Surgery is commonly used to treat patients with laryngeal and hypopharyngeal cancers. Depending on the stage of the cancer and its location, different operations may be used to remove the cancer and some of the surrounding laryngeal or hypopharyngeal tissue.
After surgery to remove the cancer, reconstructive surgery may be used to help restore the appearance and function of the affected areas.
Vocal cord stripping
This technique uses,a long surgical instrument to strip away the superficial layers of tissue on the vocal cords. This can be done to biopsy and treat some stage 0 cancers (carcinoma in situ) of the vocal cords. Most people can speak normally again after recovering from this operation.
Laser surgery
Lasers can be used to treat some stage 0 (carcinoma in situ) and T1 cancers. An endoscope is passed down the throat to locate the tumor, which is then either vaporized or excised (cut out) using a high-intensity laser on the tip of the endoscope. A drawback of using vaporization is that by destroying the tissue being treated, it leaves nothing behind that can be sampled to look at under the microscope. If the laser is used to remove part of a vocal cord, it may result in hoarse speech.
Cordectomy
For a cordectomy the surgeon removes all or part of the vocal cords. This can be used to treat very small or superficial glottic (vocal cord) cancers. The effect of this procedure on speech varies depending on how much of the vocal cords are removed. Removing part of a vocal cord may result in hoarse speech. Normal speech is no longer possible if both vocal cords are removed.
Laryngectomy
Laryngectomy is the removal of part or all of the larynx (voice box).
Partial laryngectomy: Smaller cancers of the larynx often can be treated by removing only part of the voice box. This is called partial laryngectomy. There are different types of partial laryngectomy procedures, but they all have the same goal: to remove the entire cancer while leaving behind as much of the natural larynx as possible.
In a supraglottic laryngectomy, only the portion of the larynx above the vocal cords is removed. This procedure can be used to treat some supraglottic cancers, and allows the patient to retain normal speech.
For small cancers of the vocal cords (glottis), the surgeon may be able to remove the cancer by taking out only one vocal cord and leaving the other behind. This allows for some speech to remain and is known as a hemilaryngectomy.
Total laryngectomy: In this procedure, the entire larynx (voice box) is removed. The windpipe is then brought up through the skin of the front of the neck as a stoma (or hole) that you breathe through (see the illustration below). This is known as a tracheostomy. Once the entire larynx is removed, normal speech is no longer possible, but people can learn other forms of speaking (see "What happens after treatment for laryngeal and hypopharyngeal cancers?"). The connection between the throat and the esophagus is usually not affected, so after recovering from surgery, food and liquids can be swallowed just as they were before the operation.
Total or partial pharyngectomy
Surgery to remove all or part of the pharynx is called a pharyngectomy. This operation may be needed to treat cancers of the hypopharynx. Often, the larynx is removed along with the hypopharynx. After surgery, you may need a reconstructive procedure to rebuild this part of the throat and improve your ability to swallow.
Reconstructive procedures
These operations may be done to help restore the structure or function of areas affected by more extensive surgeries to remove the cancer.
Myocutaneous flaps: Sometimes a muscle and area of skin may be rotated from an area close to your throat, such as the chest (pectoralis major flap), to reconstruct the throat.
Free flaps: With the advances of microvascular surgery (sewing together small blood vessels under a microscope), surgeons now have many more options to reconstruct the area of your throat. Tissues from other areas of your body such as a piece of intestine or a piece of arm muscle can be used to replace parts of your throat.
Lymph node removal
Cancers of the larynx and hypopharynx may spread to the lymph nodes in the neck. If, based on the stage and location of the tumor, your doctor thinks that lymph node spread is likely, it may be necessary to remove lymph nodes (and other nearby tissues) from your neck. This operation, called a neck dissection, is done at the same time as the surgery to remove the main tumor.
There are several forms of neck dissections, ranging from the radical neck dissection to a less extensive selective neck dissection. They differ in the amount of tissue removed from the neck. The amount removed depends on the size and extent of cancer spread. In a full radical dissection, nerves and muscles responsible for some neck and shoulder movement are removed along with the lymph nodes. This may be needed in order to be sure that all of the lymph nodes likely to contain cancer are removed. Sometimes doctors will try to remove less normal tissue in order to keep the shoulder and neck functioning normally.
Tracheotomy/tracheostomy
A tracheotomy is an incision (hole) made in the trachea (windpipe) to help a person breathe by letting air in and out of the lungs. It may be used in different circumstances.
As described above, a permanent tracheotomy is needed after a total laryngectomy. This procedure, in which the opening in the trachea is connected to a hole in the skin in the front of the neck, is known as a tracheostomy.
A temporary tracheotomy (using a small plastic tube) may be put in place after a partial laryngectomy or pharyngectomy to help protect the airway during recovery from surgery. It stays in place for a short time, and is then removed later when it is no longer needed.
If a laryngeal or hypopharyngeal cancer is blocking the windpipe and is too large to remove completely, an opening may be made to connect the lower part of the windpipe to a stoma (hole) in the front of your neck to bypass the tumor and allow you to breathe more comfortably. The new opening is called a tracheostomy.
Gastrostomy tube
Cancers in the larynx and hypopharynx may prevent you from swallowing enough food to maintain good nutrition. This can make you weak and make it harder to complete treatment.
A gastrostomy tube (G tube) is a feeding tube that is placed through the skin and muscle of your abdomen directly into your stomach. Sometimes this tube is placed during an operation, but often it is placed endoscopically, with the patient sedated. When it is placed through endoscopy, it is called a percutaneous endoscopic gastrostomy, or PEG tube. Once in place, it can be used to deliver nutrition directly into the stomach.
Often, the gastrostomy tube is only needed for a short time to help you get adequate nutrition during radiation and/or chemotherapy. The feeding tube can be removed once your swallowing function improves after treatment.
Possible risks and side effects of surgery
All surgeries carry some risks, including blood clots, infections, complications from anesthesia, and pneumonia. These risks are generally low but are higher with more complicated operations.
Laryngectomy and pharyngectomy typically lead to the loss of normal speech, while less extensive operations can also affect speech in some cases.
Some people will need a tracheostomy after surgery.
Surgeries that involve the throat or voice box can lead to a gradual narrowing (stenosis) of the throat or larynx (if it remains after surgery), which in some cases could affect breathing. If this happens, a tracheostomy may be needed.
Laryngectomy and pharyngectomy can also lead to the development of a fistula (an abnormal opening between 2 areas that are not normally connected). This may require surgery to correct.
Throat or larynx surgeries may also sometimes affect a person's ability to swallow. This can be severe enough to require a permanent feeding tube in some cases.
A very rare but serious complication of neck surgery is rupture of a carotid artery (the large artery on either side of the neck).
Rarely, these operations can lead to problems with the thyroid and/or parathyroid glands, which are in the front of the neck. Damage to the thyroid gland can lead to hypothyroidism, where the patient feels very tired and sluggish. Damage to the parathyroid gland can lead to problems with low calcium levels, which can cause muscle spasms and irregular heart beat. These problems can be treated with medicines.
For more general information on surgery as a treatment for cancer, see our document, Surgery.
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