Having your laryngeal cancer operation
This page tells you about having your operation for cancer of the larynx. You can go to information about
Having your laryngeal cancer operation
Before your operation, your surgeon, anaesthetist, physiotherapist, speech therapist, nurse and dietician will come to talk with you. Your surgeon will explain the operation and tell you what to expect when you come round. Your speech therapist will talk to you about how you will communicate and swallow after the operation.
After your operation
When you wake up, you will have several different tubes in place. These may include a breathing tube in your neck. The hole in your neck is called a stoma. It may be temporary. But if you have had your whole larynx removed, it will be permanent. You will have a bell so you can call for help and a pen and paper to write down anything you want to say.
You will almost certainly have some pain at first. Tell your doctor or nurse as soon as you feel any pain, so they can find the right type and dose of painkiller for you.
Eating and drinking
Following a laryngectomy, you won’t be able to eat or drink for at least 7 to 10 days. You will have fluids through your drip (intravenous infusion), and liquid food through a tube.
You will have been through a lot. There will probably be times when you feel very down. Try to be patient with yourself while you recover. You will need a lot of support from your doctors, nurses, family and friends.
You can view and print the quick guides for all the pages in the Treating laryngeal cancer section.
Before surgery, your surgeon and anaesthetist will give you a detailed explanation of what to expect. They will also organise some tests. You may have had some of these tests when you first had your cancer diagnosis. If so, you may not have to repeat them. You may have
- Blood tests to check your general health and to find out your blood group, in case you need a blood transfusion during the operation
- A chest X-ray to check your lungs are healthy
- An electrocardiogram (ECG) to check your heart is healthy
- An ECG while you are exercising
- Breathing tests (lung function tests)
These tests are done to make sure that you are fit enough to make a good recovery from your surgery.
If you have been finding it difficult to eat and drink, you may need to go into hospital for a few days or weeks before the operation. Your surgeon may put a feeding tube into your stomach through a hole made in your tummy (abdominal wall). The tube, a percutaneous endoscopic gastrotomy (PEG), is put in under local anaesthetic. You may also be given medicines to relax you. The feeding tube can be put in using X-rays to make sure it is in the right place. Or the surgeon can use a light to see where to put the tube. The procedure is called a radiologically inserted gastrotomy (RIG). Liquid food given through the tube helps to build up your weight and strength before the surgery.
A physiotherapist will teach you breathing and leg exercises. You do these exercises after your operation to help yourself to get better. You should do them as often as you are advised you need to. Breathing exercises will help to stop you getting a chest infection. Leg exercises will help to stop blood clots forming in your legs. Both these complications of surgery can happen because you are not moving around as much as you would normally. Your nurses will encourage you to get up and about as soon as possible after your operation. But this is major surgery and you may have to stay in bed for the first day or two.
Below is a short video showing breathing and circulation exercises after surgery. Click on the arrow to watch it.
View a transcript of the video showing breathing and circulation exercises after surgery (opens in new window)
When you go into hospital for your operation, your surgeon, anaesthetist, physiotherapist, speech therapist, nurse and dietician, will come to talk to you about what will happen. Your surgeon will explain the operation and tell you what to expect when you come round from the anaesthetic. Your speech therapist will talk to you about how you will communicate and swallow after the operation.
Ask as many questions as you need to. It may help to make a list of questions before you go into hospital. There are some suggestions for questions at the end of this section. The more you know about what is going to happen, the less frightening it will seem. Don’t worry if you think of more questions later. Your nurses should be able to answer any questions you have, but they can arrange for your doctor to talk with you again if needed.
If you've had a big operation, you may wake up in intensive care or a high dependency recovery unit. This is nothing to worry about. These are places where you can have one to one nursing care. As soon as your doctors are sure you are recovering well, you will go back to the ward.
When you first wake up, you will have a little clip on your finger to measure your pulse and blood oxygen levels. This is called a pulse oximeter. You may also have an oxygen mask on for a while. Your nurse will measure your blood pressure regularly. You will have several different tubes going into your body. This can be a bit frightening. It helps if you know what they are all for. You may have
- Drips (intravenous infusions) to give you fluids until you are eating and drinking again, and blood if you need it
- A breathing tube in your neck
- A fine tube into your stomach via your nose (a nasogastric tube) for liquid foods OR a gastrostomy tube
- One or more wound drains coming out of your neck near your wound
- A tube into your bladder (a catheter) so that your urine can be collected and measured to show whether you have too much fluid or are getting dehydrated
The hole in your neck is called a stoma. It may be temporary if you have only had part of your larynx removed. If you have had your whole larynx removed, it will be permanent. You will breathe through this hole from now on. There is information about life with a breathing stoma in the living with cancer of the larynx section.
You may have a couple of electronic pumps attached to your drips. These are for controlling painkillers or other drugs you might have through your drip.
The nasogastric tube comes from your stomach and stops you feeling sick. Later it will be used as a feeding tube. The tube may go up your nose and down your throat into your stomach. Or it may go into your breathing stoma, through a small hole at the back of your windpipe and into your oesophagus. The tube helps to keep open the small hole for the speaking valve that you will have fitted later.
The wound drains stop blood and fluid collecting around the operation site. This helps your wound to heal and helps to stop infection. The wound drains connect to suction bottles. When there is no more fluid coming out, the drains are taken out. This is usually after a few days.
Because you have had surgery to your voice box, you will not be able to talk to the doctors and nurses. This can be very frustrating and may make you feel as if you have no control over things. Staff will be very aware of this and will visit you often to see if you need anything. You will have a call bell close by, so that you can call for help whenever you need it. Your nurse will also give you a pen and paper for you to write down anything you want to say.
