Surgery for Laryngeal and Hypopharyngeal Cancers

In deciding whether to recommend surgery for you, your doctor will consider your overall health. For example, if you have heart or lung disease, you might not do well with an operation. The doctor will also consider whether the tumor can be safely removed by surgery without damaging any critical structures in your body.

If you have a small, early-stage cancer, it might be possible to remove your cancer through endoscopy (a procedure involving a long, thin fiberoptic tube attached to a light).

• Vocal cord stripping - The doctor inserts a special instrument through the endoscope and strips away the top layers of tissue on the vocal cords.
• Laser surgery - The surgeon uses an endoscope to find the tumor. He or she then uses a high-intensity laser to burn or cut the tumor out.
  

The most common type of surgery for laryngeal and hypopharyngeal cancers is resection, or surgical removal of the entire tumor as well as some of the healthy tissue around it. The normal-looking tissue is taken out just in case it contains any cancer cells. The following types of resection procedures are often used to remove laryngeal and hypopharyngeal cancers:

• Laryngectomy - The surgeon removes some or all of the larynx:
  • Partial laryngectomy (hemilaryngectomy) - The surgeon removes the part of the larynx above the vocal cords if you have a small cancer in the supraglottis. After this procedure (supraglottic laryngectomy), you will be able to speak normally. If you have a small tumor in the vocal cords (glottis), the surgeon might be able to remove just one vocal cord (cordectomy) and leave the other one so that you can still speak.
  • Total laryngectomy - The surgeon removes the entire larynx and then attaches your windpipe (trachea) to the skin of your neck (see tracheostomy below). You will no longer be able to speak normally using your vocal cords after this operation.
• Pharyngectomy - The surgeon removes part (partial pharyngectomy) or all (total pharyngectomy) of the pharynx.
  
• Laryngopharyngectomy - Pharyngectomy is usually done in combination with laryngectomy. The surgery to remove both the larynx and pharynx is known as a laryngopharyngectomy. Like laryngectomy and pharyngectomy, laryngopharyngectomy can be partial (if the surgeon removes only part of the larynx and part of the pharynx) or total (if the surgeon removes all of the larynx and all of the pharynx).
  
• Thyroidectomy -  The surgeon removes most or all of the thyroid gland.
  
  • Near-total - The surgeon removes nearly all of the thyroid gland but leaves small amounts of tissue around the parathyroid glands (which produce a hormone that helps control the levels of calcium and phosphorus in the body) to reduce the risk of damage to these glands.
  • Total - The surgeon removes the entire thyroid through an incision in the neck.
    

During your resection, the surgeon doctor might remove some of the lymph nodes (small organs that help fight infection) in your neck because laryngeal and hypopharyngeal cancers often spread to these lymph nodes:

• Neck dissection - The goal of neck dissection is to remove lymph nodes that do or are likely to contain cancer that has spread (metastasized) from the original tumor in larynx or hypopharynx. There are different types of neck dissection:
  • Modified radical - The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. However, the surgeon does not take out sections of muscle, nerve, and the large veins in the neck.
  • Radical -  The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. The surgeon also takes out sections of muscle, nerve, and the large veins in the neck.
    

If you had a large tumor removed by resection, you might need additional surgery to fix parts of your mouth, throat, or neck. The following plastic surgery techniques might be used to repair your mouth or throat after cancer surgery:

• Free flap reconstruction - The surgeon rebuilds your throat using tissue from other parts of your body, such as the intestines or arm muscles.
• Myocutaneous flaps - The surgeon rebuilds your throat by rotating a muscle or piece of skin from an area near your throat, such as your chest (pectoralis major flap).
  

If your tumor is too large to remove completely by surgery, it might be difficult for you to breathe and/or eat properly. Certain procedures can help with these problems:

• Gastrostomy tube - If your cancer prevents you from swallowing, your surgeon will place a feeding (gastrostomy) tube through the skin and muscle of your abdomen into your stomach. Liquid nutrients are dripped through the tube and this process can be used to feed you.
• Nasal gastric tube - If the swallowing problem is temporary,a nasal gastric tube might be inserted through your nose, down your esophagus, and into your stomach. Liquid nutrients are dripped through the tube and this process can be used to feed you.
• Tracheostomy - After a partial or total laryngectomy, the surgeon will make a hole (tracheostomy) in front of your neck into the trachea and will insert a tube to keep the hole open. You will breathe through this hole. If you had a partial laryngectomy or laryngopharyngectomy, the tube will be removed after you recover from surgery and you will be able to breathe normally. If you had a total laryngectomy or laryngopharyngectomy, the tube will stay in permanently and you will need to learn how to speak in a different way.
  

This content has been reviewed and approved by Myo Thant, MD.