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A practical guide to understanding cancer
‘My surgeon says I will never be
the same again. But I refuse to be a
victim of cancer, and more a victor
– with the opportunity to enjoy life.’
Jacob, diagnosed with laryngeal cancer in 2011
About this booklet 1
About this booklet
This booklet is about cancer of the voicebox
(larynx), which is also called laryngeal cancer.
We hope it answers some of your questions and
helps you cope with some of the feelings you may
have. We’ve also listed other sources of support
and information, which we hope you’ll find useful.
We can’t advise you about the best treatment for you.
This information can only come from your doctor, who knows
your full medical history.
In this booklet, we’ve included comments from people who have
had laryngeal cancer, which you may find helpful. Some are from
Jacob, who is also on the cover of this booklet. He has chosen to
share his story with us. Others are from members of our online
community (macmillan.org.uk/community).
If you’d like to discuss this information, call the Macmillan Support
Line free on 0808 808 00 00, Monday to Friday, 9am to 8pm.
If you’re hard of hearing, you can use textphone 0808 808 0121,
or Text Relay. For non-English speakers, interpreters are available.
Alternatively, visit macmillan.org.uk
2 Understanding cancer of the voicebox (larynx)
Turn to pages 107–112 for some useful addresses and websites,
and page 113 to write down any notes or questions you have for
your doctor or nurse. We’ve also included a leaflet that you can
remove in the back of this booklet. It has some useful questions to
ask your doctor or nurse about treatment. There is space to write
down the answers, or your own notes or questions. You may want
to take it with you to your appointments. Finding out the answers
to your questions may help you feel less anxious.
If you find this booklet helpful, you could pass it on to your
family and friends. They may also want information to help them
support you.
Contents 3
Contents
The larynx and laryngeal cancer
5
Diagnosing laryngeal cancer
15
Treating laryngeal cancer
25
After your treatment
75
Your feelings and relationships
83
Work and financial support
95
Further information
101
The larynx and laryngeal cancer 5
The larynx
and laryngeal
cancer
What is cancer?
6
The larynx
8
The lymphatic system
10
Risk factors and causes
12
Symptoms13
6 Understanding cancer of the voicebox (larynx)
What is cancer?
Cancer starts in cells in our body. Cells are tiny building blocks
that make up the organs and tissues of our bodies. They divide to
make new cells in a controlled way. This is how our bodies grow,
heal and repair. Cells receive signals from the body telling them
when to divide and grow and when to stop growing. When a cell
is no longer needed or can’t be repaired, it gets a signal to stop
working and die.
Cancer develops when the normal workings of a cell go wrong
and the cell becomes abnormal. The abnormal cell keeps
dividing, making more and more abnormal cells. These eventually
form a lump (tumour). Not all lumps are cancerous. Doctors can
tell if a lump is cancerous by removing a small sample of tissue
or cells from it. This is called a biopsy. The doctors examine the
sample under a microscope to look for cancer cells.
Normal cells
Cells forming a tumour
The larynx and laryngeal cancer 7
A lump that is not cancerous (benign) may grow but cannot
spread to anywhere else in the body. It usually only causes
problems if it puts pressure on nearby organs.
A lump that is cancer (malignant) can grow into nearby tissue.
Sometimes, cancer cells spread from where the cancer first
started (the primary site) to other parts of the body. They can
travel through the blood or lymphatic system (see pages 10–11).
When the cells reach another part of the body, they may begin
to grow and form another tumour. This is called a secondary
cancer or a metastasis.
We have a video on our website that explains how cancer
develops. You can watch it at macmillan.org.uk/informationand-support
8 Understanding cancer of the voicebox (larynx)
The larynx
The larynx is the voicebox. It is in the neck, above the windpipe
(trachea) and in front of the gullet (oesophagus). The windpipe is
the tube that takes air to and from the lungs. The gullet is the tube
that food goes down when you eat. The larynx is tube-shaped
and about 5cm (2in) long.
