Laryngectomy

This surgical procedure is performed in cases of cancer of the larynx. It can include removal of the tumour only or a partial or complete removal of the larynx.

There are four types of surgery to remove a cancerous tumour which are:

• Removal of the tumour only and/or surrounding tissues (if also infected).
• Partial removal of the larynx
• Complete removal of the larynx
• Removal of the lymph glands

If a tumour is found to be cancerous then it will be removed along with surrounding tissues, and in some cases, the lymph glands. This depends upon the extent of the cancer but doing so will prevent it from spreading to other parts of the throat.

Complete removal of the larynx is a major form of surgery and is not performed very often. But it is still undertaken in cases of malignancy or if a person has sustained a severe injury to their larynx.

The type of surgery you have will depend upon the location and extent of the tumour within your larynx.

If you have a tumour within your larynx which is small then laser surgery will be used to remove it. Another option is to use an endoscope – a slim tube passed into your throat which surgical instruments are passed through. The surgeon is able to remove the tumour via this method.

There is more the one type of laryngectomy which includes:

• Endoscopic resection
• Partial laryngectomy
• Total laryngectomy
• Neck dissection

(Source: Cancer Research UK: laryngeal cancer)

All of these surgeries are classed as major procedures and are performed under general anaesthesia.

Endoscopic resection

This is the name given to the procedure which uses an endoscope to remove the infected growth from the larynx. He or she will insert this slim tube –which has a light inside and a camera mounted at one end –into your mouth and pass this into your throat.

The surgeon is able to insert surgical instruments into this tube and use these to remove the growth. Another option is a laser which is very effective at cutting away infected tissues and results in little or no bleeding.

Partial laryngectomy

If the tumour has developed inside your vocal cords then a partial laryngectomy is required. This involves removing part of the infected cords which will affect the quality of your voice. You will still be able to speak but your voice will be weak or sound hoarse.

The procedure involves the surgeon making a small incision in your neck. This incision is later widened into a hole or ‘stoma’ at the end of the procedure.

The surgeon then removes the tumour and part of your larynx.

He or she then creates the stoma and will place a tracheostomy tube within that to aid with breathing. This tube keeps the stoma open and remains in place whilst your larynx is healing. Once it is healed the tube is removed. The stoma will gradually close.

As only part of your vocal cords has been removed you will still be able to speak although not in the same way as before. Your speech will be affected and will require help from a speech therapist. This therapist will form part of your multi-disciplinary team.

What is the main difference between a partial laryngectomy and a total laryngectomy?

The difference between this and a total laryngectomy is that the tracheostomy tube is removed after a short period of time whereas it is a permanent fixture in cases of total laryngectomy.

Total laryngectomy

If your larynx has been injured or suffered some other type of trauma then it will need to be removed via a total laryngectomy. This means a complete removal of your vocal cords and tissues surrounding this and possibly part of your pharynx.

The procedure is still the same as for a partial laryngectomy but with one major difference: your vocal cords are removed which means that you will have to permanently breathe through your stoma.

You will also have to learn new ways of talking which includes using prosthetic devices to mimic the sounds made during speech.

As you no longer have a larynx this means that you will not be able to inhale and draw air down into your lungs in the normal manner. In order to enable you to breathe the surgeon will create a stoma by attaching the trachea (windpipe) to the stoma.

This is known as a ‘laryngectomy stoma’ and is permanent.

You will have a tracheostomy tube inserted into the stoma after your surgery to keep this open. This enables it to remain open whilst it heals. Once the stoma has healed the tube will be removed.

You will have to become accustomed to using your stoma to breathe and cough through. This can seem a bit daunting but you will be given advice on how to do this.

Neck dissection

This is surgery performed to remove infected lymph glands in your neck if cancer has spread to any of these. These lymph glands are located in groups around the larynx and the group nearest to this will be removed first.

If a couple of glands within a group are cancerous then the others in that group will be also be removed. This is done to arrest the spread of the disease.

There are two types of neck dissection:

• Selective neck dissection
• Radical neck dissection

Selective neck dissection

This involves the removal of a group of lymph glands from one side of the neck.

Radical neck dissection

This procedure involves the removal of all of the lymph glands on that side of the neck plus the main vein, nerve and muscle. In some situations the lymph glands can be removed with touching the vein, nerve and muscle in a procedure called a ‘modified radical dissection’.

After a laryngectomy

The difficult part for many people is adapting to life after a laryngectomy especially a total laryngectomy which is a permanent state of affairs.

This means having to learn how to breathe again and speak which can be frustrating and distressing. But there is help available.

There are cancer support groups, counselling services and the care team itself. They are all trained in this aspect of cancer care and understand the problems people face after surgery. Talk to someone if you need to or alternatively, discuss this with someone in your family or a close friend.

You will be given help from a speech therapist on how to use your stoma to help you communicate. This includes covering the stoma in order to speak or swallowing air via your oesophagus as a form of speech.

Other options include voice prosthesis or an electronic larynx (‘electrolarynx’) which produces sound to enable you to speak. Another option is to write things down via a pen and paper or a small laptop.