Laryngeal cancer is almost always squamous cell carcinoma. It arises in the glottis (vocal cords — most common), supraglottis, or subglottis. Glottic tumors cause early hoarseness and spread late because the vocal cords have few lymphatics; supraglottic tumors present later with a neck mass.

• Risk factors: tobacco and alcohol (strongly synergistic), older age, male sex, occupational exposures (asbestos, wood dust, paint fumes), chronic laryngopharyngeal reflux

Lung cancer is the leading cause of cancer death worldwide.

• Lung cancer risk factors: smoking (cause of most cases), secondhand smoke, radon (leading cause in never-smokers), asbestos (multiplies risk with smoking), air pollution, occupational carcinogens (arsenic, chromium, silica, diesel exhaust), prior chest radiation, family history, COPD and pulmonary fibrosis. A high-fat diet is not an established lung cancer risk factor
• Pancoast (superior sulcus) tumor: shoulder and arm pain, Horner syndrome (ptosis, miosis, anhidrosis)

Laryngeal cancer

• Persistent hoarseness or voice change lasting more than 2–3 weeks — the key early warning sign, especially in a smoker
• Sensation of a lump in the throat, persistent sore throat, dysphagia, odynophagia
• Pain referred to the ear
• Late: stridor, dyspnea, hemoptysis, neck mass, weight loss, halitosis

Lung cancer (often silent until advanced)

• New cough or change in a chronic cough, hemoptysis, dyspnea, wheeze
• Chest pain, including pleuritic pain
• Recurrent or unresolved pneumonia
• Hoarseness (recurrent laryngeal nerve involvement), dysphagia
• Weight loss, fatigue, clubbing
• Signs of spread: bone pain, headache or neurologic change (brain), jaundice (liver)
• Superior vena cava (SVC) syndrome: swelling of the face, neck, and upper arms, distended neck and chest veins, dyspnea, headache — lower-limb edema is not a feature

Staging uses the TNM system (tumor, nodes, metastasis). SCLC is also described as limited-stage or extensive-stage.

Laryngeal cancer

• Early disease: radiation therapy or transoral laser/partial laryngectomy — voice is largely preserved
• Advanced disease: concurrent chemoradiation (larynx preservation) or total laryngectomy with neck dissection, often followed by radiation
• Total laryngectomy removes the whole larynx: the trachea is brought out as a permanent stoma, and the airway and esophagus are completely separated. The client breathes only through the stoma, cannot aspirate from the mouth into the lungs, loses the natural voice, and has a reduced sense of smell and taste
• Voice restoration: tracheoesophageal puncture (TEP) with a voice prosthesis (most common), electrolarynx, esophageal speech

Lung cancer — by stage (NSCLC)

• Stage I–II: surgery (lobectomy or segmentectomy; pneumonectomy occasionally) ± adjuvant chemotherapy, immunotherapy, or targeted therapy; stereotactic body radiation therapy (SBRT) if not a surgical candidate
• Stage III: usually not fully resectable → concurrent chemotherapy plus radiation, followed by consolidation immunotherapy (or targeted therapy for EGFR-mutated tumors); selected resectable cases receive chemo-immunotherapy with surgery
• Stage IV: systemic therapy guided by biomarkers — targeted therapy, immunotherapy ± chemotherapy; palliative radiation
• SCLC: chemotherapy (platinum + etoposide) plus radiation for limited stage, followed by durvalumab consolidation; chemotherapy plus immunotherapy for extensive stage; surgery is rarely used

Drug safety

Listed in priority order.

