Name
LARYNGEAL CANCER
DESCRIPTION
DETAIL
CAUSES β’ Smoking β’ Alcohol abuse -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Acute or chronic laryngitis β’ Benign vocal cord lesions such as polyps, nodules, and papillomas β’ Tuberculosis or fungal infection of the larynxLABORATORY Liver function studies to rule out metastatic disease SPECIAL TESTS β’ Laryngoscopy - fungating, friable tumor with heaped up edges and granular appearance with multiple areas of central necrosis and exudate surrounding areas of hyperemia β’ CT or MRI if chest and liver or brain metastasis suspected IMAGING β’ Bone scan if bone metastasis suspected β’ Screening chest x-ray to rule out metastatic disease DIAGNOSTIC PROCEDURES Indirect and/or direct laryngoscopy and biopsy to determine stage of disease as well as histologic confi rmation
TYPENOTES
GENERAL MEASURES Tracheotomy care, when applicable SURGICAL MEASURES β’ Tracheotomy may be necessary if tumor is large enough to cause upper airway obstruction β’ Early disease may be treatable by either radiation therapy or laser cordectomy on an outpatient basis. 90% cure rates are the rule. β’ More advanced disease needs inpatient care necessitating partial or total laryngectomy, and postoperative radiation therapy 4-5 weeks after surgery depending on the stage of disease ACTIVITY Fully active unless the patient is debilitated from more advanced disease and/or greater degree of surgery DIET β’ Nasogastric or gastrostomy feeding may be necessary if tumor involves esophageal inlet β’ No special diet otherwise DRUG(S) OF CHOICE β’ Narcotics may be necessary for pain control during treatment for mucositis secondary to radiation therapy β’ Nystatin mouth rinses for oral thrush PATIENT MONITORING β’ Repeat indirect laryngoscopy and complete head and neck examinations for at least fi ve years after treatment to detect early recurrence or second primary β’ Yearly chest x-ray and liver function tests β’ Patients with dysphagia should undergo barium swallow and/or esophageal endoscopy to rule out second tumor in the esophagus β’ Patients with unexplained pain should have appropriate radiological or nuclear medicine, bone scans β’ Mental status change indicates CT scan of the brain to rule out brain metastases PREVENTION/AVOIDANCE β’ Indirect laryngoscopy for patients with persistent hoarseness lasting beyond one to two weeks β’ Cessation of smoking and/or alcohol abuse POSSIBLE COMPLICATIONS β’ Temporary odynophagia or dysphagia secondary to mucositis and/or thrush during radiation therapy β’ Persistent hoarseness despite adequate treatment necessitating further adjunctive procedures and/or speech therapy β’ Tracheostomal stenosis requiring stenting with laryngectomy tubes or further surgery β’ Dysphagia, secondary to upper esophageal stricture after total laryngectomy necessitating dilatation β’ Aspiration, after partial laryngectomy necessitating completion laryngectomy or tracheotomy β’ Inability to decannulate after partial laryngectomy due to laryngeal stenosis and/or aspiration β’ Radiation induced chondronecrosis which mimics tumor recurrence β’ Radiation edema necessitating emergent tracheotomy EXPECTED COURSE/PROGNOSIS β’ Early disease is expected to have greater than 90% cure
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
X-RAY CHEST P.A. VIEW( NORMAL ), BONE SCAN, COMPLETE BLOOD COUNT, CT SCAN THORAX, BIOPSY