The larynx is a very important organ in the human body. It has three major functions: breathing, vocalization and protection. The larynx is connected to the oral cavity and the trachea, and is the gateway to the lower respiratory tract. Human breathing goes through the larynx, and if something goes wrong with the larynx, breathing difficulties will occur; in serious cases, it may even suffocate and die. The larynx has the vocal cords, which is the location of human voice, and this is where we actually refer to when we talk about the voice. If there is a problem with the larynx, it affects the pronunciation and hoarseness. If the larynx is removed, a person cannot speak. If there is a problem with the larynx, people will choke and cough when they eat, and the food they eat will choke on the trachea. With tumor, one cannot breathe, speak and eat normally. Only when laryngeal cancer is detected early and treated reasonably at an early stage can laryngeal function be preserved to the maximum extent based on the eradication of laryngeal cancer. Why do you get laryngeal cancer? Laryngeal cancer accounts for about 1% to 2% of the whole body tumors, mostly seen in the age of 40 to 70. The incidence of laryngeal cancer is higher in the north than in the south of China, and the incidence is higher in urban than in rural areas, and there are more men than women. At present, the incidence of laryngeal tumor has a tendency to increase, the etiology is very complicated, the more clear causes are: cancer of vocal cord leukoplakia, cancer of laryngeal papilloma, smoking, air pollution, etc. What are the types of laryngeal cancer? Taking the vocal folds as the boundary, larynx is divided into supraglottic, glottic and infraglottic regions. The supraglottis type is the part above the vocal cords, such as epiglottis and ventricular zone (also called pseudovocal cords); the main structure of the glottis is the vocal cords; the subglottis is the part below the vocal cords. Correspondingly, laryngeal cancer is divided into supraglottis laryngeal cancer, glottis laryngeal cancer and subglottis laryngeal cancer. What are the clinical manifestations of laryngeal cancer? Vocal cord cancer: The clinical manifestations of laryngeal cancer in different parts are different, for example, cancer of the vocal cord, also called vocal cord cancer, the main symptom in the early stage is hoarseness, which is gradually aggravated and in severe cases, complete loss of voice. If hoarseness is not given enough attention and timely examination in ENT hospital, the tumor will grow bigger and bigger, the vocal folds will become smaller and smaller, and finally there will be difficulty in breathing, and late stage vocal fold cancer will show enlarged lymph nodes in the neck (laryngeal cancer cervical lymph node metastasis). 2. Supraglottis and infraglottis cancer: they are tumors of parts other than the vocal folds and do not have hoarseness in early stage, but due to cancer stimulation or necrosis of cancer tissues, the secretion of throat increases, which may cause cough, sputum, blood in sputum, foreign body sensation in throat and sore throat, and only in late stage will there be hoarseness, which may also cause difficulty in swallowing and shortness of breath (dyspnea). Cancer of supraglottic region is prone to cervical lymph node metastasis. What tests should be done if I suspect laryngeal cancer? Age above 40 years old, with long-term smoking history, hoarseness without improvement for 2 weeks, symptoms such as foreign body sensation in the throat with swallowing discomfort, blood in sputum, shortness of breath, painful swallowing and difficulty in swallowing, should go to an ENT specialist hospital for examination (including laryngoscopy). If new organisms are found, the doctor will order you to be hospitalized for pathological biopsy and enhanced CT examination. Treatment plan of laryngeal cancer The treatment plan of laryngeal cancer is related to the part of laryngeal cancer and the size of tumor, the technique and experience of the doctor, the equipment condition of the hospital, and also the patient’s general condition. Doctors can adopt the most suitable treatment according to their own experience and patients’ requirements, such as laser resection of laryngeal cancer, partial laryngectomy and total laryngectomy. It is important to prevent under-treatment or over-treatment. Laser resection of laryngeal cancer If the tumor is limited to one side of the vocal folds, without invading the contralateral vocal folds in the forward direction and the vocal fold protrusion in the backward direction, laser resection of laryngeal cancer is feasible for this type of laryngeal cancer. There are many advantages of laser laryngectomy, such as no need to cut the trachea (no metal tube in the neck), only the diseased vocal folds are removed during the surgery, and the surgery is very traumatic, and the patient can be discharged from the hospital on the first day after the surgery. Laser resection of laryngeal cancer can preserve the function of pronunciation, and the treatment effect is also good, with a five-year survival rate of over 90%. Partial laryngectomy If the tumor is larger in scope, invades the contralateral vocal