Which surgery for laryngeal cancer?

• A quick guide to what's on this page
• Why you may have surgery
• Laser treatment for laryngeal cancer
• Surgery to remove the cancer
• Surgery through the mouth (endoscopic resection)
• Removing part of the voice box (partial laryngectomy)
• Removing all of the voice box (total laryngectomy)
• Surgery to remove lymph nodes (neck dissection)
• Neck surgery after radiotherapy
• Recovering from a laryngeal surgery
• Surgery to relieve symptoms

You can have radiotherapy or surgery if you have a cancer diagnosed at an early stage. For very small, early cancers, you may have laser surgery or surgery through your mouth (endoscopic surgery).

If you had radiotherapy that did not kill off all the cancer, you may have surgery after your radiotherapy to remove the cancer that is left. In many cases, this will cure the cancer, even if the radiotherapy hasn't.

For larger cancers, or those diagnosed at a later stage, surgery may be the best treatment option if

• One of your vocal cords does not move any more
• Your cancer has spread beyond the vocal cords
• Your cancer has come back some time after having radiotherapy

If the cancer has spread upwards from the vocal cords (called supraglottic extension), you may still be able to have radiotherapy instead of surgery.

The amount of surgery you need to have depends on the stage of your cancer. The tests you have beforehand will help your specialist decide if surgery is an option. But your doctor may not be able to tell you exactly what stage your cancer is until after surgery. Surgery can be used to

• Remove the cancer and try to cure it
• Relieve symptoms (palliative surgery)

If the tumour in the larynx is very small, your doctor may destroy it by using laser surgery. A laser light is directed at the tumour. This is done under general anaesthetic. Your surgeon passes a thin, flexible, fibre optic tube with a light at the end down your throat and aims the laser at the cancer cells. This destroys the cancer cells.

There are a number of different operations to remove cancer of the larynx. You may have

• Just the affected tissues taken away
• Part of your larynx removed
• All of your larynx removed

Most of these operations are major surgery. They are all done under general anaesthetic. So you will be asleep for the whole operation. How much of your larynx the surgeon takes away will depend on where the cancer is in the larynx.

This operation is done to remove early cancer of the larynx. The surgeon removes the area containing the affected cells. You will not have a wound after this operation. Your surgeon puts a tube down your throat to cut away the cancer cells, so you don't have a wound in your neck.

When you are under anaesthetic, your surgeon puts a rigid tube, with a camera and light inside it (an endoscope) down your throat. The surgeon can use surgical instruments through the endoscope to remove your cancer. Or they can use a type of laser to cut away the affected tissues. A laser is an extremely fine and hot beam of light. It can cut through tissue in much the same way as a surgical knife (scalpel), but causes less bleeding.

You may have a partial laryngectomy for early laryngeal cancer. Or you may have it for cancer that has come back after earlier treatment (recurrent cancer).

In a partial laryngectomy you have part of your voice box (larynx) removed. You will keep at least part of one vocal cord and will still be able to speak. But your voice may be quite hoarse or weak.

There are several different types of partial laryngectomy, depending on where the cancer is in your larynx. This does not make that much difference to you. But we have included the names of these operations, in case you hear your doctor use the term and want to know what it means.

You may hear your operation called a vertical partial laryngectomy. Your doctor may call this operation a supraglottic laryngectomy. This means removing the area above the vocal cords (the supraglottis).

You may have a horizontal partial laryngectomy. There are 3 types of operation

• Cordectomy - removal of one vocal cord
• Frontolateral laryngectomy - removal of the front of both vocal cords and half or most of the affected cord
• Anterior frontal laryngectomy - removal of front of both vocal cords
• Hemilaryngectomy - removal of one side of the voice box
• Subtotal laryngectomy - just enough larynx is left to allow you to speak with a hoarse voice

After the operation, a hole is made in your neck, which you breathe through. This is called a stoma, or tracheostomy. The tracheostomy allows your larynx to heal after the surgery.

