cancer of larynx series of ear nose and throat .pptx

a brief dive into the cancer of larynx

1. CANCER OF LARYNX DR. CHIKONDE

2. Content: Introduction Definition of laryngeal cancer Etiology and Risk factors Clinical manifestations of laryngeal cancer Pathophysiology Diagnostic evaluation Management of larynx cancer Complication of surgery Nursing management of laryngectomy Patient teaching New research done on laryngeal cancer in India Nursing diagnosis Summary Evaluation

3. Larynx

4. The larynx, or voice box, is located in the throat. The larynx helps us breathe, speak, and swallow. The vocal cords, which help us speak, are part of the larynx. The larynx is made up mostly of cartilage, a flexible tissue that forms a framework of support. There are three parts to the larynx: The supraglottis, or upper part. The glottis, the middle part. This is where the vocal cords are located. The vocal cords open and close, and allow you to breathe and speak. The subglottis, the lower part. FUNCTIONS OF LARYNX: Production of sound Speech Protection of the lower respiratory tract Passage way of air Humidifying filtering and warming

5. Introduction: Cancer of the larynx is a malignant tumor in and around the larynx ( voice box). Squamous cell carcinoma is the most common form of cancer of the larynx. Cancer of larynx occurs more frequently in men and than in women and it is most common in people between the ages of 50 and 70 years. Laryngeal cancer can be classified into three categories : Supraglottic ( false vocal cords) Glottic ( true vocal cords) and Subglottic ( downward extension of disease from the vocal cords)

6. Definition: Laryngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the larynx ( Voice Box). Laryngeal cancer occurs when cells in the lining of the throat grow uncontrollably and form tumors that invade normal tissues and spread to other part of the body.

7. Etiology and risk factors: Smoking Alcohol Gastroesophageal reflux disease (GERD) Poor nutrition Human papillomavirus (HPV) Race Gender Age Weakened immune system Toxic exposure Voice overuse

8. Clinical manifestation :- A lump in the neck Sore throat Persistent cough Bad breath Respiratory obstruction Dysphagia Hoarseness and other voice changes Stridor Fever Earache Pain in throat referred to the ear Aspiration on swallowing Hemoptysis Dyspnea

9. Pathophysiology :

10. Diagnostic evaluation :- Medical history Physical examination Laryngoscopy Endoscopic biopsy C T Scan MRI PET Chest X-ray Fine needle aspiration (FNA)Biopsy

11. Management :- Radiation therapy Chemotherapy Surgery New types of treatment are being tested in clinical trials 1.RADIATION THERAPY: Radiation therapy delivers high energy x-rays to the tumor to kill cancer cells. By focusing the radiation on the cancer cells, the damage to normal structures can be minimized.

12. 2. CHEMOTHERAPY:- Chemotherapy is the use of medications to kill or to slow the growth of rapidly multiplying cancer cells. These medications are often given intravenously (through a needle into a blood vessel) Cisplatin and 5-flurouracil are two agents found to be the most effective against larynx cancer. 3. SURGERY:- Surgery is a common treatment for alll stages of laryngeal cancer. The following surgical procedure may be used.. Cordectomy : Surgery to remove the vocal cords only . Supraglottic Laryngectomy: Surgery to remove the supraglottis only. Hemilaryngectomy : Surgery to remove half of the larynx (Voice Box). A partial hemilaryngectomy helps keep the patient’s ability to talk.

13. Partial Laryngectomy: Surgery to remove part of the larynx (Voice box). A partial laryngectomy helps to keep the patient’s talk ability to talk. Total Laryngectomy : Surgery to remove the whole larynx . During this operation , a hole ( stoma ) is made in the front of the necks to allow the patient to breathe . This is called a Tracheostomy . Thyroidectomy : The removal of all or part of the thyroid gland. Laser Surgery: A surgical procedures that usss a laser beam as a knife to make bloodless cuts in the tissue or to remove a surface lesion such as a tumor.

14. 4.New types of treatment are being tested in clinical trials:- Chemoprevention : It is the use of Drugs , Vitamins or other substances to reduce the risk of developing cancer or reduce the risk of cancer will reoccur. Radiosensitizers : Are the drugs that make tumor cells more sensitive to radiation therapy. Nutrition : Good nutrition is important getting enough calories and protein to prevent loss , regain strength and rebuild healthy tissues.

