1. Cancer of the Larynx
DEPARTMENT
OF
MEDICAL SURGICAL NURSING

2. Learning Objectives
At the end of this lecturer, students should be
able to:
•Define Ca larynx
•Enlist the causes & risk factors
•Enumerate the clinical manifestation
•List out the diagnostic evaluation
•Explain the management

3. Introduction
• Carcinogenes that have been associated with
laryngeal cancer include tobacco (smoke or
smokeless and alcohol and their combined
effects, as well as exposure to asbestos,
mustard gas, wood dust, cement dust, tar
products, leather, and metals. Other
contributing factors include straining the
voice, chronic laryngitis, nutritional
deficiency (riboflavin) and family
predispostions.

4. Definition
Cancer of the larynx is a malignant tumor in
the larynx (voice box).

5. Incidence
• Squamous center carcinoma is the most
common form of cancer of the larynx (95%).
• Cancer of the larynx occurs more frequently
in men than in women, and it’s most
common in people between the ages of 50
to 70 years of age.

6. CAUSES
• It represents less than 1% of all cancers
• And most commonly in persons
50 to 70 years of age.
• A malignant growth may occur in three different
areas of the larynx:

7. • The glottic area (vocal cords),
• Supraglottic area
• And subglottis

8. Risk Factors for Laryngeal Cancer
Carcinogens
• Tobacco (smoke, smokeless)
• Combined effects of alcohol and tobacco
• Asbestos
• Second-hand smoke

9. • Paint fumes
• Wood dust
• Cement dust
• Chemicals
• Tar products
• Mustard gas
• Leather and metals

10. Other Factors
• Straining the voice
• Chronic laryngitis
• Nutritional deficiencies (riboflavin)
• History of alcohol abuse
• Familial predisposition
• Age

11. • Gender
• Race
• Weekened immune system

12. Clinical manifestations
• Hoarseness of more than 2 weeks’
• The voice may sound harsh, raspy, and lower in
pitch.
• The patient may complain of a cough or sore
throat that does not go away.

13. • A lump may be felt in the neck.
• Pain and burning in the throat,
• dysphasia, dyspnea , unilateral nasal obstruction
or discharge.
• Persistent hoarseness, persistent ulceration,and
foul breath.

14. Glottic tumor
• Voice change
• Hemoptysis
• Respiratory obstuction
• Dyspgagia
• Weight loss
• pain

15. Supra glottic
• Aspiration on swallowing
• Sore throat
• Foreign body sensation
• Dysphagia
• Neck mass
• Hemoptysis
• Dyspnea
• Pain in the throat referred to the ear

16. Sub glottic
• Airway obstuction
• Dysphagia
• Weight loss
• hemoptysis

17. Assessment and Diagnostic Findings
• complete history , physical examination, family
history, and any underlying medical conditions.
• An indirect laryngoscopy, using a flexible
endoscope.
• Biopsy
• Barium swallow

18. • Mobility of the vocal cords is assessed.
• The lymph nodes of the neck and the thyroid
gland
• Computed tomography and magnetic resonance
imaging(MRI).
• Positron emission tomography (PET scan) may
also be used.

19. Medical Management
• An Intial assessment includes a complete history
and physical examination of the head and
neck.This includes identification of risk factors,
family history, and any underlying medical
conditions.

20. • Medical management Treatment of laryngeal
cancers depends on the staging of the tumor, which
includes location, size, and histology of the tumor
and the presence and extent of cervical lymph node
involvement.

21. Medical Management
• surgery, radiation therapy, and chemotherapy.
• Chemotherapy traditionally has been used for
recurrence or metastatic disease.
• A complete dental examination is performed to
rule out any oral disease.

22. • Patients with early stage disease (stage first
or second) can be treated with either
radiation therapy or surgery. Patients with
stage third or fourth or advanced tumours
require a combined treatment modalities
approach consisting of either surgery or
radiation therapy or chemotherapy or all
three treatment regimen.

23. • Surgery and radiation therapy are both
effective methods in the early stages of
cancer of the larynx. Chemotherapy
traditionally has been used for recurrence or
metastasis disease.

24. Radiation therapy
• The goal of radiation therapy is to eradicate
the cancer and preserve the function of the
larynx.
• The decision to use radiation therapy is
based on several factors, including the
staging of the tumor (usually used 1 or 2
stage tumors as a standard treatment
option.) and the patient over all health
status and personal preferences.

