Surgery for laryngeal cancer

Surgery is a medical procedure to examine, remove or repair tissue. Surgery, as a treatment for cancer, means removing the tumour or cancerous tissue from your body. This usually means cutting into the body, but surgery to remove cancer can also be done in different ways, such as by using lasers.

Surgery is sometimes used to treat laryngeal cancer. The type of surgery you have depends mainly on the size of the tumour, the stage of the cancer and where the cancer is in the larynx (voice box). When planning surgery, your healthcare team will also consider other factors, such as your age and overall health.

Surgery may be the only treatment you have or it may be used along with other cancer treatments. You may have surgery to:

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

The following types of surgery are commonly used to treat laryngeal cancer.

Laser surgery uses a powerful, narrow beam of light (called a laser beam) to destroy cancer cells. It’s usually done in a clinic or hospital operating room under general anesthesia.

Laser surgery for laryngeal cancer is called endoscopic laser surgery or transoral laser microsurgery (TLM). Endoscopic laser surgery is less invasive than other types of surgery because itʼs done through the mouth rather than through a cut (incision) in the neck. The surgeon places a tube-like instrument with a light and lens (called an endoscope) down the throat. The endoscope allows the surgeon to find the tumour and aim the laser beam to treat the tissue. The laser preserves healthy tissue in the neck as much as possible so the person can speak, swallow and breathe as normally as possible.

Endoscopic laser surgery may be used to treat early-stage laryngeal cancer. It can also be used to treat advanced cancer if the tumour is localized.

Find out more about laser surgery.

A laryngectomy removes all or part of the larynx. Depending on where the cancer is in the larynx, you may be offered a partial or total laryngectomy.

A partial laryngectomy removes part of the larynx. A partial laryngectomy may be done using endoscopic laser surgery or through a cut in the neck (called an open partial laryngectomy).

There are 2 different types of partial laryngectomies:

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

A total laryngectomy removes the entire larynx. A total laryngectomy may be done if treatment with radiation therapy or chemoradiation cannot remove the tumour. It may also be done if the cancer recurs after these treatments.

A tracheostomy is done during an open partial laryngectomy or a total laryngectomy. The surgeon makes an incision to create an opening (stoma) in the windpipe (trachea) through 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.

A tracheostomy can be temporary or permanent.

A temporary tracheostomy may be done during a partial laryngectomy. The stoma and tracheostomy tube will allow 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 naturally and you can breathe and talk normally again.

A permanent tracheostomy is done if you have a total laryngectomy. 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 the stoma and trach tube before they leave the hospital. Living with a permanent 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.

Find out more about a tracheostomy.

A neck dissection is the removal of lymph nodes from the neck. It may be done during surgery to treat laryngeal cancer, so the lymph nodes can be examined to see if there is cancer in them.

There are different types of neck dissection that may be done.

A selective neck dissection removes only those lymph nodes where cancer is very likely to spread. How many and which lymph nodes are removed is based on the size and location of the primary tumour. The muscle and nerve tissue around the lymph nodes are not removed, so the neck and shoulder can continue to function normally. A selective neck dissection is also called a functional neck dissection.

A radical neck dissection removes nearly all of the lymph nodes from one side of the neck. It also removes the sternocleidomastoid muscle, the internal jugular vein and the accessory nerve on the same side of the neck.

A modified radical neck dissection removes all of the lymph nodes from one side of the neck. The sternocleidomastoid muscle, internal jugular vein and accessory nerve are not removed.

Find out more about neck dissection.

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

Laryngeal cancers may make it hard to swallow enough food to get proper nutrition. The surgeon may place a gastrostomy tube (also called a feeding tube or G tube) into the stomach before treatment. 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.

Surgery for laryngeal cancer can affect how well the throat works. Reconstructive surgery can help restore the structure or function of the throat.

Types of reconstructive surgery that may be done include the following:

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

Side effects of surgery will depend mainly on the type of surgery and your overall health. Tell your healthcare team if you have side effects that you think are from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

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

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