15. Complications of surgery: Salivary fistula Hemorrhage Hematoma formation Stomas stenosis Aspiration Long term complications :- Chest infections Recurrence of cancer in stoma

16. Nursing management of laryngectomy: Pre-operative care: Explain the patient that after total laryngectomy the breathing will occur through a permanent opening made in the neck and that normal speech will not be possible. The patient should meet a speech pathologist before surgery to learn about options for post operative rehabilation and speech. Assess the anxiety levels of the client and family related to the diagnosis and proposed surgery.

17. Care of the patient after total laryngectomy: Provide comfort care and airway management- Elevate head of bed 45 degrees. Encourage deep breathing every 4 hours. Maintain oxygen to tracheostomy collar. Assess airway patency every shift as needed. Assess vitals- quality, rate of respiration and skin color(pallor , cyanosis ) 2. Provide care for suture line and stoma site- Assess suture line and stoma site every 4 hours. Monitor drain function and output. Maintain suction to drain at level ordered. Clean the stoma site and suture line with hydrogen peroxide , normal saline and dry it with dry gauze. Report changes in amount and colour of drainage of air leak.

18. 3. Attention to fluid , food and hygiene needs- Monitor hydration and ensure adequate fluid intake to maintain healthy oral mucosa. Provide mouth care at least three times in a day. Record intake and output every shift. Weigh the patient daily, at the same time and in the same amount of clothing. Provide stoma care every shift as needed. Assess bowel sounds every shift as needed. Record amount, consistency and frequency of stools. Assess swallowing ability and provide support when oral diet resumes. 4. Provide support and education for the patient family- Assess anxiety level and provide emotional support. Assist patient in communicating. Provide patient with writing materials or picture board. Instruct about use of artificial speech device and encourage its use.

19. Prepare patient for discharge. Begin teaching laryngectomy care. Provide information about soft diet. Refer the patient to a speech pathologist for voice and speech rehabilitation. SPEECH REHABILITATION Tracheoesophageal speech : in this a tracheoesophageal puncture (TEP)is made to create a tracheoesophageal fistula large enough for insertion of a valve prosthesis. Artificial larynx or electro larynx: mechanical device which create natural type of speech.

20. Patient teaching Discharge and home health care guidelines for patient with laryngeal cancer: Teach the patient Signs and symptoms of potential complications and appropriate actions to be taken. Complications include infection ( Wound , Poor Wound healing , Fever , Chills ) , Airway Obstruction and Tracheostomy stenosis( Noisy respiration , difficulty breathing , restlessness, confusion), Vocal straining, Fistula formation and Ruptured carotid artery (bleeding , hypotension) Teach the patient the name , purpose , dosage, schedule, common side effects and importance of taking all medications. Teach the patient appropriate devices and technique to ensure patent airway and prevent complications . Explore method of communication that work effectively. Encourage the patient to wear medic alert bracelet and necklace, which identifies him or her as a mouth breather.

21. Instruct the patient in good oral hygiene practices. If appropriate , instruct a male client to shave off his beard to facilitate postoperative care. Provide the patient with a list if referrals and support groups such as visiting nurses.

22. Nursing diagnosis:- Ineffective airway clearance related to altering ability to breath, cough and swallow. Acute pain related to surgical incision and tissue swelling. Impaired skin/ tissue integrity related to surgical removal of tissues and grafting, radiation or chemotherapeutic agents , reduced blood supply and edema formation. Impaired verbal communication related to anatomical deficit removal of vocal cords. Impaired oral mucous membrane related to poor or inadequate oral hygiene , dehydration or absence of oral intake , decreased saliva production secondary to radiation or surgical procedure.

23. Summary: Cancer of the larynx is a malignant tumour in and around the larynx ( voice box). 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. Most common treatment of laryngeal cancer is laryngectomy. Other treatments are Radiation therapy & Chemotherapy .

24. Evaluation: What is cancer of the larynx? What is the most common form of laryngeal cancer? What gender is most likely to get laryngeal cancer? What is the most common treatment for laryngeal cancer? What adult age range typically for laryngeal cancer? What are the etiologies of laryngeal cancer? What are the signs and symptoms of laryngeal cancer? What are the 3 functions of larynx? What is a total laryngectomy? Apart from laryngectomy what other treatments can be used ? (Or combined with it)

25. Assignment:- Write the nursing care plan of the Laryngeal Cancer.

26. Bibliography:- Suddarth’s &Brunner;“Textbook of Medical-Surgical Nursing”,twelfth edition;page no;164-170 Www. Slideplayer.com www.wkipedia.org Www.cancer.gov www.healthline.com