I. What is laryngeal cancer?
Laryngeal cancer is a malignant tumor that occurs in the laryngeal cavity. Since laryngeal cancer can appear hoarseness or throat discomfort in early stage, it is mostly easy to be detected early and is a group of cancers with high cure rate. Zhang Bin, Department of Head and Neck Surgery, Cancer Hospital of Chinese Academy of Medical Sciences, China, laryngeal cancer mainly occurs in people aged 50-65, among which men are significantly more than women. The incidence rate of laryngeal cancer in China is 3/100,000 in Shanghai and 5/100,000 in some cities of Liaoning Province. In other words, about 40,000 people get laryngeal cancer nationwide every year. Since larynx is the articulation and breathing organ of human, and also plays the role of swallowing protection. In the past, treatment mainly emphasized on curing the cancer, but with the improvement of treatment level, it is now possible to cure the cancer while preserving the function of the larynx. The goal of “enabling every laryngeal cancer patient to speak” has become a reality in some major treatment centers.
Why do people get laryngeal cancer?
Scientifically speaking, the real cause of laryngeal cancer is not fully understood, but smoking is basically related to laryngeal cancer, and almost all laryngeal cancer patients found in hospitals are smokers. People who smoke more times a day and those who have smoked for a long time have a higher chance of developing laryngeal cancer. According to statistics, the risk of laryngeal cancer in smokers is 3-39 times higher than that of nonsmokers, and the mortality rate of laryngeal cancer in heavy smokers is 20 times higher than that of nonsmokers. The risk of laryngeal cancer in heavy smokers is 20 times higher than that of non-smokers. According to the survey, laryngeal cancer is also related to alcohol consumption, but compared with smoking, alcohol consumption is only a weak correlate. Excluding the risk of smoking, the risk of laryngeal cancer is 1.5-4.4 times higher for those who only drink alcohol and do not smoke compared with those who do not drink alcohol.
Some people may ask why smokers don’t all get cancer. We say that smoking is only the external cause, but the internal cause is the different susceptibility of people, and some oncogenes and oncogenes have been found to be related to laryngeal cancer. It is believed that in the 21st century, scientists can analyze each person’s genes to predict the risk group of laryngeal cancer, so that targeted prevention can be achieved with half the effort.
What are the manifestations of laryngeal cancer and how to detect it in early stage?
In the early stage, there are hoarseness and throat discomfort, such as swallowing discomfort, throat obstruction and foreign body sensation in the throat after eating. Later on, some people may feel a lump in the upper part of the neck. Later symptoms include bleeding in the larynx, difficulty in breathing, difficulty in swallowing, and significant enlargement of the larynx.
The doctor first examines the lesion with laryngoscope (indirect laryngoscope, fiberoptic laryngoscope) and can see the lesion. Usually a tumor biopsy is needed, i.e. after spraying anesthesia in the larynx, a small piece of tumor is clamped for biopsy, and a definite diagnosis can be made after 3-5 days. In addition, the doctor has to do neck palpation to check whether there are enlarged lymph nodes in the neck to determine whether there is metastasis in the neck. Depending on the situation, X-rays, CT or MRI scans of the larynx will be taken in order to understand the size and exact location of the cancer. As a preparation for treatment, the doctor will also prescribe chest X-ray, blood test and electrocardiogram.
The early and late stages of laryngeal cancer are complicated and updated internationally every few years, so you don’t need to know them carefully, just ask your doctor. Generally speaking, it is divided into stages I, II, III and IV by combining the size of laryngeal tumor and lymph node metastasis in the neck. stages I and II are called early stage, stage III is intermediate stage and stage IV is late stage. Early stage treatment is very effective, middle stage is the second most effective, and late stage is less effective and has little possibility to preserve the larynx.
4.What are the treatments for laryngeal cancer and how should I choose?
The effective treatment for laryngeal cancer is still surgery and radiotherapy (commonly known as baking electricity). Chemotherapy alone has no curative effect. Chinese herbal medicine has not been very effective so far.