The larynx and surrounding area
Epiglottis
Larynx
Windpipe
(trachea)
Vocal cords
Gullet
(oesophagus)
The larynx and laryngeal cancer 9
The larynx allows the air you breathe to reach your lungs. It has a
flap of skin at the top, called the epiglottis. This directs food and
liquid down the gullet and prevents food and drink from going
into the windpipe when you swallow. The larynx contains the two
vocal cords, which vibrate together when air passes between them
to produce the sound of your voice.
The front of the larynx can be seen or felt as the lump in the front
of the neck known as the Adam’s apple.
The larynx has three main parts:
•• supraglottis – the area above the vocal cords
•• glottis – the middle area where the vocal cords are
•• subglottis – the area below the vocal cords that connects to
the windpipe.
Types of laryngeal cancer
Most cancers of the larynx are squamous cell carcinomas.
This means the cancer starts in the thin, flat cells (squamous
cells) that line the larynx. There are some rarer types of laryngeal
cancer. These include sarcomas, lymphomas, adenocarcinomas
and neuroendocrine carcinomas.
This booklet covers treatment for squamous cell cancer of the
larynx. For information about the rarer types of laryngeal cancer,
contact our cancer support specialists on 0808 808 00 00.
10 Understanding cancer of the voicebox (larynx)
The lymphatic system
Close to the larynx are lymph nodes, also known as lymph
glands. Cancer of the larynx can sometimes spread to nearby
lymph nodes. Lymph nodes are part of the lymphatic system.
The lymphatic system
Neck (cervical)
lymph nodes
Thymus
Armpit
(axillary)
lymph nodes
Diaphragm
Spleen
Groin
(inguinal)
lymph nodes
The larynx and laryngeal cancer 11
The lymphatic system helps to protect us from infection and
disease. It also drains lymph fluid from the tissues of the body
before returning it to the blood. The lymphatic system is made up
of fine tubes called lymphatic vessels that connect to groups of
lymph nodes throughout the body.
Lymph nodes are small and bean-shaped. They filter bacteria
(germs) and disease from the lymph fluid. When you have an
infection, lymph nodes often swell as they fight the infection.
12 Understanding cancer of the voicebox (larynx)
Risk factors and causes
The exact cause of laryngeal cancer is not known, but certain
risk factors can affect the chances of developing it. Having a risk
factor for cancer doesn’t mean you’ll definitely get it. Some people
with risk factors never develop cancer, and other people without
any known risk factors can still develop it.
Around 2,360 people in the UK are diagnosed with cancer of the
larynx each year. This type of cancer is rare in people under 40.
It’s more common in people in their 60s and 70s. It is five times
more common in men than in women. The main risk factors
are smoking tobacco and, to a lesser extent, drinking alcohol.
There may be other factors that increase the risk of developing
laryngeal cancer, but more research is needed.
Smoking
The longer a person smokes for and the more they smoke,
the greater the risk of developing laryngeal cancer.
Alcohol
Drinking a lot of alcohol, especially spirits, over a long period of
time increases a person’s risk of getting laryngeal cancer.
The risk is much higher for people who are both smokers and
heavy drinkers.
As with other cancers, cancer of the larynx is not infectious
and cannot be passed on to other people.
The larynx and laryngeal cancer 13
Symptoms
Your symptoms will depend on where in the larynx the cancer is.
Most cancers begin on one of the vocal cords or near to them.
The most common symptom is changes to your voice, such as
hoarseness. A change in your voice may be an early symptom of
laryngeal cancer affecting the vocal cords (glottis – see page 9).
If you’ve had hoarseness for more than three weeks, your GP
(family doctor) should refer you to a hospital for tests.
Occasionally, the first symptoms may be a lump in the throat
or neck, or discomfort or pain when chewing or swallowing.
These symptoms are more common when the cancer starts in
a part of the larynx that is above the vocal cords (supraglottic
laryngeal cancer – see page 9).
Other less common symptoms include feeling breathless or a
persistent cough, which may happen when the cancer is affecting
the area below the vocal cords, near to the windpipe (subglottis –
see page 9). This is very rare.
If you have any of the above symptoms, it’s important to let
your GP know. They can all be caused by other conditions,
but it’s important to get them checked.
