Nursing Care Plan for Laryngeal Cancer

Laryngeal Cancer often found in the elderly over 40 years. Most of the men. This may be related to smoking, working with wood powder dust, toxic chemicals or powders, heavy metal. How is it not certain by experts. Head and neck cancer caused 5.5% of all malignant disease. Especially laryngeal neoplasm 95% are squamous cell carcinomas. If the cancer is confined to the vocal cords (intrinsic) spread slowly. Poor vocal cords lymph vessels so there is no lymph node metastases direction. If the cancer involves the epiglottis (extrinsic) metastasis is more common. Supraglottic and subglottic tumors should be large enough, before the vocal cords leading to hoarseness. True vocal cord tumors occur earlier when the vocal cords are usually still be moved.

Is the earliest form of hoarseness, or chronic hoarseness, does not heal even though the patient is undergoing treatment at the glottis and subglottic area. Unlike hoarse voice laryngitis, is not accompanied by systemic symptoms such as fever. Discomfort in the throat, like there's something stuck. In the advanced phase can be accompanied by pain on swallowing or speaking. Shortness of breath occurs when the rhyme glottidis closed or nearly closed 80 % of tumor. Shortness of breath does not arise suddenly but slowly. Therefore, patients can adapt, so just feel claustrophobic when the tumor was large ( late treatment ). Stridor caused by airway obstruction. When you have found significant enlargement of the tumor already in the advanced stage. Even sometimes the tumor can be felt, causing swelling of the larynx.

When the larynx tumor extension to the pharynx conduct will arise symptoms of dysphagia, pain when swallowing and pain spreading towards the ear. If the case is found clearly above, especially with the raucous noise complaints over the two weeks of treatment are not cured, affects adults or elderly, the patient should be referred immediately.

Examination of the larynx with laryngeal glass, or laryngoscopy, direct can show clearly the tumor. Place tumors often arise, can be seen in the picture. Chest X-ray, bone scan, to identify possible metastases. Complete blood count, anemia can be stated that a common problem. Laryngograph can be done with contrast for examination of blood vessels and lymph vessels. Then larynx examined under general anesthesia and performed a biopsy on the tumor. Untreated cavities, should be repealed at the same time.

In the case of laryngeal carcinoma can be done with radiation treatment and removal of the larynx (laryngectomy). Treatment chosen based on the stage. Radiation is given in stages 1 and 4. The reason to have the advantage to maintain a normal voice, but rarely can cure the tumor is advanced, the more so if it is contained enlarged neck glands. Therefore radiotherapy should be used for patients with small lesions without enlarged neck glands. The ideal case is the tumor limited to one vocal cord, and is easily moved. Nine out of ten patients with such a condition can be cured by radiotherapy and can perfectly sound normal maintenance. Fixation of the vocal cords showed the spread has reached the muscle layer. If the tumor has not spread stricken supraglotticatau subglottic, these lesions can still be treated with radiotherapy, but with a worse prognosis.

Patients with tumors of the larynx which is accompanied by enlargement of the lymph nodes of the neck, the best treatment is a total laryngectomy and neck dissection radical gland. In this case enter stage 2 and 3. This is done on the type of supraglottic and subglottic tumors. In these patients the possibility of recovery is not so big, only one in three patients will recover completely. Laryngectomy classified into:

1. Partial laryngectomy. Removal of the tumor is confined to only one vocal cord and a temporary tracheotomy is done to maintain the airway. After recovering from the surgery the patient's voice will be hoarse.
2. Hemilaryngectomy or vertical. If there is a possibility of cancer including the right vocal cord, and one wrong. This section draws arytenoid cartilages and a half along the thyroid cartilage. Temporary tracheostomy performed and the patient's voice will be hoarse after surgery.
3. Supraglottic laryngectomy or horizontal. when the tumor
4. located on the epiglottis or vocal cords wrong, radical neck dissection and tracheotomies. Patient's voice remains intact or normal. Because the epiglottis raised the risk of aspiration due to increased food orally.
5. Total laryngectomy . Advanced cancer involving the majority of the larynx , requiring removal of the larynx, hihoid bone, cricoid cartilage tracheal rings from 0.2 to 3 , and liaison to the laryngeal muscles. Resulting in loss of voice and a hole ( stoma ) is a permanent tracheostomy. In this case there is no danger of aspiration of food orally, because the trachea is no longer associated with airway - digestion. An incision was made ​​dileher radical on this type of laryngectomy. This includes the removal of the lymphatic vessels, lymph nodes in the neck, the sternocleidomastoid muscle, internal jugular vein, spinal nerve asesorius, salifa submandibular gland and parotid gland fraction ( Sawyer , 1990) . Operations will make people unable to speak or speaking . But such cases can be overcome by teaching them to talk using the esophagus ( esophageal speech ), although the quality is not as good as when people speak the larynx organ . To practice speaking with oesophageal need the help of a speech community development .