If radiotherapy or surgery is applied alone, the 5-year survival rate of early laryngeal cancer is the same in foreign literature, both are around 95%. However, only surgical treatment can reach this level in domestic data; the cure rate of radiotherapy in several hospitals in China is around 70-80%, the reason is not known. The cure rate of radiotherapy for laryngeal cancer at early stage (stage II) or above is gradually inferior to that of surgical treatment, and the difference is great. From the purpose of eradication, surgery should be preferred for laryngeal cancer above stage II. In recent years, laser surgery for laryngeal cancer has avoided incision from the neck, but it is mainly limited to early stage laryngeal cancer.
There are different opinions on the effect of surgery with radiotherapy. Most doctors do not consider it superior compared to surgery alone. However, the application of preoperative or postoperative radiotherapy for very advanced or recurrent laryngeal cancer is promising to improve the chances of cure.
In terms of quality of life after treatment, radiotherapy and surgery have their own advantages and disadvantages: radiotherapy has good vocal effect after cancer control, but dryness and discomfort in the throat, some have hypothyroidism, and the treatment takes a long time, about 2-3 months; surgery has certain trauma, and the pronunciation effect varies greatly after surgery, some are nearly normal, while some will lose their pronunciation function.
V. What are the surgical methods for laryngeal cancer? Will I still be able to speak after surgery?
Simply speaking, laryngeal cancer surgery is divided into total laryngectomy and partial laryngectomy. Based on the examination results, the surgeon can generally determine the surgical method before surgery, but the final decision will be made on the operating table based on what is seen during surgery.
Total laryngectomy has been performed for more than 100 years. After total laryngectomy, the patient has to breathe through a cervical tracheostomy, and there is no airflow in the mouth, which makes the patient’s life very difficult. Over the past decades, many laryngologists have tried to develop various partial laryngectomies, which can basically preserve the laryngeal function after surgery, so that patients can speak, resume normal life and return to society. The aim of laryngeal cancer surgical treatment and the success criteria of surgery are high cure rate and considerable survival quality after treatment. The cure rate of partial laryngectomy with laryngeal function preservation is not lower than that of total laryngectomy, which is easily accepted by patients.
The number of partial laryngectomy procedures for laryngeal cancer varies greatly among hospitals, with some reporting that partial laryngectomy accounts for 75% of all laryngeal cancer procedures, but some only 5%. This is determined by the awareness of laryngeal cancer and the level of surgical technique of physicians in that unit. According to the current situation, in the otolaryngology department of a provincial or municipal hospital, partial laryngectomy should account for 50-70% of all laryngeal cancer surgeries, and the 5-year survival rate should reach 70%. In terms of the quality of survival, there is no long-term choking on food; the extubation rate of tracheal tube should be 70-80%; most patients should reach the applied level of language after surgery and have no difficulty in communicating in the society. This requirement is achievable with efforts. Partial laryngectomy has not been fully applied by physicians so far, and many laryngologists at home and abroad are still keen to do total laryngectomy. This is mainly due to two reasons: firstly, the long-standing influence of the old concept of applying the principle of “extensive resection in tumor surgery” regardless of the occasion, fearing that the narrowing of the surgical scope may cause tumor recurrence; secondly, partial laryngectomy is more demanding in terms of surgical technique, as total laryngectomy is better than partial laryngectomy, and surgeons have a familiarization process and need sufficient cases to support the surgeon’s technique. The surgeon has a familiarization process and needs enough cases to support the exercise of physicians’ skills. Domestic head and neck surgery and otorhinolaryngology physicians, driven by the reform and opening up situation in recent years, learning from foreign experience and practicing hard, have done a lot of work in laryngeal cancer laryngeal function preservation surgery.
For some patients with advanced laryngeal cancer, whose larynx has been completely occupied by tumors and invaded outside the larynx, the only treatment method is still total laryngectomy. There are many ways to restore the language after total laryngectomy, which need the guidance of physicians.
What is cervical clearance and how will it affect me after surgery?
Cervical dissection is an operation to remove all lymph nodes in one or both sides of the neck, including lymph nodes with metastasis and lymph nodes with potential metastasis.
