Introduction
The Larynx
What Is Cancer?
Cancer of the Larynx: Who’s at Risk?
Symptoms
Diagnosis
Staging
Treatment
Getting a Second Opinion
Preparing for Treatment
Methods of Treatment
Side Effects of Cancer Treatment
Radiation Therapy
Surgery
Chemotherapy
Nutrition
Living with a Stoma
Learning To Speak Again
Esophageal Speech
Tracheoesophageal Puncture
Mechanical Speech
Followup Care
Support for People with Cancer of the Larynx
The Promise of Cancer Research
National Cancer Institute Booklets
National Cancer Institute Information Resources
Introduction
This National Cancer Institute (NCI) booklet (NIH Publication No. 02-1568) has important information about
cancer* of the larynx. Each year in
the United States, more than 10,000 people learn they have this type of cancer.
This booklet discusses possible causes, symptoms, diagnosis, and treatment. It
also has information to help patients cope with cancer of the larynx.
Information specialists at the NCI's Cancer
Information Service 1 at 1-800-4-CANCER can answer questions
about cancer and can send NCI materials. They can also send up-to-date
treatment information from NCI’s PDQ® 2
database. In addition, many NCI publications and fact sheets are on the
Internet at http://www.cancer.gov/publications.
People in the United States and its territories may use this Web site to order
publications. This Web site also explains how people outside the United States
can mail or fax their requests for NCI publications.
*Words that may be new to readers appear in italics. The
Dictionary 3 section explains these terms. Some words in the Dictionary
have a "sounds-like" spelling to show how to pronounce them.
The Larynx
The larynx is an organ
at the front of your neck. It is also
called the voice box. It is about 2
inches long and 2 inches wide. It is
above the windpipe (trachea).
Below and behind the larynx is the esophagus.
The larynx has two bands of muscle that form the
vocal cords.
The cartilage at the front of the
larynx is sometimes called the Adam’s apple.
The larynx has three main parts:
The top part of the larynx is the
supraglottis.
The glottis is in the middle. Your
vocal cords are in the glottis.
The subglottis is at the bottom.
The subglottis connects to the windpipe.
This picture shows the main parts of the larynx.
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This picture shows how the larynx
looks from above. It is what the
doctor can see with a mirror.
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The larynx plays a role in breathing, swallowing, and talking.
The larynx acts like a valve over the windpipe. The valve opens and closes to
allow breathing, swallowing, and speaking:
Breathing: When you breathe, the vocal cords relax and
open. When you hold your breath, the
vocal cords shut tightly.
Swallowing: The larynx protects the windpipe. When you swallow, a flap called the epiglottis covers the opening of
your larynx to keep food out of your lungs.
The food passes through the esophagus on its way from your mouth to your
stomach.
Talking: The larynx produces the sound of your
voice. When you talk, your vocal cords
tighten and move closer together. Air
from your lungs is forced between them and makes them vibrate. This makes the sound of your voice. Your tongue, lips, and teeth form this sound
into words.
This picture shows the larynx and
the normal pathways for air and food.
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What Is Cancer?
Cancer
begins in cells, the building blocks
that make up tissues.
Tissues make up the organs of your body. Normally, cells
grow and divide to form new cells as your body needs them. When cells
grow old, they die, and new cells take their place.
Sometimes this orderly process goes wrong. New cells form when the body does
not need them, and old cells do not die when they should. These extra cells can
form a mass of tissue called a growth or
tumor.
Growths on the larynx also may be called
nodules or
polyps. Not all growths are cancer.
Growths can be benign
or malignant:
Cancer of the larynx also may be called
laryngeal cancer. It can develop
in any part of the larynx. Most cancers of the larynx begin in the glottis.
The inner walls of the larynx are lined with cells called
squamous cells.
Almost all laryngeal cancers begin in these cells. These cancers are called
squamous cell carcinomas.
