Larynx Cancer Causes, Symptoms, Diagnosis, Treatment, Prevention

Larynx Cancer Causes, Symptoms, Diagnosis, Treatment, Prevention


What is the larynx?


The larynx, also called the voice box, is a 2-inch-long, tube-shaped organ in the neck. We use the larynx when we breathe, talk, or swallow.

The larynx is at the top of the windpipe (trachea). Its walls are made of cartilage. The large cartilage that forms the front of the larynx is sometimes called the Adam's apple. The vocal cords, two bands of muscle, form a "V" inside the larynx.

Each time we inhale (breathe in), air goes into our nose or mouth, then through the larynx, down the trachea, and into our lungs. When we exhale (breathe out), the air goes the other way. When we breathe, the vocal cords are relaxed, and air moves through the space between them without making any sound.

When we talk, the vocal cords tighten up and move closer together. Air from the lungs is forced between them and makes them vibrate, producing the sound of our voice. The tongue, lips, and teeth form this sound into words.

The esophagus, a tube that carries food from the mouth to the stomach, is just behind the trachea and the larynx. The openings of the esophagus and the larynx are very close together in the throat. When we swallow, a flap called the epiglottis moves down over the larynx to keep food out of the windpipe.

Read more: Adult And Children Learning Disabilities

What Is Cancer?


Cancer is a group of more than 100 different diseases. They all affect the body's basic unit, the cell. Cancer occurs when cells become abnormal and divide without control or order.

Like all other organs of the body, the larynx is made up of cells. Normally, cells divide to produce more cells only when the body needs them. This orderly process helps keep us healthy.

If cells keep dividing when new cells are not needed, a mass of extra tissue forms. This mass of tissue, called a growth or tumor, can be benign or malignant.

  • Benign tumors are not cancer. They do not spread to other parts of the body and are seldom a threat to life. Benign tumors can usually be removed, but certain types may return.

  • Malignant tumors are cancer. They can invade and destroy nearby healthy tissues and organs. Cancer cells can also break away from the tumor and enter the bloodstream and the lymphatic system. That is how cancer spreads to other parts of the body. This spread is called metastasis.

Cancer of the larynx is also called laryngeal cancer. It can develop in any region of the larynx -- the glottis (where the vocal cords are), the supraglottis (the area above the cords), or the subglottis (the area that connects the larynx to the trachea).

If the cancer spreads outside the larynx, it usually goes first to the lymph nodes (sometimes called lymph glands) in the neck. It can also spread to the back of the tongue, other parts of the throat and neck, the lungs, and sometimes other parts of the body.

Cancer that spreads is the same disease and has the same name as the original (primary) cancer. When cancer of the larynx spreads, it is called metastatic laryngeal cancer.

Larynx Cancer Causes


Although the exact cause of cancer is unknown, some known risk factors for cancer of the larynx include:

Smoking: 


The risk of laryngeal cancer increases up to 30 times for smokers. The heavier the person smokes, the higher the risk. Second-hand smoke is also considered a hazard.

Alcohol:


Heavy drinkers more than double their risk for this type of cancer, and combining smoking with alcohol can increase the risks even more than either drinking or smoking alone.

Gastroesophageal reflux disease (GERD):


In GERD, the stomach acid backs up into the esophagus, causing a burning pain. Although not definitively proven, researchers have found that irritation from longstanding GERD is related to higher chances of laryngeal cancer.

Poor nutrition: 


Many people who abuse alcohol also have poor nutritional habits, but some research also suggests that not getting enough vitamins might be a risk factor.

Human papillomavirus (HPV):


The virus that can cause genital warts can also develop into certain cancers. Mothers may pass the virus on to their children when they're born. It settles in the larynx, developing into growths called laryngeal papillomas later on in life. These growths may develop into cancer.

Race: 


Laryngeal cancer is found twice as often among people of African descent than among Caucasians.
gender: More men than women are diagnosed with cancer of the larynx.

Age: 


This type of cancer is usually detected in people between 50 and 75 years old.

Weakened immune system: 


People with weak immune systems (due to diseases such as AIDS or medications that lower immunity to viruses) are more susceptible to laryngeal cancer.