The rate of lymph node metastasis in the neck of laryngeal cancer is high, some types (supraglottic laryngeal cancer) can reach 56%-62%, and it is also common that both lymph nodes in the neck are metastatic. Even if no lymph node enlargement is found in the neck, the actual hidden metastasis is usually about 30%. Therefore, prophylactic neck dissection is required. In the past, the traditional cervical debulking surgery was called radical or modified radical cervical debulking surgery, in which some important structures of the neck, such as the sternocleidomastoid muscle, internal jugular vein, external jugular vein, collateral nerve, and cervical plexus nerve, were removed at the same time. This causes physiological damage to the patient, especially during bilateral clearance surgery. Numbness of the neck (including the ear), prolonged facial swelling, difficulty in lifting the shoulder, and depressed appearance of the neck may occur. In the last decade or so, a new limited neck clearance procedure has been gradually developed abroad, which preserves all the important structures of the neck mentioned above and leaves patients with no other obvious functional impairment after surgery except for the less obvious surgical scar along the skin line. This new procedure has also been performed in a few hospitals in China. Clinical data confirm that the curative effect of limited neck dissection is similar to that of conventional neck dissection as long as there is no extensive lymph node metastasis.
The data shows that the main reason for laryngeal cancer treatment failure is neck metastasis, which mainly appears in the neck opposite to the neck clearance, and the metastasis rate is higher the later the disease stage is. Some types (supraglottic laryngeal cancer) have a high potential for bilateral neck metastasis, and bilateral neck clearance surgery with preserved function, such as limited neck clearance or modified radical neck clearance surgery, should be performed.
VII. What are the physiological changes after laryngectomy and how to adapt and exercise?
(A) Total laryngectomy: For some advanced laryngeal cancer, the only treatment method is still total laryngectomy. In addition to the inability of vocalization and speech function, patients have to breathe through the tracheostomy in the neck after total laryngectomy, so there is no airflow in the mouth and nasal cavity, so they lose most of the olfactory function, i.e. they cannot smell, which affects the appetite and digestive function. You can take medications to help digestion and eat foods that stimulate the sense of taste. In addition, due to the lack of the closing function of the vocal cords, it is not possible to hold the breath, and it is difficult to climb and carry heavy objects; the stool tends to be dry, so you can take laxative drugs or food.
(b) Partial laryngectomy: It includes about 10 different surgical procedures, in which the surgeon decides how much laryngeal tissue to be preserved according to the location and extent of the tumor, ranging from simple vocal cord excision to subtotal laryngectomy. The severity of the resulting physiological changes varies. Generally speaking, there are some changes as follows
1. Pronunciation The pronunciation effect after surgery varies greatly, which is mainly determined by the surgical procedure of partial laryngectomy. Good ones are nearly normal, while poor ones can only be heard in the ear. However, most of the patients can speak at an applied level after surgery and have no difficulty in social communication. In addition, postoperative speech has a recovery and adaptation process. At first, due to inflammatory edema in the larynx and wearing a tracheal tube, the amount of articulation is small and the clarity is not enough. It should be exercised early and actively to speak, and the proper pronunciation effect can be generally achieved in about 3 months.
2.Breathing Due to the edema in the larynx after surgery, most patients have to do tracheotomy at the same time of surgery, and breathe through the tracheal tube put in for a period of time after surgery, and there is no airflow in the nasal cavity temporarily. This state varies from several days to several months, and the doctor decides the timing of tracheal tube removal based on whether the patient can breathe normally for more than 24 hours after blocking the tracheal tube. The anterior neck wound left after tracheal tube removal usually heals on its own, while a few people require a minor surgery to close the wound. It should be noted that not all patients are able to remove the tracheal tube. One reason is that the laryngeal cavity is too narrow after surgery to block normal breathing after the tracheal tube; in addition, choking and coughing after long-term feeding is one of the main reasons. But in general, the extraction rate of tracheal cannula is over 70-80%.
3, feeding After partial laryngectomy, the sphincter function of the larynx is temporarily out of control, so there will be different degrees of misaspiration after the operation, especially after epiglottotomy. However, this syndrome is temporary, and after exercise, basically all can gradually adapt to the symptoms disappear. It should be explained to the patient that it is advisable to start with more viscous food, smaller and more frequent meals, and gradually adapt.