Diagnosing laryngeal cancer 15
Diagnosing
laryngeal
cancer
How it is diagnosed
16
Further tests
18
Staging and grading
22
16 Understanding cancer of the voicebox (larynx)
How it is diagnosed
Usually you begin by seeing your GP, who will ask about your
symptoms and examine you. They may arrange for you to have
some tests. You may be referred to an ear, nose and throat (ENT)
doctor or a special clinic that does tests for the symptoms you have.
At the hospital
The specialist will ask about your symptoms, your general health
and whether you are taking any medicines. They will also feel for
any lumps in your neck. These may be caused by swollen lymph
nodes, but can be due to other medical conditions, such as a
swollen salivary gland.
Nasendoscopy
You will have this test in the outpatient clinic. Your doctor will
pass a thin, flexible tube called a nasendoscope into your nose,
over the back of your tongue and down into the upper part of your
throat. The tube has a light at the end to help the doctor get a
better view of the back of your mouth and throat. You might find
this a bit uncomfortable, but it only takes a few minutes. Before the
procedure, you may be given an anaesthetic lozenge to suck,
or the doctor may spray your throat with an anaesthetic to numb it.
Some people prefer to have this done without the anaesthetic spray.
You should not eat or drink anything for about an hour after the
test, or until the numbness wears off. This is because there’s a risk
that food and drink may go down the wrong way into your lungs
when you swallow. You could also burn your mouth or throat with
hot food or drinks.
Diagnosing laryngeal cancer 17
Laryngoscopy
You will have this done if the doctor sees anything unusual in your
throat, or cannot see the larynx clearly with the nasendoscope.
You’ll need to have a general anaesthetic for this test so that
the doctor can examine all of your larynx using a laryngoscope.
This is a thin, metal tube with a light on the end, which the doctor
passes down your throat. They can examine the larynx very closely
and may use a camera, attached to the tube, to take photos.
Biopsy
During the laryngoscopy, the doctor takes a small sample of cells
or tissue (biopsy) from any abnormal looking areas. This is the
most important test to diagnose cancer of the larynx. A doctor
called a pathologist will examine the sample under a microscope
and check for cancer cells. It may take about 7 to 10 days for your
results come back.
Fine needle aspirate (FNA)
You may have this test if you have a lump in your neck. You can
have it in the outpatient clinic. The doctor passes a fine needle
into the lump and withdraws (aspirates) some fluid or tissue into
a syringe. You might have an ultrasound scan at the same time
to help your doctor guide the needle into the correct area. This is
a scan that uses sound waves to build a picture. After the test,
a doctor will examine the sample under a microscope to check for
cancer cells.
18 Understanding cancer of the voicebox (larynx)
Further tests
If the biopsy or fine needle aspirate show there are cancer cells in
the larynx, you will need further tests.
Blood tests
There isn’t a specific blood test that can detect laryngeal cancer,
but blood tests may be done to check your general health.
Chest x-ray
This uses x-rays to take a picture of your chest, to check your lungs
and heart.
CT (computerised tomography) scan
A CT scan takes a series of x-rays, which build up a
three-dimensional picture of the inside of the body. The scan
takes 10 to 30 minutes and is painless. It uses a small amount
of radiation, which is very unlikely to harm you and will not harm
anyone you come into contact with. You will be asked not to eat
or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows
particular areas to be seen more clearly. This may make you feel
hot all over for a few minutes. It’s important to let your doctor
know if you are allergic to iodine or have asthma, because you
could have a more serious reaction to the injection.
You’ll probably be able to go home as soon as the scan is over.
Having a CT scan
20 Understanding cancer of the voicebox (larynx)
MRI (magnetic resonance imaging) scan
This test uses magnetism to build up a detailed picture of areas
of your body. The scanner is a powerful magnet, so you may be
asked to complete and sign a checklist to make sure it’s safe for
you. The checklist asks about any metal implants you may have,
for example a pacemaker, surgical clips or bone pins. You should
also tell your doctor if you’ve ever worked with metal or in the
metal industry, as very tiny fragments of metal can sometimes
lodge in the body. If you do have any metal in your body, it’s
likely that you won’t be able to have an MRI scan. In this situation,
another type of scan can be used. Before the scan, you’ll be asked
to remove any metal belongings including jewellery.
