Laryngeal Cancer Patient Guide

This guide has been prepared to inform patients diagnosed with larynx cancer and their relatives thr

This guide has been prepared to inform patients diagnosed with larynx cancer and their relatives throughout the process.

This document is for general information purposes only; For personal medical decisions, be sure to consult your ear, nose and throat / head and neck surgery specialist.

Contents

1. Introduction: What is Laryngeal Cancer?3

• Introduction: What is Laryngeal Cancer?3

2. Risk Factors4

• Risk Factors4

3. Signs and Symptoms5

• Signs and Symptoms5

4. Diagnostic Process6

• Diagnostic Process6

5. Staging and Prognosis7

• Staging and Prognosis7

6. Treatment Options: Surgery8

• Treatment Options: Surgery8

7. Treatment Options: Radiotherapy and Chemotherapy9

• Treatment Options: Radiotherapy and Chemotherapy9

8. Postoperative Process and Voice Rehabilitation10

• Postoperative Process and Voice Rehabilitation10

9. Feeding and Swallowing Management11

• Feeding and Swallowing Management11

10. Quality of Life and Psychosocial Support12

• Quality of Life and Psychosocial Support12

11. Follow-up, Control Process and Stoma Care13

• Follow-up, Control Process and Stoma Care13

12. Pre-Surgery Checklist14

• Pre-Surgery Checklist14

13. Post-Surgery Checklist15

• Post-Surgery Checklist15

1. Introduction: What is Laryngeal Cancer?

• Introduction: What is Laryngeal Cancer?

The larynx (larynx) is an organ located in the upper part of the windpipe (trachea) in the neck, which undertakes vital functions such as sound production and protection of the airway during breathing and swallowing. Laryngeal cancer develops as a result of uncontrolled proliferation of cells in this area and is one of the most common types of head and neck cancers.

The larynx is divided into three main regions: supraglottis (upper region), glottis (middle region where the vocal cord is located) and subglottis (lower region, the transition point to the trachea). The area where cancer begins directly affects symptoms, treatment options and prognosis.

Types of Laryngeal Cancer According to Location

Types of Laryngeal Cancer According to Location

Glottic cancer: The most common type; Since it directly affects the vocal cords, it is usually noticed by hoarseness in the early stages Supraglottic cancer: Originates from the upper region; It is usually noticed later because it may not cause any significant sound changes in the early period

Subglottic cancer: It is the rarest type; may cause respiratory distress

Subglottic cancer: It is the rarest type; may cause respiratory distress

Laryngeal cancer constitutes an important group among all head and neck cancers and is more common especially in men over the age of 60. It is observed that the prevalence in society gradually decreases over the years as cigarette and alcohol use decreases.

If hoarseness lasts longer than 3 weeks, an ear, nose and throat specialist should be consulted.

2. Risk Factors

• Risk Factors

Various risk factors have been identified that play a role in the development of laryngeal cancer. The combination of these factors can significantly increase the risk.

Cigarette and all kinds of tobacco product use (the most important risk factor) Excessive and long-term alcohol consumption (the risk increases exponentially when used with cigarettes)

High risk HPV (Human Papilloma Virus) infection

Occupational exposures: chemicals such as asbestos, sulfur dioxide, nickel, paint and solvent vapors Chronic gastroesophageal reflux disease (GERD) can lead to long-term irritation of the laryngeal mucosa

Poor diet and low fruit and vegetable consumption

3. Signs and Symptoms

• Signs and Symptoms

Symptoms of laryngeal cancer may vary depending on the location of the tumor. Hoarseness is an early warning sign, especially in glottic tumors.

Early Findings

Unexplained hoarseness lasting more than 3 weeks

Unexplained hoarseness lasting more than 3 weeks

Constant feeling of stuckness or foreign body in the throat

Mild swallowing difficulty or discomfort

Chronic cough

Later Period Findings

Marked shortness of breath or change in breath sounds (stridor)

Severe difficulty swallowing and painful swallowing

Swelling or palpable mass in the neck

Unexplained weight loss

pain radiating to the ear

Having one or more of these symptoms does not directly mean cancer; However, it is recommended to consult a specialist without wasting time.

