Example Of Research Paper On Laryngeal Cancer And Communication
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Laryngeal cancer is cancer of the larynx (voice box, vocal cords, or other areas of the throat. Laryngeal carcinoma is the second most common malignancy of the neck and head and the eleventh most common form of cancer among men over the world (Chu and Kim, 2008). The larynx is responsible for the respiration, phonation, and deglutition while it also contributes to smell and taste by allowing the air to move over the special sense organs. Therefore, loss of laryngeal function directly affects swallowing and speech (Chu and Kim, 2008).
In 2011, there were more than 89,000 people with laryngeal cancer in the United States, alone, with one per 100,000 men and women eventually dying from it, as per the National Cancer Institute SEER Stat Fact Sheet (2014). Laryngeal cancer represents almost one percent of all new cancer cases in America and affects mainly men, usually, after their 55th year of age (National Cancer Institute, 2014). It is estimated that approximately half percent of the population will be diagnosed with laryngeal cancer at some point in their life.
In laryngeal cancer, malignant cells form in the tissues of the larynx, especially the squamous cells (National Cancer Institute, 2014). Although most laryngeal cancers form from the squamous cells (cells that line the larynx’s surface), there are other types of laryngeal cancers, although rare. These types may arise from the cartilages and the glandular tissues, and include: (1) chondrosarcoma, (2) adenoid cystic carcinoma, (3) adenocarcinoma, and (4) metastases from other cancers (National Institutes of Health, 1995).
It is believed that people that either use tobacco or smoke are at higher risk of developing laryngeal cancer, and the same applies to those that consume excessive amounts of alcohol over a long time. The combination of both though leads to an even more increased risk of throat cancer (Davidson, 2011).
Symptoms of Laryngeal Cancer
The symptoms of laryngeal cancer are dependent on the location of the tumor. Usually, tumors on the vocal cords cause hoarseness but are rarely painful. For that reason, anyone with a continuous hoarseness or persistent cough with a duration that exceeds two weeks should consult a doctor (Davidson, 2011).
The symptomatology of laryngeal cancer in the supraglottic region (above the vocal cords) include any of the following distinct symptoms:
Difficulty in swallowing
Abnormal breathing sounds (high-pitched)
Coughing up blood
Ear or neck pain
Lumps or swelling in the neck
Sore throat that does not improve, even with the use of antibiotics, within two weeks
Weight loss not related to dieting
Hoarseness that does not improve within a fortnight (Davidson, 2011).
Finally, tumors below the vocal cords may cause difficult or noisy breathing although they are rare. However, since the aforementioned symptoms are also included in the symptomatology of other health problems, the patient that is suspected of laryngeal cancer should undergo a long diagnosis process so the doctor can be sure of the presence of laryngeal cancer (Davidson, 2011).
Diagnostic Tests and Screening of Laryngeal Cancer
The first line of diagnosis is via a throat and neck physical examination, where the doctor checks the neck and the throat (including the mouth, tongue, lips, cheeks, and gums) for abnormal areas and swollen lymph nodes.
Diagnosis of laryngeal cancer is usually made through the following:
Extralaryngeal tumor spread can be detected by assessing the status of the neck nodes, based on clinical palpation. However, nodes with a small deposit of carcinoma may not be clinical palpable. Also, not all larger sized lymph nodes have metastatic deposits. Finally, cancer that has spread to regional lymph nodes is usually much harder to detect (Castelijns, Snow, and Valk, 2012).
Both direct and indirect laryngoscopy can reveal much information in regards the volume, size, and the extent of the intralaryngeal lesion. Direct laryngoscopy examines the laryngeal ventricles, the apex of the pyriform sinuses, and the anterior commissure. The procedure allows the doctor to remove tissue for histopathological examination. Indirect laryngoscopy provides the opportunity to assess superficial structures of the larynx’s interior. During phonation, indirect laryngoscopy can also allow the examination of the mobility of the cords, but it does not interfere with the normal mobility (Castelijns, Snow, and Valk, 2012).
