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 and try to cure it
• 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 your surgeon removes.

Your test results help your specialist decide if surgery is an option. Your doctor 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. All types of surgery are done under general anaesthetic. So you will be asleep for the whole operation. 

Usually, surgery for early stage cancer is through your mouth (endoscopic surgery). You might also have a type of surgery called transoral robotic surgery (TORS). 

Laser surgery through the mouth (endoscopic resection)

This is also called:

• transoral laser microsurgery (TLM) 
• transoral resection of the larynx (TORL)

Photodynamic therapy (PDT) can be used to treat early laryngeal cancer or precancerous cells. Before having PDT, you have an injection of a drug that makes laryngeal cancer cells sensitive to the laser light. PDT may also be used to control symptoms of advanced laryngeal cancer.

Removing part of the voice box (partial laryngectomy)

You might have a partial laryngectomy for early laryngeal cancer, or cancer that has come back after treatment (recurrent cancer).

How you have it

The surgeon makes a cut in your neck. They remove part of your voice box (larynx). This is called an open partial laryngectomy. Surgery through your mouth (endoscopic surgery) is becoming a more common surgery to remove part of your voice box (larynx).

You keep at least part of one vocal cord. You are usually still able to speak afterwards. But your voice may be quite hoarse or weak.

During the operation the surgeon also makes a hole in your neck, which you breathe through. The hole is called a stoma (tracheostomy). The tracheostomy allows your voice box to heal after the surgery. 

Most people who have a partial laryngectomy have a temporary tracheostomy. After a brief recovery time, your nurse removes your tracheostomy tube and your stoma gradually closes up. Once it has closed, you can start to speak naturally again. Some people need a permanent tracheostomy, but this is rare.

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.

So 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 very difficult to cope with. But there are now several ways to help you make sounds and learn to speak again. 

A speech therapist visits you before your operation to discuss the different ways of communicating after surgery.

Removing lymph nodes (neck dissection)

Your surgeon examines your larynx and surrounding area. They might remove some of the lymph nodes from around your larynx. The lymph nodes are in groups.

This can be a big operation, but it reduces the chance of the cancer coming back. 

Recovery

Surgery to the larynx is a big operation. It can be difficult to cope emotionally and physically.