4. Diagnostic Process

• Diagnostic Process

The diagnosis of laryngeal cancer is made through a phased evaluation process. This process aims to both confirm the presence of the disease and determine the extent of its spread.

4.1 Laringoskopi

4.1 Laringoskopi

The larynx is directly viewed with the help of a thin instrument with a camera at the end (laryngoscope). This procedure can be performed as fiberoptic laryngoscopy, which can be performed under office conditions, or as direct laryngoscopy, which can be performed under general anesthesia. A biopsy may also be taken during direct laryngoscopy.

4.2 Biyopsi

4.2 Biyopsi

A small piece taken from the suspicious tissue is examined in the pathology laboratory. A definitive diagnosis can only be made with a biopsy result.

4.3 Imaging Methods

4.3 Imaging Methods

Computed Tomography (CT): Used to evaluate tumor size, cartilage involvement and neck lymph nodes Magnetic Resonance Imaging (MRI): It is preferred in the evaluation of soft tissue spread

PET-CT: Used to investigate distant organ spread (metastasis)

PET-CT: Used to investigate distant organ spread (metastasis)

Neck ultrasonography: Can be used in lymph node evaluation

Neck ultrasonography: Can be used in lymph node evaluation

4.4 Evreleme

4.4 Evreleme

After all diagnostic tests are completed, the disease is staged according to the internationally accepted TNM system. This staging is the main guide in determining the treatment plan and evaluating whether the larynx can be preserved.

5. Staging and Prognosis

• Staging and Prognosis

The TNM system consists of three basic components: T (size and extent of the tumor, including vocal fold motility), N (regional lymph node involvement), and M (distant organ metastasis). The combination of these components allows the disease to be classified from Stage 0 to Stage IV.

The location of the tumor within the larynx (glottic, supraglottic or subglottic) also directly affects the prognosis. Since glottic tumors usually show early symptoms, they are detected at an earlier stage and their prognosis is relatively more positive.

Prognosis varies from person to person; The most accurate information should be obtained from the physician team carrying out the treatment.

6. Treatment Options: Surgery

• Treatment Options: Surgery

Surgery plays an important role in the treatment of laryngeal cancer. Different surgical approaches can be applied depending on the size and location of the tumor.

Lazer Cerrahisi

In early stage glottic tumors, it may be possible to remove the tumor with a laser through the mouth. This method provides great protection of the larynx.

Partial Laryngectomy

It is a surgical method in which only the tumorous part of the larynx is removed and the voice and respiratory functions are largely preserved.

Total Larenjektomi

In advanced stage tumors, it may require removal of the entire larynx. In this case, the trachea is opened outside with a permanent stoma (tracheostomy) opened in the neck, and the patient no longer breathes through the nose but through the stoma.

Boyun Diseksiyonu

If there is suspicion or evidence of lymph node involvement, some or all of the lymph nodes in the neck are surgically removed.

7. Treatment Options: Radiotherapy and Chemotherapy

• Treatment Options: Radiotherapy and Chemotherapy

Radyoterapi

It is aimed to destroy cancer cells by using high energy rays. It may be preferred as the primary treatment method that protects the larynx in early stage laryngeal cancer. Common side effects include temporary increase in hoarseness, dry mouth and difficulty swallowing.

Kemoterapi

In advanced stage disease, the aim is to protect the larynx by applying it together with radiotherapy (chemoradiotherapy). This approach is called 'larynx-sparing treatment' and may be an alternative to surgery in selected patients.

Treatment combination; It is planned individually by a multidisciplinary team according to the stage of the disease, location and general health condition.

8. Post-Operative Process and Voice Rehabilitation

• Post-Operative Process and Voice Rehabilitation

After total laryngectomy, the patient has to learn a new way of speaking because he loses his natural vocal cords. Speech and language therapists play an important role in this process.

Tracheostomy and Stoma

After total laryngectomy, a permanent opening (stoma) is created in the neck and the patient breathes through this opening from now on. Stoma care becomes a permanent part of daily life.

