Free cancer support
Laryngeal cancer
Laryngeal carcinoma is a malignant tumor arising from the tissues of the larynx, primarily originating from the laryngeal mucosal epithelium (squamous cell carcinoma being the predominant histological type). It is significantly more common in males and typically occurs in individuals over 50 years of age. Etiology is strongly associated with tobacco smoking, chronic heavy alcohol consumption, environmental/occupational exposures, and certain viral infections. Early-stage disease is often subtle or asymptomatic, making timely screening and comprehensive nursing management essential for preserving voice, swallowing function, airway patency, and overall quality of life.
Major risk factors include:
- Tobacco smoking: The most significant and well-established risk factor; carcinogenic compounds in tobacco smoke directly damage laryngeal mucosa and exhibit a clear dose-response relationship.
- Chronic heavy alcohol consumption: Acts synergistically with smoking to markedly elevate risk through mucosal irritation and promotion of carcinogenesis.
- Chronic irritants: Long-term exposure to dust, chemical fumes, asbestos, or acid mists in occupational settings.
- Viral infection: High-risk human papillomavirus (HPV), particularly HPV-16, is implicated in a subset of laryngeal carcinomas, especially oropharyngeal-extension and supraglottic subtypes.
- Genetic and familial predisposition: Family history of head and neck cancer or inherited syndromes affecting DNA repair increase susceptibility.
Early detection, functional preservation strategies (voice and swallowing rehabilitation), and proactive lifestyle management are critical for maintaining speech, deglutition, and long-term quality of life.
Early-stage laryngeal carcinoma often presents with subtle or nonspecific symptoms. As the tumor progresses, the following manifestations may develop:
- Voice changes: Persistent hoarseness (lasting >2–3 weeks) or alteration in voice quality; the most common and earliest warning sign, particularly in glottic tumors.
- Globus sensation in the throat: Feeling of a lump, foreign body, or constant throat irritation/pressure.
- Cough or hemoptysis: Chronic dry cough, irritative cough, or blood-streaked sputum.
- Dysphagia: Progressive swallowing difficulty, odynophagia (painful swallowing), or food sticking sensation, more prominent in supraglottic or hypopharyngeal extension.
- Cervical lymphadenopathy: Painless, firm, enlarged neck nodes, often the first presenting sign in supraglottic tumors and indicative of regional metastasis.
- Constitutional symptoms: Unintentional weight loss, fatigue, and chronic malaise, suggesting advanced disease or paraneoplastic effects.
Some patients may experience dyspnea, stridor, or nocturnal cough, requiring prompt clinical evaluation and nursing intervention.
Diagnosis of laryngeal carcinoma employs a multimodal approach focused on early detection, accurate subsite classification, staging, and development of individualized nursing care plans:
- Imaging studies
- Contrast-enhanced computed tomography (CT) neck or magnetic resonance imaging (MRI): Primary modalities for assessing tumor size, local extension (cartilage involvement, pre-epiglottic/paraglottic space invasion), vocal cord mobility, and cervical lymph node metastasis.
- 18F-FDG PET-CT: Indicated for detection of occult distant metastases, unknown primary with cervical nodes, and restaging in advanced or recurrent disease.
- Endoscopic evaluation
- Indirect laryngoscopy, flexible fiberoptic laryngoscopy, or videostroboscopy; direct rigid laryngoscopy under anesthesia: Allows direct visualization of tumor location (glottis, supraglottis, subglottis), extent, and vocal cord function; facilitates targeted biopsy and accurate biopsy.
- Histopathological examination
- Biopsy (office-based or operative) or surgical resection specimen: Gold standard for confirming squamous cell carcinoma (or rare variants), WHO/ISUP grading, depth of invasion, and perineural/lymphovascular invasion.
- Tumor biomarkers and molecular testing
- Serum markers (limited role; SCC-Ag or CEA occasionally used for monitoring.
- HPV testing (p16 immunohistochemistry and HPV DNA ISH/PCR) mandatory in selected cases (especially supraglottic/oropharyngeal-extension tumors) for prognostic and therapeutic stratification.
- Next-generation sequencing for actionable alterations (e.g., EGFR, PIK3CA) and PD-L1 expression to guide targeted therapy or immunotherapy eligibility and personalize long-term nursing and surveillance strategies.
Nursing and supportive care strategies for laryngeal carcinoma can be divided into conventional modalities and personalized supportive approaches, aimed at delaying disease progression, preserving quality of life, enhancing immunity, and promoting overall health:
Surgical Management
- Indicated for early-stage and selected locally advanced tumors; procedures include transoral laser microsurgery, partial laryngectomy (open or endoscopic), or total laryngectomy with neck dissection when indicated.
- Postoperative care includes nutritional support (enteral feeding if needed), wound/tracheostoma care, voice rehabilitation (speech therapy, voice prosthesis, esophageal speech, or electrolarynx), and psychological counseling to facilitate recovery and maintain communication and swallowing function.
Radiation Therapy and Chemotherapy
- Radiotherapy (definitive or adjuvant, often intensity-modulated) for organ-preservation in early disease or to reduce recurrence risk.
- Chemotherapy (concurrent cisplatin-based chemoradiotherapy or induction regimens) for locoregionally advanced or metastatic disease; combined with rigorous hydration, antiemetic therapy, nutritional support, and mucositis management to minimize toxicity.
Targeted and Immunotherapy
- Personalized regimens guided by molecular profiling (e.g., PD-L1 expression, EGFR status, HPV status); includes immune checkpoint inhibitors (pembrolizumab, nivolumab) as first-line in recurrent/metastatic disease.
- Integrated with immune enhancement, nutritional optimization, and functional rehabilitation to improve resistance and quality of life.
Nutritional and Intravenous Supportive Therapy
- High-dose intravenous vitamin C, glutathione, amino acids, and trace elements to support energy metabolism, immune function, and tissue repair.
- Dietary recommendations: soft, easy-to-swallow, high-protein, nutrient-dense foods; avoidance of irritants (alcohol, spicy/acidic foods, tobacco) to protect laryngeal mucosa and facilitate swallowing.
Individualized Monitoring and Long-term Care
- Regular imaging (CT/MRI/PET-CT), fiberoptic laryngoscopy, serum markers, and molecular surveillance to monitor disease status.
- Patient-specific care plans with ongoing adjustment of nutrition, lifestyle, voice/swallowing therapy, and psychosocial support.
- Specialized protocols for patients with impaired swallowing/speech, immunosuppression, or high recurrence risk to optimize long-term quality of life and functional outcomes.
