a. Malignancy lies above the clavicle, for instance lip, mouth,
nasal cavity, paranasal sinuses, pharynx, larynx, but excludes
the brain, spinal cord, axial skeleton, and vertebrae.
b. Cancers limited to the vocal cords (intrinsic) tend to
spread slowly, whereas cancers involving the epiglottis
(extrinsic) are more likely to metastasize to lymph nodes
c. 90% to 95% of laryngeal neoplasms are squamous cell carcinomas
that arise from the oral cavity (Campbell & de le
Torre, 2008; Oral Cancer Foundation, 2008).
d. Rate of disability is high because of the potential loss of
voice, disfigurement, and social consequences.
a. Radiation alone is the most common treatment for early
stages of some head and neck cancers, such as those
affecting the nasopharynx, larynx, and oropharynx.
b. Combination of radiation and chemotherapy is increasing in
use to preserve structures.
c. Surgery remains mainstay of treatment for advanced-stage
laryngeal cancer, often in combination with radiation.
i. Total laryngectomy (TL), resulting in a permanent tracheostomy,
with normal speech and swallowing no longer
ii. Near total laryngectomy (NTL) or conservation laryngeal
surgery, with swallowing function and some speech
a. Between 85% to 90% of all head and neck cancers can
be traced to the use of tobacco products or excessive
consumption of alcohol (American Association for Cancer
b. Additional risk factors include chronic candidiasis, poor
oral hygiene, ill-fitting dentures, human papillomavirus
(HPV), Epstein-Barr virus (EBV), and acid reflux disease
(Campbell & de la Torre, 2008).
IV. Statistics (National Cancer Institute [NCI], 2007b)
a. Morbidity: Head and neck cancers compose approximately
4% of all cancer cases in the United States, with an
estimated 40,000 men and women diagnosed in 2004.
i. Peak incidence between ages 50 and 60
ii. Male-to-female rates greater than 2:1 (Campbell & de la
b. Mortality: 5-year survival rate is at 50% (Mouth Cancer
c. Cost: In 2001, lifetime economic burden in the United
States was estimated at $976 billion (Lee et al, n.d.) and the
annual cost for treatment in the United States was approximately
Client is treated in inpatient surgical and possibly subacute
Psychosocial aspects of care
Total nutritional support: parenteral/enteral feeding
1. Maintain patent airway and adequate ventilation.
2. Assist client in developing alternative communication
3. Restore or maintain skin integrity.
4. Reestablish or maintain adequate nutrition.
5 Provide emotional support for acceptance of altered body
6. Provide information about disease process, prognosis,
1. Ventilation and oxygenation adequate for individual
2. Communicate effectively.
3. Complications prevented or minimized.
4. Begin to cope with change in body image.
5. Disease process, prognosis, and therapeutic regimen
6. Plan in place to meet needs after discharge.