Week 6: Laryngeal Cancer (Upper Respiratory Disorder) Flashcards
Where does Laryngeal Cancer Originate?
originates from the squamous cell that line the larynx and hypopharynx, the part of the pharynx behind the larynx, the entrance to the esophagus
How does Laryngeal Cancer Develop?
changes in the squamous cells from irritation, usually from heavy alcohol drinking and smoking, result in the squamous cells becoming precancerous
Clinical Manifestations
- 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
Diagnosis
- 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
Diagnosis Procedures
- health history and physical exam
- endoscopy and imaging (barium swallow, laryngoscopy, chest x-ray, CT, MRI, PET)
Laryngoscopy
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
Barium swallow
evaluates the throat and ability to swallow
Chest x-rays for?
obtained to evaluate the lungs for presence of lung cancer
CT, MRI, and PET scans are completed for?
to determine the presence of metastasis into the surrounding and distant soft tissues and for regional adenopathy, or lymph node involvement
Information Obtained through biopsy and diagnostic imaging
is used for determining the stage of the tumor and disease progression
How to determine the stage of cancer
based on size of the tumor, the involvement of the lymph nodes, and whether the cancer has spread to other sites within the body
Treatment is based off of?
- stage of disease
- location and size of the tumor
- whether the tumor is a reoccurrence
Treatment
- radiation therapy
- surgery
- chemotherapy
Radiation Therapy
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
Side Effects of Radiation Therapy
increased hoarseness, prolonged tissue healing, sore throat, difficulty swallowing, and if salivary glands are involved, dry mouth (xerostomia)
Chemotherapy
- 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)
Surgical procedures
-laser surgery
-cordectomy
-partial laryngectomy
-total laryngectomy
>goal: remove the tumor and maintain the function of the larynx, speech, swallowing ability, and breathing
Cordectomy
removal of part or all of a vocal cord through the use of transoral laser
Safety Alert
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
Partial Laryngectomy
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
Total Laryngectomy
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
Nursing Care
- 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)
Nursing Care: For Post-Operative
- 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)
Tracheostomy care
- 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
Client Education
- disease management
- tracheostomy management
- radiation therapy care; skin oral and throat care
- nutrition management
- chemotherapy management
- communication management
Client Education: Radiation therapy care; Skin
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
Client Education: Radiation therapy care; Oral
-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
Client Education: Radiation Therapy care; Throat
- 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
Client Education: Nutritional Management
-easy-to-eat, soft, non-spicy, non-acid containing foods; small-frequent feedings; liquid nutritional supplements may be added
Client Education: Chemotherapy Management
- 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)
