Laryngeal Cancer

1. MRS.SHALINI
MSC (N),MEDICAL SURGICAL NURSING
ASSISTANT.PROFESSOR
GANGA COLLEGE OF NURSING
COIMBATORE

2. Laryngeal cancer
PRESENTED BY
MRS.SHALINI, MSC(NURSING),
ASST.PROFESSOR,
GANGA COLLEGE OF NURSING

3. Objectives
• At the end of this lesson, students will be able to:
• Define Cancer Larynx
• State the etiology of Cancer Larynx
• Explain the pathophysiology of Cancer Larynx
• State the clinical manifestation of Cancer Larynx
• Explain the staging of Cancer Larynx
• Discuss the investigations of Cancer Larynx
• Describe the treatment for Cancer Larynx
• Enlist the complications of surgery.
• Explain about pre and post operative management
• Describe the post laryngectomy speech therapy

4. INTRODUCTION
Cancer of the larynx is a malignant tumour in
and around the larynx ( voice box). Cancer can
develop in any part of the larynx but usually
begins in the glottis. Most laryngeal cancers
start in the flat, scale like squamous cells that
line inner walls of the larynx.

5. DEFINITION
Laryngeal cancer is a disease in which
malignant (cancer) cells form in the tissues of
the larynx. Most laryngeal cancers form in
squamous cells, the thin, flat cells lining the
inside of the larynx. Laryngeal cancer is a
type of head and neck cancer.

6. ANATOMY AND
PHYSIOLOGY
The larynx
The larynx is a continuation of the trachea
and is made up of cartilaginous skeleton.
There are two folds of mucosa within the
larynx which extend on each side from the thyroid
and these folds comprise the vocal cords. It can be
divided roughly into three sections: the glottis
consisting of the vocal cords, the sub glottis
which is below the cords and the supra glottic
region which encompasses the laryngeal
ventricles, false cords and epiglottis.

7. FUNCTIONS
• It allows air to reach the lungs, protects the
• lungs by closing and by coughing, and it
produces
• the voice. Voice is produced by the vocal cords
• when air passes between them.

8. ANATOMY AND PHYSIOLOGY

9. INCIDENCE
• Cancer of the larynx occurs more frequently in
men than in women, 4 times higher in men
and it’s most common in people between the
ages of 50 to 70 years of age.
• This accounts for half of all head and neck
cancers.

10. Risk factors
• Gender- 4 times more common in men than women.
• Age- Over half of patients with these cancers are 65
or older
• Race- more common among African Americans and
whites
• Poor Diet- Nutritional deficiencies- vit. B - This may
be due to a lack of vitamins and minerals.
• Family history- People who have a first degree
relative diagnosed with a head and neck
cancer have double the risk .

11. • Low immunity- HIV or AIDS, who take drugs to
suppress their immune system following an organ
transplant.
• Acid reflux – GERD- This irritation and damage
can extend to the larynx and may increase cancer
risk.
• Tobacco- The more you smoke, the greater the
risk.
• Smoking - Smoke from cigarettes, pipes, and
cigars and Long-term exposure to second hand
smoke
• Alcohol Use- Heavy drinkers often have
vitamindeficiencies,

12. • Human papilloma virus-. The type linked to
throat cancer is HPV16.
• Genetic syndromes- People certain genes have a
very high risk of throat cancer.
• Fanconi anemia: This condition can be caused by
inherited defects in several genes
• Work place exposures- Long and intense
exposuresto wood dust, paint fumes, and certain
chemicals used in the metalworking, petroleum,
plastics, and textile industries .
• Exposure to asbestos is an important risk factor
for lung cancer and mesothelioma
• Straining of voice
• Chronic layrngitis

13. PATHOPHYSIOLOGY:
Due to the etiological factors
Progressive accumulation of genetic alterations in the cells
Transformation of squamous cells of larynx (takes often 20-25yrs
period of latency after initial toxin exposure)
DNA damage ,mutations of genes

