Beverlyn Jackson, MSN, RN, CCRN Nursing Faculty

 Upper respiratory cancers can include the following: bones - mandible, pharynx, oral mucosa, tonsils, palate, gums, tongue, lips, or Larynx  Larynx - the most common site of upper airway cancers. Constitutes % of all malignancies. If detected early, has a high cure rate and a survival rate of %. For patients requiring a total laryngectomy and radical neck dissection, survival rate drops to %.  Incidence: Increased in men, especially years old who smoke and drink ETOH heavily. Also increased risk for individuals who use their voices a lot - singers, actors, public speakers. If detected and treated early, 90% of cancers of the larynx are cured.  PREVENTION: Stop smoking

 95% Squamous Cell carcinomas  Three areas can be affected:  supraglottic  glottis  subglottic

 HOARSENESS  Pain in the throat  Dysphagia  Cough  Lump in the throat  Burning sensation  Hemoptysis  Dyspnea & stridor  Mass in the neck  Weight loss

 Usually occurs in smokers  Radiation therapy  Prognosis Excellent  Cure rate over 90%  Voice returns to normal

 Commonly involves vocal cord  Above the cord (supraglottic)

 Commonly involves the vocal cords  Below the cord (subglottic)

 Laryngoscopy a tube with light is passed down the throat to look around. Can take a biopsy. Treatment  Depends on the site and stage of the lesion, the presence of metastasis, the patient’s age, the wishes of the patient

 Nutritional supplement  Oral Hygiene  Antibiotic therapy  Speech therapy prn  Radiation therapy

Total Laryngectomy  Tranoral Cordectomy/ Laryngofissure  Supraglottic Partial Laryngectomy  Vertical Laryngectomy  Total Laryngectomy

 Radical neck Dissection -Self image concerns

 Salivary fistula - most common  Lymph fistula  Pulmonary  Facial edema  Neurologic disorders  Infection  Hemorrhage  bleeding around trach site  venous erosion  bleeding into tissues  carotid artery rupture

Hemorrhage  bleeding around trach  Venous erosion  Bleeding into tissue  Carotid artery rupture (medical emergency)

Pre-operative care  psychosocial interventions  patient/family teaching Post-operative care  assessment  airway maintenance

 Complications (post op)  Airway obstruction R/T Edema  hemorrhage  wound breakdown  tumor recurrence  Goals

 During the immediate post-operative period provide means  Esophageal speech  Artificial larynx  Surgical Voice Restoration

 reference;  Iggy, 7 th ed.  Table 31-1 pg.589  Table 31-2 pg.591  Chart 31-3 pg.595  Chart 31-4 pg. 595