Several operations are commonly used in treating patients with laryngeal and hypopharyngeal cancers. Depending on the stage of the cancer and its location, one or more of these may be used to remove the cancer and some of the surrounding laryngeal or hypopharyngeal tissue and to help restore the appearance and function of the tissues affected by the treatment.

Vocal cord stripping

This technique involves using a long instrument to strip away the superficial layers of tissue on the vocal cords. This can be a way to biopsy and treat stage 0 (carcinoma in situ) cancer of the larynx. 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 used to locate the tumor, which is then either vaporized or excised (cut out) using a high-intensity laser. A drawback of using vaporization is that it destroys the tissue being treated leaving 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

Cordectomy involves removing all or part of the vocal cords. It can be used to treat very limited or superficial glottic 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 after both vocal cords are removed.

Laryngectomy

Partial laryngectomy: Smaller cancers of the larynx often can be treated by removing only part of the voice box. This is called partial laryngectomy (removing the entire voice box is called total larygectomy). 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.

Total laryngectomy: In this procedure, the entire larynx (voice box) is removed. The voice box is removed and the windpipe is then brought up to the skin of the front of the neck as a stoma (or hole) that you breathe through (see the illustration below). Once the entire larynx is removed, normal speech is no longer possible.

Potential complications of total laryngectomy may include bleeding and infection. In rare cases, rupture of the carotid artery (a large artery in the neck) can also occur.

Laryngectomy can also lead to the development of a fistula (an abnormal opening between 2 areas that are not normally connected) or narrowing of the throat (a pharyngeal stricture).

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 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 the pharynx and improve your ability to swallow.

Reconstructive procedures

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 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.

Neck dissection

Cancers of the supraglottic larynx and hypopharynx often spread to the lymph nodes in the neck. If, based on the stage and exact location of the tumor, your doctor thinks that lymph node spread is likely, it may be necessary to remove lymph nodes from your neck. This operation is called a neck dissection.

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 of tissue to be removed depends on the size and extent of cancer spread. In a full radical dissection, nerves and muscles responsible for full 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 metastatic cancer are removed. Sometimes doctors will try to remove less normal tissue in order to keep the shoulder and neck functioning normally.

Tracheotomy

If a laryngeal or hypopharyngeal cancer is blocking the windpipe and is too large to remove completely, an opening may be made in your neck to bypass the tumor and allow you to breathe more comfortably. The new opening is called a tracheotomy. Often, a tracheotomy is only needed to protect the airway during recovery after a partial laryngectomy or pharyngectomy. It stays in place for a short time, and is removed later when it is no longer needed.

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 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. Once in place, it can be used to deliver extra nutrition directly into the stomach. Often, the gastrostomy tube is only needed temporarily to help you get adequate nutrition during radiation and/or chemotherapy. The feeding tube can be removed once your swallowing function improves after treatment.

Last Medical Review: 05/07/2009
Last Revised: 05/07/2009