Cancer of Larynx

Definition

• The cancer of laryngeal cells.

Classification

• Glottic tumour: tumour in the glottis.• Sub-glottic tumour: tumour in the sub-glottic

area.• Supra-glottic tumour: Tumour in the supra-

glottic area.

Etiology

• Cigarette smoking• Alcoholism• Occupational risk factors : asbestos, wound

dust, mustard gas & petroleum products.• Inhalation of noxious fumes• Chronic laryngitis and voice abuse

PathophysiologyEtiological factors

Carcinoma of the squamous cell lining of the larynx

Rapid metastasis of the carcinoma, due to abundant lymphatic vessels, into lymph nodes

and lungs

Clinical Manifestations

Glottic tumour• Voice changes• Hoarsness• Hemoptysis• Dyspnoea• Respiratory obstruction• Dysphagia• Weight loss• Pain

Supraglottic tumor• Aspiration on swallowing• Persistent unilateral sore

throat• Foreign body• Dysphagia• Weight loss• Mass in neck• Hemoptysis

Supraglottic tumour• Dyspnoea• Airway obstruction• Dysphagia• Weight loss• Hemoptysis

Diagnostic finding

• Physical examination: swollen lymph nodes in the neck

• Indirect laryngoscopy • Direct laryngoscopy• Pan endoscopy• CT and MRI scan• Biopsy

Medical management

• Radiation therapy is given 5 days a week for 5-8 weeks.

Surgical Management

• Laser surgery : for vocal cord tumours.• Partial laryngectomy / Vertical partial

laryngectomy: Removal of half or more of the larynx– Supraglottic laryngectomy: for Ca of supraglottis– Supra-cricoid partial laryngectomy: for confined

transglottic Ca.

• Total laryngectomy: For glottic tumours• Cervical lymph node dissection / Neck

dissection: – Radical neck dissection / En Bloc– Modified radical neck dissection

Complications of surgery

• Haemorrhage• Airway obstruction• Carotid artery rupture• Fistula formation

Nursing Management

– Assess ABG values, pulse oximetry & FiO2 levels– Semi fowlers to High fowlers position– Monitor oxygen therapy– Tracheostomy care and suctioning– Chest physiotherapy– Nebulization

Partial laryngectomy

Total laryngectomy• Nutrition– Tube feeding– Start oral feeding with fluids & semi-soft foods

• Communication– Give pen and paper– Communication board– Keep speaking with the client; do not avoid

conversation because it will build up frustration• Artificial larynx– Can be used after 3-4 days of surgery

The end