Low Grade Laryngeal Cancer

A 45 year old man presented with hoarseness. He had a microlaryngoscopy and biopsy of his left vocal cord 2 weeks ago. The histology has shown a squamous cell carcinoma with no spread beyond the vocal cord. Both vocal cords are moving normally on nasendoscopy. Inform the patient of their diagnosis and the likely management plan.

Setting

  • WIPER  (wash hands, introduce yourself, permission, expose patient, reposition)
  • Ask if he is happy to see you
  • Introduce the Head and Neck Specialist Nurse
  • Ask if wants any family/friends present

Perception

  • Recap on past events – symptoms, investigations so far
  • “Thank you for bringing me up to date.”

Invitation 

  • Results are back, can I give them to you now?
  • Patient asks whether it is cancer – “I am afraid it is not good news, the investigations do indicate that you have a cancer”

Knowledge

  • I’m afraid it is not the news we were hoping for
  • The results show that you have a cancer –  Remember to pause afterwards

Empathy

  • I am sorry to have to give you this news today.
  • I can see this is a huge shock- Pause and wait
  • You appear very anxious – Pause and wait
  • What is worrying you the most?
  • Only answer questions they ask at this stage
  • Not only smokers and drinkers get head and neck cancers.

Strategy and Summary

  • MDT will discuss case and present treatment options – eventual options will take their views into account but it likely will involve surgery transoral laser resection or radiotherapy. Surgery is an attempt at a cure.
  • Describe the operation if they ask 

Summary

  • Today we have talked about…. Do you have any further questions?
  • Once again my name is…
  • Secretary number, head and neck nurse number – will spend some time with them now.
  • Book appointment for 1-2 weeks with consultant, can come with relative
  • Some literature on the diagnosis

Safety net

  • Dial 999 or attend A&E if they develop stridor
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