The type of surgery you have will depend on the size of the cancer and where it is in the larynx.

Surgery may be used to remove the tumour if:

• The cancer has stopped the vocal cords moving at all.
• The cancer has affected more of the larynx than just the vocal cords.
• You have an early tumour (a small tumour which is only in the larynx) that has not completely gone after radiotherapy treatment (which is unusual).
• The cancer comes back some time after radiotherapy.

Surgery may also be used to control symptoms of advanced cancer of the larynx.

If the tumour is very small, it may be destroyed by directing a laser light beam at the tumour. A thin, flexible, fibre optic tube with a light at the end is passed down the throat so that the laser can destroy the cancer cells.

Laser surgery is done under general anaesthetic. It may be possible to go home later the same day, but you might need to stay in hospital overnight. You may have some pain in your throat, but it shouldn’t last for more than a couple of days. You may be asked to rest your voice after surgery. Your doctor or specialist nurse will give you more information about this before you go home from hospital.

This type of surgery is used for small early stage cancer of the larynx. It is done under general anaesthetic. An endoscope (thin, flexible tube with a camera and light) is passed through your mouth and down to your throat. The camera gives the surgeon a magnified view of the affected area on special screens in the operating room. The surgeon uses either surgical instruments or laser to remove the affected area. You won’t have a wound in your neck after this type of surgery as the endoscope is passed through your mouth to the throat. However, you may have some soreness in your mouth and throat.

Sometimes, part of the larynx will need to be removed – this is known as a partial laryngectomy. There are different types of partial laryngectomy operations. You might hear your surgeon use the terms vertical partial laryngectomy or horizontal partial laryngectomy. The type of operation you have will depend where in the larynx your cancer is.

Part of the voicebox will be left so that you will still be able to speak, but your voice is likely to be weaker or hoarse. After this operation, you may have a temporary opening in your neck (held open by a tube) to allow you to breathe. This is called a temporary tracheostomy or temporary stoma. This helps the remaining part of the larynx to heal. While you are recovering from surgery the tube will be removed and the stoma will then eventually close up. When the stoma closes up you may be left with a small scar on your neck.

Sometimes a temporary tracheostomy may be needed to help with your breathing if you have a partial laryngectomy. It can also be necessary in the following situations:

• Before you start treatment if the cancer is likely to block or is actually blocking your airway.
• During radiotherapy if the tissues become inflamed and swollen leading to narrowing of your airway.
• To help with breathing difficulties if the cancer is very advanced.

Usually these temporary tracheostomies will only be needed for a short time.

Some people need to have the whole voicebox removed. This operation is known as a total laryngectomy. People who have had a laryngectomy are sometimes called laryngectomees.

When the larynx is completely removed, there is no connection between the mouth or nose and the lungs. So, during the operation the surgeon creates an opening called a tracheostomy (or stoma) in the lower part of the neck for you to breathe through.

Sometimes during the operation your surgeon may need to remove some lymph nodes from around the larynx. This is called a neck dissection. Sometimes this is done because the nodes may contain a small number of cancer cells that did not show up in the earlier scans.

Immediately after the operation the stoma will need to be held open by a tube (sometimes called a laryngectomy tube or tracheostomy tube) while it heals. You won’t be able to speak at first and may need to communicate by writing. Our section on voice restoration discusses the different ways of being able to speak again.

In time, the stoma will stay open without the tube, but it’s common for a tube to be used for the first few days or weeks. You will be taught how to keep the tube clean and how to replace it if necessary. You will breathe and cough through the tracheostomy.

A drip going into a vein in your arm will give you fluids for a few days. You may also have liquid foods given through a tube going into your nose which goes down into your stomach (NG tube). After a few days or weeks you will be able to eat and drink normally again. However you will need to build up your eating gradually and the hospital dietitian can advise you about this. Our diet section contains helpful tips.

There will be thin plastic tubes going into your wound to drain off fluid and allow healing.

You will have your tracheostomy for the rest of your life. This may be frightening at first, but you will be taught how to look after the tracheostomy until you are confident about doing it yourself.