Laryngeal and Hypopharyngeal Cancer

+ -Text Size

Treating Laryngeal and Hypopharyngeal Cancer TOPICS

Surgery for laryngeal and hypopharyngeal cancers

Surgery is commonly used to treat patients with laryngeal and hypopharyngeal cancers. Depending on the stage and location of the cancer, different operations may be used to remove the cancer and some nearby parts of the larynx or hypopharynx.

After the cancer is removed, reconstructive surgery may be done to help restore the appearance and function of the affected areas.

Vocal cord stripping

In this technique, the doctor 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 your 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 vaporization is that 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 a hoarse voice.

Cordectomy

For a cordectomy the surgeon removes all or part of your vocal cords. This can be used to treat very small or superficial glottic (vocal cord) cancers. The effect of this procedure on speech depends on how much of the vocal cords are removed. Removing part of a vocal cord may result in hoarseness. 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. There are different types of partial laryngectomies, but they all have the same goal: to remove the entire cancer while leaving behind as much of the larynx as possible.

In a supraglottic laryngectomy, only the portion of your larynx above the vocal cords is removed. This procedure can be used to treat some supraglottic cancers, and will allow you to speak normally afterward.

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 operation, known as a hemilaryngectomy, will allow some speech to remain.

Total laryngectomy: In this procedure, your entire larynx 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 picture below). This is known as a tracheostomy. Once the entire larynx is removed, you can no longer speak normally, but you can learn other ways 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, you can swallow food and liquids just as you did before the operation.

Illustrations by permission of the Mayo Foundation. From "Looking Forward...A Guidebook for the Laryngectomee" by R.L. Keith, et al, New York, Thieme-Stratton, Inc. and copyrighted by the Mayo Foundation, 1984.

Total or partial pharyngectomy

Surgery to remove all or part of the pharynx (throat) 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 surgery

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 part of your throat.

Free flaps: With the advances in 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, lymph nodes (and other nearby tissues) may be removed 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 a radical neck dissection to a less extensive selective neck dissection. They differ in the amount of tissue removed from the neck. In a full radical dissection, nerves and muscles responsible for some neck and shoulder movement are removed along with the lymph nodes. This might be needed to be sure that all of the lymph nodes likely to contain cancer are removed. Sometimes doctors will try to remove less normal tissue to try to keep your shoulder and neck functioning normally.

Tracheostomy/tracheotomy

A tracheostomy (tracheotomy) is an incision (hole) made in the trachea (windpipe) through the front of the neck to help a person breathe by letting air in and out of the lungs. It may be used in different circumstances.

After a partial laryngectomy or pharyngectomy, a temporary tracheostomy (using a small plastic tube known as a trach tube) may be put in place to help protect your airway while you recover from surgery. The tube stays in place for a short time, and is then removed later when it is no longer needed.

As described above, a permanent tracheostomy is needed after a total laryngectomy. In this procedure, the opening in the trachea is connected to a hole in the skin in the front of the neck. A trach tube or stoma cover may be needed to help keep the tracheostomy open.

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 your windpipe to a stoma (hole) in the front of your neck to bypass the tumor and allow you to breathe more comfortably.

Gastrostomy tube

Cancers in the larynx and hypopharynx may keep 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. The tube is often put in place with the help of a flexible, lighted instrument (endoscope) passed down your mouth and into the stomach. This is done while you are sedated. When it is placed through endoscopy, it is called a percutaneous endoscopic gastrostomy, or PEG tube. Another option is to put the tube in place during an operation. Once in place, the tube can deliver nutrition directly into the stomach.

Often, the gastrostomy tube is only needed for a short time to help you get enough nutrition during radiation and/or chemotherapy. The tube can be removed once your swallowing improves after treatment. It is important to keep swallowing even when getting most of your nutrition through a G tube to keep those muscles active and increase the likelihood that you will return to normal swallowing after treatment is complete.

Possible risks and side effects of surgery

All surgery carries some risks, including blood clots, infections, complications from anesthesia, and pneumonia. These risks are generally low but are higher with more complicated operations.

Patients who have a laryngectomy or pharyngectomy typically lose the ability to speak normally. Less extensive operations can also affect speech in some cases (see “What happens after treatment for laryngeal and hypopharyngeal cancers?” for more about speech after surgery).

Some people will need a tracheostomy after surgery (see “What happens after treatment for laryngeal and hypopharyngeal cancers?” for information on tracheostomy care).

Surgeries that affect 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, you might need a tracheostomy.

Throat or larynx surgeries may also sometimes affect your ability to swallow. This can affect how you eat, and might be severe enough to require a permanent feeding tube in some cases.

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.

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 heartbeat. These problems can be treated with medicines.

For more general information on surgery as a treatment for cancer, see our document, Understanding Cancer Surgery: A Guide for Patients and Families.


Last Medical Review: 12/14/2012
Last Revised: 02/03/2014