14. CLINICAL FEATURES
• Hoarseness or change in voice( hot potato voice)
• Sore throat and ear pain – main symptoms.
• Persistent cough or chest infection
• Difficulty swallowing (Dysphagia)
• Painful swallowing (Odynophagia)
• A lump in the throatShortness of breath
• Bad breath (halitosis)
• Weight loss
• Prolonged earache
• Cervical lympadenopathy

15. DIAGNOSIS
• History collection and Physical examination
• Indirect Laryngoscopy using Endoscopy
• CT scan, MRI
• PET scan
• Bone scan
• Barium swallow
• Biopsy

16. PROGNOSIS
Prognosis depends on the following:
The stage of the disease, The location and
size of the tumor., The grade of the tumor, The
patient's age, gender, and general health,
including whether the patient is anaemic.

17. STAGES OF LARYNGEAL
CANCER:
Stage 0 (Carcinoma in Situ)
• In stage 0, abnormal cells are found in the
lining of the larynx. Stage 0 is also called
carcinoma in situ.

18. Stage I
• In stage I, cancer has formed. Stage I laryngeal
cancer depends on where cancer began in the
larynx:
• Supraglottis: Cancer is in one area of the
supraglottis only and the vocal cords can move
normally.
• Glottis: Cancer is in one or both vocal cords
and the vocal cords can move normally.
• Subglottis: Cancer is in the subglottis only.

19. Stage II
• In stage II, cancer is in the larynx only. Stage II
laryngeal cancer depends on where cancer began in
the larynx:
• Supraglottis: Cancer is in more than one area of the
supraglottis or surroundingtissues.
• Glottis: Cancer has spread to the supraglottis and/or
the subglottis and/or the vocal cords cannot move
normally.
• Subglottis: Cancer has spread to one or both vocal
cords, which may not move normally.

20. Stage III
• Stage III laryngeal cancer depends on whether
cancer has spread from the supraglottis,glottis,
or subglottis.
• Cancer is in the larynx only and the vocal
cords cannot move, and/or cancer is in tissues
next to the larynx.Cancer may have spread to
one lymph node on the same side of the neck
as the original tumor and the lymph node is 3
centimeters or smaller;

21. • cancer is in one or both vocal cords and in one
lymph node on the same side of the neck as the
original tumor; the lymph node is 3 centimeters or
smaller and the vocal cords can move normally; or
• cancer has spread to the supraglottis and/or
the subglottis and/or the vocal cords cannot move
normally. Cancer has also spread to one lymph
node on the same side of the neck as the original
tumor and the lymph node is 3 centimeters or
smaller

22. Stage IV
• Stage IV is divided into stage IVA, stage IVB,
and
• stage IVC.
• Each substage is the same for cancer in
• the supraglottis, glottis, or subglottis.

23. stage IVA:
• In stage IVA:
• Cancer has spread through the thyroid cartilage and/or
has spread to tissues beyond the larynx such as the
neck, trachea, thyroid, or esophagus.
• cancer has spread to one lymph node on the same side
of the neck as the original tumor and the lymph node is
larger than 3 centimeters but not larger than 6
centimeters.
• The vocal cords may not move normally.

24. In stage IVB:
• Cancer has spread to the space in front of the spinal
column, surrounds the carotid artery, or has spread to
parts of the chest.
• Cancer has spread to a lymph node that is larger than
6 centimeters and may have spread as far as the space
in front of the spinal column, around the carotid artery,
or to parts of the chest. The vocal cords may not move
normally.
• In stage IVC, cancer has spread to other parts of the
body, such as the lungs, liver, or bone.

25. TREATMENT
• Standard treatment are
• Radiation therapy
• Surgery
• Chemotherapy
New types of treatment
• Chemoprevention
• Radio sensitizers.

26. Radiation therapy
• Radiation therapy is a cancer treatment that
uses high energy x-rays or other types of
radiation to kill cancer cells.
• External radiation therapy uses a machine
outside the body to send radiation toward the
cancer.
• Internal radiation therapy uses a radioactive
substance sealed in needles, seeds, wires, or
catheters that are placed directly into or near
the cancer..