VIII. Am I suitable for laser surgery for laryngeal cancer?
The benefits of laser treatment mainly adopt CO2 laser, because the tissues absorb laser energy rapidly and completely and evaporate in milliseconds, thus achieving the effects of vaporization, cutting and coagulation. CO2 laser has good hemostatic effect, light postoperative edema, no need to make tracheotomy and place nasogastric tube, and avoid the scar of neck surgery. It can be applied to early laryngeal cancer, which is time-saving and economical, and is in line with the modern “minimally invasive” surgical principle, so it is getting more and more attention and the indications are gradually expanding. The quality of life of patients after laser treatment is high and the quality of pronunciation is good. Compared with radiotherapy alone, it saves time and cost, eliminates the damage and complications of radiotherapy, and the quality of pronunciation is not significantly different from that of patients after radiotherapy.
It is suitable for early vocal fold type (T1 and T2a) and supraglottic type (T1-T2) tumors, and the tumor cure effect is similar to that of conventional surgery. However, supraglottic laryngeal cancer still requires surgery in the neck due to the high possibility of neck metastasis. The indications should be strictly controlled by experienced surgeons. Although this technology has matured in western countries such as the United States, laser surgery is still only carried out in a few large hospitals in China.
IX. Post-operative care should be noted
The nurse will help and teach you and your family to take care of the tracheotomy and the placed cannula so that you can take care of yourself when you go home.
(1) Aspiration and replacement of the endotracheal tube: the secretions in the trachea increase after surgery, especially for smokers and those with chronic tracheitis. Use the negative pressure generated by the aspirator to frequently aspirate sputum from the trachea, and brush and replace the endotracheal tube of the tracheal cannula at least four times a day.
(2) Keep the tracheostomy wound clean: remove blood and sputum crusts attached to the wound surface with saline gauze balls daily for early healing.
(3) The air in the room should be kept above 90% humidity after surgery to prevent infection in the lungs and concentration of sputum in the trachea into dry crusts, especially in the northern winter when the air is dry and the dry crusts obstruct the tracheal cannula causing breathing difficulties. Humidifier or steam inhalation method can be used, and several drops of saline can be dripped through the tracheal tube at regular intervals.
(4) When unhealthy granulation appears around the tracheostomy opening, it should be cut out in time to facilitate early wound healing.
X. How does radiation treat laryngeal cancer?
Indications for radiotherapy: (1) Stage I lesions, especially vocal hilar stage I lesions, can be firstly selected for radiotherapy. (2) If the invasion of laryngeal cancer is extensive, radiotherapy before or after surgery is feasible in order to cooperate with radical surgery. (3) For reasons that cannot be treated surgically, radiotherapy can be used for palliation to relieve pain and prolong life.
Radiotherapy machine is mainly used 60Co treatment machine, linear gas pedal. The radiation emitted by it is used to kill the tumor cells. The doctor draws a box on your neck, which represents the range of radiotherapy field, generally ranging from 8x6cm2-13x11cm2 area. The appropriate dose of radiotherapy for laryngeal cancer is 6,000-8,000 cGy, five times a week, for about a few minutes per exposure. It takes 6-8 weeks in total. Swelling of neck, laryngeal edema, sore throat, increased hoarseness, dry mouth and throat are all normal during the treatment of laryngeal cancer. Most of the symptoms can be gradually relieved after the treatment. After the end of radiotherapy, the patient should be reviewed regularly. If tumor recurrence is detected in time, it can be saved by surgery, but generally the whole larynx should be removed.
XI. What are the complications of surgery?
The occurrence of various complications is mainly related to the patient’s physical condition and individual differences, in addition to the size of the operation, radiotherapy or not, surgeon’s experience, and good or bad facilities. The incidence varies from 10-30%. The following are some common complications.
1. Infection: There are neck wound infection and laryngeal infection. Patients with preoperative radiotherapy, anemia and diabetes are prone to this. The treatment of infection is incision and drainage, removal of necrotic tissue as well as foreign bodies. Usually after a period of dressing change, the infected wound will heal on its own.