Toxic exposure: 


These risk factors include being exposed to wood dust, asbestos, or many types of chemicals that can increase the chances of cancer.

Voice overuse: 


People who use their voices a lot, such as singers, may develop polyps (lumps of tissue) that can become cancerous if not removed.

Symptoms of Larynx Cancer


The symptoms of larynx cancer depend mainly on the size and location of the tumor. Most cancers of the larynx begin on the vocal cords. These tumors are seldom painful, but they almost always cause hoarseness or other changes in the voice. Tumors in the area above the vocal cords may cause a lump on the neck, a sore throat, or an earache. Tumors that begin in the area below the vocal cords are rare. They can make it hard to breathe, and breathing may be noisy.

A cough that doesn't go away or the feeling of a lump in the throat may also be warning signs of cancer of the larynx. As the tumor grows, it may cause pain, weight loss, bad breath, and frequent choking on food. In some cases, a tumor in the larynx can make it hard to swallow.

Any of these symptoms may be caused by cancer or by other, less serious problems. Only a doctor can tell for sure. People with symptoms like these usually see an ear, nose, and throat specialist (otolaryngologist).

Larynx Cancer Diagnosis


To find the cause of any of these symptoms, the doctor asks about the patient's medical history and does a complete physical exam. In addition to checking general signs of health, the doctor carefully feels the neck to check for lumps, swelling, tenderness, or other changes. The doctor can also look inside the larynx in two ways:

  • Indirect laryngoscopy. The doctor looks down the throat with a small, long-handled mirror to check for abnormal areas and to see whether the vocal cords move as they should. This test is painless, but a local anesthetic may be sprayed in the throat to prevent gagging. This exam is done in the doctor's office.

  • Direct laryngoscopy. The doctor inserts a lighted tube (laryngoscope) through the patient's nose or mouth. As the tube goes down the throat, the doctor can look at areas that cannot be seen with a simple mirror. A local anesthetic eases discomfort and prevents gagging. Patients may also be given a mild sedative to help them relax. Sometimes the doctor uses a general anesthetic to put the person to sleep. This exam may be done in a doctor's office, an outpatient clinic, or a hospital.

If the doctor sees abnormal areas, the patient will need to have a biopsy. A biopsy is the only sure way to know whether cancer is present. For a biopsy, the patient is given a local or general anesthetic, and the doctor removes tissue samples through a laryngoscope. A pathologist then examines the tissue under a microscope to check for cancer cells. If cancer is found, the pathologist can tell what type it is. Almost all cancers of the larynx are squamous cell carcinomas. This type of cancer begins in the flat, scale-like cells that line the epiglottis, vocal cords, and other parts of the larynx.

If the pathologist finds cancer, the patient's doctor needs to know the stage (extent) of the disease to plan the best treatment. To find out the size of the tumor and whether the cancer has spread, the doctor usually orders more tests, such as x-rays, a CT (or CAT) scan, and/or an MRI. During a CT scan, many x-rays are taken. A computer puts them together to create detailed pictures of areas inside the body. An MRI scan produces pictures using a huge magnet linked to a computer.

Larynx Cancer Treatment Options


Treatment for cancer of the larynx depends on a number of factors. Among these are the exact location and size of the tumor and whether the cancer has spread. To develop a treatment plan to fit each patient's needs, the doctor also considers the person's age, general health, and feelings about the possible treatments.

Many patients want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. When discussing treatment options, the patient may want to talk with the doctor about taking part in a research study of new treatment methods. Such studies, called clinical trials, are discussed in the Treatment Studies section.

The patient and the doctor should discuss the treatment choices very carefully because treatments for this disease may change the way a person looks and the way he or she breathes and talks. In many cases, the patient meets with both the doctor and a speech pathologist to talk about treatment options and possible changes in voice and appearance.

People with larynx cancer have many important questions. The doctor and other members of the health care team are the best ones to answer them. Most patients want to know the extent of their cancer, how it can be treated, how successful the treatment is expected to be, and how much it is likely to cost. These are some questions patients may want to ask the doctor:

  • What are my treatment choices?
  • Would a clinical trial be appropriate for me?
  • What are the expected benefits of each kind of treatment?
  • What are the risks and possible side effects of each treatment?
  • How will I speak after treatment?
  • How will I look?
  • Will I need to change my normal activities? If so, for how long?
  • When will I be able to return to work?
  • How often will I need to have checkups?