Some people are given an injection of dye into a vein in the arm,
which doesn’t usually cause discomfort. This is called a contrast
medium and can help the images from the scan to show up
more clearly.
During the test, you’ll lie very still on a couch inside a long
cylinder (tube) for about 30 minutes. It’s painless but can be
slightly uncomfortable, and some people feel a bit claustrophobic.
It’s also noisy, but you’ll be given earplugs or headphones.
You can hear, and speak to, the person operating the scanner.
Diagnosing laryngeal cancer 21
PET-CT scan
This is a combination of a CT scan, which takes a series of x-rays
to build up a three-dimensional picture (see page 18), and a
positron emission tomography (PET) scan. A PET scan uses
low-dose radiation to measure the activity of cells in different parts
of the body. PET-CT scans give more detailed information about
the part of the body being scanned. You may have to travel to a
specialist centre to have one.
You can’t eat for six hours before the scan, although you may
be able to drink. A mildly radioactive substance is injected into
a vein, usually in your arm. The radiation dose used is very small.
The scan is done after at least an hour’s wait. It usually takes
30 to 90 minutes. You should be able to go home after the scan.
Waiting for test results
Waiting for test results can be a difficult time. It may take from
a few days to a couple of weeks for the results of your tests to
be ready. You may find it helpful to talk with a partner, family
member or close friend. Your specialist nurse or one of the
organisations listed on pages 107–112 can also provide support.
You can also talk to one of our cancer support specialists on
0808 808 00 00.
22 Understanding cancer of the voicebox (larynx)
Staging and grading
Staging
The stage of a cancer describes its size and if it has spread from
where it first started. This information helps your doctors decide
on the best treatment for you.
Staging aims to find out how much of the larynx and surrounding
area is affected. It also finds out whether the cancer has spread to
lymph nodes nearby, or to other areas of the body (metastasised).
This is a simplified staging system for cancer of the larynx:
•• Stage 0 – The cancer cells are only in the lining of the larynx.
There are usually no symptoms, so the cancer is not usually
diagnosed at this stage.
•• Stage 1 – The cancer has grown further into the lining of the
larynx where it started. The vocal cords still move normally.
•• Stage 2 – The cancer is affecting another part of the larynx, but
the vocal cords still move. It has not spread outside the larynx.
•• Stage 3 – The movement of the vocal cords is affected. Or the
cancer may have spread to one lymph node (no larger than
3cm). The cancer has spread within the larynx.
•• Stage 4 – The cancer has spread into the area surrounding
the larynx. It may have spread to one or more lymph nodes
(which may be larger than 3cm). It may have spread to other
parts of the body.
In this booklet, we use the term early-stage cancer to describe
laryngeal cancers that are stages 0, 1 and 2.
Diagnosing laryngeal cancer 23
We use the term locally advanced cancer for stage 3 tumours
and stage 4 tumours that have spread outside the larynx but not
to other parts of the body.
We use the term advanced cancer for stage 4 tumours that
have spread to other parts of the body.
Staging for cancer of the larynx is complex and will vary
depending on where in the larynx the cancer started.
For example, if the cancer started in the vocal cords
(glottis – see page 9), it rarely spreads to other parts of
the body. Your doctor will be able to tell you more about
your situation.
Grading
Grading is about how the cancer cells look under a microscope
compared with normal cells. The grade helps your doctor plan
your treatment.
•• Grade 1 (low-grade or well differentiated) – The cancer
cells look similar to normal cells. They usually grow slowly and
are less likely to spread.
•• Grade 2 (moderate- or intermediate-grade) – The cancer
cells look more abnormal and are slightly faster growing.
•• Grade 3 (high-grade or poorly differentiated) – The cancer
cells look very different from normal cells and may grow
more quickly.
‘I can communicate with
what is now a loud whisper.
I just need to think and plan
before I speak.’
Jacob
Treating laryngeal cancer 25
Treating
laryngeal
cancer
Treatment overview
26
Before treatment starts
32
Radiotherapy34
Surgery47
Speaking after a laryngectomy
58
Chemotherapy63
Targeted therapies
70
Research – clinical trials
72
26 Understanding cancer of the voicebox (larynx)
Treatment overview
You will usually be treated in a specialist centre by a team of
healthcare professionals.
