• 8/22/2007
  • Derbyshire, United Kingdom
  • Angela Brooks
  • DailyMail (www.dailymail.co.uk)

About 2,200 people a year are diagnosed with cancer of the voice-box, or larynx. In conventional surgery, the voice-box is removed, leaving patients unable to speak. But a new technique leaves it intact.

The Patient – Roger Stone

My work involves travelling around the world. In February 2001, I was in Nigeria when I couldn’t shake off a sore throat.

When I got back home five months later, my GP prescribed antibiotics, but the sore throat continued over the summer when I went to work in Mozambique.

By the time I went back to see my GP four months later, swallowing had become painful. He noticed the lymph nodes in my neck were swollen and referred me to a specialist at Derbyshire Royal Infirmary.

Mr Sean Mortimore, an ear, nose and throat surgeon, examined my throat and said I needed a biopsy, where pieces of tissue are removed under a general anaesthetic for laboratory testing.

When he asked if I could come in for it the next day, alarm bells started ringing.

As soon as I came round, I asked Mr Mortimore straight out whether he had found a malignancy on my larynx. He told me they wouldn’t know for certain until they got the results back from the laboratory a couple of weeks later.

My results came back on Christmas Eve and I had an appointment with Mr Mortimore the same day. He introduced the Macmillan cancer nurse specialist to me as soon I came into the room, but I had already prepared myself for the worst.

I had a medium-sized cancer of the epiglottis – part of the voice-box on top of the vocal cords. It was probably caused by heavy smoking – I was on 20 cigarettes a day at the time – and drinking.

I feared I’d need a total laryngectomy – I’d lose my voice-box and be left mute. But Mr Mortimore suggested a new technique: minimally invasive laser surgery to cut out the laryngeal tumour.

The lymph nodes in my neck – where the cancer had also spread – would still need to be removed with open surgery.

Laser surgery minimises the loss of healthy tissue around the tumour because instead of removing the whole voice-box, the tumour is pared away inside the throat, with blood vessels being sealed along the way.

I was worried about the cutting around my neck to remove the lymph nodes because there was a risk of paralysis in my face.

During the third week of January 2002, Iwent into hospital. I woke up in intensive care two days after the 12-hour operation. I had a lot of lines coming in and out of me. My face and neck were swollen and bruised.

The surgeon had slit my throat to remove the lymph nodes, so I had stitches across my throat and up to my ears. I felt grim for several weeks.

My epiglottis had been removed and, as this is vital for swallowing, I had intensive therapy to help me use other muscles instead.

Fortunately, my voice wasn’t affected long-term, though it was weaker at first.

For the two-and-a-half weeks I was in hospital and then for more than a month after I was home, I was fed through a tube in my stomach. It was three months before I was on proper food and the tube was removed.

I then had six weeks of radiotherapy to zap any stray cancer cells. My final appointment is this Christmas Eve. I feel as fit as I did before my surgery, except for some slight numbness on one side of my face.

I know the cancer may recur in ten to 20 years, but I’ve had a superb team looking after me and I’ve had more years than I should anyway.

The Surgeon – Sean Mortimore (ENT)

Sean Mortimore, consultant ear, nose and throat surgeon at Derbyshire Royal Infirmary, says: MEN outnumber women five to one in getting cancer of the larynx or voice-box. It is five to seven times more common in people who drink or smoke, and 35 times more common in people who do both.

Early symptoms may include a sore throat, hoarseness, difficulty in swallowing and earache.

The larynx is at the top of the windpipe, and the food pipe or gullet is behind it. The larynx prevents food from entering the windpipe and going into the lungs. Its secondary function is voice production.

The larynx is divided into three parts: the vocal cords (the glottis), the subglottis and the supraglottis.

Roger’s cancer developed in the epiglottis, part of the supraglottis, and had spread to the tongue.

With large tumours, laryngectomy (complete removal of the voice-box) may be necessary; otherwise we try to remove just the cancerous tissue. THIS still leaves patients hoarse, either because we’ve needed to remove tissue or because of scarring.

For small tumours, radiotherapy alone can be enough. For intermediate tumours – such as Roger’s – surgery is advised, sometimes followed by radiotherapy.

Transoral C02 laser resection is minimally invasive surgery to remove the tumour. It is available at only about ten NHS hospitals.

This spares the voice-box and preserves the voice, as we just remove the malignant tissues inside it.

With the patient anaesthetised, the anaesthetist slips a slim breathing tube down their throat. I then put a laryngoscope – a titanium pipe – down the windpipe and examine the tumour through a microscope. All the instruments we use, including the laser, are fed through the pipe.

We cut through the tumour with the laser. With forceps in one hand, I hold the tumour and with a joystick in the other I manoeuvre the beam to cut out the cancerous tissue.

No internal stitches are necessary because the raw tissue seals over itself.

If the cancer has spread to the lymph nodes on either side of the neck – as in Roger’s case – we strip those out next. This is done through an incision from behind the ear across the front of the throat. We close the skin with stitches. This is major surgery, so patients recover for a couple of days in intensive care.

The speech and swallowing therapist is critical in helping patients build up other muscles in the throat to compensate for those removed in surgery.

The success rate for small tumours (treated by radiotherapy only) is 90 to 95 per cent, for intermediate ones it is 70 per cent, and for large tumours, it drops to below 50 per cent.

Laser surgery for intermediate tumours isn’t better than conventional surgery as a cure, but it does spare the patient’s voice.

Transoral C02 laser surgery costs the NHS £20,000. Few private hospitals are equipped to do it.