Surgical Procedures: Surgery and Staging for Laryngeal Cancer

What is the larynx?

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

• Supraglottis.
• Glottis.
• Subglottis.

What is laryngeal cancer?

Cancer cells in the larynx (voice box) 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: This is a general exam to look at your body and talk about your health history with your provider.

Imaging: Radiology tests can look inside your body to look 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 the larynx (voice box) 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 obtain tissue for a biopsy.

Laryngeal cancer can spread to other body parts 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 used is based on things like the size and location of your cancer. The procedure you will have is based on your situation. Your surgeon will talk to you about the procedure you will have.

Common surgical procedures to treat laryngeal cancers include:

• Vocal cord stripping: The superficial (outermost) layers of the vocal cords are removed.
• Laser surgery: Removal of the vocal cords.
• Partial Laryngectomy: Removal of only the diseased parts of the larynx to spare as much of the vocal cords as possible.
• Total Laryngectomy: The entire larynx and vocal cords are removed. A tracheostomy (hole for breathing located in the neck) is needed.
• Supraglottic laryngectomy: Removal of the supraglottis (upper part of the larynx).
• Hemilaryngectomy: Removal of half of the larynx, which spares the voice.
• Thyroidectomy: Partial or complete removal of the thyroid gland.
• Neck dissection: Removal of lymph nodes and part of the neck muscles.
• Tracheotomy: A hole is made in the 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 will depend on the extent of the procedure you have had. Depending 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 care team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection and constipation prevention, and/or other conditions.

Your healthcare 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 ok 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 team 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 care team 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.