If cancer of the larynx spreads (metastasizes), the cancer cells often
spread to nearby lymph nodes in
the neck. The cancer cells can also spread to the back of the tongue, other
parts of the throat and neck, the lungs, and other parts of the body. When this
happens, the new tumor has the same kind of abnormal cells as the primary tumor
in the larynx. For example, if cancer of the larynx spreads to the lungs, the
cancer cells in the lungs are actually laryngeal cancer cells. The disease is
called metastatic cancer of the larynx, not lung cancer. It is treated as
cancer of the larynx, not lung cancer. Doctors sometimes call the new tumor
“distant” disease.
Cancer of the Larynx: Who’s at Risk?
No one knows the exact causes of cancer of the larynx. Doctors cannot
explain why one person gets this disease and another does not. We do know that
cancer is not contagious. You cannot “catch” cancer from another
person.
People with certain risk factors are more likely to get cancer of the
larynx. A risk factor is anything that increases your chance of developing this disease.
Studies have found the following risk factors:
Age. Cancer of the larynx occurs most often in people over the age
of 55.
Gender. Men are four times more likely than women to get cancer of
the larynx.
Race. African Americans are more likely than whites to be diagnosed
with cancer of the larynx.
Smoking. Smokers are far more likely than nonsmokers to get cancer
of the larynx. The risk is even higher for smokers who drink alcohol heavily.
People who stop smoking can greatly decrease their risk of cancer of the
larynx, as well as cancer of the lung, mouth, pancreas, bladder, and esophagus.
Also, quitting smoking reduces the chance that someone with cancer of
the larynx will get a second cancer in the head and neck region. (Cancer of
the larynx is part of a group of cancers called
head and neck cancers.)
Alcohol. People who drink alcohol are more likely to develop laryngeal
cancer than people who don’t drink. The risk increases with
the amount of alcohol that is consumed.
The risk also increases if the person drinks alcohol and also smokes
tobacco.
A personal history of head and neck cancer. Almost
one in four people who have had head and neck cancer will develop a second
primary head and neck cancer.
Occupation.
Workers exposed to sulfuric acid mist or nickel have an increased risk
of laryngeal cancer. Also, working with
asbestos
can increase the risk of this disease.
Asbestos workers should follow work and safety rules to avoid inhaling
asbestos fibers.
Other studies suggest that having certain
viruses or a diet low in vitamin A may
increase the chance of getting cancer of the larynx. Another risk factor is
having gastroesophageal reflux disease
(GERD), which causes stomach acid to flow up into the esophagus.
Most
people who have these risk factors do not get cancer of the larynx. If you are concerned about your chance of
getting cancer of the larynx, you should discuss this concern with your health
care provider. Your health care
provider may suggest ways to reduce your risk and can plan an appropriate
schedule for checkups.
Symptoms
The symptoms of cancer of the
larynx depend mainly on the size of the tumor and where it is in the
larynx. Symptoms may include the
following:
Hoarseness or other voice changes
A lump in the neck
A sore throat or feeling that something is stuck in
your throat
A cough that does not go away
Problems breathing
Bad breath
An earache
Weight loss
These symptoms may be
caused by cancer or by other, less serious problems. Only a doctor can tell for sure.
Diagnosis
If you have symptoms of cancer of
the larynx, the doctor may do some or all of the following exams:
Physical exam. The doctor will feel your neck and check your
thyroid, larynx, and lymph nodes for
abnormal lumps or swelling. To see your throat, the doctor may press down on
your tongue.
Indirect laryngoscopy.
The doctor looks down your throat using a small, long-handled mirror to check
for abnormal areas and to see if your vocal cords move as they should. This
test does not hurt. The doctor may spray a
local anesthesia in your
throat to keep you from gagging. This exam is done in the doctor's
office.
Direct laryngoscopy. The doctor inserts a thin, lighted tube called a
laryngoscope through your nose
or mouth. As the tube goes down your throat, the doctor can look at areas that
cannot be seen with a mirror. A local anesthetic eases discomfort and prevents
gagging. You may also receive a mild sedative to help you relax. Sometimes the doctor uses general anesthesia to put a person to sleep.
This exam may be done in a doctor's office, an outpatient clinic, or a
hospital.
CT scan. An x-ray
machine linked to a computer takes a series of detailed pictures of the neck
area. You may receive an injection of a special dye so your larynx shows up
clearly in the pictures. From the CT scan, the doctor may see tumors
in your larynx or elsewhere in your neck.
