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Laryngeal Cancer | 마이메르시 MyMerci
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Laryngeal Cancer

NCLEX Review Guide: Laryngeal Cancer

Pathophysiology & Risk Factors

Understanding Laryngeal Cancer

  • Laryngeal cancer is a malignant tumor that develops in the tissues of the larynx (voice box), most commonly squamous cell carcinoma. The larynx is divided into three anatomical regions: supraglottis, glottis, and subglottis.
  • Primary risk factors include tobacco use, alcohol consumption, HPV infection, and prolonged vocal cord irritation. Men over 60 are at highest risk, with smoking being the most significant modifiable risk factor.

Memory Aid - LARYNX Risk Factors

Liquor (alcohol)
Age (>60)
Reflux (GERD)
Years of smoking
No protection (occupational exposure)
X-tra infections (HPV)

Key Points

  • Glottic tumors have better prognosis due to early symptom development (hoarseness)
  • Supraglottic and subglottic tumors often present later with more advanced disease

Clinical Manifestations & Assessment

Signs and Symptoms

  • Progressive hoarseness lasting >2 weeks is the earliest and most common symptom, especially with glottic involvement. Any persistent voice change requires immediate evaluation in high-risk patients.
  • Advanced symptoms include dysphagia, odynophagia, referred otalgia, weight loss, and palpable neck mass. Stridor indicates significant airway compromise requiring emergency intervention.
  • Late-stage manifestations include hemoptysis, chronic cough, and respiratory distress. Cervical lymphadenopathy suggests metastatic spread and worsens prognosis significantly.

Clinical Scenario

A 65-year-old male smoker presents with 3-week history of hoarseness and mild throat pain. He reports 40-pack-year smoking history and social alcohol use. Priority nursing assessment includes voice quality evaluation, neck palpation for lymph nodes, and respiratory status monitoring.

Key Points

  • Hoarseness >2 weeks in smokers = red flag for laryngeal cancer
  • Stridor indicates >50% airway obstruction - emergency situation

Diagnostic Procedures & Staging

Diagnostic Workup

  • Direct laryngoscopy with biopsy is the gold standard for diagnosis, allowing visualization of tumor location, size, and tissue sampling. Flexible fiberoptic laryngoscopy is often performed first as an office-based screening procedure.
  • Imaging studies include CT scan of neck and chest, MRI for soft tissue evaluation, and PET scan for metastasis detection. These help determine tumor extent and treatment planning.

Staging Comparison

StageDescription5-Year Survival
Stage ILimited to larynx, normal vocal cord mobility85-95%
Stage IIInvolves adjacent structures, impaired mobility70-80%
Stage IIIRegional lymph node involvement50-60%
Stage IVDistant metastasis25-35%

Key Points

  • Early detection dramatically improves survival rates
  • TNM staging guides treatment decisions and prognosis

Treatment Options & Nursing Care

Surgical Interventions

  • Partial laryngectomy preserves voice function while removing tumor tissue, suitable for early-stage cancers. Total laryngectomy involves complete removal of larynx, resulting in permanent tracheostomy and loss of natural voice.
  • Post-operative priorities include airway management, tracheostomy care, pain control, and communication support. Monitor for bleeding, infection, and respiratory complications in immediate post-op period.

    Post-Laryngectomy Nursing Care

  1. Assess respiratory status and tracheostomy patency every 2 hours
  2. Provide humidified oxygen and suction as needed
  3. Monitor surgical site for bleeding, swelling, or signs of infection
  4. Establish alternative communication methods immediately
  5. Begin feeding assessment and nutritional support planning
  6. Provide emotional support and connect with speech therapy

Key Points

  • Airway management is TOP priority post-laryngectomy
  • Communication alternatives must be established immediately

Commonly Confused Concepts

Tracheostomy vs. Laryngectomy Stoma

AspectTracheostomyLaryngectomy Stoma
ConnectionTrachea to skinTrachea directly to neck
Upper airwayIntactCompletely separated
Mouth-to-lungPossibleImpossible
CPR methodMouth-to-mouth OR stomaStoma ONLY
ReversibilityUsually temporaryPermanent

Critical Alert

NEVER attempt mouth-to-mouth resuscitation on laryngectomy patients - air will not reach lungs! Always ventilate through stoma.

Study Tips & Memory Aids

SPEECH Memory Aid for Post-Op Care

Suctioning and stoma care
Pain management
Emotional support
Eating/nutrition assessment
Communication alternatives
Humidification of air

Quick Check Questions

  • ☐ Can you identify the difference between partial and total laryngectomy?
  • ☐ Do you know the emergency CPR method for laryngectomy patients?
  • ☐ Can you list the top 3 risk factors for laryngeal cancer?
  • ☐ Do you understand why hoarseness >2 weeks requires evaluation?

Common Pitfalls

  • Pitfall: Assuming all neck breathing holes are the same - laryngectomy stomas are permanent and completely separate from upper airway
  • Pitfall: Forgetting that laryngectomy patients cannot hold their breath or perform Valsalva maneuver
  • Pitfall: Not recognizing that aspiration risk changes post-surgery due to altered anatomy

Remember: You're preparing to save lives and provide compassionate care. Every concept you master brings you closer to becoming the nurse your patients need. Stay focused, stay positive, and trust your preparation! 🌟

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