Laryngectomy Laryngectomee

What is cancer of the larynx? Cancer of the larynx (or voicebox) is a disease in which cancer (malignant) cells are found in the tissues of the larynx. The larynx is a short passageway shaped like a triangle that is just below the pharynx in the neck. The pharynx is a hollow tube about 5 inches long that starts behind the nose and goes down to the neck to become part of the esophagus, the tube that goes to the stomach. Air passes through the pharynx and then the larynx on the way to the windpipe (trachea) and into the lungs. Food passes through the pharynx on the way to the esophagus. The larynx has a small piece of tissue over it, called the epiglottis, to keep food from going into it or the air passages

The American Cancer Society estimates that in 2001, 10,000 new cases of laryngeal cancer (8,000 in men and 2,000 in women) are diagnosed per year and 4,000 people (3,100 men and 900 women) will die of this disease in 2001. An estimated 2,500 cases of hypopharyngeal cancer are diagnosed per year When patients newly diagnosed with larynx and hypopharynx cancers are carefully examined, about 15% will have another cancer in nearby areas such as the mouth, esophagus, or lung. Another 10% to 20% will develop a cancer in one of these organs at a later time. For this reason, it is very important that patients with larynx and hypopharynx cancer understand the value of follow-up examinations for the rest of their lives and of avoiding risk factors like smoking and drinking.

The “normal” larynx A. Tongue press to inject air into esophagus. B. Air enters esophagus. C. Air released from esophagus to produce voice. D. Voice shaped into speech.

Surgical Amputation of the Larynx Total Laryngectomy Removal of the contents of the larynx and laryngeal vestibule Could include part(s) of the tongue, pharynx or esophagus Radical Neck Dissection Total laryngectomy PLUS axial lymph nodes, submaxillary gland and part of the accessory nerve Unilateral or bilateral

Laryngeal CA Intrinsic Laryngeal CA Extrinsic Laryngeal CA On the true vocal fold or between the folds Audible; has early warning Can be dx’d early Extrinsic Laryngeal CA Any location in the larynx other than on the true vocal fold Silent; inaudible May not be dx’d until “too late”

Symptoms of Laryngeal CA Lump in the throat feeling Persistent throat clearing Persistent coughing Sense of discomfort in the throat Persistent sore throat Difficulty breathing Burning sensation when swallowing Difficulty swallowing or pain when swallowing Referred pain to from the larynx to the ear Unexplained weight loss

Etiology of Laryngeal Cancer “ The primary carcinogens for laryngeal cancer appear to be inhaled cigarette, pipe and cigar smoke.” (Stemple, 2000) The risks of developing laryngeal CA are: Depend on daily consumption, type and manner of tobacco use Synergistic effect with alcohol and tobacco

Joint Committee for Cancer Staging and End Results Reporting System Classification of Glottal Cancers T: location of primary tumor Tx can not be staged T0 no evidence of tumor Tis Carcinoma in situ T1 confined to the vocal folds T 2 Supraglottal or subglottal extension; normal or impaired mobility T3 Confined to larynx but with fixed cord T4 Massive tumor

TNM staging N: Involvement of the regional lymph nodes Nx can not be assessed N0 No involvement N1 A single small note on one side N2 A single large or multiple small nodes on one side N3 Massive nodes on one or both sides

TMN Staging M: Distant metastasis Mx can not be assessed M0 No known metastasis M1 Metastasis present

Alaryngeal Speech Artificial Larynx Neck type vibrator Intra-oral adaptor Pneumatic device Tracheoesophageal prosthesis

Tracheoesophageal Puncture Surgical procedure Prosthesis Speech production “hands-free valve

“TE Speech’ By occluding the opening in the neck (tracheostoma), air is directed through the voice prosthesis into the throat causing vibration of the soft tissue and generating voice.

Class goodies Electrolarynx Pneumatic device (Tokyo Reed) With intra-oral adaptor AT&T Pneumatic device (Tokyo Reed) Tracheoesophageal prosthesis Low pressure/indwelling 2 way breathing valve

Some thoughts before I fade away………… Gender differences: feminine perspective? Psychosocial aspects And then there’s………………

SEX........