Finishing treatment can be both stressful and exciting. While you will be relieved to be done, it is hard not to worry about cancer coming back. (When cancer returns, it is called recurrence.) This is a very common concern among those 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 possibility of cancer coming back in the American Cancer Society document, Living with Uncertainty: The Fear of Cancer Recurrence, available at 1-800-ACS-2345 (1-800-227-2345).

Follow-up tests

Because cancers of the larynx and hypopharynx can come back or a new cancer can develop, patients must be followed closely after treatment. The cancer is most likely to come back in the first 2 years, so you will likely have head and neck exams often, including a scope exam, about every other month during the first year after treatment and about 4 times a year during the second year. Follow-up may then be spread out to 3-, 6-, and 12-months as time goes on and there is no sign of cancer. Chest x-rays and other imaging studies may be used to watch for a return of the cancer or for a new tumor.

It is important to report any new symptoms to the doctor right away because they may alert the doctor to do tests that could help find a cancer that has returned. The earlier cancer is found, the better the chances of successful treatment.

It is also important to keep medical insurance. Even though no one wants to think of their cancer coming back, it is always a possibility. If it happens, you don't want to have to worry about paying for treatment. Should your cancer come back the American Cancer Society document, When Your Cancer Comes Back: Cancer Recurrence gives you information on how to manage and cope with this phase of your treatment. You can get this document by calling 1-800-ACS-2345 (1-800-227-2345).

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. 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 mouth and food pipe. 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 valve placed into the hole allows you to force air from the lungs into the mouth. You cover the stoma with your finger to force air out of your mouth. With practice, 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 this tool.

Stoma care after total laryngectomy

Having a stoma instead of a larynx 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.

Sexual impact of laryngectomy

Losing a voice box also 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 talking 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.

Smoking and alcohol use

If you smoke or drink, it is very important to quit. Quitting helps improve your overall health, your appetite, and can reduce your chance of developing a new cancer. Other cancers such as lung and oral cancers often occur in smokers, too. For this reason, follow-up visits and avoiding risk factors are especially important.

Seeing a new doctor

At some point after your cancer treatment, you may find yourself seeing a new doctor. It is important that you be able to give your new doctor the exact details of your diagnosis and treatment. Make sure you have the following information handy:

• a copy of your pathology report from any biopsy or surgery
• if you had surgery, a copy of your operative report
• if you were hospitalized, a copy of the discharge summary that every doctor must prepare when patients are sent home from the hospital
• if you had radiation, a final summary of the dose and field
• finally, since some cancer-treatment drugs can have long-term side effects, a list of your drugs, drug doses, and when you took them

After you show this to your new doctor, get your copies back and keep them in a safe place. You will likely need them again and again.

Lifestyle changes to think about during and after treatment

Having cancer and dealing with treatment can take up a lot of your time and be emotionally draining, but it can also be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term.

Make healthier choices

Think about your life before you learned you had cancer. Were there things you did that might have made you less healthy? Maybe you drank too much alcohol, or ate more than you needed, or smoked, or didn't exercise very often.

Now is not the time to feel guilty or blame yourself. But you can start making changes today that can have positive effects for the rest of your life. Not only will you feel better but you will also be healthier.

You can start by working on those things that you feel most concerned about. Get help with those that are harder for you. For instance, if you are thinking about quitting smoking and need help, call the American Cancer Society at 1-800-227-2345.

Diet and nutrition

Eating right can be a challenge for anyone, but it can get even tougher during and after cancer treatment. If you are still in treatment and are having eating problems related to your treatment, please ask for a copy of Nutrition for the Person with Cancer.

One of the best things you can do after treatment is to put healthy eating habits into place. You will be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Try to eat 5 or more servings of vegetables and fruits each day. Choose whole grain foods instead of white flour and sugars. Try to limit meats that are high in fat. Cut back on processed meats like hot dogs, bologna, and bacon. If you drink alcohol, limit yourself to 1 or 2 drinks a day at the most. And don't forget to get some type of regular exercise. The combination of a good diet and regular exercise will help you stay at a healthy weight and give you more energy.

Rest, fatigue, work, and exercise

Tiredness (fatigue) is a very common symptom in people being treated for cancer. This is often not an ordinary type of tiredness but a "bone-weary" exhaustion that doesn't get better with rest. For some, this fatigue lasts a long time after treatment, and can interfere with being active. But exercise can actually help you reduce fatigue.

If you are ill and need to be on bed rest during treatment, it is normal to expect to lose some of your fitness, endurance, and muscle strength. Physical therapy can help you maintain strength and range of motion in your muscles. This can help you fight fatigue and the sense of depression that sometimes comes with feeling so tired.

Any program of physical activity should fit your own situation. Talk with your health care team before starting, and get their advice about your exercise plans. Then, try to get an exercise buddy so that you're not doing it alone.

If you are very tired, though, you will need to balance activity with rest. It is OK to rest when you need to. (For more information about fatigue, please see the publication, Fatigue in People with Cancer.)

Exercise can improve your physical and emotional health.

• It improves your cardiovascular (heart and circulation) fitness.
• It strengthens your muscles.
• It reduces fatigue.
• It lowers anxiety and depression.
• It makes you feel generally happier.
• It helps you feel better about yourself.

And long term, we know that exercise plays a role in preventing some cancers. The American Cancer Society recommends that adults take part in at least 1 physical activity for 30 minutes or more on 5 or more days of the week; 45 to 60 minutes is even better. Children and teens should try to get at least an hour of high-energy physical activity each day for at least 5 days a week.

How about your emotional health?

Once your treatment ends, you may find yourself overwhelmed by emotions. This happens to a lot of people. You may find that you think about the effect of your cancer on your family, friends, and career. You may also begin to re-evaluate your relationship with your spouse or partner. Unexpected issues may also cause concern -- for instance, as you become healthier and have fewer doctor visits, you will see your health care team less often. That can cause anxiety for some people.

This is an ideal time to look for emotional and social support. You need people you can turn to for strength and comfort. Support can come in many forms: family, friends, cancer support groups, church or spiritual groups, online support communities, or individual counselors.

The cancer journey can feel very lonely, but you don't need to take it all by yourself. Your friends and family may feel shut out if you decide not include them. Let them in and anyone else who you feel may help. If you aren't sure who can help, call your American Cancer Society at 1-800-227-2345 and we can put you in touch with a group or resource.

You can't change the fact that you have had cancer. What you can change is how you live the rest of your life -- making healthy choices and feeling as well as possible, physically and emotionally.

Last Medical Review: 05/27/2009
Last Revised: 05/27/2009