2, wound skin necrosis: wound skin necrosis can be manifested as blackened skin at the intersection of the incision, caused by the following reasons: 1) excessive tension on the wound edge; 2) improperly designed incision, causing insufficient distal blood flow; 3) rough surgical operation; 4) high-dose radiotherapy; 5) other factors such as hematoma, infection, etc.
The treatment of skin necrosis, according to the severity, can be taken to clean and change the skin, skin implants, various skin flaps and myocutaneous flap repair, depending on the size of the necrosis area, the doctor’s experience and hospital conditions.
3. Pharyngeal fistula: It is the most serious complication of laryngeal surgery because it causes the heaviest physiological damage and the patient cannot eat through the mouth and has to rely on the nasogastric tube for long-term feeding. Saliva and secretions can easily flow downward into the trachea, causing pneumonia. Pharyngeal fistula can also cause exposure of large blood vessels in the neck that do not heal, resulting in the risk of rupture of the common carotid artery and death from hemorrhage. After multifactorial analysis, the occurrence of pharyngeal fistula is related to the following factors: 1) large tumor scope, extensive mucosal resection, and tension after suture; 2) uncut tumor; 3) poor nutritional status, such as anemia and significant weight loss before surgery; 4) previous radiotherapy.
Most pharyngeal fistulas appear within 3 weeks after surgery, and late onset pharyngeal fistulas should be considered as a result of tumor recurrence. Initially, it presents with redness of the skin around the pharynx, followed by a fluctuating sensation and saliva seen after opening the neck wound. Mild pharyngeal fistula can be healed after drainage and dressing change. Severe pharyngeal fistulas with infected necrosis require unobstructed drainage and wound debridement. Surgical repair of non-healing fistulas can be considered and the timing varies from person to person, ranging from 1-6 months after the fistula occurs. The repair of pharyngeal fistula is done with a cervical flap, or a pectoralis major flap, depending on the situation.
4, tracheostomy stenosis: occurs after total or near-total laryngectomy, mainly because of poor anastomosis between tracheal mucosa and neck skin during fistula, or excessive tension at the anastomosis, causing scar growth; postoperative circumferential scar contraction, related to the individual scar body; treatment: mild stenosis can be treated by gradually increasing the diameter of the laryngeal tube, but after removal of the laryngeal tube, most of the stenosis will recur. Surgical enlargement of the fistula should be used.
5. Laryngeal stenosis: It occurs in patients with partial laryngectomy and occurs because: 1) early laryngeal stenosis is due to granulation tissue formation on the trabecular surface of the vocal cords. It subsides naturally after several months; 2) long-term laryngeal stenosis, patients mostly have a history of radiotherapy and laryngeal infection, causing cartilage necrosis and mucosal defects, resulting in laryngeal web formation, laryngeal cavity scarring or lack of adequate laryngeal cartilage scaffolding.
Treatment Early stenosis due to granulation can be treated with hormones to prevent later scar formation, and removal of the tracheal tube can be attempted after the granulation has subsided. Simple laryngeal webs are best treated with CO2 laser cautery, or re-surgical placement of a laryngeal stent or laryngeal mold expansion. Repair of complex laryngeal stenosis is difficult and should be done with great caution.
6, eating choking cough: after laryngeal cartilage removal, supraglottic nerve removal or injury, poor vocal cord closure, etc., can lead to food accidentally entering the trachea causing choking cough, which can seriously lead to aspiration pneumonia.
7, treatment: early mis-aspiration can be exercised to overcome. Take a deep breath before eating, cover the mouth of the tracheal cannula with your finger so that you can hold your breath, then swallow a small group of soft food, cough and then swallow. Soft foods are easier to swallow than liquids. Approximately 85-90% of patients can resume normal feeding after feeding training. Patients who cannot resume feeding can only undergo surgery, and those with severe aspiration pneumonia need total or near-total laryngectomy.
How to regain voice function in patients without larynx after total laryngectomy?
