What is Laryngeal Cancer?
This is essentially cancer of the voice box, where cancerous (malignant) cells form on the larynx, or voice box causing significant damage to the area and impeding speech. The larynx is made up of specialised folds, known as vocal cords that vibrate to create a sound when air passes through them. A person’s voice can be heard when this sound is echoed through the throat, mouth and nose.
Symptoms and Diagnosis
Individuals with laryngeal cancer may notice:
- a lump in their throat
- increased bad breath
- changes in their voice
- shortness of breath
- difficulty swallowing and
- a bad cough or chest infection
The condition can be diagnosed by their doctor using an endoscope to observe the larynx for any abnormalities, this procedure is known as a laryngoscopy. The doctor may need to do a biopsy on a small selection of tissue, whereby the cells of the tissue are observed under a microscope to confirm whether it is cancerous or not.
One or more of these treatments may apply depending on the characteristics of the cancer itself – mainly the severity, size, location, and time of cancer detection:
- radiation therapy
- partial removal of the larynx (laryngectomy)
- total laryngectomy
In these cases, the patient may still be able to speak. However, the patient’s voice may not be the same due to the removal of parts of the larynx, changes to laryngeal tissue from radiation or chemotherapy, or removal of nearby neck muscles (to prevent or stop the spread of the cancer).
In extreme cases, total laryngectomy, with or without radiation therapy or chemotherapy, may be the only life-saving solution. This is the complete removal of the larynx or voice box and during this operation a new pathway for breathing is surgically created, where the end of the trachea (windpipe) is connected to the stoma (hole in the neck) for the patient to breathe through.
Causes and Occurrence
The risk of contracting Laryngeal Cancer is increased by a number of different contributors, including but not limited to:
- heavy smoking and drinking
- malnutrition or vitamin lacking diet where not enough raw food is being eaten
- a compromised immune system
- excessive exposure to harmful chemicals and certain substances (e.g., wood dust, paint fumes, soot)
- acid reflux
Cancers of the voice box or larynx make up about 2%-5% of diagnosed cancers. More than twice as many men as women are diagnosed. Most cases occur between the ages of 50 and 70.
Before and After Care
Once the severity of your condition has been accessed, your doctors will select the best treatment plan to combat the onset and spread of your cancer. Your Speech-Language-Therapist or SLP will explain the effects treatment will have on your speech and how it can be managed.
Speaking after a Laryngectomy
Your Speech-Language-Therapist will be present after surgery with alternative ways to communicate, such as a pen and paper to help you communicate in the early days. Once you’ve adjusted and recovered from surgery you can focus on developing your speech using the tools and exercises your SLP has recommended for you.
(Restoring your voice after surgery)
This is the most basic form of speech rehabilitation and requires the patient to learn how to swallow air and force it through their mouth to create a sound. With training and assistance from your SLP these sounds can be used to form speech. However, new devices and surgical techniques often make learning esophageal speech unnecessary.
Tracheo-esophageal puncture (TEP):
This method is most commonly used to restore speech and can be done during the surgery or later. The surgeon creates a connection between the windpipe (trachea) and food pipe (oesophagus) by means of a small valve that is present at the stoma (puncture site in the neck). This allows patients to be able to force air from the lungs through the mouth. Simply covering the stoma with a finger allows the air to push through to the oral cavity to create a sound. With practice and training from your Speech-Language-Therapist you can regain the power to communicate freely.
This is the mechanically assisted speech, so if you cannot have a TEP for medical reasons, or while you are learning to use your TEP voice, you may use an electrical device to produce a mechanical voice. This is a battery operated device that is placed in the corner of the mouth or against the skin in the neck to produce a mechanical voice. Your Speech-Language-Therapist will provide extensive training on how to use this properly.
Before we initiate testing, we firstly administer an in depth case history (collecting background information) with the parents. The Case History identifies any red flags that may be a factor or a contributing factor to Speech and Language difficulties. The Case history may take 15 minutes to 30 minutes before the Speech Therapist starts to testing the child. The more information the parent is able to give the therapist during this 30 minute session, the better the diagnosis will be. In most cases the collection of information during the Case History provides is more important than the testing as it gives the therapist an indication of what Speech and Language difficulty to look out for.
What does the Case History consist of?
The Case History consists of the following:
- General Background information- What is the child’s home language? What are the parents occupations? What are the parents ages? Who does the child live with? Does the child have siblings? etc.
- Prenatal and Birth History- What was the mother’s health like during pregnancy? Birth weight? Type of Delivery? etc.
- Medical History- Was the child ever hospitalized? Did he/she suffer from ear infections? Is she on any form of medication? etc.
- Developmental History – When did he start to sit, crawl, stand and walk? When did she start to use single words? etc.
- Educational History – What school does she attend? How is the child’s performance at school? Doe he attend any special classes? etc.
The collection of background information provides the key to the puzzle in identifying what may be the child’s difficulty and the cause of the difficulty. Without background information children may continue to struggle to incorrect diagnosis and inappropriate intervention. For accurate diagnosis it is important that the therapist collects a detailed case history of the child’s development and family history. This will ensure that the child will receive therapy relevant to his/her needs.
What to expect during a Speech Therapy session age 2 and up
Children love Speech Therapy, as they don’t realize that they are working while they are playing. Therapy will occur in an office or clinic setting. How many therapy sessions and how long the therapy will be is determined during the feedback session with the parent.
What occurs during the initial therapy session?
The Speech Therapist will build a relationship with your child. It may take more than one therapy session to build the relationship. The therapist may request that you bring your child’s favourite toys or use her own toys during the session. It is vital that your child has fun during therapy. It is important that your child has fun with her and feels comfortable for success in ongoing therapy.
The therapist may ask more questions regarding your child’s interests and disinterests. She may give you ideas on how to stimulate your child’s language at home.
What occurs during the rest of the therapy sessions?
Your little one may visits the Speech Therapist once or twice a week depending on what was discussed during the feedback session. Session may be based on themes e.g. My Body, My 5 Sense, Farm animals etc.
The therapist will work on a set of goals that were identified during the evaluation. Feel free to ask what goal the activity is targeting during the therapy session. It is very important that you are aware of the goals and feel free to ask any questions during the session if you don’t understand. Parents are an important part of the therapeutic process.
The intervention is based on play. Children learn while playing. Playing is a natural way that children learn. Children want to talk and communicate during play. Play allows children to develop their communication ability, physical ability, imagination, emotional strength and cognitive ability. Therapy will consist of reading books, playing with theme-based toys, building puzzles, playing with cards and colouring worksheets.
After each therapy session the therapist will give feedback on the session. At this point you may discuss your concerns with her or ask any questions. The therapist should be able to give you any resources, tips or information. Usually a home programme is give to practice at home. Sufficient progress does not occur if a home programme is not practiced on a daily basis.
Please note that if you are aware that your child is not speaking appropriately for his age, please have him/her evaluated immediately. It will make a huge difference to you and your toddler’s life