The preparation and recovery for this operation is much the same as for a total laryngectomy. But the main difference is that your tracheostomy will be temporary (except for a subtotal laryngectomy). After a brief recovery time, your surgeon will ask your nurse to remove your tracheostomy tube and your stoma will gradually close up. Once it has closed, you will be able to speak and will not need a permanent stoma to breathe through.

To get rid of the cancer completely, your surgeon may remove the whole of your voice box. This is a total laryngectomy. Part of the pharynx may also be removed.

Your larynx is the connection between your mouth and your lungs. After it is removed, that connection is no longer there. So your surgeon attaches the end of your windpipe to a hole in your neck, which you will now breathe through. This is called a stoma. If you have a total laryngectomy, this stoma is permanent. You will now always breathe through your stoma.

Without your vocal cords and with a stoma, you will not be able to speak in the normal way. This is often the greatest loss for people who have this operation. But there are now several ways to help you make sound and learn to speak again. A speech therapist will visit you before your operation to talk about the different ways of communicating afterwards.

During your operation, your surgeon examines your larynx and surrounding area. They may remove some of the lymph nodes from around your larynx. This might be a big operation - it depends on what exactly is done. But it reduces the chance of the cancer coming back. Lymph nodes are usually arranged in groups.

Your surgeon will remove

• The nearest group of lymph nodes to your cancer, to see if they contain cancer cells
• Any lymph nodes that look as if they contain cancer, together with all the other nodes in that group

In a selective neck dissection, some nodes are removed from one side of the neck. In a radical neck dissection all of the nodes are removed from that side of the neck.

Even if there is no sign of cancer in the nodes, there is still a chance that some cells have spread to the nearest lymph nodes. There may be too few to see. So the surgeon sends these lymph nodes to the laboratory to check for cancer cells. This helps your doctor to find out the stage of your cancer. If there is cancer in these nodes, you may need to have the rest of the nodes in your neck removed or treated with radiotherapy.

After neck dissection, your neck will look different on that side. Depending on the type of operation, quite a bit of tissue will be taken away. You may need to have the muscle, main vein and nerve removed. This is called a modified radical dissection. There is more detail about this in the paragraph below. If your surgeon thinks you need to have the muscle taken away, your neck will look thinner and a bit sunken on that side.

If you have radiotherapy to treat the cancer in your voice box, your specialist will also treat any lymph nodes in your neck that have a high risk of containing cancer cells. But nodes that are bigger than 1 centimetre can't be treated properly with radiotherapy. If you have nodes bigger than 1cm, your specialist will recommend that you have a neck dissection. You will have all the lymph node groups on that side of your neck removed. Your surgeon may also have to remove

• A muscle called the sternocleidomastoid
• A vein called the internal jugular vein
• A nerve called the accessory nerve

if the lymph nodes next to them contain cancer cells. This is vital to give the best chance of stopping the cancer from coming back. The accessory nerve controls your shoulder movement, so after the operation, your shoulder will be stiff and more difficult to move. If your muscle is removed, your neck will look thinner and sunken on that side.

It takes time to get over a laryngectomy. It is a big operation. And it can affect you emotionally as well as physically. Learning to speak in a different way and breathing through a stoma can be difficult to come to terms with. You will need to give yourself time to adjust to these major changes. There is more about coping, speaking after laryngectomy and life with a breathing stoma in the CancerHelp UK section about living with cancer of the larynx.  Before or after your operation you may find it useful to speak to someone who has been through the same treatment as you.  This can be very reassuring. It can give you confidence and help you to realise that things will get easier. Most hospitals will arrange this for you before your surgery.

Even if your laryngeal cancer cannot be cured, your doctor may suggest surgery to relieve symptoms. This can give you a better quality of life for longer. You are most likely to need this type of treatment if your cancer is blocking your larynx and making it difficult for you to breathe and swallow.