1.Where is the larynx located and what is its function?
The larynx is a breathing tube and an organ of articulation, located in front of the pharynx in front of the neck. The larynx is connected to the pharynx by the laryngopharynx and the trachea by the lower part of the larynx.
2.What should you do when you or your family have any symptoms?
Most laryngeal cancers develop in the vocal cords. Even a small tumor can prevent the two vocal cords from meeting and vibrating. Therefore, if you or your family members experience hoarseness, throat discomfort, sore throat, etc., and if these symptoms persist for a long time and get progressively worse, anti-inflammatory treatment is not effective, you should suspect. Any middle-aged or elderly person with a hoarse voice for more than six weeks, and in a few cases a neck lump, should seek medical attention from an ear, nose and throat specialist.
If you notice any of these symptoms, it is important to have them checked by a doctor. But remember, most people who have these symptoms do not necessarily have cancer. For example, laryngitis caused by common viral infection may also show these symptoms.
3.What can cause laryngeal cancer?
So far, the cause of laryngeal cancer is not fully understood, but there are many studies and reports.
It is generally believed that the occurrence of laryngeal cancer is related to heavy smoking, viral infection, human papilloma virus infection, oncogene, anti-cancer gene and sex hormone.
People with laryngeal cancer are mainly middle-aged and elderly, and men are more likely to develop laryngeal cancer than women. Like other cancers, laryngeal cancer is not contagious.
4.How to diagnose?
When you arrive at the hospital, the specialist will ask you about your medical history and then do a physical examination, which includes any swollen lymph nodes on both sides of your neck, using a laryngoscope. The doctor will ask you to open your mouth and stick your tongue out, spray anesthetic into your throat, and then place the laryngoscope in the back of your mouth to examine the larynx. If abnormalities are found, or if you cannot see clearly with the mirror, the doctor will ask you to have a fiberoptic examination, which can know exactly the appearance of the lesion site, the scope and the activity of the organ, can see the parts that cannot be seen by indirect laryngoscopy, whether there is a tumor, and can clamp the biopsy for pathological examination, with video and photos for data preservation. Only after the biopsy is done, the doctor can make the final diagnosis. If your larynx is anesthetized, please do not eat anything for one hour after the examination until your larynx returns to normal sensation. Otherwise, there may be a risk of food entering elsewhere when you swallow.
5.What should I do if I am diagnosed with laryngeal cancer?
If the biopsy shows that you have laryngeal cancer, please do not panic and be afraid, but go to a specialist hospital as soon as possible and discuss with the specialist which treatment option to choose.
The choice of treatment for laryngeal cancer is related to the extent of the disease. Early stage patients can choose radiotherapy or surgery, while middle and late stage patients can choose a comprehensive treatment based on surgery, including partial laryngectomy, total laryngectomy and combined radical laryngectomy.
You may find that other laryngeal cancer patients in the hospital are treated differently from you. This happens all the time because they have different types of cancer and therefore need different treatments.
Some people want to get more professional advice before choosing a treatment, so talk to your doctor and ask for an intra-departmental consultation so that you can hear more expert opinions.
When you are suffering from laryngeal cancer, please quit your smoking habit as soon as possible, it will help you a lot to heal.
6.Radiotherapy.
Radiation therapy is to make tumor cells necrotic by shooting at radiation. You must have a clear diagnosis, that is, a clear diagnosis by pathological histology or cytological examination, before you can have radiation therapy, because radiation can damage normal and diseased tissues alike. Early stage laryngeal cancer is usually treated in this way.
Radiation therapy can also be done after surgical treatment, and if there is no accident, radiation therapy can be done within two weeks after surgery.
Before radiotherapy, routine examination must be prepared, such as blood routine, liver and kidney function, pathological diagnosis, etc. Teeth must be cleaned, oral inflammation must be treated, shallow filled caries must be filled, deep caries and stump roots must be extracted.
Keep the skin of irradiated field clean and dry during radiotherapy. Do not scratch with fingers, do not rub Yuan soap, do not apply adhesive tape, do not shave, and avoid rubbing with rough clothes. Avoid hot and cold stimulation, do not blow, sunburn, UV, infrared and laser irradiation. Do not apply irritating or heavy metal-containing drugs, such as iodine, kaleidoscope oil, etc.
Pay attention to gargle with Dobell’s liquid after meals and before bedtime. Those who have oral mucosal reactions should switch to gargle with 10% licorice water, and in case of painful oral mucosal ulcers, use 0.5% procaine gargle.
If postoperative radiation therapy has to wear a tracheal sleeve or laryngeal tube must be plastic, wearing metal tracheal sleeve and laryngeal tube is not possible for radiation therapy.
