Cancer: 1) With laryngeal cancer, look for whispering, raspy voice because it could have metasticzed to the vocal

cords. 2) Does not have any screening to prevent growth. 3) Usually found in stage 3 or 4, and affecting lymph nodes. 4) Risk factors: a. Smoking b. ETOH (Alcohol) c. Asbestos - families at risk. d. GERD irritates and mutates into cancer. e. HPV 3 times more chance men than women; African American. 5) Symptoms: a. Voice change is number one!! Never goes away b. Dysphagia, sore throat, lump in throat, dyspnea larynx gets bigger and blocks airway. c. Hemoptysis d. Cough, aspiration e. Airway obstruction 6) Diagnositic Tests: a. CXR b. CT c. MRI d. Endoscopy -Without biopsy, cannot confirm cancer. Need to grade. 7) Medical a. Radiation 2nd treatment: must wait til everything heals (delays wound healing process) b. Chemotherapy 3rd treatment: c. Surgery 1st treatment: Cut with safety margin and surrounding structures (neck dissection) to remove entire cancer (laryngectomy). 1) Bleeding/swelling could cause airway obstruction. NEVER overextend the neck- 30 to 45 degree HOB, pain medication, interlace hands and put in back of neck when doing exercises. 2) Bleeding- check pillow/sheets, color of blood, amount of blood. 3) Safety (gag reflex is impaired)- need evaluation 4) Pain- need to take meds otherwise develop pneumonia. Wont get addicted to pain meds in 3 to 4 days (reassure that they need to take pain meds). 5) Malnourishment Put on TPN 1 week before surgery and probably wont eat for months. 6) Communication give pt writing pad. When they go back home, will have problems communicating with society- refer to specialist with speaking devices. 8) Stage Grouping a. Invasion on one side of neck is better than 2 sides. 9) Clinical Manisfestations: a. Chronic coughing or change in regular coughing pattern, hemoptysis b. Dyspnea c. Wheezing d. Chest or abdominal pain

e. Cachexia loss of appetite*** f. Fatigue** 10) Pleural Effusion a. Cancer could cause pleural effusion. b. Decreasing lung capacity dyspnea, difficulty breathing. Only way to help them is via thoracentesis.

Lung Cancer 1) Surgery: a. Wedge resection- remove tumor in lungs with safety margin. Probably lots of drainage (blood, fluid) ***questions about drainage. b. Lobectomy- remove entire lobe. Also need chest tube for drainage c. Pneumenectomy- remove entire lung. Clean surgery and probably without chest drainage. Make sure other lung is stronguse IS!!! **** 2) 90% of lung tumors arise from bronchi. 3) Risk Factors: a. 85-90% chance of getting cancer if smoker. b. 15% chance of getting cancer if non-smoker. 4) Types of lung cancer: a. Non-small cell lung cancer (arise from adeno grandular tissue OR squamous cell carcinoma of epithelial tissue) b. Small cell carcinoma (oat cells) c. Mesothelioma (lining of lungs) nothing to do with smoking. Everything has to do with asbestos. Occurs over the lungs. d. Lung cancer survival rate 15%. 5 years survival or longer usually die before then. Pleura 1) If increased inflammation pleural friction rub (painful) more inflammation increased permability within capillaries albumin albumin attracts more H20 in plural space. a. Give anti-inflammatory and steroids. If caused by a bug, give antibiotic too. b. Find dull sounds with percussion (normal is tympany and resonance). Due to fluid in pleural space. c. Pain will go away once pleural effusion develops not good!