The larynx (throat) is located in the neck where it makes up the upper 4-5 cm of the airways, and it can be seen on the front of the neck. The larynx has many functions of which the voice is of special importance. In the larynx, the voice is formed when the air passes from the windpipe, up through our vocal chords and then out of the mouth, while the vocal chords, the tongue, and the lips move. The symptoms of laryngeal cancer include hoarseness, throat pain and difficulty swallowing. In Britain, about 2,400 people are diagnosed with laryngeal cancer each year.
Treating laryngeal cancer
Laryngeal cancer is currently treated in several ways as each individual case varies on many factors. The choice of treatment depends on the size and positioning of the cancerous tumour, if it has spread to nearby structures or remote organs, and on the patient’s general health. Usually, the patients will first be offered radiation treatment as this therapy is effective in treating the disease, and because it cures the majority and makes it possible to preserve the larynx. By keeping the larynx, the patients can also keep their own voice. If radiation treatment cannot cure the patient, or if the cancer returns, it may be necessary with an operation. Depending on the size and position of the tumour, there are different ways of operating on the larynx which include:
- Removing one or both vocal chords, which is called ‘cordectomy’. After this procedure, the patient’s voice will become hoarse. Many experience that the mucus membrane in the larynx tries to imitate a vocal chord, which means the voice on many occasions will improve over time. After the operation, the patient will also be able to breathe and eat normally again.
- Removal of the top part of the larynx is done with a procedure called ‘supraglottic’ laryngectomy’
- Removal of one side of the larynx; a procedure called ‘hemi laryngectomy’.
- Removal of the entire larynx; called a ‘total laryngectomy’.
How is it possible to breathe if the larynx, or parts of it, has been removed?
During the last three forms of operations, the entire larynx or parts of it is removed, and in these cases the patient’s windpipe will be positioned on the outside of the throat, just above the chest bone, to enable breathing. A syringe will be inserted into the hole to ensure that the hole does not heal. Therefore, there will be an opening on the front of the neck to guide air into the windpipe and lungs, when breathing. This procedure is referred to as a ‘tracheostomy’.
If only parts of the larynx have been removed, the throat opening will be temporary. When the patient has recovered from the operation, it will rarely be necessary to keep the hole in the neck on a permanent basis, and thus the opening is allowed to heal again. Afterwards, the patient’s voice may have changed compared to before the operation – the voice may be weaker or hoarse.
If the entire larynx has been removed, the opening on the front of the neck is a permanent solution. This means that the patients must learn to speak in a different way and learn to cough through the opening. Many patients, who lose the larynx, will have a ‘speaking valve’ installed. A speaking valve is a small opening between the windpipe and the oesophagus. By covering the hole with a finger, the air will be forced up in the speaking valve and out through the mouth, which results in a so-called ‘gullet voice’. It requires training and patience to train this voice, but with help from a speech therapist and persistence, the patient can regain the ability to speak, albeit with a new voice.
Research results that have improved the patient’s quality of life
Research now shows that there is an important element in the treatment of patients with speaking valves which has been unknown until now. In collaboration with East Kent Hospital University NHS Foundation, a group of researchers from the School of Biosciences have developed a new method that involves the examination and treatment of infections by the fungus ‘Candida Albicans’. If the prevention and treatment of the fungus infection are included, the speaking valve will last longer. According to the researchers, such fungus infection can damage the speaking valve. Based on these research results, the researchers could prolong the functionality of the speaking valve for the first time ever.
Therefore, the researchers have developed a number of guidelines for the treatment of patients with a speaking valve, which are now used in the hospitals in England. This means that patients can preserve their speaking valve for a much longer period than previously, and it provides them with the opportunity of preserving their voice and ability to speak. Simultaneously, it reduces the risk of developing dangerous secondary infections in the chest. According to the researchers, this can contribute to a notably greater quality of life for cancer patients.
References:
1. https://www.cancer.dk/strubekraeft-larynxcancer/kort-om-strubekraeft-larynxcancer/
2. https://www.cancer.dk/strubekraeft-larynxcancer/behandling-strubekraeft/operation/
3. http://www.krabbamein.fo/Files/Billeder/Nýggj%20heimas%C3%ADða/Faldarar/Kræftens%20Bekæmpelse/135536_kb_struben_low.pdf
4. https://www.news-medical.net/news/20161129/Scientists-develop-new-method-of-care-to-maintain-speech-in-throat-cancer-patients.aspx
5. https://www.nhs.uk/conditions/Cancer-of-the-larynx/Pages/Introduction.aspx
