needed
• avoid crowds and persons with infections, and report signs of infection
• report increases in bruising, presence of blood in urine or stool, or increased fatigue (chemotherapy may cause nausea and vomiting, immunosuppression, and decreased platelets)