BSC NURSING III YEAR

1. Mr. Manikandan.T,
RN., RM., M.Sc(N)., D.C.A .,(Ph.D)
Assistant Professor,
Dept. of Medical Surgical Nursing,
VMCON, Puducherry.

2. DEFINITION
• Cancer of the larynx
• Abnormal growth and proliferation of
cells(larynx)

3. Incidence
• about 11,300 new cases and 3,660 deaths
occur annually, with an overall survival rate of
65%. Cancer of the larynx is most common in
people between the ages of 60 and 70 years ,
and it occurs four to five times more
frequently in men than in women.

4. CAUSES/RISK FACTORS
• Tobacco
• Alcohol
• Occupational exposure to coal dust, steel dust, iron compounds and fumes,
formaldehyde, and dust from hard alloys (eg., still or iron compounds)
• Dietary patterns of Western cultures are associated with an increased risk of
supraglottic cancer of the larynx.
• straining the voice
• family predisposition.
• Tobacco (smoke, smokeless)
• Asbestos, Paint fumes, Wood dust, Cement dust, Chemicals
Other Factors
• Straining the voice
• Chronic laryngitis
• Nutritional deficiencies (riboflavin)
• History of alcohol abuse
• Age (higher incidence after 60 years of age)
• Gender (more common in men)
• Weakened immune system

5. CLINICAL FEATURES
• Hoarseness
• Lump in throat or pain or burning when
drinking citrus juices or hot liquids
• Dysphagia
• Dyspnea
• Enlargement of lympnodes
• Weight loss

6. DIAGNOSIS
• H.C
• P/E
• Laryngoscopy
• CT
• Chest X-Ray

7. STAGING - TNM
T
• T is – CA in-situ
• T1- Limited to subglotis
• T2- extends to vocal cord
• T3 – limited to larynx
• T4a- invades thyroid cartilage, tissue beyond larynx
• T4b-invades prevertebral space, carotid artery, mediatibal structure
N
• N0- No regional lymphnode
• N1 – single node 3cm or less
• N2a – single node 3-6 cm
• N2b- multiple node – 6 cm
• N2c – bilateral 6 cm
• N3- node more than 6 cm
M
• MX- Unknown
• M0- no distant metastasis
• MM1- distant metastasis

8. MANAGEMENT
• Radiation therapy,
• chemotherapy.
• Surgical procedures may include transoral
endoscopic laser resection
• classic open vertical hemilaryngectomy for glottic
tumors, or classic horizontal supraglottic
laryngectomy.
• In supraglottic tumors, selective neck dissection
or irradiation is necessary because of the high
risk of neck node involvement

9. SURGICAL MANAGEMENT
• Vocal Cord Stripping:
Stripping of the cord is used. The procedure
involves removal of the mucosa of the edge of the
vocal cord, using an operating microscope. Early vocal
cord lesions are initially treated with radiation therapy.
• Cordectomy:
Cordectomy, which is an excision of the vocal cord,
is usually performed via transoral laser. This procedure
is used for lesions limited to the middle third of the
vocal cord. The resulting voice quality is related to the
extent of tissue removed.

10. • Laser Surgery
Laser microsurgery is well known to have
several advantages for treatment of early
glottic cancers.
• Microelectrodes are useful for surgical
resection of smaller laryngeal carcinomas. The
carbon dioxide (CO2) laser can be used for the
treatment of many laryngeal tumors, with the
exception of large vascular tumors.

11. Partial laryngectomy
• A partial laryngectomy (laryngofissure–thyrotomy) is
often used for smaller cancers of the larynx.
• It is recommended in 540 Unit 5 Gas Exchange and
Respiratory Function the early stages of cancer in the
glottic area when only one vocal cord is involved.
• A portion of the larynx is removed, along with one
vocal cord and the tumor; all other structures remain.
The airway remains intact, and the patient is expected
to have no difficulty swallowing.
• The voice quality may change, or the patient may
sound hoarse.

12. • Total Laryngectomy : Complete removal of the
larynx (total laryngectomy) can provide the
desired cure in most advanced laryngeal cancers,
when the tumor extends beyond the vocal cords.
the laryngeal structures are removed, including
the hyoid bone, epiglottis, cricoid cartilage, and
two or three rings of the trachea. The tongue,
pharyngeal walls, and trachea are preserved.
• A total laryngectomy results in permanent loss of
the voice and a change in the airway, requiring a
permanent tracheostomy