Biopsy.
If an exam shows an abnormal area, the doctor may remove a small sample of
tissue. Removing tissue to look for cancer cells is
called a biopsy. For a biopsy, you receive local or
general anesthesia, and the doctor removes tissue samples through a
laryngoscope. A pathologist
then looks at the tissue under a microscope to check for cancer cells. A
biopsy is the only sure way to know if a tumor is cancerous.
If you need a
biopsy, you may want to ask the doctor the following questions:
What
kind of biopsy will I have? Why?
How
long will it take? Will I be
awake? Will it hurt?
How
soon will I know the results?
Are
there any risks? What are the
chances of infection or bleeding after the biopsy?
If
I do have cancer, who will talk with me about treatment? When?
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Staging
To plan the best treatment, your doctor needs to know the
stage, or extent, of your disease.
Staging is a careful attempt to
learn whether the cancer has spread and, if so, to what parts of the body.
The doctor may use x-rays, CT scans, or
magnetic resonance imaging
to find out whether the cancer has spread to lymph
nodes, other areas in your neck, or distant sites.
Treatment
People
with cancer of the larynx often want to take an active part in making decisions
about their medical care. It is natural
to want to learn all you can about your disease and treatment choices. However, shock and stress after a diagnosis
of cancer can make it hard to remember what you want to ask the doctor. Here are some ideas that might help:
Make a list of questions.
Take notes at the appointment.
Ask the doctor if you may use a tape
recorder during the appointment.
Ask a family member or friend to
come to the appointment with you.
Your doctor may refer you to a specialist who treats cancer of the
larynx, such as a surgeon,
otolaryngologist
(an ear, nose, and throat doctor),
radiation oncologist, or
medical oncologist. You
can also ask your doctor for a referral. Treatment usually begins within a
few weeks of the diagnosis. Usually, there is time to talk to your doctor about
treatment choices, get a second opinion, and learn more about the disease
before making a treatment decision.
Getting a Second Opinion
Before starting treatment, you might want a second opinion about your
diagnosis and treatment plan. Some insurance companies require
a second opinion; others may cover a second opinion if you or your doctor
requests it. There are a number of ways
to find a doctor for a second opinion:
Your doctor may refer you or you may ask for a referral to one or more
specialists. At cancer centers, several
specialists often work together as a team.
The team may include a surgeon,
radiation oncologist,
medical oncologist,
speech pathologist, and
nutritionist. At some cancer
centers, you may be able to see them all on the same day.
The Cancer Information Service, at 1-800-4-CANCER, can tell
you about treatment centers near you.
A local medical society, a
nearby hospital, or a medical school can often provide the names of specialists
in your area.
The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information on the Internet at http://www.abms.org. (Click on "Who's Certified.")
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Preparing for Treatment
The doctor can
describe your treatment choices and the results you can expect for each
treatment option. You will want to
consider how treatment may change the way you look, breathe, and talk. You and your doctor can work together to
develop a treatment plan that meets your needs and personal values.
The
choice of treatment depends on a number of factors, including your general health,
where in the larynx the cancer began, the size of the tumor, and whether the
cancer has spread.
If you smoke, a good way to prepare for
treatment is to stop smoking.
Studies show that treatment is more likely to be successful for
people who don’t smoke. Your doctor
or the Cancer Information Service (1-800-4-CANCER) may be
able to suggest
ways to help you stop smoking.
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You
may want to talk with the doctor about taking part in a clinical trial, a research study of new treatment
methods. Clinical trials are an
important option. Patients who join
trials have the first chance to benefit from new treatments that have shown
promise in earlier research. The
section on “The Promise of Cancer Research 4” has more
information about research in progress.
These are questions you may want to ask your
doctor before treatment begins:
Where
is my cancer and has it spread?
What
are my treatment choices? Which do
you recommend for me? Why?
What
are the benefits of each treatment?
What are the risks and possible
side effects
of each treatment?
How will I look after treatment?
How will I speak after treatment? Will I need to work with a speech therapist?
Will I have problems eating?
Will I
need to change my daily activities?
When
can I return to work?