If you have breathing problems during or after radiation therapy, you should seek medical attention as soon as possible to avoid delaying treatment.
Do not extract teeth within one year after radiotherapy. If it is necessary to extract teeth, antibiotics must be added to prevent induced osteomyelitis of the jaws.
7.Surgical treatment
Surgical treatment methods include partial laryngectomy, total laryngectomy and combined radical laryngectomy for laryngeal cancer.
If partial laryngectomy is performed, the articulation function will be affected and become hoarse, but the patient can still speak, and the breathing usually does not need to be rerouted, and the life is generally normal. If total laryngectomy is performed, the patient’s life will be more affected by the loss of articulation function and the need for anterior and inferior median tracheostomy, and the breathing will be rerouted, causing inconvenience.
Patients often have ideological concerns about the loss of speech function after total laryngectomy. Medical staff and family members should do patient and meticulous explanation work, pointing out that after the postoperative exercise, they can also communicate with others through electronic larynx to eliminate their concerns, do routine examination before the operation, match blood, skin test and measure body temperature one day before the operation, and give sleeping pills and fasting the night before the operation.
During the procedure, the surgeon will insert a gastric tube to bring liquid nutritious food through the nose and into your stomach. A drainage tube at the wound to drain unnecessary fluid and allow the wound to heal as quickly as possible. The nasal feeding tube is very important for patients with total laryngectomy, please do not remove it at will, it is usually left in place for 7-10 days, if the wound heals well, then removed, if a pharyngeal fistula develops, continue nasal feeding until the fistula heals and only then eat through the mouth.
Pay attention to the tightness of the tracheal tube ligature, it is usually appropriate to stretch a finger without patient discomfort, and must be tightened if it is too loose to prevent the tracheal tube from slipping out.
After hemilaryngectomy, the tracheal sleeve can be removed after the swallowing function is restored. After blocking the tracheal sleeve for 24 hours and no respiratory distress occurs, the sleeve can be removed and the wound can be closed with butterfly tape. In case of dry weather, a mixture of proportional saline alpha-chymotrypsin and gentamicin, 2-3 drops once an hour, can be used and put into the tracheal sleeve.
The tracheostomy will follow you for the rest of your life and you may panic at the beginning. The nurse will help you take care of this stoma until you are confident to handle it yourself.
Because the air inhaled through the breathing hole goes directly into the lungs, patients must remember to avoid cold and hot environments, as well as inhaling exhaust fumes, smoke and dust. You will not sneeze through your nose again in the future. In addition, the sense of smell will sometimes be affected, although some of it will be restored after a few months.
Total laryngectomy
8.Chemotherapy
Chemotherapy alone is not effective in the treatment of laryngeal cancer. Chemotherapy should be mostly used in preoperative induction chemotherapy, radiotherapy combined with chemotherapy, postoperative adjuvant chemotherapy and treatment of patients with distant metastasis in advanced stage. The choice of chemotherapy regimen is mainly based on the pathological tissue type of the tumor, and the selection of drugs should be based on the results of tumor drug sensitivity test when available.
The drugs can be divided into intravenous drugs and oral drugs. When anti-cancer drugs work on cancer cells in the body, it will also temporarily reduce the number of normal cells in the blood, and you will be more susceptible to infection and feel tired. Please avoid going to public places at this time and pay attention to ventilation to prevent cross infection.
Other possible side effects include nausea, vomiting, diarrhea, and hair loss. Some medications can make your mouth sore and cause minor ulcers. At this time, it is important to rinse your mouth regularly.
9. Rehabilitation instructions.
Patients who wear tracheal sleeves home should not wear clothes such as high collar and crew neck cotton sweaters in order to keep the airway open. To keep the airway opening clean and dry, the tracheal tube should be cleaned regularly. If the cannula is plastic, it should not be soaked in hot water to avoid deformation. In patients after total laryngectomy, the stoma is permanent. If the stoma is well healed, try to wear it without a cannula during the day and before going to bed at night, which can reduce the inconvenience of wearing a cannula during the day and prevent the tracheostomy from narrowing. Lubrication with paraffin oil before putting on the cannula can facilitate putting it in.
With the development of science, families with conditions can buy their own electronic larynx to solve the problem of inability to pronounce after surgery. It can also train the esophagus to pronounce or prescribe some movements, which can be expressed by gestures or writing to exchange ideas. In daily life, you should strengthen the diet and nutrition, eat easily digestible, high protein and high vitamin food. Prohibit swimming and prevent soap suds and dirty water from entering the tracheostomy during bathing. Regular review, and if you find any self-existing problems or notice any new symptoms, you must contact your doctor as soon as possible.