Laryngeal Cancer

Laryngeal Cancer

-accounts only 2-3% of all malignancy but care presents a unique challenge to nurse because of functional & cosmetic deformities commonly seen when disorder is treated

-untreated patient will die in 3 yrs

Risk Factors

-smoking -excessive alcohol consumption

-chronic laryngitis -vocal abuse

-family predisposition

Types

a.Supraglottic

-"extrinsic" laryngeal CA

-involves epiglottis & false cords

-usually assymptomatic until advance stage

b.Glottic

-"intrinsic" laryngeal CA

-involves true vocal cords

-produces early symptoms as :progressive hoarseness & dyspnea

Management

-Radiation

-Chemotherapy

-Surgery

a. partial laryngectomy

-patient can talk but can have difficulty swallowing

*Supraglottic Laryngectomy

-problem: ASPIRATION due to removal of epiglottis which closes over the larynx

b.Total Laryngectomy

-pharyngeal opening to trachea is closed & remaining trachea ,out to neck to form permanent tracheostomy

Problem -loss of normal speech

-loss of olfaction

-loss of normal breathing pattern

Nursing Care

Pre-operative

-explain procedure with emphasis to changes that will happen after surgery

-introduce client to changes in modes of communication

-etablish method os communication to be used immediately post-op

Post-operative

-promote optimum ventilatory status

-suction secretions regularly

-routine care for tracheostomy

-pain relief

-lean forward when expectorating

-wear ID bracelet at all times reminding everybody that patient is neck breather

-teach about proper exercises to increase ROM & muscle strength

*COMMUNICATION

>1-3 days post op :writing

>3-5 days post op :artificial larynx & esophageal speech