ear, nose, and throat disorders
Laryngeal Cancer
Treatment of Laryngeal Cancer
Surgery Radiation therapy Chemotherapy Treatment of laryngeal cancer depends on the stage and the precise location of the cancer. For early-stage cancer, doctors may use either Surgery for Cancer or For larger laryngeal tumors that may have spread slightly into nearby tissues, doctors may use radiation therapy combined with Chemotherapy and Other Systemic Cancer Treatments (called chemoradiation) instead of surgery, which can be as effective while having less of an impact on the person's voice. However, surgery still may be required to remove any cancer that remains after the chemoradiation therapy. If laryngeal cancer has spread to the bone or cartilage, doctors usually prefer using surgery to remove part or all of the larynx and vocal cords, called a partial or total laryngectomy, followed by radiation therapy and sometimes chemotherapy. If the cancer is too advanced for surgery or radiation therapy, chemotherapy can help reduce the pain and the size of the tumor but is unlikely to provide a cure. Surgical or nonsurgical treatment almost always has significant side effects. Radiationmay cause skin changes (such as inflammation, itching, and loss of hair), scarring, loss of taste, dry mouth, and, occasionally, destruction of normal tissues. People whose teeth will be exposed to the radiation treatments must have dental problems corrected and any unhealthy teeth removed prior to radiation treatment, because radiation makes any subsequent dental work more likely to fail and severe infections of the jawbone may occur. Chemotherapytypically causes a variety of side effects, depending on the drug used. These side effects may include nausea, vomiting, hearing loss, and infections. Surgery,other treatments, and the tumor itself may affect swallowing and speaking. In such cases, rehabilitation is necessary. A number of methods have been developed that allow people without vocal cords to speak, often with good results. Depending on the specific tissues affected, reconstructive surgery may be done. Speech requires a source of sound waves (vibrations) and a means of shaping those vibrations into words. The vocal cords normally provide the vibrations, which are then shaped into words by the tongue, palate, and lips. People whose vocal cords have been removed can regain their voice if a new source of sound vibrations can be provided because their tongue, palate, and lips remain able to shape these new vibrations into words. There are three ways that people with no larynx can produce sound vibrations. In all three techniques, sound changes into speech through the throat (pharynx), palate, tongue, teeth, and lips. Esophageal speech No surgery or mechanical accessories required Person taught to swallow air into the esophagus (pathway from the throat to the stomach) and expel the air (as in a belch) to produce a sound Difficult to learn and may be hard for other people to understand Tracheoesophageal puncture One-way valve inserted in surgically created hole between the windpipe (trachea) and the esophagus Air enters the windpipe (trachea) through an opening in the front of the neck (stoma) Speech produced with air diverted into the esophagus through the valve while the person exhales Requires significant practice and training Often eventually produces easy and fluent speech Valve requires daily cleaning and needs to be replaced after many months With some valves, person must block the opening in the windpipe with a finger to speak Risk of fluids or food accidentally entering the windpipe if the valve malfunctions Electrolarynx Battery-powered vibrating device that acts as a sound source when held against the neck Produces an artificial, mechanical sound Easier to use and understand than esophageal speech Requires batteries and must be carried with the person Requires little or no training Can carry a great deal of social stigma for many people 