N211: Health Differences Across the Lifespan I
3.27 Cancer of the Larynx Cancer of the larynx is a neoplasm occurring in the larynx, most commonly squamous cell in origin. Most laryngeal tumors are benign. Etiology is smoking, and alcohol ingestion. Other contributing factors include vocal straining, chronic laryngitis, family predisposition, industrial exposure to carcinogens and nutritional deficiencies. Men are affected eight times more than women. Most common site for laryngeal metastasis is lungs. Nursing Assessment Includes hoarseness, change in voice characteristics, palpable jugular nodes, pain with swallowing, unexplained earache, dyspnea, cough, hemoptysis, weight loss and halitosis (late change). The tongue and mouth often appear gray, dark brown or black and may appear patchy. Diagnostics Include MRI, direct laryngoscopy, radiographs of head, neck and chest, along with CAT scan of neck and biopsy. Nursing Diagnosis • Ineffective breathing pattern related to presence of artificial airway, accumulated secretions and inability to cough secondary to surgical procedure • Altered nutrition: less than body requirements related to impaired swallowing secondary to surgical alterations of larynx, laryngeal edema, pain or radiation induced mucositis. • Impaired verbal communication related to surgical alterations of the larynx and creation of an artificial airway • Pain related to surgery and possible progression of the disease. Medical Interventions • Partial laryngectomy: removal of small lesion of the vocal cords and a margin of healthy tissue • Supraglottic laryngectomy and hemilaryngectomy: removal of the affected vocal cord and some surrounding structures. A tracheostomy is performed to maintain the airway • Total laryngectomy: removal of the entire larynx and some surrounding structures. A radical neck dissection may be performed to remove involved cervical lymph nodes. A permanent tracheostomy may be placed. Radiation therapy or brachytherapy (placement of radioactive source near the tumor and chemotherapy may also be performed.
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