1. Airway after total laryngectomy or head and neck surgery
   • Airway is only through the stoma — deliver humidified oxygen to the stoma, never to the face
   • Humidification (heat–moisture exchanger or humidified collar), suction as needed with sterile technique
   • Position semi-Fowler's to reduce edema; monitor for bleeding, flap viability, stridor
   • Keep a spare laryngectomy tube, suction, and obturator at the bedside
2. Airway and breathing after lung surgery
   • Monitor SpO₂, breath sounds, chest tube function and air leak
   • Deep breathing, coughing with splinting, incentive spirometry, early ambulation
   • Positioning: after pneumonectomy, keep supine or turned slightly toward the operative side (avoid full lateral on the non-operative side — risk of mediastinal shift); a chest tube is usually not used after pneumonectomy — if one is present, it is not placed to suction and is managed per the surgeon's orders. After lobectomy, clients can usually turn to either side unless ordered otherwise
   • Watch for atrial fibrillation, air leak, and bronchopleural fistula
3. Pain management
   • Give prescribed analgesics on a scheduled (around-the-clock) basis before pain becomes severe, with breakthrough doses; epidural, PCA, or nerve blocks after thoracotomy
   • Good pain control allows deep breathing and coughing
4. Nutrition
   • After total laryngectomy, enteral feeding (nasogastric or other tube) is typical until the pharyngeal suture line heals (often about 7–10 days, depending on surgeon); then oral intake is started gradually
   • Watch for pharyngocutaneous fistula: saliva or food leaking through the neck wound, redness, fever
5. Oral care during chemotherapy and radiation (mucositis, xerostomia)
   • Soft toothbrush, bland rinses (saline or sodium bicarbonate), frequent sips of water, saliva substitutes
   • Avoid alcohol-based mouthwash, hydrogen peroxide, hot, spicy, acidic, or rough foods
   • Topical anesthetics or analgesics as prescribed; dental evaluation before head and neck radiation; fluoride
6. Communication — after laryngectomy, provide a writing board or device before surgery teaching; call bell within reach; speech-language pathology referral
7. Monitor for oncologic emergencies (section 7)
8. Psychosocial support — altered body image and voice, grief, smoking-related guilt, end-of-life planning; involve palliative care early

After total laryngectomy

• Do not cover or block the stoma when coughing — cough through the open stoma and wipe secretions with a tissue. (A client with a voice prosthesis briefly covers the stoma only to speak)
• Keep the stoma covered with a light foam or cloth filter to warm, moisten, and filter air
• Use a room humidifier; drink plenty of fluids
• Use a shower guard to keep water out of the stoma; no swimming
• Clean the stoma and surrounding skin daily; watch for redness or crusting
• Wear medical identification as a "neck breather"; rescue breathing is given via the stoma
• Seek emergency help for sudden difficulty breathing
• Stop smoking and alcohol

Lung cancer

• Smoking cessation at any stage improves treatment tolerance and survival
• Screening eligibility for family members who smoke
• Report fever ≥ 38.0 °C (100.4 °F) during chemotherapy (neutropenia), new cough or dyspnea, diarrhea, rash, extreme fatigue (immunotherapy effects)
• Shoulder and arm exercises on the operative side after thoracotomy to prevent frozen shoulder
• Home radon testing

• Hoarseness > 2–3 weeks in a smoker = evaluate for laryngeal cancer
• Tobacco + alcohol are the main laryngeal cancer risks; smoking, radon, asbestos, secondhand smoke for lung cancer
• Total laryngectomy = permanent stoma, no aspiration route to lungs, no natural voice
• Never cover the stoma to cough; use shower guard, no swimming, humidify
• Early nutrition after laryngectomy is usually by tube until the pharynx heals
• SCLC: aggressive, usually metastatic at diagnosis, chemotherapy-based, SIADH
• Stage III NSCLC: concurrent chemoradiation, then consolidation therapy
• LDCT screening: 50–80 years, ≥ 20 pack-years, current or quit within 15 years
• SVC syndrome = swelling of face, neck, and upper arms
• Cancer pain: scheduled analgesia before pain is severe
• Mucositis: soft toothbrush, bland rinses, no alcohol or peroxide rinses
• Checkpoint inhibitors → immune-related pneumonitis, colitis, endocrinopathies; cisplatin → kidney and hearing damage