When a person is diagnosed as having cancer, shock and stress are natural reactions. These feelings may make it difficult for patients to think of everything they want to ask the doctor. Often, it helps to make a list of questions. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor -- to take part in the discussion, to take notes, or just to listen.

Treatment Methods for Larynx Cancer


Cancer of the larynx is usually treated with radiation therapy (also called radiotherapy) or surgery. These are types of local therapy; this means they affect cancer cells only in the treated area. Some patients may receive chemotherapy, which is called systemic therapy, meaning that drugs travel through the bloodstream. They can reach cancer cells all over the body. The doctor may use just one method or combine them, depending on the patient's needs.

In some cases, the patient is referred to doctors who specialize in different kinds of cancer treatment. Often several specialists work together as a team. The medical team may include a surgeon; ear, nose, and throat specialist; cancer specialist (oncologist); radiation oncologist; speech pathologist; nurse; and dietitian. A dentist may also be an important member of the team, especially for patients who will have radiation therapy.

Radiation therapy


Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing. The rays are aimed at the tumor and the area close to it. Whenever possible, doctors suggest this type of treatment because it can destroy the tumor and the patient does not lose his or her voice. Radiation therapy may be combined with surgery; it can be used to shrink a large tumor before surgery or to destroy cancer cells that may remain in the area after surgery. Also, radiation therapy may be used for tumors that cannot be removed with surgery or for patients who cannot have surgery for other reasons. If a tumor grows back after surgery, it is generally treated with radiation.

Radiation therapy is usually given 5 days a week for 5 to 6 weeks. At the end of that time, the tumor site very often gets an extra "boost" of radiation.

Surgery or surgery combined with radiation is suggested for some newly diagnosed patients. Also, surgery is the usual treatment if a tumor does not respond to radiation therapy or grows back after radiation therapy. When patients need surgery, the type of operation depends mainly on the size and exact location of the tumor.

If a tumor on the vocal cord is very small, the surgeon may use a laser, a powerful beam of light. The beam can remove the tumor in much the same way that a scalpel does.

Surgery


Surgery to remove part or all of the larynx is a partial or total laryngectomy. In either operation, the surgeon performs a tracheostomy, creating an opening called a stoma in the front of the neck. (The stoma may be temporary or permanent.) Air enters and leaves the trachea and lungs through this opening. A tracheostomy tube, also called a trach ("trake") tube, keeps the new airway open.

A partial laryngectomy preserves the voice. The surgeon removes only part of the voice box -- just one vocal cord, part of a cord, or just the epiglottis -- and the stoma is temporary. After a brief recovery period, the trach tube is removed, and the stoma closes up. The patient can then breathe and talk in the usual way. In some cases, however, the voice may be hoarse or weak.

In a total laryngectomy, the whole voice box is removed, and the stoma is permanent. The patient, called a laryngectomee, breathes through the stoma. A laryngectomee must learn to talk in a new way.

If the doctor thinks that the cancer may have started to spread, the lymph nodes in the neck and some of the tissue around them are removed. These nodes are often the first place to which laryngeal cancer spreads.

Chemotherapy


Chemotherapy is the use of drugs to kill cancer cells. The doctor may suggest one drug or a combination of drugs. In some cases, anticancer drugs are given to shrink a large tumor before the patient has radiation therapy or surgery. Also, chemotherapy may be used for cancers that have spread.

Anticancer drugs for larynx cancer are usually given by injection into the bloodstream. Often the drugs are given in cycles -- a treatment period followed by a rest period, then another treatment and rest period, and so on. Some patients have their chemotherapy in the outpatient part of the hospital, at the doctor's office, or at home. However, depending on the drugs, the treatment plan, and the patient's general health, a hospital stay may be needed.

Side Effects of Treatment for Larynx Cancer


The methods used to treat cancer are very powerful. It is hard to limit the effects of therapy so that only cancer cells are removed or destroyed; healthy cells also may be damaged. That's why treatment often causes unpleasant side effects.

