554 Laryngeal Cancer

Most patients describe hoarseness or throat irritation that lasts longer than 2 weeks and may report a change in voice quality. Ask about dysphagia, persistent cough, hemoptysis, weight loss, dyspnea, or pain that radiates to the ear, which are late symptoms of laryngeal cancer. Because of potential problems with alcohol and weight loss, inquire about the patient's nutritional intake and dietary habits.

PHYSICAL EXAMINATION. Inspect and palpate the neck for lumps and involved lymph nodes. A node may be tender before it is palpable. Inspect the mouth for sores and lumps. Palpate the base of the tongue to detect any nodules. Perform a cranial nerve assessment because some tumors spread along these nerves.

PSYCHOSOCIAL. The patient with laryngeal cancer is faced with a potentially terminal illness. The patient may experience guilt, denial, or shame because of the association with cigarette smoking and alcohol consumption. Efforts to cure patients of this disease often result in a loss of normal speech and permanent lifestyle changes. Patients may experience radical changes in both body image and role relationships (interpersonal, social, and work). Assess both the patient's and the significant others' coping mechanisms and support system because extensive follow-up at home is necessary.

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