Laryngeal and Hypopharyngeal Cancers
These cancers are usually squamous cell carcinoma. Several operations are commonly used in treating patients with laryngeal and hypopharyngeal cancers. Depending on the stage of the cancer and its location, one or more of these may be used to remove the cancer and some of the surrounding laryngeal or hypopharyngeal tissue and to help restore the appearance and function of the tissues affected by the treatment.
- Total Laryngectomy - In this procedure, the entire larynx (voice box) is removed. With the removal of the voice box, the windpipe is then brought up to the skin in the front of the neck as a stoma (or hole) that you breathe through. This is called a tracheostomy. Air enters and leaves the windpipe (trachea) and lungs through this opening. A tracheostomy tube, also called a trach (“trake”) tube, keeps the new airway open until healed enough to remove the tube.
- Partial Laryngectomy - Smaller cancers of the larynx can often be removed without taking out the entire voice box. There are several different types of partial laryngectomy procedures. For supraglottic cancers, only the portion of the larynx above the vocal cords may be removed. This allows the patient to retain normal speech. In small cancers of the vocal cords (glottis) the surgeon may be able to remove the cancer by taking out only one vocal cord (called a cordectomy) and leaving the other behind. This will allow for some speech to remain. These procedures differ in which areas of the larynx are removed. Their goals are the same – keeping as much of the natural larynx as possible while removing the cancer.
- Total or Partial Pharyngectomy - Surgery for cancers of the hypopharynx will remove a portion or all of the hypopharynx. Several reconstructive procedures can be used to rebuild the pharynx and improve your ability to swallow after the operation. The larynx must also be removed when it is also involved.
- Neck Dissection - Cancers of the oral cavity and oropharynx often spread to the lymph nodes in the neck. Depending on the stage and exact location of the cancer, it may be necessary to remove these lymph nodes by an operation called a neck dissection. The goal is to remove lymph nodes proven or likely to contain cancer. There are several types of neck dissection procedures, and they differ in how much tissue is removed from the neck and the resulting functional losses. The amount of tissue removed depends on the primary cancer’s size and extent of spread to lymph nodes.
- Gastrostomy Tube - Cancers in the larynx and hypopharynx may prevent you from swallowing enough food to maintain adequate nutrition. Sometimes it may be necessary to have a feeding tube placed through the skin and muscle of your abdomen directly into your stomach to provide extra nutrition. The patient and family are taught how to use the tube. After the patient goes home, home health nurses usually visit to make sure that the patient is comfortable with tube feedings.
Flap Reconstruction - Microvascular reconstruction can provide improved function in many cases of head and neck cancer. Surgery and/or chemotherapy/radiation therapy may impair speech and swallowing while destroying tumor. Reconstruction can many times improve these side effects.
- Myocutaneous Flaps: Sometimes a muscle and area of skin may be rotated from an area close to your throat, such as the chest (pectoralis major flap), to reconstruct the throat.
- Free Flaps: With the advances of microvascular surgery (sewing together small blood vessels under a microscope), surgeons have many more options to reconstruct the area of the throat. Tissues from other areas of the body such as a piece of intestine or a piece of skin can be used to replace parts of the throat and bone can be used to replace parts of the facial skeleton, such as the jaw.
These cancers are usually papillary or follicular. Uncommon types are medullary and undifferentiated. Most people with thyroid cancer have surgery. The surgeon removes all or part of the thyroid. The type of surgery depends on the type and stage of thyroid cancer, the size of the nodule and your age.
- Total thyroidectomy - The surgeon removes the thyroid through an incision in the neck. Radioactive iodine therapy is often used to look for cancer outside the gland and to destroy it. Nearby lymph nodes also may be removed. If cancer has invaded tissue within the neck, the surgeon may remove nearby tissue. External radiation therapy may be used to treat areas of cancer.
Lobectomy - Some people with follicular or papillary thyroid cancer may have only part of the thyroid removed. The surgeon removes one lobe and the isthmus. Rarely the pathologic findings after lobectomy require complete removal of the thyroid gland at a second surgery.
Surgery for thyroid cancer removes the cells that produce thyroid hormones. After surgery, nearly all people need to take medication to replace the natural thyroid hormone.