In a laryngoscopy, the doctor inserts a laryngoscope, a lighted fiberoptic tube, with a tiny camera attached to it, into the patient’s throat through the nose and mouth, in order to see the larynx and surrounding area (Davidson, 2011). The use of local anesthetic or sedative is considered necessary; however, the majority of cases use general anesthesia and is performed in an outpatient surgery hospital or clinic. The doctor takes biopsies of any areas that look abnormal, with the help of very small clips attached to the end of the laryngoscope. It is a painless, hourly procedure that leaves the patient with a sore throat after the procedure. Based on the findings of the pathologist, laryngeal cancer can be diagnosed and staged (Davidson, 2011).
The doctor uses a strobe light that helps visualize the rapidly vibrating vocal folds, revealing any changes on the vocal folds that might have been otherwise not seen with the use of other methods (Everything Speech, 2012).
When cancer is diagnosed, a doctor may require additional tests to help diagnose the exact location and size of the tumors. These diagnostic tests include:
CAT or CT (Computed Tomography).
FNA (Fine Needle Aspiration) biopsy
Finally, to determine which cancer treatment is more appropriate for the patient, it is important the patient also has blood and urine tests that will show the patent’s overall health condition (Davidson, 2011).
New Treatments for Laryngeal Cancer
There are three types of treatments for laryngeal cancer: (1) surgery, (2) radiation, and (3) chemotherapy, which can be either used combined with one another or alone, always depending on the stage of the cancer.
Any tissue with cancerous cells are removed with surgery, and there are several types of surgeries performed depending on the stage of the tumor. For example, cancer of Stages III and IV are usually treated with laryngectomy, which is an operation that that cuts off the entire larynx and, sometimes, surrounding tissues, if necessary (Davidson, 2011). With total laryngectomy, the patient loses all their vocal cords, which is why an alternative method of voice communication is necessary. However, in case of smaller tumors, partial laryngectomy is performed and removes the cancer while saving as much of the larynx as possible. Laser excision surgery is mainly used to remove cancer in situ or very small tumors (Davidson, 2011). For advanced cancers, where cancer has spread to the lymph nodes, a neck dissection is required. Neck dissection is a procedure that removes the lymph nodes and does not allow the cancer to spread.
If the larynx is removed completely, a tracheotomy (a procedure that creates an artificial opening in the trachea) lets the air flow into the lungs, allowing the patient to breathe. In cases where the oesophagus is blocked or the patient cannot swallow due to a tumor in the oesophagus, a gastrectomy tube is placed directly into the patient’s stomach, through the skin (Davidson, 2011).
Radiation uses gamma rays or x-rays to destroy cancer cells and preserves the patient’s ability to speak while leaving the larynx intact. However, it may not kill all cancerous cells. Radiation is mainly used in the early stages of cancers or combined with surgery. It is also a therapy used to destroy the malignant cells that may not have been removed by a surgeon, in advanced cancers. From the two types of radiation, the most common treatment for laryngeal cancer, external beam radiation, sends rays outside the body on cancerous tissue of the laryngeal cancer while internal radiation treatment is a therapy where radioactive materials are placed directly on the malignant tissue (Davidson, 2011).
Chemotherapy uses drugs (taken orally or intravenously) to destroy malignant cells. It is a therapy used for advanced inoperable laryngeal cancers that have metastasized to a distant site. It is also a treatment used after surgery, or it could be combined with radiation therapy, as well. The disadvantage of this treatment is that the conventional drugs used to treat laryngeal cancers have numerous side effects (e.g. hair loss, mouth sores nausea, etc.). Finally, chemotherapy increases the risk of abnormal bleeding and infection (Davidson, 2011).
How Patients Adapt to New Ways of Communicating
After a patient has been treated for advanced laryngeal cancer, meaning they have had their larynx removed in its entirety, patients need to adapt to the new disrupted anatomy and the creation of a permanent tracheostomy. There are several rehabilitation options available, including (1) electrolarynx (EL), (2) esophageal (ES), and (3) tracheoesophageal (TE) speech. With the help of a speech pathologist and physicians, the patient can obtain their vocal function again (Angel, Doyle, and Fung, 2011).
The electrolarynx is a device that transfers vibrations through the tissues of the neck and into the vocal tract. It can also be introduced directly into the patient’s oral cavity and allow the patient to communicate in a very effective manner. However, due to the monotonous voice that it produces, studies have shown that it scores low on voice-related quality of life, compared to other rehabilitation methods (Angel, Doyle, and Fung, 2011).