25. • Complications from radiation therapy are a
result of external radiation to the head and
neck area, which may also include the
parotid gland, which is responsible for
mucous production. Symptoms may include
acute mucositis, ulceration of the mucous
membranes, pain, Xerostomia (dry mouth) ,
loss of taste, dysplasia, fatigue, and skin
reactions.
• Later complications may include laryngial
necrosis, edema and fibrosis.

26. Speech therapy
• The patient who undergoes a Laryngectomy
faces potentially complex and frustrating
communication problems. These are related
to alterations in communication methods.

27. Surgical management
• Surgical management depends largely on the
stage of the disease. The overall goals for the
patient include minimizing the effects of
surgery on speech, swallowing, and
breathing while maximizing the cure of the
cancer. Complete removal of the larynx
(total Laryngectomy) can provide the
desired cure, but it is also leaves the patient
with significant loss of the natural voice and
the need to breathe through an opening
(stoma) created in the lower neck.

28. SURGICAL MANAGEMENT
• Partial laryngectomy
• Supraglottic laryngectomy
• Hemilaryngectomy
• Total laryngectomy

29. Partial Laryngectomy
• Partial Laryngectomy ( a partial Laryngectomy is
recommended in the early stages of cancer in the
glottic area only one vocal cord is involved. • The
surgery is associated with a very high cure rate. It
may also performed for recurrence when high dose
radiation has failed. A portion of the larynx is
removed, along with one vocal cord and tumour all
structure remain.

30. Supraglotic Laryngectomy
• This Is a voice – sparing operation that can
be tailored the supraglotic lesion. A
Supraglotic Laryngectomy is indicated in the
management of early stage first supraglottic
and stage second lesion.The hyoid bone,
glottis and false cords the are removed.

31. Hemilaryngectomy
• A Hemilaryngectomy is performed when the
tumor extends beyond the vocal cord but is
less than 1 cm in size and is limited to the
subglottic area. It may be used in stage first
glottic lesions.
• In this procedure, the thyroid cartilage of
the larynx is split in the midline of the neck,
and the portion of the vocal cord.

32. • In this type of surgical therapy patient will
have a trachestomy tube and naso gastric
tube in place for number of days after the
surgery. •The patient is at risk for aspiration
postoperatively. Some changes may occur in
the voice quality.

33. Total Laryngectomy
• A total Laryngectomy is performed in most
advanced stage 4th stage of laryngeal
cancers,when the tumors extended beyond
the vocal cords,or for cancer that recurs or
persists after radiation therapy. In a total
Laryngectomy, the laryngeal structures are
removed, including the hyoid bone,
epiglottis, cricoid cartilage, and two or three
rings of the trachea.

34. • A total Laryngectomy results in permanent
loss of the natural voice and a change in the
airway, requiring a permanent trachestomy

35. Complications
• Respiratory distress (hypoxia, airway
obstruction)
• Hemorrhage
• Infection
• Wound break down
• Aspiration

36. Nursing management patient
undergoing Laryngectomy
• Assessment The nurse obtains a health
history and assess the patient’s physical,
psychological, and spiritual domains. The
health history addresses the following
symptoms:hoarseness, sore throat, dyspnea,
dysphagia and pain or burning in the throat.
The physical assessment includes a through
head and neck examination with an
emphasis on the patient’s airway.

37. • The nurse also assess the patient’s general state of
nutrition, including height and weight and body
mass index (BMI) and reviews of laboratory valves
that assist determing the patient nutritional status
(albumin, protein, glucose and electrolytes.)

38. NURSING DIAGNOSIS
• Anxiety and depression related to the diagnosis
of cancer and impending surgery
• Ineffective airway clearance related to excess
mucus production

39. • Impaired verbal communication related to
anatomic deficit
• Imbalanced nutrition: less than body
requirements, related to inability to ingest food
• Deficient knowledge about the surgical procedure
and postoperative course

40. Nursing Interventions
• Teaching The Patient Preoperatively
• Reducing Anxiety And Depression
• Maintaining A Patent Airway
• Promoting Alternative Communication Methods

41. • Promoting Adequate Nutrition
• Promoting Positive Body Image And Self-esteem
• Monitoring And Managing
Potential Complications
• Promoting Home And Community-based Care

42. Summary
• So far we have discussed about Definition, causes & risk
factors, clinical manifestation, diagnostic evaluation and
management of Cancer of the Larynx.

43. Bibliography
• Lewis et al, Medical Surgical Nursing, Mosby
Elsevier,7th edition.
• Joyce.M.Black et al, Medical Surgical
Nursing, Saunders publication.
• Brunner and Siddhartha, Medical Surgical
Nursing, Lippincott Williams and Wilkins.

44. Thank You