Cancer of the Larynx

  1. General information
    1. Most common upper respiratory malignancy.
    2. The majority of laryngeal malignancies are squamous cell carcinomas.
    3. Types
      1. Supraglottic (also called extrinsic laryngeal cancer): involves the epiglottis and false cords and is likely to produce no symptoms until advanced stages.
      2. Glottic (also referred to as intrinsic laryngeal cancer): affects the true vocal cords; the most frequently occurring laryngeal cancer; produces early symptoms
    4. Occurs most often in white men in middle or later life
    5. Caused by cigarette smoking, excessive alcohol consumption, chronic laryngitis, vocal abuse, family predisposition to cancer of larynx
  2. Medical management
    1. Radiation therapy: may be effective in cases of localized disease, affecting only one vocal cord
    2. Chemotherapy: used as adjuvant therapy to help shrink tumor and eradicate metastases (experimental)
    3. Surgery
      1. Partial laryngectomy: a lesion on the true cord on one side is removed along with adjoining tissue. Useful in early, intrinsic lesions. Client is able to talk and has a normal airway post-op.
      2. Total laryngectomy (see below)
      3. Radical neck dissection
        1. performed when metastasis from cancer of the larynx is suspected
        2. includes removal of entire larynx, lymph nodes, sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve
        3. may also involve removal of the mandible, submaxillary gland, part of the thyroid and parathyroid gland
        4. nursing care: same as for total laryngectomy, below
  3. Assessment findings
    1. Supraglottic: localized throat pain; burning when drinking hot liquids or orange juice; lump in the neck; eventual dysphagia; dyspnea; weight loss; debility; cough; hemoptysis; muffled voice
    2. Glottic: progressive hoarseness (more than 2-week duration), eventual dyspnea
    3. Enlarged cervical lymph nodes
  4. Nursing interventions: provide care for the client with a laryngectomy.