Our Summary

Over the past 20 years, the approach to treating throat cancer has shifted to focus on preserving the function of the larynx (voice box) while still effectively treating the disease. Transoral laser microsurgery, a minimally invasive procedure, is now often used instead of more invasive surgeries. For early-stage throat cancer, endoscopic laryngeal surgery and targeted radiation are commonly used treatments.

For more advanced throat cancer, a total removal of the larynx followed by radiation or chemoradiation (a combination of chemotherapy and radiation) is typically the chosen treatment. However, in the hands of a skilled surgeon and with carefully chosen patients, a less invasive surgery called supracricoid laryngectomy can be a good alternative to total removal of the larynx, as it can help preserve laryngeal function. However, total removal of the larynx is still the recommended treatment for patients who have difficulty breathing or other problems with their larynx.

FAQs

  1. What are the common primary modalities for early-stage laryngeal cancer treatment?
  2. What are the potential treatment options for advanced laryngeal cancer?
  3. What is supracricoid laryngectomy and when can it be considered as an alternative to total laryngectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laryngectomy is to practice good communication techniques such as using a speaking valve or electrolarynx to help regain speech after surgery. They may also recommend working with a speech therapist to improve vocal function and quality of speech. It is important for patients to follow up with their healthcare team regularly to monitor their progress and address any concerns or complications that may arise.

Suitable For

Patients with advanced laryngeal cancer, particularly those with airway compromise and/or laryngeal dysfunction, are typically recommended for total laryngectomy. In cases where preservation of laryngeal function is desired, supracricoid laryngectomy may be considered as a viable alternative to total laryngectomy in select patients. For early-stage laryngeal cancer, options such as endoscopic laryngeal surgery and narrow field radiation may be recommended. Overall, the decision on the type of surgery recommended for a patient with laryngeal cancer will depend on the stage of the cancer, the patient’s overall health, and their treatment goals.

Timeline

Before laryngectomy:

  1. Patient is diagnosed with laryngeal cancer through imaging studies and biopsies.
  2. Patient undergoes preoperative evaluations and consultations with a multidisciplinary team including otolaryngologists, oncologists, and speech therapists.
  3. Treatment options are discussed with the patient, including the possibility of laryngectomy.
  4. Patient may undergo preoperative radiation or chemotherapy to shrink the tumor and improve surgical outcomes.
  5. Patient undergoes laryngectomy surgery, which involves the removal of the larynx and possibly surrounding tissues depending on the extent of the cancer.

After laryngectomy:

  1. Patient is monitored closely in the hospital postoperatively for any complications such as bleeding or infection.
  2. Patient undergoes rehabilitation with a speech therapist to learn how to communicate without a larynx, using techniques such as esophageal speech, tracheoesophageal puncture, or a voice prosthesis.
  3. Patient may experience physical and emotional changes due to the loss of their larynx, and may require counseling or support groups.
  4. Patient undergoes regular follow-up appointments with their healthcare team to monitor for any signs of recurrence or complications.
  5. Patient adjusts to their new way of life without a larynx, including changes in eating, breathing, and speaking patterns.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a laryngectomy procedure?
  2. How will my ability to speak be affected after a laryngectomy? What options are available for communication post-surgery?
  3. What are the long-term effects of a laryngectomy on my overall quality of life?
  4. How will eating and swallowing be impacted after a laryngectomy? Will I need to make any dietary changes?
  5. What type of rehabilitation or therapy will be necessary after a laryngectomy?
  6. How often will I need to follow up with my healthcare provider after a laryngectomy?
  7. Are there any support groups or resources available for individuals who have undergone a laryngectomy?
  8. What are the chances of the cancer returning after a laryngectomy? How will this be monitored?
  9. How soon can I expect to return to normal activities and work after a laryngectomy?
  10. Are there any alternative treatment options to consider before deciding on a laryngectomy?

Reference

Authors: Ramsey T, Tikhtman R, Tang AL. Journal: Surg Oncol Clin N Am. 2024 Oct;33(4):761-773. doi: 10.1016/j.soc.2024.04.009. Epub 2024 Jul 8. PMID: 39244293