Best Laryngeal Cancer Surgery in Delhi, India

Vocal cord cancer surgery is a treatment option for individuals diagnosed with cancer of the voice box or larynx. The goal of the surgery is to remove cancerous cells while preserving or rehabilitating the patient's ability to speak.

Laryngeal cancer is defined as a cancer of the larynx, commonly called the voice box. In other words, laryngeal cancer can be characterized by the formation of malignant cells in the tissues around the larynx. The larynx's enables an individual to speak, breathe and swallow without aspiration. The larynx is divided into three parts. These are as follows:

1. The upper section is called the supraglottis.
2. The middle section is termed the glottis.
3. The lower section is called the subglottis.

When laryngeal cancer begins to spread, it affects the lymph nodes in the neck and, in some cases, adjoining structures as well.

Symptoms

The following are the symptoms of laryngeal cancer:

⮚ A sore throat

⮚ Hoarseness of voice

⮚ Difficulty or pain while consuming food or other eatables

⮚ Persistent cough

⮚ Frequent choking while having food

⮚ Formation of an abnormal lump near the throat or neck

⮚ Persistent bad breath

⮚ Weight loss

⮚ Pain in the ear

⮚ High pitched breathing

⮚ Haemoptysis (coughing up blood) 

Why is Laryngectomy (Vocal Cord Cancer Surgery) Done?

The aim of vocal cord cancer surgery is to remove the tumour while restoring the larynx's function. Depending on the size and extent of the tumour, the doctor removes either part of the larynx or, in some cases, the entire larynx.

For early lesions of the vocal cord, resection using laser may be feasible for select cases. This may allow us to remove the cancer without impacting the voice of the patient.

In advanced cases, removal of the entire voice box may be required. This procedure is called a laryngectomy. It can be of two types: partial laryngectomy and total laryngectomy.

Partial laryngectomy is further divided into horizontal or vertical partial laryngectomy. Here, part of the larynx is removed, leaving behind the other part. In supraglottic laryngectomy, a specific part of the larynx situated above the vocal cord is removed. The patient can speak after the completion of this surgery.

Here we have discussed regarding total laryngectomy, and it is considered when the disease has extended out of the voice box (extra-laryngeal) or has eroded the cartilage forming the framework of the larynx. It can also be considered for patients with bulky disease and aspiration. It may even be considered when the disease is still left behind after chemo-radiation.

Laryngectomy (Voice Box Cancer Surgery) Procedure Details

Before Laryngectomy

The patient undergoes a complete physical examination before undergoing this procedure. The doctor also recommends certain tests to be done, which include:

1. Complete blood count (CBC) and other blood tests
2. Chest X-ray
3. Electrocardiogram (EKG) and echocardiography to monitor heart rhythm.

The patient may also be referred to a speech therapist. They play a vital role in the patient's rehabilitation after this procedure.

The patient is expected to:

⮚ Stop the consumption of blood thinners.

⮚ Avoid smoking and drinking.

⮚ Avoid consumption of meals after midnight before the procedure.

During Laryngectomy

• Marking of an incision: The doctor initiates the procedure by making an incision on the neck region.
• Removal of Larynx: After making the incision, the surgeon removes either part or the entire larynx. They may also remove adjacent lymph nodes and part of the pharynx.
• Stoma: The next step in this procedure involves making an opening in the neck and in front of the windpipe. This opening is called a stoma. A laryngectomy tube is then placed in the stoma, which will help the patient breathe after the surgery.
• Tracheoesophageal puncture (TEP): In some cases, the surgeon may create a small hole between the region of the trachea and the oesophagus. This is called a tracheoesophageal puncture. The puncture allows the placement of voice prostheses. A TEP is not recommended for everyone, and the surgeon takes the final call regarding this.
• Closing of the incision: Finally, the surgeon will close these incisions with sutures.

After the Laryngectomy

The patient is administered feeds with the help of a feeding tube. The patient has to be in the hospital for 5-7 days. The surgeon refers the patient to a speech therapist for further recovery by learning how to speak and communicate.

Voice prosthesis

A voice prosthesis, also called trachea-esophageal prosthesis, is placed through the stoma. With proper training, the patient can learn to move air from the lungs into the esophagus. The resulting vibrations create speech. It has the best speech outcomes amongst the various options of speech rehabilitation.

Electrolarynx

The doctor places an artificial larynx, also called the electrolarynx, against the neck to enhance speech. It is one of the fastest methods adopted by patients, although the speech may sound robotic or electronic.

Esophageal speech

In certain cases, patients make use of oesophageal speech to communicate after a laryngectomy. With the help of this method, patients can redirect air from the mouth, trap it in the throat and esophagus and use it to form speech.

Nonverbal communication

Anyone who undergoes a laryngectomy will use nonverbal communication at some point during their recovery to communicate with his family members and friends at his home or workplace. These generally include:

•  Gestures
• Mouthing words
• Facial expressions
• Writing by hand
• Typing on a computer or tablet
• Sign language.

Risks Associated with Laryngectomy (Laryngeal Cancer Surgery)

• Blood clots
•  Infection
•  Heart problems
• Breathing difficulties

Complications of Laryngectomy (Voice Box Cancer Surgery)

• Difficulty in speaking
• Reduced function of thyroid glands
• Limited range of motion around the neck region
• Fistulas or leakage of saliva into the neck
• Difficulty in eating and swallowing
• Damage to the trachea and oesophagus.

Recovery After Laryngectomy Surgery

Generally, it takes two to three weeks to recover after laryngectomy surgery; however, this period may vary among different individuals based on factors like the extent of the surgery and the patient's general health. Most patients undergoing laryngeal cancer surgery lead good and healthy lives.

Success Rate of Vocal Cord Cancer Surgery

The success rate of vocal cord cancer surgery depends on factors like the stage of stage and type, the patient's general health, and the extent of surgery. Success rates may range from 70% to 90% for early-stage cancer but may be about 60% for advanced-stage cancer.

Review 

Reviewed By Dr Akshat Malik Senior Consultant Cancer Care / Oncology on 26 June 2024.