What is the treatment likely to cost? Is this treatment covered by my
insurance plan?
Would a clinical
trial (research study) be right for me? Can you help me find one?
How often will I need checkups?
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You do
not need to ask all your questions or understand all the answers at once. You will have many chances to ask the doctor
and the rest of the health care team to explain things that are not clear and
to ask for more information.
Methods of Treatment
Cancer of the larynx may be treated with
radiation therapy,
surgery,
or chemotherapy.
Some patients have a combination of therapies.
Radiation therapy (also called radiotherapy)
uses high-energy x-rays to kill cancer cells. The rays are aimed at the tumor and the
tissue around it. Radiation therapy is local therapy. It affects cells only in the treated area. Treatments are usually given 5 days a week
for 5 to 8 weeks.
Laryngeal cancer may
be treated with radiation therapy alone or in combination with surgery or
chemotherapy:
Radiation therapy alone: Radiation therapy is used alone for small
tumors or for patients who cannot have surgery.
Radiation therapy combined with surgery: Radiation therapy may be used to shrink a
large tumor before surgery or to destroy cancer cells that may remain in the
area after surgery. If a tumor grows
back after surgery, it is often treated with radiation.
Radiation therapy combined with chemotherapy:
Radiation therapy may be used before, during, or after chemotherapy.
After radiation
therapy, some people need feeding tubes placed into the abdomen. The feeding tube is usually temporary.
These are
questions you may want to ask your doctor before having radiation therapy:
Why
do I need this treatment?
What
are the risks and side effects of this treatment?
Are
there any long-term effects?
Should
I see my dentist before I start treatment?
When
will the treatments begin? When
will they end?
How
will I feel during therapy?
What
can I do to take care of myself during therapy?
Can
I continue my normal activities?
How
will my neck look afterward?
What
is the chance that the tumor will come back?
How
often will I need checkups?
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Surgery is an operation in which a doctor
removes the cancer using a scalpel or
laser while the patient is asleep. When patients need surgery, the type of
operation depends mainly on the size and exact location of the tumor.
There are several
types of laryngectomy (surgery
to remove part or all of the larynx):
Sometimes the surgeon also removes the lymph nodes in the neck. This is
called lymph node dissection. The surgeon also may remove the thyroid.
During surgery for cancer of the larynx, the surgeon may need to make a
stoma. (This surgery is called a
tracheostomy.) The stoma is a
new airway through an opening in the front of the neck. Air enters and leaves
the windpipe (trachea) and lungs through this opening. A
tracheostomy tube, also
called a trach (“trake”) tube, keeps the new airway open. For
many patients, the stoma is temporary. It is needed only until the patient
recovers from surgery. More information about stomas can be found in the
“Living with a Stoma 5” section.
After surgery, some
people may need a temporary feeding tube.
This picture shows the pathways
for air and food after a total laryngectomy.
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The stoma is the new opening into the trachea.
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Here are some
questions to ask the doctor before having surgery:
How
will I feel after the operation?
Will
I need a tracheostomy?
Will
I need to learn how to take care of myself or my incision when I get home?
Where
will the scars be? What will they
look like?
Will
surgery affect my ability to speak?
If so, who will teach me how to speak in a new way?
When
can I get back to my normal activities?
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Chemotherapy is the use of drugs to kill cancer cells. Your doctor
may suggest one drug or a combination of drugs.
The drugs for cancer of the larynx are usually given by injection into the
bloodstream. The drugs enter the
bloodstream and travel throughout the body.
Chemotherapy is used
to treat laryngeal cancer in several ways:
Before surgery or radiation therapy: In some cases, drugs are given to try to
shrink a large tumor before surgery or radiation therapy.
After surgery or radiation therapy: Chemotherapy may be used after surgery or
radiation therapy to kill any cancer cells that may be left. It also may be used for cancers that have
spread.
Instead of surgery: Chemotherapy may be used with radiation
therapy instead of surgery. The larynx
is not removed and the voice is spared.
Chemotherapy may be
given in an outpatient part of the hospital, at the doctor’s office, or at
home. Rarely, a hospital stay may be
needed.
These are questions you may want to ask your doctor before having chemotherapy:
Why do I need this treatment?
