Moving on after treatment for laryngeal or hypopharyngeal cancers
For some people with laryngeal or hypopharyngeal cancer, treatment may remove or destroy the cancer. Being done with treatment can be both stressful and exciting. You might be relieved to finish treatment but find it hard not to worry about cancer growing or coming back. (When cancer comes back after treatment, it is called recurrence.) This is a very common concern in people who have had cancer.
It may take a while before your recovery begins to feel real and your fears are somewhat relieved. You can learn more about what to look for and how to learn to live with the chance of cancer coming back in Living With Uncertainty: The Fear of Cancer Recurrence.
For other people, the cancer may never go away completely. These people may get regular treatments with chemo, radiation, or other treatments to help keep the cancer in check for as long as possible. Learning to live with cancer as more of a chronic disease can be hard and very stressful. It has its own type of uncertainty.
If you have finished treatment, your doctors will still want to watch you closely. It is very important to go to all follow-up visits. When these cancers come back, it is most often in the first couple of years, so you will likely have head and neck exams often, including a scope exam, about every other month during the first year or so after treatment. Follow-up may then be more spread out as time goes on and there is no sign of cancer. Chest x-rays and other imaging tests may be used to watch for a return of the cancer or for a new tumor.
If you were treated with radiation and it reached your thyroid gland, you may need blood tests to check your thyroid function. Your doctor may also suggest dental exams or tests to check your speech and swallowing, especially if you are having any problems after treatment.
Almost any cancer treatment can have side effects. Some may last for a few weeks or months, but others can be permanent. Please tell your cancer care team about any symptoms or side effects that bother you so they can help you manage them. Use this time to ask your health care team questions and discuss any concerns you might have.
It is also important to keep health insurance. While you hope your cancer won’t come back, it could happen. If it does, you don’t want to have to worry about paying for treatment. Should your cancer come back, our document When Your Cancer Comes Back: Cancer Recurrence can help you cope with this phase of your treatment.
Restoring speech after total laryngectomy
If you have had a total laryngectomy, you will not be able to talk like you did before. But there are many ways you can talk again. Learning to speak again will take time and effort, and your voice will not sound the same. You will need to see a person trained to help people who have lost their vocal cords (a speech therapist). Here are some of the options for speech after laryngectomy:
Esophageal speech: After laryngectomy, your windpipe (trachea) no longer connects to the throat. So you cannot expel air from the lungs through your mouth to speak. With training, you can learn to swallow air and force it through your mouth. And with practice you can turn this into speech. But with new devices and new types of surgery, learning this method may not be needed.
TEP (tracheoesophageal puncture): This surgery (done either during the first surgery or later) creates a connection between the windpipe and the food pipe through a small hole at the stoma. A one-way valve placed into the hole allows you to force air from the lungs into the mouth but keeps food and liquids out of the lungs. You cover the stoma with your finger to force air out of your mouth. (Some newer “hands-free” models do not need for you to cover the stoma to speak.) With practice and the help of a speech therapist, you can learn this way of speaking.
Electrolarynx: If you cannot have TEP for some reason, or while you are learning to use your TEP voice, you might use an electrical device to produce speech. These use batteries and are placed in the corner of the mouth or against the skin of the neck. When you press a button it makes a vibrating sound. By moving your mouth and tongue, you can form this sound into words. You will need training with a speech therapist to learn to use this tool.
Stoma care after total laryngectomy
Having a stoma (tracheostomy) means that the air you breathe in and out will not pass through your nose or mouth. The air reaching your lungs will be dryer and cooler. This may cause problems with the lining of the breathing tubes and thick or crusty mucus may form.
For this reason, you should learn how to take care of your stoma. The cancer care team will give you information about stoma care, such as protecting and cleaning it. And there are support groups for people who have had this surgery. They can give you information about caring for the stoma and how to use products to help protect and clean it.
Help for trouble swallowing and nutrition problems
Cancers of the larynx or hypopharynx and their treatments can sometimes cause problems such as trouble swallowing, dry mouth, or even loss of teeth. This can make it hard to eat, which can lead to weight loss and weakness due to poor nutrition.
Some people may need to adjust what they eat during and after treatment or they might need nutritional supplements. Some may even need a feeding tube placed in the stomach for a short time after treatment. A team of doctors and nutritionists can work with you to help sort out what works for you. This can help you maintain your weight and nutritional intake.
Sexual impact of laryngectomy
Losing the voice box changes the way a person looks, sounds, and breathes. This can have an impact on lovemaking. Feeling self-conscious about the stoma can affect intimacy. A scarf, ascot, or turtleneck shirt can look nice and hide the stoma cover. Even during sex, a stoma cover may look more appealing than a bare stoma.
Other common-sense ideas are to avoid garlic or spicy foods that might cause odors from the stoma, and to use perfume, cologne, or after-shave lotion.
Sometimes problems with speech can be an issue for couples. Most methods of speech after laryngectomy require some effort and don’t allow you to whisper. But you can still say a lot by guiding your partner’s hand and using body language.
Seeing a new doctor
At some point after your cancer is found and treated, you may find yourself in the office of a new doctor. It is important that you be able to give your new doctor the exact details of your diagnosis and treatment. Gathering these details soon after treatment may be easier than trying to get them at some point in the future. Make sure you have this information handy and always keep copies for yourself:
- A copy of your pathology report from any biopsy or surgery
- Copies of imaging tests (CT or MRI scans, etc.), which can usually be stored on a CD, DVD, etc.
- If you had surgery, a copy of your operative report
- If you stayed in the hospital, a copy of the discharge summary that the doctor wrote when you were sent home from the hospital
- If you had radiation treatment, a copy of the treatment summary
- If you had chemotherapy or targeted therapies, a list of your drugs, drug doses, and when you took them
Last Medical Review: 01/22/2013
Last Revised: 01/22/2013