Laryngeal Cancer
Squamous cell carcinoma constitutes about 95% of laryngeal cancers. Rare laryngeal cancer forms—adenocarcinoma and sarcoma—account for the rest. The disease affects males about five times more often than females, and most victims are between ages 50 and 65.
A tumor on the true vocal cord seldom spreads because underlying connective tissues lack lymph nodes. On the other hand, a tumor on another part of the larynx tends to spread early. Laryngeal cancer is classified by its location:
supraglottis (false vocal cords)
glottis (true vocal cords)
subglottis (rare downward extension from vocal cords).
Causes
The cause of laryngeal cancer is unknown. Major risk factors include smoking and alcoholism. Minor risk factors include chronic inhalation of noxious fumes, familial disposition, and a history of frequent laryngitis and vocal straining.
Assessment
Varied assessment findings in laryngeal cancer depend on the tumor’s location and its stage.
Stage 0 is asymptomatic. In stage I disease, the patient may complain of local throat irritation or hoarseness that lasts about 2 weeks. In stages II and III, he usually reports hoarseness. He may also have a sore throat, and his voice volume may be reduced to a stage whisper. In stage IV, he typically reports pain radiating to his ear, dysphagia, and dyspnea. In advanced (stage IV) disease, palpation may detect a neck mass or enlarged cervical lymph nodes.
Diagnostic tests
The usual workup includes laryngoscopy, xeroradiography, biopsy, laryngeal tomography and computed tomography scans, and laryngography to visualize and define the tumor and its borders. Chest X-ray findings can help detect metastases.
Treatment
Early lesions may respond to laser surgery or radiation therapy; advanced lesions, to laser surgery, radiation therapy, and chemotherapy. Treatment aims to eliminate cancer and preserve speech. If speech preservation isn’t possible, speech rehabilitation may include esophageal speech or prosthetic devices. (See Alternative speech methods, page 518.) Surgical techniques may be used to construct a new voice box.
In early disease, laser surgery destroys precancerous lesions; in advanced disease, it can help clear obstructions. Other surgical procedures vary with tumor size and include cordectomy, partial or total laryngectomy, supraglottic laryngectomy, and total laryngectomy with laryngoplasty.
Radiation therapy alone or combined with surgery can create complications, including airway obstruction, pain, and loss of taste (xerostomia).
Chemotherapeutic agents may include methotrexate, cisplatin, bleomycin, fluorouracil, and lomustine.
Key nursing diagnoses and patient outcomes
Impaired swallowing related to presence of tumor. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:
consume a nutritionally balanced diet containing sufficient calories
maintain his weight within a normal range
not exhibit signs or symptoms of aspiration pneumonia.
Impaired verbal communication related to presence of tumor. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:
communicate his needs and desires without undue frustration
use an alternate method of communication as necessary
use available resources to help him maximize his communication skills.
Ineffective airway clearance related to presence of tumor. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:
cough effectively and expectorate any sputum
maintain a patent airway
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