Surgical Procedures: Surgery and Staging for Laryngeal Cancer

What is the larynx?

The larynx (voice box) is in your throat. It holds your vocal cords. The larynx is between the back of your tongue and your trachea (windpipe). It has three parts:

• Supraglottis.
• Glottis.
• Subglottis.

What is laryngeal cancer?

Cancer cells in the larynx are called laryngeal cancer. Most often, laryngeal cancer starts in the glottis. The most common form of laryngeal cancer is squamous cell. Other types are:

• Carcinoma in situ.
• Verrucous, spindle cell, and basaloid squamous cell cancers.
• Undifferentiated carcinoma.
• Adenocarcinoma.
• Sarcomas.
• Other cancers such as adenoid cystic and neuroendocrine cancers.

What is staging and how is it done?

Staging is a way to find out if and how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. For laryngeal cancers, these tests may be:

Physical Exam: An exam to look at your body and talk about your health history with your provider.

Imaging: Radiology tests can look inside your body at the cancer and see if it has spread. These tests can be:

• X-ray.
• CAT scan (CT scan).
• Positron emission tomography scan (PET scan).
• Magnetic resonance imaging (MRI).
• Bone scan.
• Barium swallow.

Procedures: These may be:

• Laryngoscopy: A thin, lighted tube with a camera is used to look at your larynx for any changes. A biopsy may be done if needed.
• Endoscopy: An endoscope, or a lighted tube, is used to look for any abnormal areas. If needed, the endoscope can take tissue for a biopsy.

Laryngeal cancer can spread to other parts of your body through the tissue, lymph, and blood systems. The cancer stage describes how extensive the cancer is, how far it has spread, and helps guide what treatment should be used. Laryngeal cancer is described as stages 0 (carcinoma in-situ) through stage IV (four).

Surgical Procedures Used in Laryngeal Cancer

Laryngeal cancer can be treated with surgery in some cases. The surgical procedure is based on things like the size and location of your cancer. Your surgeon will talk to you about the procedure you will have.

Common surgical procedures to treat laryngeal cancers are:

• Vocal cord stripping: Removes the superficial (outermost) layers of your vocal cords.
• Laser surgery: Removes your vocal cords.
• Partial Laryngectomy: Removes only the diseased parts of your larynx to keep as much of the vocal cords as possible.
• Total Laryngectomy: Removes the entire larynx and vocal cords. A tracheostomy (hole made in your neck for breathing) is needed.
• Supraglottic laryngectomy: Removes the supraglottis (upper part of your larynx).
• Hemilaryngectomy: Removes half of your larynx, which keeps your voice.
• Thyroidectomy: Partial or complete removal of the thyroid gland.
• Neck dissection: Removes lymph nodes and part of your neck muscles.
• Tracheotomy: Surgery to make a hole in your neck for breathing.
• Gastrostomy tube (G-Tube) placement: Placement of a tube into the stomach for nutrition.

Reconstructive surgery (implants, skin grafting, and other procedures) may be needed in cases of extensive surgical procedures.

What are the risks of having laryngeal cancer surgery?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling and low blood pressure).
• Pneumonia (infection in the lungs).
• Blood clots.
• Infection.
• Loss of normal speech.
• Throat or larynx stenosis (narrowing).
• Issues breathing and/or swallowing.
• Fistula development (abnormal tissue opening/connections).
• Carotid artery (artery in the neck) rupture.
• Thyroid and/or parathyroid damage. If the thyroid is harmed, hypothyroidism can happen, leading to low calcium levels.
• Changes in appearance and/or sexuality.

What is recovery like?

Recovery from laryngeal cancer surgery depends on the procedure you have had. A hospital stay may be needed.

You will be told how to care for your surgical incisions, tracheostomy, any drains you may have, and feeding tube (if needed). You will be given any other instructions before leaving the hospital.

Your provider will talk with you about the medications you will be taking, such as those for pain, blood clot, infection and constipation prevention, and/or other conditions.

Your provider will talk to you about any changes you will need to make in activity level. You may be asked to meet with a speech therapist, and possibly a dietitian.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is okay to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection, and/or constipation. Call your provider with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your provider before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.