27. SURGICAL
MANAGEMENT
• Vocal cord stripping - It is used to treat
dysplasia, hyperkeratosis and leukoplakia
• Cordectomy: Surgery to remove the vocal
cords only.
• Supra glottic laryngectomy: Surgery to remove
the supraglottis only.
• Hemilaryngectomy: Surgery to remove half of
the larynx (voice box). A hemilaryngectomy
saves the voice.

28. HEMILARYNGECTOMY

29. • Partial laryngectomy: Surgery to remove
part of the larynx.
• Total laryngectomy: Surgery to remove the
whole larynx.
• Thyroidectomy: The removal of all or part of
the thyroid gland.
• Laser surgery: A surgical procedure that uses
a laser beam as a knife to make bloodless cuts
in tissue or to remove a surface lesion such as
a tumor.

30. CHEMOTHERAPY
• Uses drugs to stop the growth of cancer cells,
either by killing the cells or by stopping the
cells from dividing. The mostly used drug is
• 5- flurouracil

31. CHEMOPREVENTION
• Chemoprevention is the use of drugs, vitamins,
or other substances to reduce the risk of
developing cancer or to reduce the risk cancer
will recur.
• The drug isotretinoin is being studied to
prevent the development of a second cancer in
patients who have had cancer of the head or
neck

32. Radiosensitizers
• Radiosensitizers are drugs that make tumor
cells more sensitive to radiation therapy.
Combining radiation therapy with radio
sensitizers may kill more tumor cells.

33. COMPLICATIONS
• Wound infection , breakdown,
• Pharyngocutaneous fistula
• Carotid artery rupture
• Tracheobronchitis
• Respiratory distress
• Haemorrhage
• Aspiration
• Trachelostenal stenosis

34. NURSING MANAGEMENT
PREOPERATIVE CARE
• Assess knowledge and understanding of the
diagnosis and proposed surgery.
• Clarify information and reinforce previous teaching as
needed.
• Assess anxiety levels of the client and family related to the
diagnosis and proposed surgery.
• Point out that surgery will affect the sense of taste and smell,
and eating in the initial postoperative period.
• Emphasize that total laryngectomy results in a loss of speech
and that the client will breathe through a permanent stoma in
the neck.

35. • Establish a means of communicating postoperatively,
using a magic slate, alphabet board,eye or hand
signals, or other strategies.
• Reassure that nutritional and fluid needs will be met
with intravenous or enteral feedings until eating can
be resumed.
• Arrange a visit by a post laryngectomy client who
effectively uses an alternate form of verbal
communication.
• Do the routine lab tests and get anesthestist opinion
• Overnight fasting, enema should be given.

36. POST OPERATIVE
MANAGEMENT
Airway & Breathing
• Ensuring a stable airway with the
tracheostomy and oxygen
• One or more drains may be present in the
postoperative period.
• If the patient is able, allow him to cough. If the
patient is not able to cough, suctioning via the
stoma is necessary.

37. • Take thin liquids by mouth, encourage 6-8
glasses of fluids per day
• Listen to the lungs frequently to assess for
breathsound changes that may indicate
pneumonia or pulmonary infections.
• Frequent position changes,
• Encouraging deep breathing and monitoring
pulse oximetry.

38. CARE OF THE STOMA
• The stoma site requires meticulous care to
reduce infection and bleeding
• Daily care involves ensuring that the stoma
site is clean and the skin surrounding the site is
free of infection.
• Gently wipe with warm water to remove any
dried secretions

39. SAFETY ISSUES
• When the patient uses the call system, it must
be answered immediately
• Personnel working on the floor should be
made aware of this need. Patients need hand
call bells that they can constantly ring if no
one answers the light.

40. NUTRITIONAL
SUPPLEMENTATION
• Generally, a nasogastric tube is inserted during
laryngectomy. It usually remains in place for
about7 to 10 days. The tube is used to remove
gastric contents via intermittent suction for the
first 24 to 48 hours post-operatively.
• When bowel sounds are present, tube feedings
are started slowly and advanced to meet the
patient’s nutritional needs

41. • Daily weight and blood chemistries are
obtained to monitor for any fluid or electrolyte
imbalances, and replacement therapy is
administered as indicated.
• When patient’s incisions are healed with no
evidence of fistula formation, the patient is
advanced to an oral diet, patients should have a
high fiber diet to keep stools soft or use stool
softeners if necessary.

