For some people with laryngeal or hypopharyngeal cancer, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer growing or coming back. (When cancer comes back after treatment, it is called recurrence.) This is a very common concern in people who have had cancer.
It may take a while before your fears lessen. But it may help to know that many cancer survivors have learned to live with this uncertainty and are leading full lives. Our document, Living With Uncertainty: The Fear of Cancer Recurrence, gives more detailed information on this.
For other people, the cancer may never go away completely. These people may get regular treatments with chemotherapy, radiation therapy, or other therapies to help keep the cancer in check for as long as possible. Learning to live with cancer as more of a chronic disease can be difficult and very stressful. It has its own type of uncertainty.
Follow-up care
If you have completed treatment, your doctors will still want to watch you closely. It is very important to go to all follow-up appointments. People with cancer of the larynx or hypopharynx are at risk for developing recurrences or new cancers in the head and neck area, so they must be observed closely after treatment. Your health care team will discuss which tests should be done and how often based on the type and initial stage of your cancer, the type of treatment you received, and the response to that treatment.
These cancers recur most often in the first 2 years after treatment, so doctor visits will be more frequent during this time. Your head and neck will be examined (often including laryngoscopy) about every other month during the first year after treatment. Follow-up may then be spread out to 3-, 6-, and 12-month intervals as time progresses if there is no evidence of recurrence. Chest x-rays and other imaging tests may be used to watch for a recurrence or a new tumor, especially if new symptoms develop.
If your thyroid gland received radiation as part of your treatment, you may also need regular blood tests to check its function.
Almost any cancer treatment can have side effects. Some last for a few weeks to several months, but others can last the rest of your life. Don't hesitate to tell your cancer care team about any symptoms or side effects that bother you so they can help you manage them.
It is very important to report any new symptoms to the doctor right away, because they may prompt your doctor to do tests that could help find recurrent cancer as early as possible, when the likelihood of successful treatment is greatest.
If cancer does recur, treatment will depend on the location of the cancer and what treatments you've had before. For more information on how recurrent cancer is treated, see the section, "Recurrent laryngeal and hypopharyngeal cancers." For more general information on dealing with a recurrence, you may also want to see the document, When Your Cancer Comes Back: Cancer Recurrence. You can get this document by calling 1-800-227-2345.
Restoring speech after total laryngectomy
After a total laryngectomy, you will not be able to speak using your vocal cords. However, there are several options for restoring speech after total laryngectomy. Losing your voice box to cancer does not mean you lose your ability to talk, but learning to speak again will take time and effort, and your voice will not sound the same. You will need to see a speech therapist who is trained in rehabilitating people who have had a laryngectomy. The speech therapist will play a major role in helping you to learn to speak.
Esophageal speech: After a laryngectomy, your windpipe (trachea) has been separated from the throat, so you can no longer expel air from the lungs through your mouth to speak. With training, some patients learn to swallow air and force it through their mouth. As the air passes through the throat it will cause vibrations which, with training, people can turn into speech. This is the most basic form of speech rehabilitation. New devices and surgical techniques often make learning esophageal speech unnecessary.
Tracheo-esophageal puncture (TEP): This is the most common way that surgeons try to restore speech. It can be done either during the surgery to treat the cancer or later. This procedure creates a connection between the windpipe and food pipe through a small puncture at the stoma site. A small one-way valve placed into this puncture restores your ability to force air from your lungs into your mouth. After this operation, you can cover your stoma with a finger to force air out of your mouth, producing sustained speech. This takes practice, but after surgery you can work closely with a speech therapist to learn this technique.
Electrolarynx: If you cannot have a TEP for medical reasons, or while you are learning to use your TEP voice, you may use an electrical device to produce a mechanical voice. The battery-operated device is either placed in the corner of the mouth or against the skin of the neck. When you press a button on the device, it will make a vibrating sound. By moving your mouth and tongue, you can form this sound into words. You will need training with a speech therapist to learn to use it properly.
Stoma (tracheostomy) care following total laryngectomy
Having a stoma (tracheostomy) means that the air you breathe in and out will no longer pass through your nose or mouth, which would normally help moisten, warm, and filter the air (removing dust and other particles). After a laryngectomy and tracheostomy, the air reaching the lungs will be dryer and cooler. This may irritate the lining of the breathing tubes and cause thick or crusty mucus to build up.
It is important to learn how to take care of your stoma. You will need to use a humidifier over the stoma as much as possible, especially soon after the operation, until the airway lining has a chance to adjust to the drier air now reaching it. You will also need to learn how to suction out and clean your stoma to help keep your airway open. Your doctors, nurses, and other health care professionals can teach you how to care for and protect your stoma, which includes precautions to keep water from entering the windpipe while showering or bathing, as well as keeping small particles out of the windpipe.
Support groups formed by other patients who have also had a laryngectomy can provide essential information on stoma care and use of products for protecting and cleaning the stoma.
Help for trouble swallowing and nutrition problems
Cancers of the larynx or hypopharynx and their treatments can sometimes cause problems such as trouble swallowing, dry mouth, or even loss of teeth. This can make it hard to eat, which can lead to weight loss and weakness due to poor nutrition.
Some people may need to adjust what they eat during and after treatment. Some may even need a feeding tube placed in the stomach for a short time after treatment. A team of doctors and nutritionists can work with you to provide nutritional supplements and information about your individual nutritional needs. This can help you maintain your weight and nutritional intake.
Sexual impact of laryngectomy
Laryngectomy changes not only your physical appearance with the stoma but also your speech and breathing. Sexual intimacy may be affected because of uncomfortable feelings about your appearance. However, there are things you can do to decrease these feelings during intimacy.
A scarf, ascot, or turtleneck shirt can look nice and hide the stoma cover. Even during sexual activity, a stoma cover may look more appealing than a bare stoma.
You can lessen odors from the stoma by avoiding garlic or spicy foods and by wearing perfume, cologne, after-shave, or lotion.
Sometimes problems speaking interfere with communication for some couples. If you have learned esophageal speech, talking during lovemaking is not a big problem. It does take more effort, though, and you may lose some of the emotional overtones. A speech aid built into the stoma might also work well. However, neither method lets you whisper romantically in your partner's ear.
If you use a hand-held speech aid, communication during sex is likely to be awkward and distracting. You can say a great deal sexually, however, by guiding your partner's hand or using body language.
Talking is not needed in many sexual situations. With a new partner, you may want to discuss the kinds of touching and positions you like before you start making love.
Seeing a new doctor
At some point after your cancer diagnosis and treatment, you may find yourself seeing a new doctor who does not know anything about your medical history. It is important that you be able to give your new doctor the details of your diagnosis and treatment. Make sure you have this information handy:
- A copy of your pathology report(s) from any biopsies or surgeries
- Copies of imaging tests (CT or MRI scans, etc.), which can usually be stored on a CD, DVD, etc.
- If you had surgery, a copy of your operative report(s)
- If you were in the hospital, a copy of the discharge summary that doctors prepare when patients are sent home
- If you had radiation therapy, a summary of the type and dose of radiation and when and where it was given
- If you had chemotherapy, a list of the drugs, drug doses, and when you took them
It is also important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
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