The voice box (larynx) sits at the top of the windpipe. It produces the voice, protects the airway during swallowing and lets us breathe. Cancer of the larynx is one of the more common cancers of the head and neck, and when it is found early it can often be treated well. Laryngeal cancer surgery is one of the three main areas of Prof. Hafız’s work.
What it is
Laryngeal cancer surgery removes a tumour of the vocal cords or of the parts of the larynx above and below them. The operation is matched to the size and position of the tumour. Small tumours can be removed through the mouth with a laser (transoral laser microsurgery). Larger ones may need a partial laryngectomy, which removes part of the larynx and keeps the rest working. Advanced tumours may need a total laryngectomy, in which the whole larynx is removed and the windpipe is brought out to an opening in the neck (a stoma) for breathing.
Who it is for
Adults with a biopsy-proven cancer of the larynx, adults with a suspicious lesion of the vocal cords, and people whose cancer has returned after radiotherapy. Treatment after earlier therapy is planned with particular care.
Symptoms and diagnosis
Hoarseness that lasts more than a few weeks is the most important warning sign, particularly in smokers. Other symptoms are a change in the voice, pain or difficulty on swallowing, ear pain, a lump in the neck, noisy breathing or shortness of breath. Diagnosis starts with an examination of the larynx with a thin flexible or rigid endoscope in the consultation room. A biopsy under general anaesthesia (microlaryngoscopy) confirms the diagnosis, and imaging with CT or MRI shows how deep the tumour reaches and whether the lymph nodes of the neck are involved.
How the operation is done
All laryngeal operations are performed under general anaesthesia. In transoral laser surgery a tube is placed through the mouth to expose the larynx, and the tumour is removed under a microscope with a carbon dioxide laser, layer by layer, so that healthy tissue is spared. Open partial laryngectomy removes the affected part of the larynx through a neck incision and rebuilds the remaining structures so that breathing, voice and swallowing continue. Total laryngectomy separates the airway from the throat permanently; the throat is closed so that swallowing continues by the normal route, and a small valve (voice prosthesis) can be placed between the windpipe and the gullet so that speech is possible again. Lymph nodes of the neck are removed in the same operation when needed.
Recovery
After laser surgery most people go home the same day or the next, and the voice recovers over a few weeks as the area heals. After a partial laryngectomy the hospital stay is longer, and swallowing is relearned with the help of a therapist. After a total laryngectomy, breathing through the stoma, care of the stoma and speech with the prosthesis are taught step by step before discharge, and the voice returns over the following weeks. Follow-up visits continue at regular intervals for years.
How Prof. Hafız works
Laryngeal and voice-box cancer surgery, transoral laser surgery and airway surgery are among the focus areas of Prof. Hafız’s practice. He is a member of the Laryngology Society, and his published work includes studies on laryngectomy techniques and on quality of life after treatment for laryngeal cancer. The choice between laser, partial and total operations, and between surgery and radiotherapy, is explained with its consequences for voice, breathing and swallowing before any decision is made.