42. SPEECH & COMMUNICATION
• Pre-operatively, nurses play an essential role in
helping the patient and family to identify the
best methods of communication.
• Magic slates, writing materials, pictorial
guides, or hand signals are useful ways for the
new laryngectomy patient to communicate.

43. The three major methods of speech post
laryngectomy
• Esophageal speech
• Speech with the use of an artificial larynx.
• Tracheoesophageal puncture

44. BODY-IMAGE CHANGES
• Patients should be encouraged to express their
feelings and concerns and to identify past
coping strategies.
• Participation in a support group is very
beneficial and allows the person to meet
others with a similar diagnosis and surgical
experience

45. SLEEPING & POSITIONING
• When sleeping, laryngectomy patients should
have the head of the bed elevated 30 degrees to
promote downward drainage of secretions and
decrease the risk of aspiration.
• Because these patients also may have impaired
mobility and range of motion in their neck,
propping with extra pillows may be helpful to
not occlude the stoma.

46. Assessing & Monitoring for
Complications
• The nurse must frequently assess the stoma and
surrounding for increased redness, drainage and
pain, and check vital signs and clinical status for
signs of infection.
• WBC assessment can be helpful if infection is
suspected. Postoperative infections may include
local infection at the site, tracheitis or pneumonia.
• If an infection is suspected, a culture of the
effluent must be obtained and the patient should
be put on appropriate antibiotics as soon as
possible.

47. • In the case of internal airway bleeding, suction
should be readily available to prevent large
amounts of aspiration of blood and consequent
respiratory collapse.
• A cuffed tracheostomy tube should be kept
nearby to help put pressure on the bleeding
area and provide a means of suctioning.
• A large-bore intravenous line or a central line
should be placed in preparation to administer
blood transfusions

48. HOME-CARE NEEDS
 Patient education by providing written material about
post-laryngectomy care
 Airway management and safety, the primary focus of
home care, includes 6 : 1. suctioning 2. daily cleaning
3. humidification 4. the use of stoma covers 5. changing
twill ties or Velcro®-type holders 6. resuscitation
 Patients should wear a medic alert bracelet
 The stoma should be protected during bathing and
showering to prevent the entrance of large amounts of
water. Stoma bibs or covers should be worn to warm,
moisten, and filter the air.

49. NURSING DIAGNOSIS
Risk for ineffective airway clearance related to
postoperative edema.
 Disturbed body image related to total
laryngectomy and presence of tracheostomy
stoma.
Pain related to surgical procedure.
Impaired Verbal Communication related to.
Total laryngectomy characterized by: Inability
to speak, changes invoice characteristics.

50. SUMMARY
In this class, we have discussed about the
definition, etiology, pathophysiology, clinical
features, diagnosis, complications, treatment, pre
and post operative nursing management of
Cancer Larynx and post laryngectomy speech
therapy.Hope you have clearly understood about
the topic.

51. REFERENCES
Lewis,S,L.,Heitkemper,M.M.,Dirksen,S.R,O’Bri
en,P.G.,&Bucher,L.(2007). Medical Surgical
Nursing.
Assessment and management of Clinical
Problems.
7th Edition.Missouri. Mosby Publishers
Suresh K.Sharma. S. Madhavi. (2018). Brunner
andsuddarth’s Textbook of Medical- Surgical
Nursing.Volume II. South Asian Edition.
Wolters Kluver Publications

52. Javed Ansari.(2015). A Text Book of Medical
Surgical Nursing- II.1st edition. PV Books
PublishersB. Venkatesan. (2015).Textbook of
Medical-Surgical Nursing. 1st Edition. EMMESS
Medical
PublishersDhingra, P.L(2007). Text book of
Ear,Nose and
Throat, 4th edition. New Delhi. Elseiver Publishers
Net references
• http://www.cancer.org
• http://www.medicalnewstoday.com
• http://www.nhs.uk