Imagine waking up in the morning and being unable to clear your throat or speak. You want to say something but your voice is gone. And when you feel your throat, there is only a hole through which you breathe.
That is the life of a laryngectomee.
Laryngectomees are people who have undergone laryngectomy, that is surgical removal of their larynx or voice box for a cancer in the larynx. The procedure is not as rare as one might think. “We performed about 10 laryngectomies in the past two months,” says Dr. Mrs. Chandra Jayasooriya, Consultant ENT Surgeon at the National Hospital, Colombo.
Cancer of the larynx is not uncommon; it is the commonest head and neck cancer in the country and worldwide, and is directly related to smoking. Cigarette smoke is known to contain well over 30 carcinogens i.e. cancer causing substances. Thus, the more you smoke, the more the chances of laryngeal cancer. Alcohol is also known to increase the risk of the disease.
The combination of tobacco and alcohol is believed to be more than additive. As the number of female smokers are few in our country, laryngeal cancer is hardly seen among Sri Lankan women. But in other countries, female cancer patients do account for a significant number. Apart from smoking and alcohol, HIV infection, occupational hazards like exposure to metal, plastic fumes, paints can also add to the risk. Dietary factors also seem to play a role as salt preserved meat and fatty food increase the risk. Fresh fruits and vegetables are known to have a protective effect.
As in any cancer if laryngeal cancer is detected early, it is possible for the person to lead an almost normal life following treatment. Laryngectomy or removal of voice box is only necessary for advanced cases.
The earliest symptom to identify that there is some problem in the larynx is a change in your voice. But a cold or other respiratory tract infections are much more common causes of voice change than cancer. Voice change itself is not indicative of cancer. However, persistent voice change in a person usually above 50 years with risk factors such as smoking needs further assessment.
In addition, difficulty in swallowing, pain on swallowing, recent onset of noisy breathing (stridor or wheezing) in a person above 50 years warrants medical advice. The disease can even present late with lumps in the neck, which could be the result of it having spread. However none of these symptoms alone is synonymous with cancer. Even in the instance of a neck lump, most of the time it could be harmless. A recently developed lump in a person with risk factors needs further evaluation. Even then the chances are that it could be something benign.
Examination of the throat by the doctor using a mirror and a light source will detect most of the pathologies in the larynx. However newer techniques like fibreoptic laryngoscopy, where the doctor passes a small flexible tube with a small camera through the nose into the larynx can clearly identify early lesions as well. The latest technique, fluorescent endoscopy further improves diagnostic methods.
When there is an identifiable lesion, the doctor will perform an examination of the larynx under anaesthesia to take a small piece from the suspicious lesion to identify whether it contains cancer cells. CT scans, MRI scans also will help in further assessment of the disease.
Having made a definitive diagnosis, the treatment options are radiotherapy, surgery and chemotherapy (anti-cancer drugs).
The optimum treatment for each patient will vary according to the exact location, degree of spread etcSurgical techniques for laryngeal cancer are also evolving, and the trend is towards larynx preserving surgery so that the patient has the ability to speak.
Laryngectomy, however, is the last option for a few unlucky people whose disease is so advanced that it is not amenable to local resection. And this ‘unlucky few’ is quite a significant number in countries like ours. Such patients, unfortunately, have to face social issues as well.
Having a laryngectomy is an informed choice. Technically speaking, the patient is given adequate information regarding the surgery, the fact that he/she is going to lose his/her voice, that he/she will have to breathe through a hole in the neck, and that he/she will have to be on medication lifelong.
All these risks are weighed against permanent loss of voice, ulcerating cancer in the neck, suffocating to death when the tumour blocks the airway or bleeding to death when it erodes onto a major blood vessel. A prolonged hospital stay, poor earning capacity, lifelong follow-up and medication all strike at once. Total laryngectomy extends patients’ lives at the expense of natural voice, subsequent quality of life and changes in lifestyle.
The only options to produce voice are either an electrolarynx or trachea oesophageal fistula with a speech valve. An electrolarynx uses a power supply to activate a vibrator that provides the sound source. The sound is delivered to the oral cavity through the skin-- a tube that fits inside the mouth or a dental palate. It is then articulated to make speech sounds. But this gives a mechanical voice quite different to the normal voice. Surgical voice restoration methods like trachea oesophageal fistula with valve can give better quality voice but frequent changing prosthesis and other problems related to a second surgery in the same area are the disadvantages.
The costs of both methods are high but currently the state funds these procedures. Both methods need significant voice rehabilitation.
Give a helping hand to this support group
The Sri Lanka Laryngectomees Association is a patient support group established in September 2005 by the College of Otorhinolaryngologists and Head and Neck Surgeons of Sri Lanka to help people who have lost their voice box due to Laryngeal Cancer. There are more than 100 such patients who have undergone laryngectomy in Sri Lanka.
The Sri Lanka Laryngectomees Association enables laryngectomee patients to get together as a group to address their needs. The association also disseminates information about their needs among the general public, government and other associations through this forum. In addition to educating the general public about the prevention of laryngeal cancer by refraining from alcohol consumption and smoking, the association also helps patients every two months to get their medication, to get new batteries for their electrolarynx and to change the trachea-oesophageal valve frequently.
The Association will next meet on December 18 at the National Hospital, in Colombo. There will be a fund raising lottery draw on the same day to collect funds for the patients. President of the Association Dr. Mrs Chandra Jayasooriya invites interested people to join the event or make any donations. The Sri Lanka Laryngectomees Association can be contacted on 0114939495. |
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