After total laryngectomy, the patient loses the function of speaking and breathing through the nose. In order to restore the speech function of laryngectomized patients, a variety of methods have been applied to reconstruct speech in clinical practice. These methods can be divided into 3 categories: surgical phonation, pharyngoesophageal phonation and artificial larynx.
1, surgical articulation clinical mainly has tracheoesophageal fistula articulation reconstruction, is between the trachea and esophagus (or hypopharyngeal cavity) to form a channel, so that the air flow generated by exhalation through this channel into the esophagus or hypopharyngeal cavity, impact the mucosa and pronunciation. Then, through the coordinated action of the tongue, palate, lips and teeth and other organs of phonation, speech is formed. In general, no special training is needed for postoperative speech, and the sound quality and volume can reach the level of nearly normal pronunciation. The disadvantage is that the artificial articulation button has to be replaced regularly.
It can be done at the same time as total laryngectomy with stage I tracheoesophageal fistula, or under surface anesthesia in stage II after surgery. A silicone tube is inserted into the esophageal lumen by puncturing the posterior wall of the anterior cervical tracheostomy, and the fistula is formed in about three weeks.
2. Pharyngoesophageal articulation is a method to restore articulation without tools or surgery. The basic mechanism is to use the esophagus to store a certain amount of air and force the air out of the esophagus with the help of intrathoracic pressure, just like burping, to impact the upper end of the esophagus or the mucous membrane of the pharynx to pronounce. This pharyngoesophageal articulation method needs to be trained for a period of time and gradually mastered freely. Therefore, it is necessary to make patients increase their confidence in order to promote active practice. The common practice method with better effect is to use the negative pressure in the esophagus during inspiration and press the air into the esophagus through the backward movement of the tongue, then practice the contraction of the abdominal muscles to make the diaphragm rise, increase the intrathoracic pressure, compress the esophagus, and expel the air from the upper mouth and pronounce. The success rate is over 90%. The quickest person can master the key points and speak simple language in a few days. Generally, after 2-3 weeks of training, most of them can master it. Some of them can reach the ideal level.
The advantages of this method are: better tone, close to the sound of the human larynx. No electronic larynx, mechanical artificial larynx unpleasant strange sound; without any equipment, tools, open the mouth can speak, so very convenient. The disadvantage is that the sound time is short, the number of words spoken per pronunciation is small, the coherence is poor, and a sentence often requires several pauses.
3.With artificial larynx
(1) Electronic larynx. A simple electronic device is used to emit a continuous beeping sound, and this device is attached to the chin or the upper part of the neck of a person without a larynx, so that the sound comes out of the mouth and can constitute speech.
The advantage of electronic larynx is that it is easy to use, does not require special training to speak, and has a long sound duration, strong coherence, and can be used for long speeches. The voice is much clearer on the phone. The disadvantage is that the voice and the human larynx pronunciation has a big difference, sounding “strange voice” sense, very unpleasant.
(2) Artificial larynx. The principle is to draw out the exhaled airflow, impact the rubber membrane to make it vibrate and pronounce. This sound from the oral cavity, can constitute the voice. The simplest artificial larynx can be replaced by a thick rubber tube, one end is connected to the tracheostomy, and the other end is inserted into the back of the mouth through the corner of one side of the mouth, and with a little practice you can make a slightly louder sound than whispering.
The advantages of the artificial larynx are that the sound time is long, the spitting is still clear, long speeches can be made, and it is also clear in the telephone. The disadvantage is the same as the electronic voice, it is a strange voice different from the human voice, which is very unpleasant to the ear. In addition, it is not very convenient to use.
Can laryngeal cancer be cured?
Laryngeal cancer can be cured, and the cure rate is higher compared with other cancers. By cured, it means no recurrence and metastasis for life, and it does not affect your normal life expectancy. In medical science, for the sake of summary, 5-year tumor-free survival rate is usually used to represent cure. Because recurrence and metastasis of laryngeal cancer mostly occur within 2 years after treatment, recurrence and metastasis after 5 years are extremely rare.
