Throat Cancer

About 10,000 new cases of throat cancer occur in the United States per year, affecting mainly older males who have been heavy smokers or alcohol abusers. The incidence of throat cancer in women and young people has increased as these groups have been using cigarettes and alcohol in greater numbers.

Cancer of the pharyngeal wall or voice box can have devastating effects on the ability to eat, speak, and breathe. Fortunately, cancer of the voice box causes hoarseness early in the course of the disease and can be detected while still curable. However, if the symptoms are ignored until difficulties breathing or eating occur, the cancer becomes advanced and requires more aggressive therapy with diminished chances of cure. Pain or coughing up blood are usually late signs and often suggest involvement of the pharyngeal walls or tongue.

If the cancer is left untreated, it will slowly grow over a year or slow with increasingly intense pain, difficulty breathing, and inability to eat. With early intervention laryngeal cancer can be cured up to 90% of the time. Although chemotherapy can be used with other forms of treatment late in the disease process or by itself to reduce the miserable symptoms in supporting someone who has no hope of cure, it typically is not recommended as one of the main forms of treatment. Radiation therapy administered daily for approximately six weeks is successfully used in curing early stage disease with surgery reserved for salvage of disease that returns. Occasionally, partial laryngectomy ( removing a portion of the voice box so that speech is preserved) is an alternative if the tumor remains contained in a small portion of the voice box.

Total laryngectomy is the most common form of surgery for cancer of the larynx. It requires complete removal of the voicebox and the creation of a permanent breathing opening in the neck (tracheostoma). If part of the pharyngeal wall is involved, part or all of the pharynx will usually have to be removed usually with the larynx. If a large amount of tissue is removed, additional skin from other parts of the body (flap) will be used for reconstruction. People are usually able to swallow reasonably normally after total laryngectomy, but will not be able to breathe through their mouth or nose and will not be able to talk.

Spoken communication may be restored with mechanical generation of sound with an electrolarynx enabling the patient to mouth words while vibrating their neck and throat. Another more easily understood method of talking is esophageal speech. Air is injected into the esophagus, and reversed back up to produce sound for speech. This is often difficult to master.

A popular method of speech production following laryngectomy is the voice restoration procedure developed by Drs. Eric Blom and Mark Singer. A puncture is placed through the back wall of the trachea windpipe (trachea) into the esophagus and held open with a one-way valved prosthesis. 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. Fluent speech that is usually readily understandable is produced.

Top | Head and Neck Surgery | Voice Restoration | Dr. Blom
last updated: 01/19/08