Types of surgery for laryngeal cancer
The main types of surgery for laryngeal cancer are laser surgery through the mouth, removing the voice box (larynx) and removing lymph nodes.
Why you might have surgery for laryngeal cancer
Surgery can:
- remove the cancer
- treat cancer that comes back after radiotherapy
- relieve symptoms (
palliative 
surgery)
The surgery you have depends on the stage and position of your cancer. The position of your cancer affects how much of the voice box (larynx) your surgeon removes.
Your test results help your specialist decide if surgery is an option. Your surgeon might not be able to tell you exactly what stage your cancer is until after surgery.
How you have surgery for laryngeal cancer
Surgery for cancer of the larynx can be a big operation. You have surgery under a . So you will be asleep during the operation.
Usually, surgery for early stage or is through your mouth (transoral surgery). Your surgeon does not need to make any cuts (incisions) in your neck. Or you might have open surgery through a cut in the neck.
Recovery from transoral surgery is often quicker than open surgery for laryngeal cancer. It can reduce possible problems with swallowing and speech that you might have after surgery.
Surgery through the mouth
Types of surgery include:
- transoral laser microsurgery (TLM)
- transoral robotic surgery (TORS)
Transoral laser microsurgery (TLM)
A laser is a very thin, focused beam of light that heats and destroys tissue. Lasers can focus very accurately on tiny areas. TLM is the standard treatment option for early stage laryngeal cancer.
Transoral robotic surgery (TORS)
Surgeons can use a special machine to help them with some types of surgery. The surgeon controls the instruments robotically. They use cameras to see the area clearly. They then move the instruments very precisely to remove the cancer.
TORS is not available at all cancer hospitals in the UK.
Removing part of the voice box (partial laryngectomy)
You might have part of the larynx removed (partial laryngectomy) for early laryngeal cancer, or cancer that has come back after treatment (recurrent cancer).
You might have this surgery through the mouth. Or you might have open surgery through a cut in the neck.
With this surgery, you keep part of one vocal cord. You are usually still able to speak afterwards. But your voice may be hoarse or weak. You might also have some difficulty swallowing after the surgery. Your surgeon and speech and language therapist (SLT) will talk to you about your surgery and how you might feel afterwards.
Having a temporary tracheostomy
Sometimes your surgeon may expect you to have a lot of swelling in the mouth and throat after surgery. In this case, you might have a temporary to help you breathe until the swelling goes down.
The surgeon puts a plastic tube into the hole to keep it open. The tube is a few centimetres long. Surgical ribbon or a cuff helps to keep it in place.
Your nurse will show you how to care for your tracheostomy. They will carefully clean the area and regularly check it to make sure it is not red or swollen.
With some tracheostomies you may not be able to speak. As you recover your nurse can adjust the tube so you can speak. This can be frustrating and worrying for some people, but your nurse will show you ways to help, such as reading charts and mobile devices.
Removing a temporary tracheostomy
Your nurse removes the temporary tracheostomy tube when the swelling has gone down. They put a dressing over the hole.
They will show you how to look after the area until it has healed, this takes about 1 to 2 weeks. You may have a scar in the area where the opening was.
Your nurse will explain everything before surgery so you will know what to expect afterwards.
Removing the voice box (total laryngectomy)
Your surgeon might take out the whole of your voice box (larynx) to remove your cancer. This is called a total laryngectomy. They might also remove part of the pharynx. The pharynx is the area that starts behind the nose and ends at the top of the windpipe and food pipe.
Your larynx is the connection between your mouth and your lungs. After they remove it, that connection is no longer there.
Your surgeon attaches the end of your windpipe to a hole in your neck, which you now breathe through. This is called a stoma. After a total laryngectomy, this stoma is permanent. You will now always breathe through your stoma.
Speaking after a laryngectomy
Without your vocal cords and with a stoma, you are not able to speak in the normal way. This can be difficult to cope with. But there are now several ways to help you make sounds and learn to speak again.
Your speech therapist will discuss the different ways of communicating after surgery. They continue to help you with any speech and swallowing problems throughout your treatment and follow up.
Removing lymph nodes (neck dissection)
Laryngeal cancer can spread to the in the neck. If there is a risk the cancer might spread to the lymph nodes or tests show that the cancer has spread to lymph nodes in your neck, you have surgery to remove some or all of them. This is called a neck dissection.
There are different types of neck dissection surgery. This can be a big operation, but it reduces the chance of the cancer coming back.
Other types of surgery
Reconstruction surgery
Sometimes surgeons use nearby healthy tissue to replace the tissue removed. The tissue has its own blood supply. This is called reconstructive surgery. Your surgeon rebuilds the area they remove. You might have this to help you to breathe, chew, and swallow more easily after your surgery.
As with most types of surgery, this is very complex. You might also need more than one operation. Your surgeon and specialist nurse will explain what's involved in as much detail as you want. They will also explain the possible risks and what they can do to help you manage them.
Removing all or part of the thyroid gland
The thyroid is a small butterfly shaped gland that makes and releases hormones. It’s found at the front, lower part of your neck. And is near the larynx.
Rarely, you might have all or part of your thyroid gland removed. You might have this if the cancer has spread to the thyroid. Or there is a risk the cancer may spread to the thyroid.
If the surgeon removes your whole thyroid gland, you will need to take tablets. These replace the hormones that your thyroid would normally make. This is called thyroid hormone replacement.
Recovery
Surgery to the larynx can be a big operation. This can be a difficult time for you and those close to you. we have information that may help you cope during this time.
