Surgery for laryngeal cancer

When surgery may be used Back to top

Surgery may be used to remove the tumour if:

• it’s small enough to be removed by laser surgery
• the cancer has stopped the vocal cords from moving at all
• the cancer has affected more of the larynx than just the vocal cords
• an early stage tumour is not completely gone after radiotherapy treatment, although this is rare
• the cancer comes back some time after radiotherapy.

Surgery may also be used to control the symptoms of advanced cancer| of the larynx.

Before having surgery, you’ll be assessed to ensure you are fit enough for an operation. This is likely to include some blood tests, a chest x-ray and an electrocardiogram (ECG) to assess your lungs and heart. As most surgery for laryngeal cancer involves a general anaesthetic, smokers should try to stop smoking| before surgery.

Laser surgery (laser treatment) Back to top

Early stage tumours may be treated by directing a laser light beam at the tumour. A tube with a light at the end (endoscope) is passed down the throat so that the laser can destroy the cancer cells.

Laser surgery is done under general anaesthetic. It may be possible to go home later the same day, but you may need to stay in hospital overnight. You may have some pain in your throat and difficulty swallowing|, but this shouldn’t last for more than a couple of days.

If surgery involves a vocal cord, your voice may be hoarse and you may be asked to rest it for a few days after surgery. Sometimes long-term voice changes can occur. Other rare side effects include bleeding, infection and damage to your teeth. Your doctor or specialist nurse will give you more information about this before you go home.

Temporary tracheostomy Back to top

A tracheostomy is a procedure to create an opening in the lower part of your neck for you to breathe through. The opening is held open with a tube. It may occasionally be needed in the following situations to help with your breathing:

• before you start treatment if the cancer is likely to block, or is actually blocking, your airway
• to help with breathing difficulties if the cancer is very advanced
• during radiotherapy if the tissues become inflamed and swollen leading to a narrowing of your airway (this is a rare side effect).

A temporary tracheostomy will usually only be needed for a short time.

Total laryngectomy Back to top

Some people need to have the whole voicebox removed. This operation is known as a total laryngectomy. When the larynx is completely removed, there is no connection between the mouth or nose and the lungs. So during the operation, the surgeon creates a permanent opening in the lower part of the neck for you to breathe through (see diagram below). This is called a laryngectomy stoma.

 

There is a diagram of a voice prothesis valve in the section on voice restoration|.

Partial laryngectomy Back to top

Very rarely, part of the larynx, rather than the whole larynx, can be removed. This is known as a partial laryngectomy. Part of the voicebox will be left so that you will still be able to speak, but your voice is likely to be weaker or hoarse. After this operation, you may have a temporary tracheostomy to allow you to breathe.

If the cancer has spread into the lymph nodes| in the neck, these may need to be removed with surgery. This will be done as part of the laryngectomy or occasionally before or after radiotherapy to the tumour. Your doctor will discuss this with you before your operation.

After a total laryngectomy operation Back to top

Immediately after the operation, you will breathe and cough through the laryngectomy stoma in your neck. Sometimes the laryngectomy stoma will need to be held open by a tube for a few days (sometimes called a laryngectomy tube or tracheostomy tube) while it heals. Your nurses and physiotherapist will help you with breathing exercises.

You won’t be able to speak at first and may need to communicate by writing or by using a picture book. The different ways of being able to speak again are known as voice restoration|. You’ll be taught how to keep the tube clean and how to replace it if necessary.

Your doctor or nurse will explain how your pain| will be controlled after your operation. You may be given pain relief through a syringe| connected to an electronic pump. The pump can be set to give you a continuous dose of painkiller.

You may also have a hand control with a button to press if you feel sore. This is called patient controlled analgesia (PCA). It’s designed so that you can’t have too much painkiller (an overdose), so it’s okay to press it whenever you’re uncomfortable.

There will be thin plastic tubes going into your wound to drain off fluid and allow healing.

A drip going into a vein in your arm will give you fluids for a few days. You may also have liquid foods and medicines given by enteral nutrition|. After a few days or weeks, you’ll be able to eat and drink normally again. However, you’ll need to build up| your eating gradually and the hospital dietitian can advise you about this.

Our section on eating well| contains helpful tips.

You will have your laryngectomy stoma for the rest of your life. This may be frightening at first, but you’ll be taught how to look after it until you are confident doing it yourself.