folds forward over the anterior joint, or invades the vocal fold prominence backward, the lesioned side of the vocal folds should be removed, and the contralateral part of the vocal folds should also be removed, so as to reduce the recurrence rate. Partial laryngectomy is much more traumatic than laser laryngectomy. The trachea has to be cut and a metal tube has to be worn in the neck for several weeks to months, and some patients have to wear a metal tube for life if it is difficult to remove the tube. Some patients have to wear a metal tube for several weeks to months, and some patients have to wear a metal tube for life if they have difficulty in removing the tube. If laryngeal cancer in the supraglottis area, such as epiglottis cancer, does not invade the vocal folds downward, horizontal hemilaryngectomy is feasible, i.e., the part above the vocal folds is removed, and the articulation function can also be preserved. You can start to try food about 7-10 days after partial laryngectomy, usually try to eat noodles, chaos, steamed buns and other foods without water first. Because the normal laryngeal structure is destroyed by surgery, the protective function of the larynx is affected to different degrees, and it is normal to have choking and coughing at the beginning of the trial. C. Total laryngectomy Laryngeal cancer that is not suitable for partial laryngectomy or advanced laryngeal cancer should generally undergo total laryngectomy. If there is no pharyngeal fistula, the stomach tube can be removed the next day and semi-liquid food can be eaten orally. If there is no pharyngeal fistula, you can try to eat only after the fistula is healed. The common goal of doctors and patients is to completely remove laryngeal cancer through surgery and to stop radiotherapy after surgery. Most patients do not need postoperative supplemental radiotherapy, but there are some patients who need postoperative supplemental radiotherapy, and the basis of postoperative radiotherapy is insufficient cutting edge. The so-called cutting edge: that is, the distance from the tumor when removing the tumor. When removing the tumor, there should be a certain distance from the tumor, not close to the tumor, and the further away from the tumor, the safer it is. For early stage laryngeal cancer treated with laser, it should be more than 2mm away from the tumor; for early stage laryngeal cancer treated with partial laryngectomy, it should be more than 3mm away from the tumor; for slightly larger laryngeal cancer, it should be more than 5mm away from the tumor; for middle and advanced laryngeal cancer treated with total laryngectomy, it should be more than 10mm away from the tumor, which is safer and less likely to recur after surgery. If the above requirements are not met, it is easy to recur after surgery, so it is necessary to supplement radiotherapy after surgery. II. Post-operative and post-radiotherapy follow-up of laryngeal cancer Monthly within six months, 1-2 months after six months, 2-3 months after one year. C. Removal of tracheal tube after partial laryngectomy Patients who have undergone partial laryngectomy should have their trachea cut and wear tracheal tube, and the inner tube of tracheal tube should be cleaned and disinfected every day. After surgery, if the tracheal tube is blocked and there is no respiratory distress, you can block the mouth of the tracheal tube to breathe through the mouth; if the tracheal tube is blocked and there is respiratory distress, it is recommended not to block the tracheal tube. If you plug the tracheal tube mouth to breathe through the mouth, and there is no breathing difficulty after activity or sleep, you can consider removing the tracheal tube after 2-3 weeks. Removal of the tracheal tube should be approved by the doctor, who will decide when to remove the metal tube from the neck according to the patient’s breathing condition. After blocking the tracheal tube, the inner tube of the tracheal tube does not need to be cleaned and disinfected every day. After partial laryngectomy, laryngeal buds may grow in the larynx, which will subside after 3-4 months. If they do not subside after 4 months and are larger, affecting breathing and vocalization, they can be surgically removed. V. Pulling out the full laryngeal tube after total laryngectomy The full laryngeal tube should be placed after total laryngectomy, and the full laryngeal tube should be cleaned, disinfected and replaced every day. The purpose of placing the full laryngeal tube is to prevent the tracheal opening from shrinking, and the full laryngeal tube should generally be placed for about six months. If the tracheal opening is large, it can also be removed in advance (some patients can be removed 1-2 months after surgery), before removing the tracheal tube, get the doctor’s consent. VI. Pronunciation training after total laryngectomy After total laryngectomy, patients cannot pronounce normally, but one month after surgery, they can go to our hospital for esophageal pronunciation training and also can use electronic larynx for pronunciation practice. If both esophageal pronunciation and electronic larynx pronunciation are not satisfactory. You can choose to install pronunciation tube to assist pronunciation.