Surgical Treatment for Advanced Cancer of the Larynx
In the video below, Physician’s Assistant Allison Seamon, describes what to expect when you are facing surgical treatment for advanced cancer of the larynx.
Before your surgery
If you have cancer in your larynx, otherwise known as the “voicebox,” you may have be considering a laryngectomy as a treatment option. Laryngectomy is a surgical procedure which removes the larynx. Depending on the stage of your cancer, you may be a good candidate for a partial laryngectomy, which entails removing only part of the larynx. If your cancer is advanced enough, your best option for treatment may be a total laryngectomy. The term “total laryngectomy” means removal of the entire voicebox and the structures that house it. Our goal as head and neck surgery specialists is to not only remove the tumor, but reconstruct the esophagus and the airway so that you can maintain function of these organs. We aim to preserve speech and swallow function so that you can learn to talk and eat again after your surgery.
Meeting the Team
There are a number of clinicians that will be involved in your care during and after surgery. A few examples include physicians, nurses, speech therapists, dieticians, and social workers. There are a few key people who will be heavily involved in your care. At Swedish, your intimate team of head and neck cancer specialists will most likely consist of a physician, physician assistant, and a specially trained speech pathologist. They work together from start to finish, in an effort to treat your cancer and rehabilitate your speech and swallow function. This involves surgical planning, pre-operative training and counseling, post-operative visits, speech rehabilitation, and coordinating necessary supplies.
The Surgical Procedure
During a laryngectomy an incision is made to the neck and down through the soft tissue to isolate the larynx. When the larynx is removed from your body, your windpipe, which is your air circuit, will be disconnected. The airway will be missing a large segment without the larynx. Your throat will be rebuilt your by our reconstructive head and neck surgeons so that these organs will function again. To achieve tracheoesophageal speech, a connection will be built between the windpipe and the esophagus. This involves puncturing the back wall of the trachea and implanting a voice prosthetic device.
The voice prosthesis is a small, pliable tube with a one-way valve. The purpose of the prosthesis is to reroute the airflow from your lungs, allowing you to speak. After surgery, the air you breathe will pass in and out of a hole in your neck, rather than your nose. This hole is called a “stoma.” This will be how you breathe from here on out. You will learn how to reroute the air from your lungs up through the prosthesis and out your mouth to create a new voice. Once your throat has healed from surgery, you will start eating and drinking by mouth again. Regular follow up with the head and neck team will be required. This is very important to monitor for cancer recurrence.
In most cases, you will meet with your speech pathologist before surgery. This allows you and your family or caregiver (s) to ask questions and express any concerns you may have about surgery and recovery process. This appointment also allows the speech pathologist to evaluate your swallowing and communication needs which will help you make choices for rehabilitation after surgery. The speech pathologist will instruct you on the structural, functional, and lifestyle changes that may occur as a result of the surgery.
Two common changes in your function that occur following removal of your larynx involve methods of breathing and talking. Your speech pathologist will work with you to develop skills to manage both of these changes.
After a laryngectomy, your breathing and airway will be altered. You will breathe through the new airway, or stoma, that has been surgically created in your neck. You will be trained to use specific devices that help restore the function that your upper airway performed before your surgery. These functions include warming, moistening and filtering the air.
There are three communication options for individuals that undergo a total laryngectomy. While this may be your primary method of communication, it is important to be able to have a backup method in the event that your prosthesis is temporarily not able to function properly. Most patients also learn to use an electrolarynx, either as their primary form of communication or as a backup.
You may also be a candidate for learning esophageal speech. Each option has advantages and disadvantages, and may or may not be a good option for you. Your speech pathologist will help you select the appropriate method or methods of communication based on your specific needs and physical capabilities. Some of the supplies related to each method may not be covered by your insurance and may require some out of pocket expenses.
Facing a diagnosis of laryngeal cancer and the removal of your voice box is very frightening. There are several options for restoring speech and many people are able to return to a life similar to the one that they had before surgery. Your speech pathologist and the head and neck cancer team will work together to walk you through every step of this difficult journey.