Types of treatment

There are three main types of surgery for laryngeal cancer: Transoral Microlaryngoscopic Resection, Partial laryngectomy and Total laryngectomy

Transoral Microlaryngoscopic Resection

If you have early laryngeal cancer (T1, T2 stage) it may be possible to cut the tumour out with special surgical instruments or a laser. The surgeon does the operation under a general anaesthetic and can see your voice box by passing a rigid tube into the throat and looking through a magnifying microscope.

If you have a very small laryngeal cancer (T1a squamous cell carcinoma of vocal cord) or precancerous changes (dysplasia or carcinoma-in-situ) it may be possible to remove it completely when you come in for a Microlaryngoscopy and biopsy as part of your work up find out why you have a hoarse voice. If there is uncertainty about the cause of your hoarseness the surgeon may just take a small piece of the abnormal tissue and then discuss the treatment options. The surgery is usually restricted to the surface layers of the vocal cords. If the abnormal tissue turns out the be cancer further treatment may mean further surgery or possibly radiotherapy. For more details click on Microlaryngoscopy with or without biopsy or Microlayngoscopy and excision biopsy.

If the cancer is a bit bigger and grown into the vocal cord but still early (T1a, T2 stage) it can be removed by cutting it out with a laser. For more details click on Transoral laser resection.

Partial laryngectomy

This involves making a cut over the voice box and removing the part affected by cancer. This is operation can be done when tumours affect the upper part of the voice box (supraglottis). The aim is to leave your vocal cords in place so that you can still talk. However the voice may be quite weak and hoarse and swallowing requires a lot of retraining to stop food and drinks going down the wrong way. Because of the side effects of the operation, improvements in laser techniques and generally good outcome with radiotherapy this operation is not performed a lot nowadays. However it can be a choice these alternatives are not possible or the alternative is a Total laryngectomy. For more details click on Partial laryngectomy.

Total laryngectomy

A total laryngectomy is usually used to treat advanced laryngeal cancer (T3, T4 stage). The operation involves removing the whole of your voice box and the nearby lymph nodes in the neck. You will need to breathe through a permanent hole in your neck (called a stoma) but once everything has healed up you should be able to eat an almost a normal diet. Because your vocal cords are removed, you won't be able to speak in the usual way after the operation. There are however several ways to help you speak again. For more details click on Total laryngectomy.

A Deep Vein Thrombosis (DVT) is the formation of a blood clot (thrombus) within a deep vein in the body or a limb, most commonly the lower leg.

• some pain, swelling and redness
• the limb may feel warm compared to the other one
• distended and more obvious veins under the skin

In some cases however there may be no symptoms or signs and some people only find out they've had one when they suffer with a pulmonary embolus. Also if a DVT is not recognised and treated one in 10 people will go on to develop a pulmonary embolism which is a serious and potentially life-threatening complication. Link: Pulmonary embolism.

• those over the age of 40
• having had a previous DVT or pulmonary embolism
• having a family history of blood clots
• being inactive for long periods – such as after an operation (or during a long journey)
• damage to a blood vessel wall
• having certain conditions or treatments that cause your blood to clot more easily than normal – such as cancer (including chemotherapy and radiotherapy treatment), heart and lung disease, thrombophilia and Antiphospholipid syndrome
• being overweight or obese
• being pregnant, being on the combined contraceptive pill or taking hormone replacement therapy (HRT)

Although people with Head and Neck cancer tick quite a few of these boxes, DVTs are fortunately relatively uncommon as we take lots of precautions to reduce the risks. These include:

• getting you to wear anti-embolism stockings (often known as T.E.D stockings)
• using intermittent pneumatic compression devices applied to their legs when under a general anaesthetic in high-risk people 
• having injections subcutaneously (i.e. under the skin) of a drug called Enoxaparin which helps to stop blood clots forming

What you can do:

- Tell your surgeon or the Preadmission Nurse if you:

• have had a previous DVT or Pulmonary Embolism
• have a family history of blood clots
• have been diagnosed with Antiphosholipid Syndrome, Thrombocythaemia or Polycythaemia
• are taking any of the following medications:
• hormone replacement therapy (HRT), tamoxifen, some birth control pills, erythropoietin, thalidomide

- Stop smoking

- Drink plenty of fluids up to the point you are told not to in the instructions you have been given before   coming into hospital for your operation 

- Remain as active as possible before coming into hospital and while in hospital

- Keep wiggling your toes and moving your legs after your operation

- Avoid crossing your legs

A pulmonary embolism or blood clot in the lung is a very serious condition which can cause gradual or a sudden shortness of breath and/or chest pain or sudden collapse. It is a complication of a Deep Vein Thombosis. Dont worry we can fix i. 

