Surgery for laryngeal cancer

If you have an early-stage cancer, your surgeon may be able to remove it through your mouth. This is called an endoscopic resection or transoral laser microsurgery (TLM).

A partial laryngectomy is where the surgeon makes a cut in the neck and removes the affected part of the larynx. After surgery, you should be able to speak but your voice may be weak or hoarse.

Surgery to your larynx can cause temporary swelling in your neck. This may affect your breathing. If this happens, the surgeon can make a small, temporary hole in your windpipe for you to breathe through, until the swelling goes down. This is called a temporary tracheostomy.

Some people need to have the whole larynx removed. This is called a total laryngectomy. You will breathe and speak in a different way after this operation. You will breathe through a hole in your neck, called a stoma. Your speech and language therapist (SALT) will explain about ways to speak after a total laryngectomy. This operation may sound frightening but you will have lots of support from your health care team.

When is surgery used?

The surgery you have will depend on the stage of the cancer. Surgery is used:

  • if the cancer is small enough to be removed through the mouth using an endoscope with a laser (high-power light) or small surgical instruments
  • when the cancer is locally advanced
  • if radiotherapy has not completely got rid of all the cancer (this is rare)
  • if the cancer comes back after radiotherapy.

Types of operation

There are different operations used to treat cancer of the larynx:

  • Removing the cancer through the mouth (endoscopic resection or transoral laser microsurgery – TLM).
  • Removing part of the larynx (partial laryngectomy).
  • Removing all of the larynx (total laryngectomy).

Endoscopic resection and transoral laser microsurgery (TLM)

Your surgeon may be able to remove the cancer through your mouth if you have early-stage cancer. This type of surgery is called transoral (through the mouth) surgery and means you will not have a wound in your neck afterwards. It’s done with a general anaesthetic and you only need a short stay in hospital.

The surgeon passes an endoscope (a thin, flexible tube with a camera at the end) into your throat. They use the camera to show images on a screen in the operating theatre. They then guide small surgical instruments through the endoscope or use a laser to remove the cancer.

If a laser is used, it‘s called transoral laser microsurgery (TLM). The surgeon directs the laser beam at the tumour and removes the cancer and a small margin of healthy tissue. This is to try to make sure they’ve removed all the cancer cells. They use the laser to control bleeding during surgery.

Sometimes, instead of holding the instruments themselves, the surgeon uses a machine that holds the surgical instruments. The surgeon controls the robotic arms, which can move very steadily and precisely to remove the tumour through the mouth. This is called transoral robotic surgery (TORS).

After an endoscopic resection

You may have some pain in your throat and difficulty swallowing for about two days afterwards. You can take painkillers until this improves.

If the surgery involved a vocal cord, your voice may be hoarse. Your doctor might ask you to rest it for a few days. Some people may find they’re left with a permanent change to their voice. If this happens, your surgeon can refer you to a speech and language therapist.

Rare side effects of this type of surgery include bleeding, infection and damage to your teeth. Your doctor or specialist nurse will give you more information about this before you go home.

Partial laryngectomy

This is where the surgeon makes a cut in the neck and removes the affected part of the larynx. This operation is only used rarely, as people are usually offered radiotherapy or chemoradiation instead.

After a partial laryngectomy, you should be able to speak because you’ll still have part of your voicebox. However, your voice is likely to be weak or hoarse.

Removing lymph nodes

During your operation, the surgeon may also remove some lymph nodes to check for cancer cells, or to remove affected lymph nodes. This is called a neck dissection. Your surgeon will discuss this with you before your operation. The nodes that are removed are sent to a laboratory to be examined for cancer cells.

After the operation, your neck and shoulder may be stiff on the side where the surgery took place. A physiotherapist can teach you some exercises to help with this.

Temporary tracheostomy

Sometimes, surgery to the larynx can cause swelling in your neck. This is temporary, but it can narrow your airway and may affect your breathing. If this happens, the surgeon will make a small opening in your windpipe that you can breathe through until the swelling goes down. This is called a tracheostomy.

The opening at the front of your neck is held open with a small, plastic tube that’s a few centimetres long. When the swelling goes down (after about 5 to 7 days) and you can breathe easily, you will have the tube taken out. The opening heals over naturally.

If you have a tracheostomy, you won’t usually be able to speak with the tube in place. Your speech and language therapist will give you advice on how to cope with this.

Your surgeon will tell you in advance if you’re likely to have a tracheostomy for a short time after your operation. This gives you time to prepare. You can ask questions before your operation – this can help reduce any anxiety you might have. The specialist nurse or speech and language therapist will talk to you about having a tracheostomy before your operation.

Total laryngectomy

Some people need an operation to remove all of the voicebox in order to remove all of the cancer. Your doctors may offer this if they feel that radiotherapy may not cure the cancer. You may also need to have some lymph nodes in the neck removed.

When the surgeon removes the whole larynx, there is no longer a connection between your mouth, nose and lungs. This means that you will breathe and speak in a different way. You will breathe through a hole in your neck, called a stoma. You will no longer have vocal cords to produce a voice, but will be able to speak using a choice of different ways to communicate.

Laryngectomy stoma

A laryngectomy stoma is a permanent hole in the windpipe made by the surgeon. It will be in the lower part of your neck and you will breathe through it. The stoma stays open on its own. Some people need a temporary tube to keep their stoma open for the first few days after surgery, but this is rare.

Laryngectomy stoma
Laryngectomy stoma

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The thought of having a laryngectomy stoma can be frightening. But you’ll be given a lot of support and information from your healthcare team.

You have your stoma for the rest of your life and you breathe through it from the time of your operation. Your surgeon, specialist nurse and speech and language therapist will talk to you about this before your operation. When you’re well enough, your nurse will teach you how to clean and take care of the stoma. You can continue to get support from your healthcare team for as long as you need it.

Back to Surgery explained

Before your operation

Before you have surgery, members of your MDT (multidisciplinary team) will talk to you about what will happen.

Who might I meet?

A team of specialists will plan your surgery. This will include a surgeon who specialises in your type of cancer.

After your operation

After surgery, doctors and nurses will make sure your breathing is safe and your pain is under control.