Supportive care for laryngeal cancer

Supportive care helps with the physical, practical, emotional and spiritual challenges of cancer. This important part of cancer care focuses on improving the quality of life of people with cancer and their loved ones, especially after treatment has ended.

Adjusting to life after treatment is different for everyone. Your recovery will depend on many different factors, such as where the cancer was in your body, the stage of the cancer, if all or part of the larynx (voice box) was removed, the type of treatment and side effects.

If you have been treated for laryngeal cancer, you may have the following concerns.

A tracheostomy (trach) is a surgical procedure that may be used for laryngeal cancer. The surgeon makes an incision to create an opening (stoma) in the trachea (windpipe) through the front of the neck. A tube (tracheostomy tube or trach tube) is placed through the stoma to create a new path for air to reach the lungs and help you breathe. People who have a partial laryngectomy as part of their treatment for laryngeal cancer may have a temporary trach. People who have a total laryngectomy as part of their treatment will have a permanent trach. Living with a trach may be frightening at first. However, most people adapt to the trach and live normally with it.

It takes time and patience to learn the new skills needed to care for the trach. Specially trained healthcare professionals, called enterostomal therapists, teach people how to care for the trach after surgery. They also offer support and advice after the person leaves the hospital.

Laryngeal cancer support groups and associations are available to provide support and information. The International Association of Laryngectomees has support groups in Canada.

Find out more about living with a tracheostomy.

Self-esteem is how you feel about yourself. Body image is how you see your own body. They are often closely linked. Laryngeal cancer and its treatments can affect your self-esteem and body image. Often this is because cancer or cancer treatments change your body in different ways, such as:

• voice changes
• having a tracheostomy tube
• loss of the ability to speak and communicate as before
• loss of a body part, such as the larynx
• scars
• hair loss
• skin problems
• changes in body weight

Some of these changes can be temporary. Others can last for a long time or be permanent.

For many people, body image and how they think other people see them is closely linked to self-esteem. Having a permanent trach can affect self-confidence and cause emotional distress. Having a trach will change the way you look, and you may feel embarrassed about the stoma. Improvements in plastic surgery mean that your appearance isn’t affected as much as it used to be by a stoma. Members of your healthcare team can give information and support. You also may find it helpful to get emotional and practical support from other cancer survivors.

Find out more about coping with body image and self-esteem worries.

Surgery or radiation therapy for laryngeal cancer can cause problems with speech. People who have a partial laryngectomy or radiation therapy for laryngeal cancer may experience hoarseness or weakness of voice. People who have a total laryngectomy cannot speak using their vocal cords and must learn new ways of speaking.

Different speech rehabilitation techniques may be used to help you speak or communicate. A speech-language pathologist (also called a speech therapist) will help find the method or combination of methods that will work best for you.

Find out more about speech therapy.

Surgery or radiation therapy for laryngeal cancer can cause problems with swallowing. You may have trouble swallowing food and liquid again after a laryngectomy. Radiation therapy can make your throat sore or your mouth dry. It may be hard to move your mouth, tongue or throat after treatment for laryngeal cancer.

A speech-language pathologist can help you learn how to use the muscles in your mouth and throat to make swallowing easier and avoid choking and gagging when you eat. They may also suggest special swallowing techniques to make swallowing safe for you.

Find out more about swallowing problems.

Taste changes can happen with treatment for laryngeal cancer. Radiation therapy to the head and neck can damage the salivary glands and taste buds in the tongue. This can affect the way some foods taste. Chemotherapy drugs can also affect the taste cells in the mouth.

A tracheostomy tube will also change your ability to smell because air no longer passes through the nose. A speech-language pathologist can help you learn new ways to smell after a tracheostomy.

Find out more about taste changes.

Many people will have a dry mouth during and after treatment for laryngeal cancer. Dry mouth may be worse with chemoradiation than with radiation alone. Dry mouth can make it hard to chew, swallow and talk. When it is severe, it can be hard to get proper nutrition because you may eat less.

