Malignant Tumor on Vocal Chord

Malignant Tumor on Vocal Chord

medical animation:

This animation illustrates a malignant tumor forming on a vocal chord




Detailed Guide: Laryngeal and Hypopharyngeal Cancer
Surgery

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.

Vocal Cord Stripping

This technique involves using a long instrument to strip away the superficial layers of tissue on the vocal cords. Stage 0 (carcinoma in situ) cancers are sometimes treated this way.

Cordectomy

Cordectomy involves removing part or all of the vocal cords. It can be used to treat very limited or superficial glottic cancers.

Laser Surgery

Lasers can be used to treat some stage 0 (carcinoma in situ) and T1 cancers. Treatment requires the use an endoscope to locate the tumor, which is then either vaporized or excised (cut out) using a high-intensity laser. One of the disadvantages with vaporization is that it does not allow for the collection of a tissue sample to look at under the microscope.

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 procedure, called supraglottic laryngectomy, 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 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 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 of the front of the neck as a stoma (or hole) that you breathe through.

Potential complications of total laryngectomy may include bleeding after surgery, infection at the site, and, in rare cases, rupture of the carotid artery (a large artery in the neck).

Laryngectomy can also lead to the development of a fistula (an abnormal opening between 2 areas that are not normally connected) or a pharyngeal stricture (narrowing). Another major concern after laryngectomy is aspiration (food or liquid entering the lungs), which can lead to a serious case of pneumonia.



Illustrations by permission of the Mayo Foundation. From "Looking Forward...A Guidebook for the Laryngectomee" by R.L. Keith, et al, New York, Thieme-Stratton, Inc. and copyrighted by the Mayo Foundation, 1984.

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. Usually the larynx must also be removed.

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 your throat. Tissues from other areas of your body such as a piece of intestine or a piece of arm muscle can be used to replace parts of your throat.

Neck Dissection

Cancers of the supraglottic larynx and hypopharynx 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 lymph nodes from your neck. This operation is called a neck dissection.

There are several forms of neck dissections ranging from the radical neck dissection to a less extensive selective neck dissection. They differ in the amount of tissue removed from the neck. In a full radical dissection, nerves and muscles responsible for full neck and shoulder movement will be removed. This is sometimes necessary to remove lymph nodes proven or likely to contain metastatic cancer. The amount of tissue to be removed depends on the size and extent of the metastasis. Sometimes doctors will try to remove less normal tissue in order to keep the shoulder and neck functioning normally.

Tracheotomy

If a laryngeal or hypopharyngeal cancer is blocking the windpipe and is too large to remove completely, an opening may be made in your neck to bypass the tumor and allow you to breathe more comfortably.

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.

Effect of Surgery on Speech

This can vary. If the surgery can avoid damaging vocal cords, then speech may be normal. With any more extensive surgery, there will usually be hoarseness. More extensive surgery, especially laryngectomy will eliminate normal speech altogether. (See the section "What Happens After Surgery?"