The main treatments for cancer of the larynx are radiotherapy
and surgery. Chemotherapy and targeted therapies (biological
therapies) may also be used, but they are not usually used for
early-stage cancer of the vocal cords. These treatments can be
given alone or in combination.
For most people, the aim is to remove or destroy the cancer and
reduce the chance of it coming back.
Your doctors will plan your treatment so that any long-term
effects on your speech, swallowing and appearance are kept to
a minimum. Your doctor and specialist nurse will explain how
the different treatment options may affect you.
The treatment you have will depend on:
•• where the cancer is in the larynx
•• the size of the cancer and whether it has spread (stage –
see pages 22–23).
Your doctor will also consider:
•• how fast-growing the cancer is (grade – see page 23)
•• your general health.
If the cancer is at an early stage, it can usually be cured by
radiotherapy (see pages 34–46) or by an operation through
the mouth with an endoscope (see pages 48–49). For other
stages, you may need a combination of surgery, radiotherapy,
chemotherapy or a targeted therapy.
Treating laryngeal cancer 27
If the tumour is large, you may need surgery to remove part or all
of the larynx (see pages 49–52).
If you have a locally advanced cancer, your doctors may
recommend a combination of chemotherapy and radiotherapy
(chemoradiation – see page 69) instead of surgery.
Your doctor may advise you to have treatment after surgery to
reduce the risk of the cancer coming back. This is called adjuvant
treatment. This may be with radiotherapy or chemoradiation.
Doctors sometimes give chemotherapy (see pages 63–68)
to reduce the size of the cancer before radiotherapy. You may
also be offered chemotherapy if the cancer has spread outside
the larynx or comes back after radiotherapy.
Some people have treatment with a targeted therapy drug
(see pages 70–71) together with radiotherapy.
If it isn’t possible to cure the cancer, your doctor will offer you
treatment to help slow down the growth of the cancer and relieve
symptoms. This is called palliative treatment.
‘I do try and remain positive, despite what I
have been through. I often look back and
think: “Did I really go through all that surgery
and treatment?” But by taking things a day at
a time, I got through it all. It’s not been easy
sometimes, but it’s worth it in the long run.’
Chris
28 Understanding cancer of the voicebox (larynx)
How treatment is planned
A team of specialists will meet to discuss and agree on the best
treatment for you.
This multidisciplinary team (MDT) will usually include:
•• a surgeon who specialises in cancer of the larynx (an ear,
nose and throat specialist)
•• a surgeon who specialises in plastic and reconstructive surgery
•• a clinical oncologist who specialises in radiotherapy,
chemotherapy and targeted therapies
•• a medical oncologist who specialises in chemotherapy and
targeted therapies
•• a therapeutic radiographer who works closely with the
doctors to plan and deliver radiotherapy
•• a radiologist who helps to interpret scans and x-rays
•• a pathologist who advises on the type and extent of the cancer
•• a clinical nurse specialist (CNS) who offers information
and support
•• a speech and language therapist (SALT) who specialises in
the voice, speech and swallowing
•• a dietitian who can advise you if you have problems with
eating, drinking or weight loss
•• a restorative dentist who advises on dental care before,
during and after treatment.
The team may also include other healthcare professionals,
such as physiotherapists, oral surgeons, social workers,
counsellors or psychologists.
Treating laryngeal cancer 29
Making decisions
Your specialist team will consider a number of factors when
advising you on your treatment options. These will include your
general health, the stage of the cancer and if it has spread
to other parts of the body. Your doctor and nurse will explain
if there are different treatment options they can use in your
situation. Sometimes people find it hard to make a decision about
treatment. If you’re asked to make a choice, make sure you have
enough information. You’ll need to know the different treatment
options, what they involve and the possible side effects to decide
what’s right for you.
You may find our booklet Making treatment
decisions helpful. You can order this at
be.macmillan.org.uk
The benefits and disadvantages of treatment
Many people are frightened at the idea of having cancer
treatments, particularly because of the side effects that can
occur. However, these can usually be controlled with medicines.
