Surgery for laryngeal cancer

Surgery is usually used to treat laryngeal cancer. The type of surgery you have depends mainly on the size of the tumour, the location of the tumour and the stage of the cancer. When planning surgery, your healthcare team will also consider other factors, such as your age and overall heath.

The main goal of surgery for laryngeal cancer is to completely remove the cancer while saving as much function of the larynx (speaking, swallowing and breathing) as possible. This is called laryngeal preservation or conservation. For laryngeal preservation, other treatments are often considered first to avoid having a total laryngectomy.

Surgery may be done for different reasons. You may have surgery to:

• completely remove the tumour
• remove as much of the tumour as possible (called debulking) before other treatments
• remove a tumour that remains after radiation therapy or chemoradiation
• remove a tumour that comes back after other treatments
• reduce pain or ease symptoms (called palliative surgery)

The following types of surgery are used to treat laryngeal cancer. You may also have other treatments before or after surgery.

Endoscopic laser surgery (also called transoral laser microsurgery, or TLM) may be used to treat early stage laryngeal tumours. Endoscopic surgery is less invasive because it is done through the mouth rather than through a cut (incision) in the neck. The surgeon passes an endoscope with a microscope down the throat and positions the laser on the tissue to be treated. Laser surgery uses a narrow, intense beam of light to remove the cancer. It helps preserve laryngeal tissue so the person can speak, swallow and breathe as normally as possible.

Find out more about laser surgery.

Cordectomy removes part or all of the vocal cords. Cordectomy can be used to treat very small tumours or laryngeal cancers on the surface of the glottis. How this procedure affects speech depends on how much of the vocal cords are removed.

A laryngectomy is the surgical removal of part or all of the larynx (voice box).

A partial laryngectomy removes part of the larynx. You will still be able to speak after a partial laryngectomy, but your voice may be hoarse or weak. A partial laryngectomy may be done using endoscopic laser surgery or through a cut in the neck (called an open partial laryngectomy). People with an open partial laryngectomy may have a temporary tracheostomy tube. There are different types of partial laryngectomies.

A supraglottic laryngectomy removes only the supraglottis (the part of the larynx above the vocal cords).

A hemilaryngectomy removes half the larynx.

A total laryngectomy removes the entire larynx. During the operation, the surgeon attaches the end of the windpipe to an opening (stoma) in the neck. If you have a total laryngectomy, you will have a permanent stoma or tracheostomy tube. You will not be able to speak normally but can learn other ways of speaking. Swallowing is usually not affected so eating and drinking will be the same as before the surgery. A total laryngectomy may be done if treatment with radiation therapy or chemoradiation fails or the cancer comes back after these treatments.

A neck dissection is removal of lymph nodes from the neck. It is done during surgery to treat laryngeal cancer, so the lymph nodes can be examined to see if they contain cancer. Different types of neck dissection may be done.

In a selective neck dissection, some lymph nodes are removed from one side of the neck.

In a radical neck dissection, all of the lymph nodes are removed from one side of the neck, along with the sternocleidomastoid muscle, the internal jugular vein and the accessory nerve on the same side of the neck.

In a modified radical neck dissection, all of the lymph nodes are removed from one side of the neck, but the muscle, internal jugular vein and accessory nerve are not removed.

Thyroidectomy removes part or all of the thyroid gland. A thyroidectomy may be done during surgery for some advanced laryngeal cancers.

A tracheostomy is done during an open partial laryngectomy or a total laryngectomy. The surgeon creates an opening (stoma) in the windpipe (trachea) through the neck. A tube is placed through the stoma to create a new path for air to reach the lungs and help you breathe.

If a partial laryngectomy is done, the stoma is usually temporary. It allows the larynx to heal after surgery. When the swelling in the neck and larynx has gone down, the tracheostomy tube is removed, the stoma closes and you can breathe and talk normally.

If you have a total laryngectomy, the stoma is permanent. You will breathe through the stoma and must learn to speak in a new way. People with a permanent tracheostomy are taught how to care for it before they leave the hospital. Living with a tracheostomy requires some changes to your life. Most people adjust well and lead normal lives after they have some time to get used to the changes.

Cancers in the larynx may make it hard to swallow enough food to maintain good nutrition. To ensure that you get enough nutrition to undergo treatment for laryngeal cancer, the surgeon may place a feeding tube (gastrostomy tube, or G tube) into the stomach to deliver nutrition. Tube feeding may only be needed for a short time to ensure that you get enough nutrition during treatment. The tube can be removed once swallowing improves.

Find out more about tube feeding.

Reconstructive surgery may be done to help restore the structure or function of areas affected by surgery for laryngeal cancer. Types of reconstructive surgery include:

• Myocutaneous flaps use a muscle or area of skin from an area close to your throat (such as the chest) that is rotated to reconstruct part of the throat.
• Free flaps use tissue from other parts of your body such as a piece of intestine or arm muscle to replace parts of your throat.

Side effects can happen with any type of treatment for laryngeal cancer, but everyone’s experience is different. Some people have many side effects. Other people have only a few side effects.

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type of surgery and your overall health.

Surgery for laryngeal cancer may cause these side effects:

• voice changes such as hoarseness or a weak voice
• swallowing problems
• difficulty breathing
• taste changes
• change to sense of smell
• thyroid problems
• extra mucus
• pneumonia
• trismus

Tell your healthcare team if you have these side effects or others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.