What will it do?
Will I have side effects? What can I do about them?
How long will I be on this treatment?
How often will I need checkups?
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Side Effects of Cancer Treatment
Cancer treatments are
very powerful. Treatments that remove
or destroy cancer cells are likely to damage healthy cells, too. That's why treatments often cause side effects. This section describes some of the side
effects of each kind of treatment.
Side effects may not
be the same for each person, and they may even change from one treatment
session to the next. Before treatment
starts, your health care team will explain possible side effects and how they
can be managed. It may help to know
that although some side effects may not go away completely, most of them become
less troubling.
It may also help to
talk with other patients. A social
worker, nurse, or other member of the medical team can set up a visit with
someone who has had the same treatment.
The NCI provides
helpful booklets about cancer treatments and coping with side effects, such as
Radiation Therapy and You 6 and
Eating Hints for Cancer Patients 7.
See the “National Cancer Institute Information Resources 8” and
“National Cancer Institute Booklets 9” sections for other
sources of information about side effects.
Radiation Therapy
People treated with
radiation therapy may have some or all of these side effects:
Dry mouth.
Drinking lots of fluids can help.
Some patients find artificial saliva helpful. It comes in a spray or squeeze bottle.
Sore throat or mouth. Your health care provider may suggest
special rinses to numb your throat and mouth and help relieve the soreness.
Delayed healing after dental care. Many doctors recommend having a dental exam
and any needed dental work before radiation therapy.
Tooth decay. Good mouth care can help keep your teeth and
gums healthy and can help you feel better.
If it's hard to floss or brush your teeth in the usual way, you can try
using gauze, a soft toothbrush, or a toothbrush that has a spongy tip instead
of bristles. A mouthwash made with
diluted peroxide, salt water, baking soda, or a combination can keep your mouth
fresh and help protect your teeth from decay.
It may also be helpful to use fluoride toothpaste or rinse.
Changes
in sense of taste and smell. During radiation therapy, food may taste or smell
different.
Fatigue. During radiation
therapy, you may become very tired, especially in the later weeks of treatment. Resting is important, but doctors usually
advise their patients to stay as active as they can.
Changes
in voice quality.
Your voice may be weak at the end of the day. It may also be affected by changes in the weather. Voice changes
and the feeling of a lump in your throat may come from swelling in the larynx
caused by the radiation. The doctor may
suggest medicine to reduce this swelling.
Skin
changes in treated area.
The skin in the treated area may become red or dry. Good skin care is important at this
time. Try to expose this area to the
air but protect it from the sun. Avoid
wearing clothes that rub, and do not shave the treated area. You should not put anything on your skin
before radiation treatments. Also, you
should never use lotion or cream without your doctor's advice.
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Surgery
People who have
surgery may have any of these side effects:
Pain. You may be uncomfortable for the first few
days after surgery. However, medicine
can usually control the pain. You
should feel free to discuss pain relief with the doctor or nurse.
Low energy. It is common to feel tired or weak after
surgery. The length of time it takes to
recover from an operation is different for each patient.
Swelling in the throat. For a few days after surgery, you won’t be
able to eat, drink, or swallow. At first, you will receive fluid through an
intravenous (IV) tube placed into
your arm. Within a day or two, you will get fluids and nutrition through a
feeding tube (put in place during surgery) that goes through your nose and
throat into your stomach. When the swelling goes away and the area begins to
heal, the feeding tube will be removed. Swallowing may be difficult at first,
and you may need the help of a nurse or speech pathologist. Soon you will
be eating your regular diet.
If you need a feeding tube for longer than one week, you may get a tube that
goes directly into the abdomen. Most
patients slowly return to eating solid foods by mouth, but for a very few
patients, the feeding tube may be permanent.
Increased mucus production. After the operation, the lungs and windpipe
produce a lot of mucus, also called
sputum. To remove it, the nurse
applies gentle suction by placing a small plastic tube in the stoma. You will
learn to cough and suction mucus through the stoma without the nurse's
help.