The healthcare team takes steps to prevent and manage a dry mouth. A registered dietitian can also give suggestions on how to get enough nutrition if dry mouth causes you to eat less.

Find out more about a dry mouth.

Tooth decay is a late side effect of radiation therapy to the head and neck. It can happen months or years after treatment.

Radiation therapy can damage the salivary glands so they don’t produce as much saliva. Saliva helps to clean the teeth and gums, so when less saliva is made, there is an increased risk of developing cavities and gum disease.

Good mouth care is very important to prevent problems. Regular visits to the dentist after treatment are often recommended.

Difficulty swallowing, dry mouth and tooth decay can lead to malnutrition (not getting enough nutrients) and weight loss. The healthcare team can suggest ways to eat more and get enough nutrition. They may recommend nutritional supplements.

A registered dietitian can often help people deal with loss of appetite, which can lead to malnutrition and weight loss.

Find out more about weight loss.

Radiation to the neck and some surgeries for laryngeal cancer can cause the thyroid to not make enough thyroid hormones. This is called hypothyroidism. Thyroid hormones help the body break down nutrients, form bones properly and maintain its temperature.

Symptoms of hypothyroidism include:

• fatigue and feeling sluggish
• dry skin and hair
• weight gain or difficulty losing weight
• being more sensitive to cold temperatures
• feeling sad or depressed

Follow-up tests for people treated for laryngeal cancer will include a blood test to check thyroid function.

Osteoradionecrosis is the death of bone tissue caused by radiation. This happens because radiation damages blood vessels in the bones. People who have had radiation therapy to the head and neck are at risk of developing osteoradionecrosis in the lower jaw.

Symptoms may include:

• pain

• swelling

• difficulty opening the jaw, or trismus

Find out more about osteoradionecrosis.

Trismus is trouble opening the jaw. It occurs when scar tissue forms in the jaw muscles or joint. Trismus can be caused by surgery or radiation therapy for laryngeal cancer. If a person has surgery and radiation therapy, the risk of developing trismus is higher.

Find out more about trismus.

People with head and neck cancers, including laryngeal cancer, often experience emotional distress. The cancer and its treatment may change a personʼs appearance and disrupt their daily lifestyle, preventing them from taking part in their usual activities. This can lead to delays in rehabilitation and can cause more distress. Symptoms of emotional distress include worry, anxiety, fatigue, depression and changes in mood.

Talk to your doctor about how you are feeling. You may be given medicines and referred to a counsellor who will help you work through any emotional distress you are experiencing.

See a list of questions to ask your doctor about supportive care after treatment.

Sexuality refers to our feelings and beliefs about ourselves as sexual beings, and the way we express those feelings and beliefs. A person with laryngeal cancer may experience changes in their sexuality because of cancer or its treatment. Some people feel uncomfortable with their bodies, especially if they have had a tracheostomy. Feeling uncomfortable about appearance can affect sexual intimacy, which is emotional connectedness or closeness with another person.

Changes in your speech after surgery may affect intimacy and make it harder to express your feelings and emotions. After a tracheostomy, it takes more effort to speak and the volume and tone of your voice will be different. Although a hand-held speaking device is available to help you communicate, using one during sex may be awkward or distracting.

If you have laryngeal cancer, your partner may be uncertain or nervous about their first sexual experience after treatment. They may avoid intimacy, touching and sexual activity. These reactions are normal. Being aware of these reactions can help you and your partner understand and cope with the changes to your lives together, and to your relationship. Talking openly can help you both overcome sexual concerns. While it may be awkward at first, you and your partner should ask questions and discuss worries about sexuality with your healthcare team. Ostomy support organizations can also help with concerns about sexuality.

Find out more about sexuality and cancer.

To make decisions that are right for you, ask your healthcare team questions about supportive care.