The side effects of cancer treatment vary. They depend mainly on the type and extent of the treatment. Also, each person reacts differently. Doctors try to plan the patient's therapy to keep problems to a minimum. Doctors, nurses, dietitians, and speech pathologists can explain the side effects of treatment and suggest ways to deal with them. It may also help to talk with another patient. In many cases, a social worker or another member of the medical team can arrange a visit with someone who has had the same treatment.

Prevention for Larynx Cancer


Cancer of the larynx occurs most often in people over the age of 55. In the United States, it is four times more common in men than in women and is more common among black Americans than among whites. Scientists at hospitals and medical centers all across the country are studying this disease to learn more about what causes it and how to prevent it.

Doctors cannot explain why one person gets larynx cancer and another does not, but we are sure that no one can "catch" cancer from another person. Cancer is not contagious.

One known cause of cancer of the larynx is cigarette smoking. Smokers are far more likely than nonsmokers to develop this disease. The risk is even higher for smokers who drink alcohol heavily.

People who stop smoking can greatly reduce their risk of cancer of the larynx, as well as cancer of the lung, mouth, pancreas, bladder, and esophagus. Also, by quitting, those who have already had cancer of the larynx can cut down the risk of getting a second cancer of the larynx or a new cancer in another area. Special counseling or self-help groups are useful for some people who are trying to stop smoking. Some hospitals have groups for people who want to quit. Also, the Cancer Information Service and the American Cancer Society may have information about groups in local areas to help people quit smoking.

Working with asbestos can increase the risk of getting larynx cancer. Asbestos workers should follow work and safety rules to avoid inhaling asbestos fibers.

People who think they might be at risk for developing cancer of the larynx should discuss this concern with their doctor. The doctor may be able to suggest ways to reduce the risk and can suggest an appropriate schedule for checkups.

Radiation Therapy


During radiation therapy, healing after dental treatment may be a problem. That's why doctors want their patients to begin treatment with their teeth and gums as healthy as possible. They often recommend that patients have a complete dental exam and get any needed dental work done before the radiation therapy begins. It's also important to continue to see the dentist regularly because the mouth may be sensitive and easily irritated during cancer therapy.

In many cases, the mouth is tender during treatment, and some patients may get mouth sores. The doctor may suggest a special rinse to numb the mouth and reduce the discomfort.

Radiation to the larynx causes changes in the saliva and may reduce the amount of saliva. Because saliva normally protects the teeth, tooth decay can be a problem after treatment. Good mouth care can help keep the teeth and gums healthy and can make the patient feel more comfortable. Patients should do their best to keep their teeth clean. If it's hard to floss or brush the teeth in the usual way, patients can use gauze, a soft toothbrush, or a special toothbrush that has a spongy tip instead of bristles. A mouthwash made with diluted peroxide, salt water, and baking soda can keep the mouth fresh and help protect the teeth from decay. It may also be helpful to use a fluoride toothpaste and/or a fluoride rinse to reduce the risk of cavities. The dentist may suggest a special fluoride program to keep the mouth healthy.

If reduced saliva makes the mouth uncomfortably dry, drinking plenty of liquids is helpful. Some patients use a special spray (artificial saliva) to relieve the dryness.

Patients who have radiation therapy instead of surgery do not have a stoma. They breathe and talk in the usual way, although the treatment can change the way their voice sounds. Also, their voice may be weak at the end of the day, and it is not unusual for the voice to be affected by changes in the weather. Voice changes and the feeling of a lump in the throat may come from swelling in the larynx caused by the radiation. The treatment can also cause a sore throat. The doctor may suggest medicine to reduce swelling or relieve pain.

During radiation therapy, patients may become very tired, especially in the later weeks. Resting is important, but doctors usually advise their patients to try to stay as active as they can. It's also common for the skin in the treated area to become red or dry. The skin should be exposed to the air but protected from the sun, and patients should avoid wearing clothes that rub the area. During radiation therapy, hair usually does not grow in the treated area; if it does, men should not shave. Good skin care is important at this time. Patients will be shown how to keep the area clean, and they should not put anything on the skin before their radiation treatments. Also, they should not use any lotion or cream at other times without the doctor's advice.

