1. Laryngectomy
Laryngectomee

2. 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

3. 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 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.

4. 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.

5. 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

7. 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”

8. 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

9. 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

10. 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

11. 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

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

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

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

16. “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.

17. 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

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

19. SEX