Voice – Laryngeal Cancer and Laryngectomy

Where does laryngeal cancer begin?
in the squamous cells that line the larynx

What happens to the cells in laryngeal cancer?
the cells undergo a mutation, often related to exposure

What system does laryngeal cancer often metastasize to?
the lymphatic system

What are the risk factors for laryngeal cancer?
– tobacco use
– alcohol use
– poor nutrition
– HPV
– weakened immune system
– occupational exposure (asbestos)
– gender (men)
– age (>55)
– race (greater in AA and C)
– reflux
– rare genetic syndromes causing aplastic anemia

What are some symptoms of laryngeal cancer?
– hoarseness/roughness
– constant sore throat/coughing
– painful or difficult swallow
– persistent ear pain
– breathing difficulty
– weight loss
– neck mass
– bad breath
– lack of normal bony crepitus
– limited movement of larynx

What is the bony crepitus?
crackling sound noticed during auscultation

What tools are used in the diagnosis of laryngeal cancer?
– endoscopy
– CT, PET, MRI
– biopsy

In cancer staging, what is T?
size of tumor

In cancer staging, what is N?
lymph node invasion

In cancer staging what is M?
metastasis

Where is a T1 tumor?
limited to VFs, with normal movement

Where is a T1a tumor?
limited to one VF

Where is a T1b tumor?
both VFs involved

Where is a T2 tumor?
tumor extends to the sub- or supraglottis with restricted vocal fold movement

Where is a T3 tumor?
tumor limited to larynx with vocal fold immobility and/or extends to paraglottic space and/or thyroid cartilage

Where is a T4 tumor?
tumor invades through thyroid cartilage and/or into the prevertebral space, around a carotid artery, or into chest cavity

What does Nx mean?
unable to assess lymph node involvement

What does Mx mean?
unable to assess metastasis

What does N0 or M0 mean?
no involvement of lymph nodes, no evidence of metastasis

What do N1, N2, and N3 mean?
number of lymph nodes involved and size of involved nodes

What does M1 mean?
distant metastasis

What are the three methods of treatment of laryngeal cancer?
– surgery
– radiation
– chemotherapy

Which type of treatment for laryngeal cancer is a one-time treatment?
radiation therapy

What are the surgical options for laryngeal cancer?
– vocal cord stripping
– cordectomy
– laser surgery: KTP, PDL, CO2
– partial or total laryngectomy
– partial or total pharyngectomy

What is vocal cord stripping?
removal of the superficial lamina propria

What are the reconstructive options when part of the larynx or pharynx is removed?
– myocutaneous flap
– free flap
– radical neck dissection

What is the myocutaneous flap?
portion of pectoralis muscle excised from chest and flipped up to cover any large tissue defects

In what case would a patient get a tracheotomy?
if the tumor is too large to remove

What is a free flap?
part of thigh taken to rebuild pharynx?

What are the side effects of radiation?
– skin burning and toughness
– dry mouth – salivary gland damage
– severe sore throat -mucousitis
– decreased taste
– breathing difficulty
– fatigue
– difficulty swallowing

What are the two kinds of radiation therapy?
– external beam radiation therapy
– intensity modulated radiation therapy

Which kind of radiation is more general and has worse side effects?
external beam radiation therapy

How does chemotherapy work?
anticancer drugs injected into vein or given by mouth

What are the side effects of chemotherapy?
– nausea and vomiting
– loss of appetite
– loss of hair
– mouth sores

In a partial laryngectomy, is voice still possible?
yes, though dysphonic

What is a common side effect of laryngectomy?
dysphagia

Why do people have a laryngectomy?
– diagnosis of malignant laryngeal tumor
– laryngeal trauma resulting in a nonfunctional larynx

What aspects of life are affected by having a laryngectomy?
– anatomical
– physiological
– communication
– psychosocial

In a total laryngectomy, what is removed?
– epiglottis
– true and false folds
– cricoid and thyroid cartilages
– hyoid bone
– cutting of supra and infrahyoid muscles
– top rings of trachea

What is the neoglottis?
the pharyngoesophageal segment created after laryngectomy

What are some non-speech changes after laryngectomy?
– respiratory changes (mucous)
– loss of smell
– changes in taste
– inability to gargle or whistle
– hazard of immersion in water
– difficulty lifting heavy objects
– possible dysphagia (stenosis)

What are some respiratory changes after laryngectomy?
– inability to cough or sneeze
– loss of filtration (nose and mouth), causing irritation, inflammation, and bacteria
– loss of heat and humidity, causing more viscous mucous
– decreased resistance to airflow, causing decreased tissue oxygenation and lung function

What are some communication changes after laryngectomy?
– no voice
– artic changes, if supraglottal structures (such as BOT) involved
– requires alternative communication measures

What are some aspects of psychosocial adjustment after laryngectomy?
– reaction to life-threatening illness
– reaction to disfigurement
– reaction to loss of voice
– reaction to loss of other functions
– concern for future
– shifting of roles

What are some aspects of successful rehabilitation after laryngectomy?
– successful cancer control
– management of secondary complications
– knowledge and skill of patient
– knowledge and skill of clinician
– psychological recovery

What is the pre-operative role of the speech-language pathologist?
– information, reassurance, support
– counseling regarding surgery, post-op period, communication, and swallowing

what is the post-operative role of the speech-language pathologist?
– establish functional communication
– education

What is the outpatient follow-up role of the speech-language pathologist?
– continued support and information
– continued therapy to establish/improve communication

What should we touch on in pre-operative counseling?
– anatomy/physiology changes
– speech options
– impact on swallow
– psychosocial
– family counseling
– hygiene
– forms for pt to obtain artificial larynx
– support groups

When can the electrolarynx with the intra-oral adapter be introduced?
when pt is medically cleared, usually 3-10 days post op

What are communication options before pt is medically cleared?
– picture board
– writing
– gesture
– AAC devices