By Dr Trinanjan Basu, Consultant, Radiation Oncologist, HCG Cancer Hospital, Mumbai
A bit of hoarseness in the voice is common when we are under the weather or get a throat infection. But it can turn to be a type of cancer that affects the larynx or voice box. When cancerous cells develop in the larynx, the voice becomes hoarse along with changes in voice, pain while swallowing, persistent cough and sore throat and ear ache, swelling in the neck and high-pitched wheezing while breathing. When the hoarseness continues to stay beyond three weeks and not settling with conservative measures, it is indication of probably laryngeal cancer which can results in damaging the larynx, the organ which helps us speak.
The larynx helps in producing sound by keeping the two vocal cords close to each other and vibrate as the air from the lung passes between them. It also helps in swallowing food. To cure cancer of the larynx especially in advanced stage where preservation by chemoradiation is not feasible, surgical removal or total laryngectomy remains as an option. This would however result in loss of natural speaking ability.
Laryngeal cancers contribute to about 5% of cancers in Men in India. All stages combined the 5 years survival would be around 30% but cure rates are very high (>90%) once detected early. The key to early detection translates into retaining normal voice box. The prevention to advanced stage or sacrificing voice box would be medical attention in case of persistence of above mentioned symptoms beyond 2-3 weeks.
Does removal of larynx mean inability to speak for life?
It is time to break this myth. The outcome of laryngeal cancer once removed surgically by compromising voice box through total laryngectomy which takes away the ability to speak with the help of the vocal cords. Using advanced technologies in surgery, chemotherapy and radiation, the larynx or part of it can be saved but the quality of voice will change. Taste and smell can also get affected. It is best to remove the tumor and the larynx when the cancer has reached its advanced stage.
After the removal of the larynx, the trachea is trimmed and turned in order to create an opening in the front of the neck. Stoma, the opening, becomes the new passage that helps in breathing and bypasses the nose and mouth. Hereafter, the patient will need additional help and treatment to regain voice and speech.
It must be kept in mind that, even if, a part or the entire larynx is removed, the voice will not sound the same as before anymore. It will be somewhat low-pitched and difficult to heard when spoken in loud places. It is important to have patience and practice to learn to speak again. Relaxation techniques will help since it will be similar to how we learnt to speak during our childhood.
Learning to speak, again
The process of speech therapy is part of the recovery process and starts during hospital stay. Upon receiving an approval from the treating doctor, a usually starts before you leave the hospital. Once your healthcare provider gives approval, the specialized speech therapist initiates the process of speech lessons and the process may involve use of the following:
This is an artificial valve which is implanted into the neck, which helps in speaking after covering the stoma and breathing out through the valve. This valve produces a noise which is used to make words as we move our mouth. This valve can be fitted during the surgery when the larynx is removed.
This technique is trained by the therapist and involves processes like learning how to swallow air and push it out through the oesophagus and to the mouth. When the air moves through the oesophagus, it causes a vibration and makes a noise. Words can be spoken by moving lips and mouth. This may take about six months to learn.
This is a small battery-operated electrical device that is kept under the chin. The device produces sound as it vibrates and while moving the mouth and lips, the vibrations can be turned into spoken words. The therapist will train to use it properly.
Communicating with an artificial larynx can be mastered with practice, so much so that the patient can talk over the phone also. Artificial larynxes are of two types: neck type and intraoral. The neck type AL is placed on the side of the neck, under the chin or on the cheek. The intraoral AL is put inside the mouth in the form of a small tube. The best position for fitting the AL depends on the part of the mouth that makes the best sound and can keep the hands free to do other work. This is the most preferred one since it does not need another surgery to fit the device.
It will take patience and encouragement from the family to revive voice after removal of larynx due to laryngeal cancer. Any discomfort while using the artificial methods of speaking must be immediately reported to the doctor and the speech therapist to evaluate any problem arising in the operated area.