In general, the cure rate of laryngeal cancer treated with regular radical treatment is 50-70%. However, the difference can be great depending on the early and late stages of the tumor. For example, the cure rate of early stage laryngeal cancer can reach 90%, middle stage about 50-60%, and late stage only about 30%. Therefore, early diagnosis and early treatment are the keys to improve the cure rate. What needs to be emphasized is that the means of treatment must be correct, otherwise the delayed condition will have poorer effect. The most common example is that many laryngeal cancer patients do not receive surgery or radiotherapy immediately, but take Chinese herbal medicine for months, as a result, effective and proper treatment is delayed and the chance of larynx preservation and radical cure is lost.
XIII. How can my family and friends prevent the occurrence of laryngeal cancer?
First of all, laryngeal cancer is certainly not contagious and family members and friends do not need to have any worries. Quitting smoking and controlling pollution may be effective methods.
The process of a normal cell turning into a cancer cell is quite long, and once it happens, it is not easy to reverse. Therefore, it is best to quit smoking at a young age for the risk of developing laryngeal cancer to drop close to normal. Quitting smoking after middle age can reduce the likelihood of developing laryngeal cancer, but it is still higher than non-smokers.
While it is important to control air pollution, it is more effective to prevent indoor pollution. The incidence of laryngeal cancer in the northeast of China is significantly higher than that in other regions, and an important reason may be indoor pollution caused by burning coal for heating. Therefore, keeping fresh air circulating in the room may help prevent the occurrence of laryngeal cancer.
There is no evidence that a certain food can induce laryngeal cancer or can prevent it from occurring. So there is no need to avoid food.
Research on chemical drugs for tumor prevention is ongoing and no definite conclusion has been made.
14.What should patients pay attention to when they go home after treatment?
1.Review: Recurrence and metastasis of laryngeal cancer mostly occur within 2 years after treatment, so you should be alert to tumor recurrence and go to the hospital for review diligently. It is better to go to the hospital where you received treatment because there are complete medical records and doctors who are familiar with your condition. Of course, if you have to travel far, you can also go to the nearest hospital for review, but don’t forget to bring the description of your condition issued by the treating hospital. In addition, large oncology hospitals have a formal follow-up letter system and will send you a questionnaire every year, so please fill it out and send it back. The time of review is usually the 3rd month, 6th month, and 12th month after discharge from hospital. 2 years later, the review will be done every interval of one year. Of course, if there are any abnormalities, you should always go to the hospital for examination. For example, the appearance of a neck lump, swelling of the neck that worsens instead of decreasing, hoarseness that worsens, difficulty in breathing, coughing up blood, and foul taste in the mouth. The review mainly includes laryngoscopy, neck palpation and chest X-ray. Sometimes B-type ultrasound and CT scan are also done.
2, care: patients who temporarily fail to remove the tracheal cannula after total laryngectomy or partial laryngectomy should pay attention to the care of the tracheal fistula cannula (see post-surgical care should be noted)
3, mental health: psychologically balanced, avoid being home alone behind closed doors, and actively participate in work and social activities. First, it reflects the purpose of modern medical treatment, that is, to cure the disease while ensuring the quality of life of the patient; second, it is a transfer of psychological pressure, which is conducive to recovery. In addition, it is also helpful to find a psychiatrist for treatment.
4.Speech rehabilitation: Patients with total laryngectomy should restore the function of speech as early as possible (see the question of how to regain the function of speech for patients without larynx after total laryngectomy).
5.Salvage treatment for recurrence of laryngeal cancer: If recurrence of laryngeal cancer can be detected in time, there is still a chance of cure, but the overall chance of cure is reduced compared with the first treatment. It mainly relies on surgical salvage treatment and supplemented with radiotherapy. The scope of surgical resection is large, and the possibility of preserving the larynx is very small. Most of the laryngectomies, even hypopharyngeal, esophageal and tracheal resections, have to be done. Large defects left behind must also be repaired by simultaneous surgery, such as using one’s own jejunum, stomach or myocutaneous flap. If the recurrence is found too late, such as the involvement of large arterial vessels in the neck and the presence of lung and bone metastases, the chance of radical treatment is lost and only palliative treatment is available.