What to Expect After Surgery for Laryngeal Cancer
After surgery for laryngeal cancer, it may take time for you to get back to breathing, eating, drinking, and speaking.
The Stoma and Your Breathing
During the surgery, the surgeon likely made a cut in your neck and into your trachea, called a tracheostomy. This opening is called a stoma, and it’s held open with a tube you breathe through, called a tracheostomy (trach) tube.
After surgery, your lungs and windpipe make a lot of mucus, also called sputum. To remove the sputum, a nurse applies suction with a small plastic tube placed in the stoma. Soon, you learn to cough and suction mucus through the stoma without the nurse’s help. It may also be necessary to suction saliva from your mouth if swelling in your throat makes it hard to swallow.
Normally, the tissues of your nose and throat moisten air before it reaches your windpipe. After surgery, air enters your trachea directly through the stoma and cannot be moistened in the same way. While in the hospital, you are kept comfortable with a special device that goes over the stoma and adds moisture to the air. After your discharge from the hospital, you may use a piece of light fabric to cover the stoma to protect your airway from dust and particles in the air. You must take care to keep the stoma from drying out and to keep foreign substances or water from getting into it. With a stoma, you cannot hold your breath so activities that require straining or holding your breath may be difficult.
Getting Back to Breathing on Your Own
After a partial laryngectomy, you will breathe through the stoma for several days. Then the trach tube is removed from the stoma. Within the next few weeks, the stoma closes. You then breathe and speak in the usual way, although your voice may not sound the same as before.
In a complete laryngectomy, the stoma is permanent. You will breathe, cough, and sneeze through the stoma and have to learn to talk in a new way. The trach tube stays in place for a couple of weeks, until your skin around the stoma heals. Some people continue to use the tube all or part of the time. If it is removed, a smaller tracheostomy button, also called a stoma button, usually replaces the tube. After a while, some people do not use a tube or a button in the stoma.
Getting Back to Eating on Your Own
For a few days after surgery, you will not be able to eat or drink. At first, you’ll get nutrients through a tube into 1 of your veins, called intravenous feeding.
In a day or 2, your digestive tract returns to normal, but you will not be able to swallow because your throat will not have healed. You’ll get foods and liquids through a feeding tube that goes through your nose and throat to your stomach. The surgeon places this tube during surgery. It will be taken out when your throat heals so that you can swallow again and take in enough food through your mouth to maintain your weight.
Swallowing may be hard at first, and you may need the help of a nurse or speech pathologist to learn how to swallow again. Over a period of time, you will return to a regular diet.
Learning to speak again
Laryngeal cancer and its treatment can cause problems with speaking. A speech-language pathologist can assess your needs and help plan therapy, which may include speech exercises.
If your entire is larynx removed, you'll need to learn to speak in a new way. It takes practice and patience to learn new ways to speak. Before surgery or soon after, the speech-language pathologist can describe your choices for speech:
Esophageal speech. For this approach, the speech-language pathologist teaches you how to release air like a burp from the walls of your throat. It takes practice, but you can learn how to form words from the released air with the lips, tongue, and teeth.
Tracheoesophageal puncture (TEP). This operation is done either at the time the larynx is removed or as a separate operation later. The surgeon makes a small opening between your trachea and esophagus, and a small device is placed in the opening. With practice, you can learn to speak by covering the stoma and forcing air through the device. The air makes sound by vibrating the walls of your throat.
Electric larynx. An electric larynx is a small device powered by a battery. It makes a humming sound like the vocal cords, and you move your lips to form words. Some models are used in the mouth, while other models are placed on the neck.
After a laryngectomy, parts of your neck and throat may be numb because nerves may have been cut during surgery. If you had surgery to remove lymph nodes in your neck, your shoulder and neck may be weak and become stiff. A physical therapist can help you with special exercises if this happens. Scarves and other neck coverings may be used to cover the stoma.
Aside from the obvious physical changes you’ll adjust to, expect that you will have significant emotional challenges as well. There is usually a lot of activity and support before cancer surgery. You may be overwhelmed with decisions and organizing appointments and treatments. But, after surgery, the activity and attention may slow down as you heal, leaving you feeling alone. It's also common to worry about cancer coming back or death. Joining a support group of others who have been through a cancer diagnosis and treatment may help. Seek professional counseling to help manage your feelings. And finally, find comfort in the fact that many others have undergone similar diagnosis and treatment.