Tumors of larynx

Tumors of Larynx

Squamous cells, which make up the bulk of a laryngeal epithelium, are the genesis of the majority of laryngeal malignancies, which are also known as squamous cell carcinomas. Any portion of the larynx can develop cancer, however the tumor's location has an impact on the likelihood of recovery.

For the purposes of tumor staging, the larynx is divided into 3 anatomical regions:

• The glossitis( true vocal cords, anterior and posterior commissures)
• The supraglottis (epiglottis, arytenoids and aryepiglottic folds, and false cord)
• The subglottis

In the glottis, laryngeal malignancies typically develop. Subglottic tumors are least frequent, whereas supraglottic cancers are less common. Laryngeal cancer can metastasize to nearby cervical lymph nodes, extend directly to neighboring structures, or spread more widely through the blood stream. Lung metastases that have spread far are most typical.

Laryngeal cancer mainly consists of conventional squamous cell carcinomas. Other laryngeal malignancies include:

• Carcinoma in situ
• Verrucous, spindle cell and basaloid SCC
• Undifferentiated carcinoma
• Adenocarcinoma
• Miscellaneous carcinoma (adenoid cystic, neuroendocrine carcinoma, etc)
• Sacromas

Squamous cell carcinoma is further divided according to tumor location into four subtypes:

• Glottic carcinoma:
  • Involves the true vocal folds
• Supraglottic carcinoma:
  • Confined to supraglottic area.
• Subglottic carcinoma:
  • Extent or arise more than 10mm below the free margin of the true vocal fold up to the interior border of cricoids cartilage.
• Transglottic carcinoma:
  • Cross the ventricle from the supraglottic area to involve the true and false vocal folds or involve the glottis and extend subglottically more than 10mm or both.

Risk factors:

• Smoking
• Heavy chronic consumption of alcohol
• Low socio-economic status
• People with a history of head and neck

Signs and symptoms:

• Persistant hoarseness in an elderly and middle aged cigarette smoker
• Dyspnea and stridor
• Ipsilateral otalgia
• Dysphasia
• Odynophagia
• Chronic cough
• Hemoptysis
• Weight loss owing to poor nutrition
• Halitosis owning to tumor necrosis
• Mass in the neck by metastatic lymph node
• Laryngeal tenderness owing to tumor necrosis or suppuration
• Lump in neck
• Broadening of the larynx on palpation with crepitation
• Tenderness of larynx
• Fullness of cricothyroid membrane

Diagnosis:

• Medical history
• Physical examination
• Special investigation like chest x-ray, MRI or CT scan, tissue biopsy
• Laryngoscopy
• Indirect or direct laryngoscopy and biopsy to determine stage of disease as well as histologic confirmation

Stages of larynx cancer and their treatment:

Stage 1: The cancer is only in the area where it started and has not spread to lymph nodes in the area or to other parts of the body. The exact definition of Stage 1 depend on where cancer started as follows:

• Supraglottis: The cancer is only in one area of the supraglottis and the vocal cords can move normally. Treatment may be one of the following:
  • External beam radiation therapy.
  • Surgery to remove the supraglottis.
  • Surgery to remove the larynx
• Glottis: The cancer is only in the vocal cords and the vocal cords can move normally. The treatment may be one of the following:
  • Radiation therapy
  • Surgery to take out a vocal cord.
  • Surgery to remove part of the larynx or total laryngectomy.
  • Laser surgery.
• Subglottis: Cancer has not spread outside of the subglottis. Treatment will probably be radiation therapy. In some cases, a Hemi laryngectomy may be done.

Stage 2: The cancer is only in the larynx and has not spread to lymph node to the area or to the other parts of the body. The exact definition of Stage 2 depends on where cancer started, as follows:

• Supraglottis: The cancer is in more than one area of the supraglottis, but the vocal cord can move normally. Treatment may be one of the following:
  • External beam radiation therapy
  • Surgery to remove the supraglottis to the entire larynx
  • Radiation therapy is given after surgery
• Glottis: Cancer has spread to the supraglottis or the subglottis or both. The vocal cords may or may not be able to move normally. Treatment may be one of the following:
  • Radiation therapy
  • Surgery to remove part of the larynx or total laryngectomy
• Subglottis: Cancer has spread to the vocal cords, which may or may not be able to move normally. Treatment may be one of the following:
  • Radiation therapy
  • Surgery to remove part of larynx

Stage 3: At stage 3, laryngeal cancer may have either of the following characteristics:

• Cancer has not spread outside of the larynx, but the vocal cords cannot move normally, or cancer has spread to tissue next to the larynx
• Cancer has spread to one lymph node on the same side of the neck as cancer, and the lymph node measures no more than 3 cm
• Treatment may be one of the following:
  • Radiation therapy
  • Chemotherapy
  • Surgery

Nursing management:

• Avoid smoking, or at the very least, get assistance in quitting.
• Alcohol should only be consumed in moderation, preferably twice weekly.
• Include fruits and vegetables in your diet since they contain antioxidants that help lower your risk of throat cancer.
• When exposed to particular substances, wear the appropriate breathing and oral cavity protection.
• Help the patient and their family cope with the psychological effects of the cancer diagnosis, the physical changes, and any potential changes in communication needs brought on by voice loss.
• The nurse can provide strategies to lessen radiation therapy side effects. The most prevalent and bothersome issue is dry mouth (xerostomia). Saliva production can be increased using pilocarpine hydrochloride.

REFERENCE

Basavanthapa B. Medical Surgical Nursing. New Delhi: Jaypee Brothers Medical Publishers; 2007 

Black j. Medical Surgical Nursing. 6th edition. Volume 2. India: Harcourt Private Ltd; 2001. 

Dhingra PL. Diseases of ear, nose, and throat. $th ed: Reed Elsevier India (P) Limited:2007

Mandal, G.N. Textbook of Adult Nursing. Kathmandu: Makalu Publication House, 2013.

MedicineNet. 1996. 2017 http://www.medicinenet.com/larynx_cancer/article.htm

Shrivastav R, Rakesh P. An illustrated Textbook of ear, nose, throat and head and neck surgery. 1st ed. Lalitpur Nepal: UPS publisher; 2008