Esophageal speech: No additional device required, but may take time to learn

Esophageal speech: No additional device required, but may take time to learn

Electrolarynx: Speech is achieved by creating vibration with an electronic device placed in contact with the neck Tracheoesophageal voice prosthesis: The most natural voice quality can be achieved with a small surgically placed valve

9. Feeding and Swallowing Management

• Feeding and Swallowing Management

General Recommendations During Treatment

General Recommendations During Treatment

Take care of a balanced, protein-rich diet

Choose small and frequent meals

Avoid excessively spicy, acidic and hard foods

Practical Suggestions in Case of Difficulty in Swallowing

Prepare food to a puree or soft consistency

Thickening liquids with thickeners may help

Sit upright during meals and eat slowly and with small bites If necessary, temporary use of a feeding tube (nasogastric or PEG) may be recommended Dietician and swallowing therapist support increases both quality of life and compliance with treatment.

10. Quality of Life and Psychosocial Support

• Quality of Life and Psychosocial Support

Laryngeal cancer treatment can place a significant emotional burden on both patient and family, especially when voice loss is involved. Changing the way of communication can lead to anxiety, sadness and social withdrawal.

Do not hesitate to seek psychological counseling and professional support when necessary Joining support groups for laryngectomy patients may be helpful in sharing similar experiences It makes the process easier for family members to learn new communication methods (writing, signing, speaking devices)

Social workers can provide guidance on practical and financial issues during the treatment process

11. Follow-up, Control Process and Stoma Care

• Follow-up, Control Process and Stoma Care

Regular follow-up after treatment is completed is critical for both detecting possible recurrence early and monitoring treatment-related late side effects.

Things to Consider About Relapse Symptoms

Things to Consider About Relapse Symptoms

Deterioration or hoarseness in the voice again

New onset difficulty swallowing or breathing

A new lump or mass in the neck

Unexplained weight loss or persistent pain

Basic Rules in Stoma Care

Keep the stoma area clean and moist daily The use of a humidifier filter (HME) is recommended to prevent the air from drying out Be careful not to let water get into the stoma while showering or swimming In case of any irritation, bleeding or blockage, consult your physician

12. Pre-Surgery Checklist

• Pre-Surgery Checklist

Completing the following steps while preparing for the day of surgery will help the process proceed more safely and orderly.

Medical Preparation

☐ All blood tests, ECG and imaging results were completed and shared with the physician

☐ Anesthesia consultation was made

☐ All medications used (especially blood thinners) were reviewed with the physician ☐ Allergies and chronic diseases were reported to the surgical team

Lifestyle and General Preparation

☐ If possible, smoking and alcohol use were stopped before surgery ☐ The fasting (hungry and thirsty) instructions given by the physician were followed ☐ If total laryngectomy is planned, a preliminary meeting was held with the speech therapist ☐ Return home and companion planning was made after the surgery

☐ Items to be brought to the operating room have been prepared (ID, health reports, comfortable clothing) Do not hesitate to ask any questions you may have to your doctor or nurse at the final pre-operative check-up.

13. Post-Surgery Checklist

• Post-Surgery Checklist

Clarifying the following issues before and after discharge facilitates the recovery process and enables early detection of possible problems.

Maintenance and Follow-up

Maintenance and Follow-up

☐ Stoma/tracheostomy care and necessary materials (humidifying filter, etc.) were learned ☐ Wound care and dressing change frequency were explained ☐ The pain management plan and the medications to be used have become clear ☐ Feeding and swallowing evaluation was performed; If necessary, a tube feeding plan was determined

Rehabilitation and Communication

☐ First appointment with speech/voice therapist scheduled

☐ The date of the first control examination is determined

☐ It is known when and to whom to contact in case of emergency (alarm symptoms) ☐ Psychosocial support resources and support groups were contacted ☐ Materials required for home care (aspiration device, wound care materials, etc.) were provided This checklist is intended as a general guide; Individualized discharge instructions should always be followed first.

— End of Guide —

— End of Guide —