If you have a stoma you will also find it difficult to cough, sniff, laugh or kiss.
You will almost certainly have some pain and soreness for the first week or so. But pain can be kept under control. There are many different painkillers you can have. It is important to tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.
Many hospitals now use electric pumps to give painkillers after surgery. These attach to your drip. You have a hand control with a button to press to give yourself extra painkillers as you need them. This is called patient controlled analgesia (PCA). Do use the button whenever you need to. You can’t overdose – the machine is set to prevent that. Your nurse is able to tell from the pump if you need to press the button very often. You may need to have a higher dose of painkiller in the pump and your nurse can arrange this for you.
This may seem impossible at first. Moving about helps you to get better, but you will need to start gradually. Your physiotherapist will visit you every day after your operation to help you with your breathing and leg exercises. Your nurses will encourage you to get out of bed and sit in a chair the day after your surgery. They will help you with all the drips and drains. Over the next couple of days, your nurse will take out most of the tubes, bottles and bags. Then, it will be much easier to move around.
Some surgeons cover wounds with a dressing after surgery. Others spray them with a protective clear spray so that they can see them clearly. Dressings are usually left on for a couple of days.
Your doctor will want your wound drains to stay in until they stop draining fluid. This is usually about 3 to 7 days after the operation. Your stitches or clips will have to stay in for up to 10 days. You will probably have them taken out before you go home. But if the wound is not quite healed and you are otherwise well, you can sometimes go home with them in. You can come back to the hospital to have them taken out. Or a district nurse will visit you and take them out in your home.
After your operation, you probably won't be able eat or drink anything for at least 7 to 10 days. This allows your throat to heal and helps to prevent infection. You will have fluids through your drip. You may be allowed to wet your mouth with ice or small sips of water. In some centres you may be able to try fluids sooner than this, if you have had surgery without radiotherapy.
When you were in the operating theatre, your surgeon may have put a soft plastic tube into your nose and down into your stomach. This is called a nasogastric tube. Or you may have had a tube put through your abdominal (tummy) wall directly into the stomach. The day after your operation, you will have liquid food through the tube to keep you nourished. The hospital dietician will visit you regularly over the next week. The dietician decides when to increase the amount of feed you have through your tube. It will build up slowly until you are having the same number of calories as you would have in your normal diet.
If you are going to have surgical voice restoration with a speech valve, your surgeon may put a tube into your breathing stoma, instead of up your nose or through your abdominal wall. The tube goes through a small hole in the back of your windpipe, into your gullet and down into your stomach. Your liquid food can go through this tube. The tube keeps the hole open for your speaking valve to fit into later. Some speech valves can be fitted at the time of your operation.
About 7 to 10 days after your operation, you will have a test to make sure that your wound has healed. You will either have a barium swallow X-ray. Or your doctor will give you a coloured drink to sip slowly. While you are drinking, your surgeon will check inside your stoma to make sure your wound has healed and that none of the fluid you are drinking leaks into the windpipe. If everything is healing well, you will be able to start drinking fluid normally again. If there are any leaks, you will have to wait 1 to 2 more weeks for your wound to heal completely.
Soon you will be able to eat a light, soft diet. This usually means starting with things like soup and jelly. As you are able to eat more, you can cut down your liquid tube feeds. Your dietician will monitor this. Once you are eating a normal diet, your nasogastric tube can be taken out. The nurses and dietician will continue to check your progress and will be able to answer any of your questions.
In about 1 in 3 laryngectomy patients, the wound takes several weeks to heal. Until it has healed, you won't be able to eat or drink. If you are able to give your own feeds through the tube, your surgeon may let you go home with the tube still in.
Once you have fully recovered from your operation, you can usually eat and drink whatever you like. But after a laryngectomy you will not be able to strain fully when you go to the toilet to open your bowels. To strain fully you need to be able to hold your breath and you can't do that after a laryngectomy. So you must be careful not to get constipated. Drink lots of fluids each day and try to eat a diet high in fibre. There is information about how to get more fibre in your diet, and our News and Resources website has information about healthy eating. A patient told us about eating after a laryngectomy
"Eating normally gives no problems. It's important to chew
everything thoroughly and to swallow small portions. When eating
out I avoid meats and stick to fish, as it is easier to swallow
and can save embarrassment"
You won't be able to smell anything if you have had a total laryngectomy. Air won't pass through your nose when you breathe in. You can learn to do this, but it takes a bit of practice. Your speech therapist can teach you to do it. Losing your sense of smell also affects your sense of taste, so learning to take air into your nose will help to improve your taste. There is more about smell and taste after laryngectomy in the living with cancer of the larynx section.
After a few days you will be moving around more. Gradually you will start to feel better. Soon you will be able to eat. At first you will find it easier to have lots of very small meals rather than 3 large meals a day. The hospital dietician will give you help and advice about dealing with your diet. The nurses and hospital physiotherapist will teach you how to look after your stoma.
A speech therapist will work closely with you to teach you a new way of speaking. The time this takes depends on what type of speech restoration you use. All methods of speech restoration take a bit of determination and practice. Your speech therapy appointments are likely to continue for some time after you go home from the hospital.
You will have been through a lot. You are likely to have times when you feel very down. Try to be patient with yourself while you fully recover from this operation. You will need a lot of support from your doctors and nurses, family and friends.
If you would like to talk to someone outside your own friends and family, look on our page about laryngeal cancer organisations for support groups and counselling organisations. You can find out about counselling in the coping with cancer section.
If you want to find people to share experiences with online, you could use CancerChat, our online forum.
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