Numbness, stiffness, or weakness. After a laryngectomy, parts of the
neck and throat may be numb because nerves have been cut. Also, the shoulder,
neck, and arm may be weak and stiff. You may need
physical therapy to improve
your strength and flexibility after surgery.
Changes in physical appearance. Your neck will be somewhat smaller,
and it will have scars. Some patients find it
helpful to wear clothing that covers the neck area.
Tracheostomy. Patients who have surgery will have a
stoma. With most supraglottic and
partial laryngectomies, the stoma is temporary. After a short recovery period,
the tube can be removed, and the stoma closes up. You should then be
able to breathe and talk in the usual way.
In some people, however, the voice may be hoarse or weak.
After a total laryngectomy, the stoma is permanent. If you have a total
laryngectomy, you will need to learn to speak in a new way. The section called
“Learning to Speak Again 10” has
more information.
More information about stomas may be found in the
“Living with a Stoma 5” section.
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Chemotherapy
The side effects of chemotherapy depend mainly on the specific drugs and
the dose. In general, anticancer drugs affect cells that divide rapidly:
Blood cells: These cells fight infection, help your blood
to clot, and carry oxygen to all parts of your body. If your blood cells are affected, you are more likely to get
infections, may bruise or bleed easily, and may feel very weak and tired.
Cells in hair roots: Chemotherapy can lead to hair loss, but hair
will grow back. However, the new hair
may be different in color and texture.
Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea
and vomiting, diarrhea, or mouth and lip sores. Many of these side effects can be controlled with new or improved
drugs.
Nutrition
Some people who
have had treatment for cancer of the larynx may lose their interest in
food. Soreness and changes in smell and
taste may make eating difficult. Yet
good nutrition is important. Eating
well means getting enough calories and protein to prevent weight loss, regain
strength, and rebuild healthy tissues.
If
eating is difficult because your mouth is dry from radiation therapy, you may
want to try soft, bland foods moistened with sauces or gravies. Thick soups, puddings, and milkshakes often
are easier to swallow. The nurse and
the dietitian will help you choose the right foods.
After surgery or radiation therapy,
some people need feeding tubes placed into the abdomen. Most people slowly return to a regular
diet. Learning to swallow again may
take some practice with the help of a nurse or speech pathologist. Some people find liquids easier to swallow;
others do better with solid foods. You
will find what works best for you.
Living with a Stoma
Learning to live with
the changes brought about by cancer of the larynx is a special challenge. The medical team will make every effort to
help you return to your normal routine as soon as possible.
If you have a stoma,
you will need to learn how to care for it:
Before leaving the hospital, you will learn to
remove and clean the trach tube, suction the trach, and care for the skin
around the stoma.
If the air is too dry, as it may be in heated buildings in the winter, the
tissues of the windpipe and lungs may produce extra mucus. Also, the skin
around the stoma may get sore. Keeping the skin around the stoma clean and
using a humidifier at home or
at the office can lessen these problems.
It is very dangerous for water to get into the windpipe and lungs through the
stoma. Wearing a special plastic stoma shield or holding a washcloth over the
stoma keeps water out when showering or shaving. Other types of stoma
covers—such as scarves, neckties, and specially made covers—help
keep moisture in and around the stoma. They help filter smoke and dust from the
air before it enters the stoma. They also catch any fluids that come out of the
windpipe when you cough or sneeze. Many people choose to wear something over
their stoma even after the area heals. Stoma covers can be attractive as well
as useful.
When shaving, men should keep in mind that the neck may be numb for several
months after surgery. To avoid nicks and cuts, it may be best to use an
electric shaver until the numbness goes away.
People with
stomas work in almost every type of business and can do nearly all of the
things they did before. However, they
cannot hold their breath, so straining and heavy lifting may be difficult. Also, swimming and water skiing are not
possible without special instruction and equipment to keep water from entering
the stoma.
Some people may feel
self-conscious about the way they look and speak. They may be concerned about how other people feel about
them. They may be concerned about how
their sexual relationships may be affected.
Many people find that talking about these concerns helps them. Counseling or support groups may also be
helpful.
Learning To Speak Again
Talking is part of nearly
everything we do, so it's natural to be scared if your voice box must be
removed. Losing the ability to
talk—even for a short time—is hard.