Treatment can be given for different reasons and the potential
benefits will vary depending upon your individual situation.
Cancer of the larynx may be cured with surgery or radiotherapy,
even when it is locally advanced. Sometimes you need other
treatment as well.
If the cancer is advanced and has spread to other parts of the
body, treatment may only be able to control it for a period of time,
which can improve symptoms and quality of life.
30 Understanding cancer of the voicebox (larynx)
However, for some people in this situation, the treatment will have
no effect on the cancer and they will get the side effects without
any of the benefit.
If you’ve been offered treatment that aims to cure the cancer,
deciding whether to accept it may not be difficult. However, if a
cure is not possible and the purpose of treatment is to control
the cancer for a period of time, it may be more difficult to decide
whether or not to have treatment.
Making decisions about treatment in these circumstances is always
difficult, and you may need to discuss in detail with your doctor
whether you wish to have treatment. If you choose not to have it,
you will still be offered supportive (palliative) care, with medicines
to control any symptoms.
Giving your consent
Before you have any treatment, your doctor will explain its
aims. They will ask you to sign a form saying that you give
permission (consent) for the hospital staff to give you the treatment.
No medical treatment can be given without your consent,
and before you are asked to sign the form, you should be given
full information about:
•• the type and extent of the treatment
•• its advantages and disadvantages
•• any significant risks or side effects
•• any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know
straight away so they can explain again. Some cancer treatments
are complex, so it’s not unusual to need repeated explanations.
Treating laryngeal cancer 31
It’s a good idea to have a relative or friend with you when the
treatment is explained, to help you remember the discussion.
You may also find it useful to write a list of questions before
your appointment.
People sometimes feel that hospital staff are too busy to answer
their questions, but it’s important for you to know how the
treatment is likely to affect you. The staff should be willing to
make time for your questions.
You can always ask for more time if you feel that you can’t make
a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff
can explain what may happen if you don’t have it. It’s essential
to tell a doctor or the nurse in charge, so they can record your
decision in your medical notes. You don’t have to give a reason
for not wanting treatment, but it can help to let the staff know
your concerns so they can give you the best advice.
Second opinion
Your multidisciplinary team (MDT) uses national treatment
guidelines to decide the most suitable treatment for you.
Even so, you may want another medical opinion. If you feel
it will be helpful, you can ask either your specialist or GP to
refer you to another specialist for a second opinion.
Getting a second opinion may delay the start of your treatment,
so you and your doctor need to be confident that it will give you
useful information. If you do go for a second opinion, it may be
a good idea to take a relative or friend with you, and have a list
of questions ready, so that you can make sure your concerns are
covered during the discussion.
32 Understanding cancer of the voicebox (larynx)
Before treatment starts
Your specialist doctor or nurse will usually give you advice on
preparing for treatment.
Smoking
If you are a smoker, stopping smoking:
•• may decrease the side effects of your treatment
•• decreases the risk of the cancer coming back
•• decreases the risk of developing a second cancer in your head
and neck, and also in other parts of your body
•• decreases the risk of other conditions such as heart disease.
Continuing to smoke increases the risk of side effects and can
make radiotherapy less effective. Smoking can be difficult to
give up, especially at times of stress. If you would like to give up
smoking, there are organisations and self-help groups that you
may find useful (see page 108). Your GP can also give advice
and prescribe nicotine replacement therapies, such as nicotine
patches, gums and inhalers.
We can send you our booklet Giving up smoking.
Call us on 0808 808 00 00 to order a free copy.
Alcohol
Avoiding alcohol, particularly spirits, may help to reduce some
of the side effects of your treatment. If you’d like support to help
reduce your alcohol intake, ask your specialist nurse or doctor.
Treating laryngeal cancer 33
Dental care
Your doctor or nurse will advise you to visit a dentist or oral
surgeon for a check-up and to have any necessary treatment.
Making sure your teeth or dentures are in good condition
reduces the risk of possible problems with your mouth during
and after treatment.
You can find out more about looking after your mouth and teeth
during and after radiotherapy on page 44. There’s also information
about mouth care during and after chemotherapy on page 67.