Some patients complain that radiation therapy makes their tongue sensitive. They may lose their sense of taste or smell or may have a bitter taste in their mouth. Drinking plenty of liquids may lessen the bitter taste. Often, the doctor or nurse can suggest other ways to ease these problems. And it helps to keep in mind that, although the side effects of radiation therapy may not go away completely, most of them gradually become less troublesome and patients feel better when the treatment is over.

Surgery


Keeping the patient comfortable is an important part of routine hospital care. If pain occurs, it can be relieved with medicine. Patients should feel free to discuss pain control with the doctor.

For a few days after surgery, the patient isn't able to eat or drink. At first an intravenous (IV) tube supplies fluids. Within a day or two, the digestive tract is getting back to normal, but the patient still cannot swallow because the throat has not healed. Fluids and nutrition are given through a feeding tube (put in place during surgery) that goes through the nose and throat to the stomach. As the swelling in the throat goes away and the area begins to heal, the feeding tube is removed. Swallowing may be difficult at first, and the patient may need the guidance of a nurse or speech pathologist. Little by little, the patient returns to a regular diet.

After the operation, the lungs and windpipe produce a great deal of mucus, also called sputum. To remove it, the nurse applies gentle suction with a small plastic tube placed in the stoma. Soon, the patient learns to cough and to suction mucus through the stoma without the nurse's help. For a short time, it may also be necessary to suction saliva from the mouth because swelling in the throat prevents swallowing.

Normally, air is moistened by the tissues of the nose and throat before it reaches the windpipe. After surgery, air enters the trachea directly through the stoma and cannot be moistened in the same way. In the hospital, patients are kept comfortable with a special device that adds moisture to the air.

For several days after a partial laryngectomy, the patient breathes through the stoma. Soon the trach tube is removed; within the next few weeks, the stoma closes. The patient then breathes and speaks in the usual way, although the voice may not sound exactly the same as before.

After a complete laryngectomy, the stoma is permanent. The patient breathes, coughs, and "sneezes" through the stoma and has to learn to talk in a new way. The trach tube stays in place for at least several weeks (until the skin around the stoma heals), and some people continue to use the tube all or part of the time. If the tube is removed, it is usually replaced by a smaller tracheostomy button (also called a stoma button). After a while, some laryngectomees get along without either a tube or a button.

After a laryngectomy, parts of the neck and throat may be numb because nerves have been cut. Also, following surgery to remove lymph nodes in the neck, the shoulder and neck may be weak and stiff.

Chemotherapy


The side effects of chemotherapy depend on the drugs that are given. In general, anticancer drugs affect rapidly growing cells, such as blood cells that fight infection, cells that line the digestive tract, and cells in hair follicles. As a result, patients may have side effects such as lower resistance to infection, loss of appetite, nausea, vomiting, or mouth sores. They may also have less energy and may lose their hair.

Nutrition


Your diet is an important part of your medical care for laryngeal cancer. You need the right amount of calories, protein, vitamins, and minerals to maintain your strength and to heal.

However, when you have laryngeal cancer, it may be difficult to eat. You may be uncomfortable or tired, and you may have trouble swallowing or not feel like eating. You also may have nausea, vomiting, dry mouth, constipation, or diarrhea from cancer treatment or pain medicine.

Tell your health care team if you're having any problems eating or drinking. Also tell your health care team if you have diarrhea, constipation, heartburn, gas, belly pain, nausea, or vomiting after eating. If you're losing weight, a dietitian can help you choose the foods and nutrition products that will meet your needs.

Trouble Swallowing


If there's a chance that swallowing will become too difficult for you, your dietitian and doctor may recommend another way for you to receive nutrition. For example, after surgery or during radiation therapy for laryngeal cancer, some people need a temporary feeding tube. A feeding tube is a flexible tube that is usually passed into the stomach through an incision in the abdomen. A liquid meal replacement product (such as Boost or Ensure) can be poured through the tube. These liquid products provide all of the calories, protein, and other nutrients you need until you are able to swallow again.

Effects of Treatment on Eating


Loss of appetite can be a problem for patients treated for laryngeal cancer. People may not feel hungry when they are uncomfortable or tired.