Patients and their families and friends need understanding and support
during this time.
Within a week or so after a partial
laryngectomy, you will be able to talk in the usual way. After a total laryngectomy, however, you
must learn to speak in a new way. A
speech pathologist usually meets with you before surgery to explain the methods
that can be used. In many cases, speech
lessons start before you leave the hospital.
Until you begin to talk again, it
is important to have other ways to communicate. Here are some ideas that you may find helpful:
Keep pads of paper and pens or pencils in your pocket
or purse.
Use a typewriter, computer, or other electronic
device. Your words can be printed on
paper, displayed on a screen, or produced in a male or female voice.
Carry a small dictionary or a picture book and point to
the words you need.
Write notes on a "magic slate" (a toy with a
plastic sheet that covers black wax; lifting the plastic erases the sheet).
The health care team can help patients learn new ways to speak. It takes
practice and patience to learn techniques such as
esophageal speech or
tracheoesophageal puncture
speech, and not everyone is successful.
How quickly a person learns, how understandable the speech is, and how
natural the new voice sounds depend on the extent of the surgery on the larynx.
Esophageal Speech
A speech pathologist can teach you
how to force air into the top of your esophagus and then push it out
again. The puff of air is like a
burp. It vibrates the walls of the throat,
making sound for the new voice. The
tongue, lips, and teeth form words as the sound passes through the mouth.
This type of speech sounds low
pitched and gruff, but it usually sounds more like a natural voice than speech
made by a mechanical larynx. There is
also no device to carry around, so your hands are free.
Tracheoesophageal Puncture
For
tracheoesophageal puncture (TEP), the surgeon makes an opening between the
trachea and the esophagus. The opening
is made at the time of initial surgery or later. A small plastic or silicone valve fits into this opening. The valve keeps food out of the
trachea. After TEP, patients can cover
their stoma with a finger and force air into the esophagus through the valve. The air produces sound by making the walls
of the throat vibrate. The sound is a
lot like natural speech.
Mechanical Speech
You may choose to use a mechanical larynx while you learn esophageal or TEP
speech or if you are unable to use these methods. The device may be powered by
batteries (electrolarynx) or by
air (pneumatic larynx).
Many different mechanical devices
are available. The speech pathologist
will help you choose the best device for your needs and abilities and will
train you to use it.
One kind of electrolarynx looks
like a small flashlight. It makes a
humming sound. You hold the device
against your neck, and the sound travels through your neck to your mouth. Another type of electrolarynx has a flexible
plastic tube that carries sound into your mouth from a hand-held device. There are also devices that are built into a
denture or retainer and can be worn inside your mouth and operated by a
hand-held remote control.
A pneumatic larynx is held over the
stoma and uses air from the lungs instead of batteries to make it vibrate. The
sound it makes travels to the mouth through a plastic tube.
Followup Care
Followup
care is important after treatment for cancer of the larynx. Regular checkups ensure that any changes in
health are noted. Problems can be found
and treated as soon as possible. The
doctor will check closely to be sure that the cancer has not returned. Checkups include exams of the stoma, neck,
and throat. From time to time, the
doctor may do a complete physical exam and take x-rays. If you had radiation therapy or a partial
laryngectomy, the doctor will also examine you with a laryngoscope.
Treatments for laryngeal cancer can affect the thyroid. A blood test can
tell if the thyroid is making enough
thyroid hormone. If the level
is low, you may need to take thyroid hormone pills.
People who have laryngeal cancer
have a chance of developing a new cancer in the mouth, throat, or other areas
of the head and neck. This is
especially true for those who are smokers or drink alcohol heavily. Most doctors strongly urge their patients to
stop smoking and drinking to cut down the risk of a new cancer and other health
problems.
The NCI has prepared a booklet for people who have completed their treatment
to help answer questions about followup care and other concerns.
Facing Forward Series: Life After Cancer Treatment 11
provides tips for getting the most out of medical visits. It describes the
kinds of help people may need.
Support for People with Cancer of the Larynx
Living with a serious
disease such as cancer is not easy.