34 Understanding cancer of the voicebox (larynx)
Radiotherapy
Radiotherapy treats cancer by using high-energy beams to destroy
cancer cells, while doing as little harm as possible to normal cells.
How and when radiotherapy is used to treat cancer of the larynx
depends on the stage of the cancer (see pages 22–23).
Radiotherapy for early-stage cancers
Radiotherapy can be used on its own if you have an
early-stage laryngeal cancer. Sometimes doctors advise you to
have radiotherapy when surgery is likely to affect your speech
or swallowing.
Radiotherapy for locally advanced cancers
If the cancer is larger or has spread to lymph nodes (glands)
or tissue nearby, you may have radiotherapy in combination
with other treatments. Radiotherapy can be given:
•• after surgery to destroy any remaining cancer cells and reduce
the risk of cancer coming back (adjuvant radiotherapy)
•• after surgery, together with chemotherapy
(adjuvant chemoradiation)
•• instead of surgery, together with chemotherapy (chemoradiation)
•• with a targeted therapy drug (see pages 70–71).
The aim of radiotherapy for early and locally advanced
cancer of the larynx is to cure the cancer. This is called
radical radiotherapy.
Treating laryngeal cancer 35
Radiotherapy for advanced cancers
Sometimes it isn’t possible to cure the cancer and the main aim
of treatment is to reduce the symptoms (palliative radiotherapy).
Radiotherapy can be used to shrink a tumour that is causing
swallowing or breathing problems. It can also relieve symptoms
if the cancer has spread to other parts of the body.
How radiotherapy is given
Treatment is usually given as a course of short, daily treatments
in the hospital radiotherapy department. Each treatment is
called a fraction. Radiotherapy can be given in different ways
and you will usually have it as an outpatient. The treatments are
normally given each day from Monday to Friday, with a rest at
the weekend. However, sometimes you may also have treatment
at the weekend, or more than one treatment each day – this is
called hyperfractionation.
Radiotherapy treatment can last between 3 to 7 weeks. Your
clinical oncologist (see page 28) will talk to you about the length
of your course of treatment and possible side effects. If you’re
having radiotherapy to relieve symptoms, you may only need a
short course or a single dose.
36 Understanding cancer of the voicebox (larynx)
Ways of giving radiotherapy
Conformal radiotherapy (CRT)
This is one way of giving radiotherapy for early laryngeal cancers.
A special attachment to the radiotherapy machine shapes the
radiation beams to match the shape of the cancer. This reduces
the radiation received by surrounding healthy cells.
Intensity-modulated radiotherapy (IMRT) and
image-guided radiotherapy (IGRT)
These treatments are now available in most hospitals. IMRT
accurately shapes the radiotherapy beams and allows different
doses to be given to different parts of the treatment area. This can
reduce the damage to healthy tissue. IGRT involves having images
taken before each treatment. These are used to check that you are
in exactly the right position for treatment. When possible, doctors
use both IMRT and IGRT to treat locally advanced and advanced
laryngeal cancer. These treatments can help reduce the risk of
some long-term radiotherapy side effects, such as damage to the
salivary glands, which causes a dry mouth.
Planning your radiotherapy
Your treatment will be carefully planned by a doctor called a
clinical oncologist to make sure it’s as effective as possible.
You will have a CT scan taken of the area to be treated.
This scan takes lots of images from different angles to build up
a 3D (three-dimensional) picture of the area.
The information from the scans is put into a computer that is used
to help your doctors plan your treatment precisely. Treatment
usually starts a week or so after your planning appointment.
Planning is important and may take a few hours. During the visit,
the staff in the radiotherapy planning department will explain
what to expect during your treatment.
Treating laryngeal cancer 37
Our booklet Understanding radiotherapy gives
detailed information about radiotherapy and its side
effects. You can order a copy at be.macmillan.org.uk
Radiotherapy masks
It’s important that you’re able to lie still, in exactly the same
position, each time the treatment is given. To help you to do this,
a special mask (or shell) of your head and shoulders is made.
Before each treatment, the radiographer fits the mask over your
head and neck. They then fix the mask to the couch to hold you in
the right position. This ensures the radiotherapy rays are directed
at the exact area each time you have your radiotherapy treatment.