Patients who have had a laryngectomy may lose their interest in food because the operation changes the way things smell and taste. Radiation therapy also tends to affect the sense of taste. The side effects of chemotherapy can also make it hard to eat. Yet good nutrition is important. Eating well means getting enough calories and protein to prevent weight loss, regain strength, and rebuild normal tissues.

After surgery, learning to swallow again may take some practice with the help of a nurse or speech pathologist. Some patients find liquids easier to swallow; others do better with solid foods. If eating is difficult because the mouth is dry from radiation therapy, patients may want to try soft, bland foods moistened with sauces or gravies. Others enjoy thick soups, puddings, and high-protein milkshakes. The nurse and the dietitian will help the patient choose the right kinds of food. Also, many patients find that eating several small meals and snacks during the day works better than trying to have three large meals.

What is involved in Rehabilitation after surgery for Larynx Cancer?


Learning to live with the changes brought about by larynx cancer is a special challenge. Rehabilitation is a very important part of the treatment plan. The medical team makes every effort to help patients return to their normal activities as soon as possible.

Each laryngectomee must be able to care for the stoma. Before leaving the hospital, the patient learns to remove and clean the trach tube or stoma button, suction the trach, and care for the area around the stoma. The skin is less likely to become irritated if it is kept clean.

When shaving, men should keep in mind that the neck may be numb for several months after surgery. To avoid nicks and cuts, it may be best to use an electric shaver until normal feeling returns.

Most people continue to use a stoma cover after the area heals. Stoma covers -- such as scarves, neckties, ascots, and special bibs -- can be attractive as well as useful. They help keep moisture in and around the stoma. Also, laryngectomees may be sensitive to dust and smoke, and the cover filters the air that enters the stoma. The cover also catches any discharge from the windpipe when the person coughs or sneezes.

Whenever the air is too dry, as it may be in heated buildings in the winter, the tissues of the windpipe and lungs may react by producing extra mucus. Also, the skin around the stoma may get crusty and bleed. Using a humidifier at home or in the office can lessen these problems.

A person who has had neck surgery may find that the neck is somewhat smaller. Also, the neck, shoulder, and arm may not be able to move as well as before. The doctor may advise physical therapy to help the person move more normally.

After surgery, laryngectomees work in almost every type of business and can do nearly all of the things they did before. However, they cannot hold their breath, so straining and heavy lifting may be difficult. Also, laryngectomees have to give up swimming and water skiing unless they have special instruction and equipment because it would be very dangerous for water to get into the windpipe and lungs through the stoma. Wearing a special plastic stoma shield or holding a washcloth over the stoma keeps water out when showering or shaving.

Learning To Speak Again


It's natural to be fearful and upset if the voice box must be removed. Talking is part of nearly everything we do, and losing the ability to talk -- even temporarily -- can be frightening. Patients and their families and friends need understanding and support during this very difficult time.

Until patients learn to talk again, it is important for them to be able to communicate in other ways. In the beginning, everyone who has had a laryngectomy has to communicate by writing, gesturing, or pointing to pictures, words, or letters. Some people like to use a "magic slate" for writing notes. Others use pads of paper and pens or pencils. It's handy to have a supply of pads that fit easily in a pocket or purse. In addition, some patients use a typewriter or computer. Others carry a small dictionary or a picture book (sometimes called a picture dictionary) and point to the words they need. Patients may want to select some of these items before the operation.

Within a week or so after a partial laryngectomy, most people can talk in the usual way. After a total laryngectomy, patients must learn to speak in a new way. A speech pathologist usually meets with the patient before surgery to explain the methods that can be used. In many cases, speech lessons can begin before the person leaves the hospital.

Patients may try out various new ways of talking. One way is to use air forced into the esophagus to produce the new voice (esophageal speech). Or the voice can come from some type of mechanical larynx. Some people rely on a mechanical larynx only until they learn esophageal speech, some decide to use this device instead of esophageal speech, and some use both.

Even though esophageal speech may sound low-pitched and gruff, many people want to use this method instead of a mechanical larynx because it sounds more like regular speech. Also, there's nothing to carry around, and the person's hands are free. A speech pathologist teaches the laryngectomee how to force air into the top of the esophagus and then push it out again. The puff of air is like a burp. It vibrates the walls of the throat, producing sound for the new voice. The tongue, lips, and teeth form words as the sound passes through the mouth.

