Lung Cancer & Laryngeal Cancer

A persistent hoarse voice or a cough that changes character after decades of smoking may not be bronchitis — it may be cancer presenting its only early warning.

Lung cancer is the leading cause of cancer death in the U.S. for both sexes. It divides into two major types: non-small cell (NSCLC, ~85%) and small cell (SCLC, ~15%). SCLC is more aggressive, metastasizes early, and is almost exclusively linked to smoking. Early lung cancer is often silent; late signs include persistent cough, hemoptysis, unilateral wheezing, dyspnea, unexplained weight loss, and chest pain. Superior vena cava syndrome (facial/neck edema, distended jugular veins) and Pancoast tumor signs (shoulder/arm pain, Horner syndrome) are high-yield emergency presentations. Diagnosis involves chest CT, biopsy, and PET scan — nursing focus is on post-bronchoscopy monitoring (NPO until gag reflex returns, watch for hemoptysis). Laryngeal cancer shares the smoking/alcohol risk profile but presents earlier with progressive hoarseness lasting longer than two weeks. Post-total laryngectomy, the patient has a permanent stoma that is their only airway — no connection to the nose or mouth exists. Suctioning is done through the stoma, never nasally. The patient cannot perform a Valsalva maneuver, and aspiration risk is essentially eliminated because the trachea is completely separated from the esophagus.

Key Distinctions

Don't confuse partial laryngectomy (patient may still speak and has some natural airway) with total laryngectomy (permanent stoma, no nasal airway, requires alternate communication). Students mix up lung cancer hemoptysis (blood-streaked or rust-colored sputum) with TB hemoptysis — lung cancer is typically less acute but more persistent. SCLC is staged limited vs. extensive, not by TNM like NSCLC.

Clinical Pearl

After total laryngectomy: the stoma IS the airway. No nasal suctioning, no oral airway, no nose-breathing — if that stoma occludes, the patient suffocates.