After laryngeal cancer surgery

Your recovery depends on the type of surgery you have and your general health.  

The length of your stay in hospital depends on what type of operation you have. You might be able to go home after a few days. But some people will stay in hospital for up to a few weeks. You will need to give yourself time to recover once you are at home.

When you wake up after your operation

After your operation, you wake up in the recovery room. Your recovery nurse looks after you until you are awake and well enough to go back to the ward.

Everybody is different when they are waking up after an operation. It takes some people longer than others to wake up. Some people remain very sleepy for a while afterwards. You may be in the recovery room for several hours before you are ready to go back to the ward.

If you have had a big operation, you might wake up in an intensive care unit   (ICU) or a high dependency unit (HDU),  instead of the ward you were on before the surgery. You usually move back to the ward within a day or so.

In intensive care you have one to one nursing care. In the high dependency unit you have very close nursing care. Your surgeon and anaesthetist also keep a close eye on your progress.

These units are busy and often noisy places that some people find strange and disorienting. You'll feel drowsy because of the anaesthetic and painkillers.

The staff in the ICU or HDU will speak to a member of your family or friends about visitors. But, you usually move back to the ward within a day or so.

After surgery

Tubes and drains

When you wake up you might have:

• a drip (intravenous infusion) into your arm to give you fluids until you are eating and drinking again

• a breathing tube in your neck

• a fine tube into your stomach (gastrostomy tube) or into your stomach via your nose (nasogastric tube) for liquid feeds

• wound drains in your neck or near your wound

• a tube into your bladder (catheter) to collect and measure urine

Wound drains 

The wound drains stop blood and fluid collecting in the area of the operation. This helps your wound to heal and prevents infection. The wound drains connect to suction bottles, which help to draw out the fluid gently.

Your nurses will check the amount of drainage regularly. They usually change the bottles attached to them daily, or more often if needed. When the fluid stops coming out, your nurse takes the drains out. This is usually a few days after the operation.

Speaking after surgery

You may need to rest your voice after surgery to your voice box (larynx). This allows the area time to heal. 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. 

When you start to speak after your surgery your voice may sound hoarse or weak. 

Speaking after removing the whole larynx 

After surgery to remove the whole larynx (laryngectomy) you are not able to speak in the normal way. This can be difficult to cope with. But there are 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.

Breathing stoma

During surgery to remove part or all of your larynx, your surgeon may make a hole in your neck that you breathe through after surgery. This is called a stoma. 

It might be temporary if you have only part of your larynx removed. If you have your whole larynx removed, the stoma is permanent. You breathe and cough through your stoma from now on. 

Feeding tubes 

You usually have food through a feeding tube after surgery. This allows time for the surgical area to heal. The amount of time you have this can vary, it might be around 10 days, but it can be longer.

You might have a gastrostomy (PEG or RIG) tube. This goes directly through the skin into your stomach. Or you might have a nasogastric tube. This tube goes up your nose, down your throat and into your stomach.

When your throat has healed, you can gradually start to eat and drink again. It may take 1 to 2 weeks, but it can take longer.

Your dietitian and speech and language therapist (SLT) work closely together and with you during this time. They help with nutrition and swallowing problems.

Your wounds

Some surgery for laryngeal cancer is done through the mouth. You ususlly have a dressing if your wound is on the neck or face. Your surgeon may have sprayed the wound with a protective clear spray.

Your surgeon and nurses will check your wound regularly to make sure it is healing well.

Stitches or clips

If you have stitches or clips they might stay in for up to 10 days. If your wound hasn't healed and you feel otherwise well, you might go home with your stitches. You can go back to the hospital to have them taken out. Your district nurse may be able to visit you at home to remove them or you can see a nurse at your GP practice. 

Your surgeon uses stitches that dissolve for wounds inside your mouth.

Pain

You usually have some pain and discomfort for the first week or so. But it is possible to control your pain. There are different painkillers you can have.

Tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.

You might have an electric pump called a PCA pump (patient controlled analgesia). It is a way of giving painkillers after surgery. It attaches to your drip. You have a hand control with a button to press to give yourself extra painkillers when you need them. Use it whenever you need to.

You can’t overdose because the machine is set to prevent giving too high a dose. But tell your nurse if you need to press the button very often. You might need a higher dose in the pump.

You get painkillers to take home. Your nurse will talk to you about:

• how often to take them
• when to take them
• what side effects you may get

Contact your specialist nurse or hospital advice line if you still have pain or if it gets worse.

After a few days

Moving around 

Your physiotherapist will help you to get up after your surgery. They will encourage you to sit in a chair the day after your operation. They will help you with your drips and tubes. During the first few days after surgery your tubes will be removed. This will make moving much easier. 

Eating and drinking 

You might not be able to eat or drink for about 7 to 10 days. This gives your throat time to heal and prevents infection. 

Speech and language therapists play an important role during your treatment. They will help you eat and drink safely after surgery to your voice box.

A dietitian will decide about the amount of liquid feed you need until you are eating and drinking normally. 

Gradually you can start to eat a soft diet. Your dietitian will monitor this and gradually cut down your liquid feeds. 

After a laryngectomy, you will not be able to strain to open your bowels. It is very important to avoid becoming constipated. Drink lots of fluid and eat plenty of fibre. 

It is important to maintain your weight after your surgery. Let your dietician or nurse know if you find that you are not eating well or off your food. They can help in lots of ways. For example, if you have lost weight and find it hard to put the weight back on, they can give you high calorie liquid supplements.

Changes in smell and taste

Removing your voice box (larynx) might affect your:

• sense of smell 
• sense of taste 

If you have all of your voice box removed (laryngectomy), air will not pass through your nose when you breathe in. This means you will not smell anything, and it affects your taste.

Your speech and language therapist can teach you techniques to take air in through your nose, which may improve your sense of smell.

How you might feel

You are likely to have times when you feel sad and very low in mood. Try to be patient with yourself while you fully recover from your operation.

You have had your cancer diagnosis to come to terms with and you have been through a big operation. You may need a lot of support from your doctors and nurses, family and friends.

Most people feel weak and lack strength for some time after their surgery. How long this lasts varies but you can feel tired for several weeks or months after your surgery.

It often helps to do a little each day. This can build up your strength. What you can do depends on how fit you were before your surgery and any problems you have afterwards.

Talk to the physiotherapist or nurse if you’re unsure about what you should be doing, they can suggest things to help

Going home

Your doctor will let you know when you can go home, how soon depends on the type of surgery you’ve had. You’ll need some help when you first go home. Your dietician, specialist nurse and other members of your healthcare team can help you prepare for going home. 

Follow up appointments

You’ll have follow up appointments to check your recovery and sort out any problems. They‘re also your opportunity to raise any concerns you have about your progress.

Coping

After surgery, it can be difficult to come to terms with your cancer diagnosis and the changes you have to make. You may need a lot of support from your doctors and nurses, family and friends.

It might be helpful to talk to someone close to you about how you feel.