Some people find they need help coping with the emotional and practical
aspects of their disease. Support
groups can help. In these groups,
people living with cancer get together to share what they have learned about
coping with the disease and the effects of treatment. People interested in finding a support group may want to talk
with their health care provider for suggestions.
People living with
cancer may worry about caring for their families, keeping their jobs, or
continuing daily activities. Concerns
about tests, treatments, hospital stays, and medical bills are also
common. Doctors, nurses, and other
members of the health care team can answer questions about treatment, working,
or other activities. Meeting with a
social worker, counselor, or member of the clergy can be helpful for those who
want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources
for help with rehabilitation, emotional support, financial aid, transportation,
or home care.
The Cancer Information Service (1-800-4-CANCER) can
provide printed materials on coping, as well as
information to help patients and their families locate programs and
services.
The Promise of Cancer Research
Doctors
all over the country are conducting many types of clinical
trials. These are research studies in which people take part
voluntarily. Studies include new ways
to treat cancer of the larynx. Research
already has led to advances, and researchers continue to search for more
effective approaches.
People who
join these studies have the first chance to benefit from treatments that have
shown promise in earlier research. They
also make an important contribution to medical science by helping doctors learn
more about the disease. Although
clinical trials may pose some risks, researchers take very careful steps to
protect their patients.
People with laryngeal cancer are
participating in several types of treatment studies:
Radiation
therapy. Researchers are studying a new approach to
radiation therapy. Patients receive
radiation three times a day, 5 days a week, for just over 2 weeks, instead of
once a day for 5 to 7 weeks.
Drugs
that reduce side effects. Researchers are testing therapies that
reduce the side effects of radiation therapy.
They are testing drugs that may help patients maintain their weight or
help lessen damage to the skin during radiation therapy.
Chemotherapy.
Scientists are
studying drugs that kill cancer cells.
These drugs are used alone or in combination with radiation therapy to
spare the larynx from surgery.
Biological therapy.
Scientists are studying
monoclonal antibodies
that slow or stop the growth of cancer.
If you are
interested in learning more about joining a clinical trial, you may want to
talk with your doctor. You may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies 12. It explains how clinical trials are carried out and explains their possible benefits and risks. NCI’s Web site includes a section on
clinical trials at
http://www.cancer.gov/clinicaltrials.
This section of the Web site provides general information about clinical
trials. It also offers detailed information about specific ongoing studies
of cancer of the larynx. The Cancer Information Service at
1-800-4-CANCER can answer questions and provide information
from the NCI’s database of clinical trials.
National Cancer Institute Booklets
National Cancer Institute (NCI) publications can be ordered by writing to
the address below, and some can be viewed and downloaded from
http://www.cancer.gov/publications on the
Internet.
Publications Ordering Service
National Cancer Institute
Suite 3036A
6116 Executive Boulevard, MSC 8322
Bethesda, MD 20892-8322
In addition, people in the United States and its territories may order
these and other NCI booklets by calling the Cancer Information Service at
1-800-4-CANCER. They may also order many NCI publications
on-line at
http://www.cancer.gov/publications.
See the complete index of What You Need To Know About Cancer 13 publications.
Booklets About Cancer Treatment
Booklets About Living With Cancer
National Cancer Institute Information Resources
You may want more information for yourself, your family, and your doctor. The following National Cancer Institute (NCI) services are available to help you.
Cancer Information Service 1 (CIS)
Provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information specialists explain the latest scientific information in understandable language and respond in English, Spanish, or on TTY equipment.
Toll-free: 1-800-4-CANCER (1-800-422-6237)
TTY (for deaf and hard of hearing callers): 1-800-332-8615
The NCI's Cancer.gov Web site provides information from numerous
NCI sources. It offers current information on cancer prevention, screening,
diagnosis, treatment, genetics, supportive care, and ongoing clinical trials.
It also provides information about NCI's research programs and funding
opportunities, cancer statistics, and the Institute itself. Cancer.gov can
be accessed at
http://www.cancer.gov on the Internet.
Cancer.gov also provides live, online assistance through LiveHelp.
Information specialists are available Monday through Friday from 9:00 AM
to 10:00 PM Eastern Time. LiveHelp is at
http://www.cancer.gov on the Internet.
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