Radiotherapy uses high energy X-rays to damage cells in the body. The idea is that any healthy cells within the treatment area will be able to repair and regrow, but any abnormal or cancerous cells are destroyed.

The treatment can be directed to specific areas of the body and like with an X-ray, you will not feel anything whilst receiving it. Your radiotherapy treatment will be prescribed by a consultant in a dose we call 'gray' and over a period of time we call a 'fraction'. We do this to give your body enough dose to damage any unwanted cells with enough resting time for healthy cells to recuperate.

For more information visit Radiotherapy Services

The majority of patients receiving radiotherapy to the head and neck area will have an immobilisation mask fitted. This is made to help keep them in the same position each day and to ensure that we are only treating the exact areas that we want to treat.

The immobilisation mask is usually made on the same day as a planning CT scan is carried out. Radiotherapy is precisely planned using a CT scanner which is located in the radiotherapy centre and we ask that you do not have anything to eat or drink in the two hours prior to your appointment. We inject a contrast dye during the scan to highlight areas of the head and neck which if you eat can be unclear.

During your first appointment you will be given a gown which will be yours to keep throughout your treatment. We ask that you wear this each day when you attend for your radiotherapy to maintain your dignity. Changing rooms are provided however you may travel to your appointment in your gown if you wish.

As there are over thirty places in the head and neck area that cancer can develop, the type of treatment you have can be very different to other patients you meet along your journey.

You will meet your Oncologist and Emma Hallam, our specialist radiotherapy head and neck radiographer at your first oncology appointment. They will discuss with you the treatment options and which is best for you. This will take place a few days after your case has been discussed at our multidisciplinary team meeting (MDT). This is where various health professionals including Surgeons and Oncologists meet to discuss the best treatment plan for you based on your diagnosis. 

Support during treatment

Every week you will be seen by your team which is lead by your oncologist.The team includes the specialist registrars and Emma Hallam. Support can be accessed at any point from our speech and language therapists and dietitians also. A selection of patient support groups can be found in our Care and Support Section.

After you have completed your treatment you will be offered a two week appointment to return for us to see how you are getting on and discuss any further plans. Your Oncologist and/or Surgeon will follow you up every four weeks to begin with and then structure your follow up appointments over a number of years to follow.

What is chemotherapy?
Chemotherapy is a form of drug treatment that is used in the treatment of advanced head & neck cancer.

Can chemotherapy cure Head & Neck cancer?
No. Chemotherapy alone, unlike either surgery or radiotherapy cannot cure head and neck cancer but when given together with radiotherapy (concurrent treatment) it helps stop the cancer coming back but unfortunately this comes at a price of more long-term side effects (toxicity).

How does it work?
Chemotherapy drugs destroy cancer cells and also make them more likely to be killed off by radiotherapy by making them more vulnerable to damage (sensitizing the tumour). On the other hand Biological therapies, which are also cancer treating drugs, change the way cells work help the body control the growth of cancer.

Why might I be given chemotherapy?
There are three main reasons for giving chemotherapy:

To increase the chance that the radiotherapy will get rid of the cancer if you have advanced head and neck cancer (stage T3 or T4) (see: chemoradiotherapy)

To help shrink tumours before starting radiotherapy (see: induction chemotherapy)

If the cancer comes back after treatment (locoregional recurrence) or shows signs of spread to other parts of the body (distant metastases)

Who looks after me when I am having chemotherapy?
Your Oncologist will discuss the pros and cons of treatment with you and prescribe the drugs. All patients will be seen on the chemotherapy suite by a specially trained nurse prior to commencing treatment where you will be told all about the process and what to expect and have some blood tests. For more information please visit NUH’s Oncology website: NUH - Oncology

How is it given?
Although some chemotherapy drugs can be given in tablet form the ones used to treat head and neck cancers need to be given through a cannula in a vein into the bloodstream.

Where do I have chemotherapy treatment?
It is given in the chemotherapy suite based at Nottingham's City Hospital Campus.

How frequently do I have chemotherapy treatment?
It is usually given once a week as an outpatient. It is given alongside radiotherapy as concurrent chemoradiation treatment.

What are the side effects?
These depend on the drug used and can happen whilst having the treatment, immediately after and long-term. They are discussed in detail under each drug.

What are the main drugs used in head and neck cancer treatment?
Although there are over 50 types of chemotherapy drugs but only a few are effective in Head and Neck cancer. The ones most commonly used in our centre are:
Cisplatin
Carboplatin
5-FU
Docetaxel (Taxotere ®)
Paclitaxel (Taxol ®)

The main biological therapy used in the treatment of head and neck cancers is a monoclonal antibody therapy:
Cetuximab (Erbitux ®)