After a laryngectomy, the patient’s natural voice is removed. For this reason, there must be a new vibratory source to allow the patient to speak again. In oesophageal speech, the patient learns to speak with the help of air injected into the esophagus, which is then expelled and vibrates the pharyngoesophageal mucosa. The patient uses that vibration, which acts as an oesophageal sound and speak. However, since only small amounts of air are injected to vibrate the mucosa, the patient experiences short phonation times. That said; those that have invested time learning oesophageal speech appear satisfied with the end results (Angel, Doyle, and Fung, 2011).
This is a significantly viable method of vocal rehabilitation after a laryngectomy. The surgeon places a controlled midline fistula between the trachea and the esophagus, which allows air to flow into the esophagus, before it reaches the puncture. According to Angel, Doyle, and Fung (2011) “This prosthesis prevents aspiration by restricting passage of esophageal contents into the airway, but airflow generated by the lungs can flow into the esophagus via the prosthesis, vibrating the PE mucosa and creating a source of sound”. The Tracheoesophageal speech is louder and is characterized by enhanced speech intelligibility and elevated pitch, compared to the other two pre-mentioned rehabilitation options (Angel, Doyle, and Fung, 2011).
Nursing Care of Laryngeal Cancer Patients
The magnitude of the total laryngectomy that the patient with laryngeal cancer has undergone requires in-depth knowledge, both technical and scientific, of the nurses, so they can see to the exact needs of the patient and plan nursing healthcare for the patient that experiences psychological, physical, and social difficulties. In general, nurses should plan interventions whose aim is to preserve the balance of the patient’s skin integrity, general clinical state, adequate hydric ingestion, and balanced diet while also monitoring the patient’s clinical signs of hydration, hygiene, and infection. They are also responsible for explaining to both the patient and his or her family about the importance of follow-up evaluations throughout the treatment (de SantanaI, Sawada, 2008).
Laryngeal cancer is the second most common type of neck and head cancer and affects mainly men after their 50s, especially those that smoke and drink too much alcohol. Its symptomatology includes many symptoms that are common with other health conditions, such as coughing for more than two weeks and difficulty in swallowing. However, if lumps or swelling in the neck is observed, a doctor will conduct a physical examination to determine whether the patient has laryngeal cancer or not and recommend the appropriate treatment from the many available right now. After the treatment, the patient will need to rehabilitate their speech and learn to speak again with the help of devices, specially designed for that reason.
Angel Doug, Doyle Philip, Fung, Kevin (2011). Measuring voice outcomes following treatment for laryngeal cancer. Expert Review of Pharmacoeconomics & Outcomes Research. 11.4 (Aug. 2011): p415.
Castelijns, J.A., Snow, G.B., Valk, Jaap (2012). MR Imaging of Laryngeal Cancer: Volume 23 of Series in Radiology. Springer Science & Business Media. ISBN 9401132860.
Chu, E., Kim, Y. (2008). Laryngeal cancer: diagnosis and preoperative work-up. Otolaryngol Clin North Am. 2008 Aug;41(4):673-95, v. doi: 10.1016/j.otc.2008.01.016.
Davidson, Tish (2011). Laryngeal Cancer. The Gale Encyclopedia of Medicine. Ed. Laurie J. Fundukian. 4th ed. Detroit: Gale, 2011. 6 vols.
de Santana, Mary-Elizabeth, Sawada, Namie-Okino (2008). Pharyngocutaneous fistulae after total laryngectomy: a systematic review. Rev. Latino-Am. Enfermagem, vol.16 no.4 Ribeirão Preto Aug. 2008. Retrieved Feb. 12, 2015 from: http://www.scielo.br/scielo.php?pid=S0104-11692008000400019&script=sci_arttext
Everything Speech (2012). VOICE DISORDERS. Retrieved Feb. 12, 2015 from: http://www.everythingspeech.com/articles/voice-disorders/?PageSpeed=noscript
National Cancer Institute (2014). SEER Stat Fact Sheets: Larynx Cancer. National Institutes of Health. Retrieved Feb. 12, 2015 from: http://seer.cancer.gov/statfacts/html/laryn.html
National Institutes of Health (1995). SEER Program: Self-Instructional Manual for Cancer Registrars- Human Anatomy as Related to Tumor Formation. Book 4 (2nd ed.). p. 430-432. Retrieved Feb. 12, 2015 from: http://seer.cancer.gov/training/manuals/Book4.pdf
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