For some laryngectomees, air for esophageal speech comes through a tracheoesophageal puncture. The surgeon creates a small opening between the trachea and the esophagus. A plastic or silicone valve is inserted into this opening through the stoma. The valve keeps food out of the trachea. When the stoma is covered, air from the lungs is forced into the esophagus through the valve. The air produces sound by making the walls of the throat vibrate. Words are formed in the mouth.

It takes practice and patience to learn esophageal speech, and not everyone is successful. How quickly a person learns, how natural the new voice sounds, and how understandable the speech is depend partly on the type and extent of the surgery. Other important factors are the patient's desire to learn and the help that's available. Patience and support from loved ones are important, too.

A mechanical larynx may be used until the person learns esophageal speech or if esophageal speech is too difficult. The device may be powered by batteries (electrolarynx) or by air (pneumatic larynx). The speech pathologist can help the patient choose a device and learn to use it.

One kind of electrolarynx looks like a small flashlight. It has a disk that makes a humming sound. The device is held against the neck, and the sound travels through the neck to the mouth. (This device may not be suitable for people who have had radiation therapy.) Another type of electrolarynx has a flexible plastic tube that carries sound to the person's mouth from a hand-held device.

A pneumatic larynx is held over the stoma and uses air from the lungs instead of batteries to make it vibrate. The sound it makes travels to the mouth through a plastic tube.

Living With Larynx Cancer


The diagnosis of cancer can change the lives of patients and the people who care about them. These changes can be hard to handle. It's natural for patients and their families and friends to have many different and sometimes confusing emotions.

At times, patients and their loved ones may feel frightened, angry, or depressed. These are normal reactions when people face a serious health problem. Most people handle their problems better if they can share their thoughts and feelings with those close to them. Sharing can help everyone feel more at ease and can open the way for people to show one another their concern and offer their support.

Worries about tests, treatments, hospital stays, learning to talk again, and medical bills are common. Doctors, nurses, speech pathologists, social workers, and other members of the health care team can help calm fears and ease confusion. They can also provide information and suggest resources.

Patients and their families are naturally concerned about what the future holds. Sometimes they use statistics to try to figure out the chance of being cured. It is important to remember, however, that statistics are averages based on large numbers of patients. They can't be used to predict what will happen to a certain patient because no two cancer patients are alike. The doctor who takes care of the patient is the best one to discuss that person's outlook (prognosis).

People should feel free to ask the doctor about their prognosis, but not even the doctor knows for sure what will happen. Doctors may talk about surviving cancer, or they may use the term remission rather than cure. Even though many people with larynx cancer recover completely, doctors use these terms because the disease can recur.

Followup Care


Regular followup is very important after treatment for cancer of the larynx. The doctor will check closely to be sure that the cancer has not returned. Checkups include exams of the stoma, neck, and throat. From time to time, the doctor does a complete physical exam, blood and urine tests, and x-rays. People treated with radiation therapy or partial laryngectomy will have a laryngoscopy.

People who have been treated for cancer of the larynx have a higher-than-average risk of developing a new cancer in the mouth, throat, or other areas of the head and neck. This is especially true for those who smoke. Most doctors strongly urge their patients to stop smoking to cut down the risk of a new cancer and to reduce other problems, such as coughing.

Support for Larynx Cancer Patients


Living with a serious disease isn't easy. Cancer patients and those who care about them face many problems and challenges. Finding the strength to cope with these difficulties is easier when people have helpful information and support services.

People who have cancer of the larynx may have concerns about the future, family and social relationships, and finances. Sometimes they worry that changes in how they look and talk will affect the way people feel about them. They may worry about holding a job, caring for their family, or making new friends.

The doctor can explain the disease and give advice about treatment, going back to work, or daily activities. It may also help to talk with a nurse, social worker, counselor, or member of the clergy, especially about feelings or other very personal matters.

Many patients find that it's useful to get to know other people who are facing problems like theirs. They can meet other cancer patients through self-help and support groups. Often, a social worker at the hospital or clinic can suggest local and national groups that can help with emotional support, rehabilitation, financial aid, transportation, or home care.