There’s a photo of someone having their mask fitted on page 41.
The mask is made of a plastic mesh and designed so you can
see and breathe normally while you’re wearing it. It is usually
made on your first visit to the radiotherapy planning department.
The radiographer or the mask room technician will explain the
whole process to you before your mask is made. Marks are drawn
on the mask to show the radiographer where the radiotherapy
rays will be directed.
‘My tip is to close your eyes when the mask is
fitted and remember to take slow, deep breaths.
Ask the radiographers to play some music
during your treatment, as it does relax you.’
Joycee
38 Understanding cancer of the voicebox (larynx)
You will need to wear the mask for the planning session and
you won’t be able to speak while you have the mask on.
The radiographers will tell you how to signal to them if you want
to communicate. Having the mask made won’t hurt, but some
people feel claustrophobic at first. Most people soon get used
to it. You will have it on for up to 15 minutes at a time. If you
feel anxious, tell your doctor or nurse. There are medicines that
can help reduce feelings of anxiety. There are also some deep
breathing relaxation exercises that your nurse may be able to
teach you.
Treatment
Before each session of radiotherapy, the radiographers will
position you carefully on the radiotherapy treatment couch with
the mask fitted. They will make sure you’re comfortable.
The treatment only takes a few minutes. During this time,
you’ll be left alone in the room. You will have to lie still while the
treatment is given. You won’t feel the radiotherapy when it’s given.
The radiographers will watch you using a closed circuit television
screen (CCTV). You can raise your arm to signal to them if you
need to.
Some treatment rooms have CD or MP3 players so you can listen
to music to help you relax during your treatment. If you’d like to
listen to your own music, ask your radiographers if this is possible.
You may hear a slight buzzing noise from the radiotherapy
machine while your treatment is being given.
Radiotherapy does not make you radioactive and it’s
perfectly safe for you to be with other people, including
children and pregnant women, throughout your treatment.
Treating laryngeal cancer 39
Side effects of radiotherapy
Radiotherapy can cause some general side effects. These
usually disappear gradually over a few weeks or months after
treatment finishes.
How you are affected will depend on the dose of radiotherapy,
the length of your treatment and the size of the area being
treated. Side effects can be more severe if you have radiotherapy
combined with chemotherapy.
Side effects usually begin to develop after two weeks of
radiotherapy. They may continue to get worse for 7 to 10 days
after treatment ends before starting to gradually improve.
Most people find that their side effects improve about
4 to 8 weeks after radiotherapy finishes, or when combined
treatments end.
Before you start your treatment, your doctor, nurse, speech and
language therapist, dietitian or radiographer will discuss your
treatment with you so you know what to expect. Let them know
about any side effects you have during or after treatment, as there
are often things that can be done to help.
Tiredness (fatigue)
Radiotherapy often makes you feel tired, especially towards the
end of treatment and if you’re travelling a long way each day.
Try to rest regularly. It can help to balance this with some gentle
physical activity, such as short walks. This will help you feel
more energetic.
We have a booklet called Coping with fatigue
(tiredness). Call us on 0808 808 00 00 or visit
be.macmillan.org.uk to order a free copy.
40 Understanding cancer of the voicebox (larynx)
Skin changes
The skin at the front of your neck will gradually become red
or darker. If you’re dark skinned, your skin may get darker or
develop a blue or black tinge. Your skin may also feel sore and
itchy, like sunburn. Skin changes can vary depending on the
amount of radiotherapy you have. Changes usually start about
two weeks after radiotherapy begins and last until about four
weeks after it finishes.
Your radiographer or specialist nurse will tell you how to look after
the skin in the treated area. During your treatment, you will usually
be advised to do the following:
•• Wear loose cotton or natural fibre clothing next to your skin with
no tight collars. When you’re outside, use a scarf to protect your
skin from the sun or cold winds.
•• Wash your skin gently with soap or aqueous cream and
lukewarm water and gently pat it dry.
•• Use a moisturiser that is sodium lauryl sulphate (SLS) free.
Your radiographer can give you more information about this.
•• Avoid using scented products on the treated area, as these can
irritate the skin. Check with your radiographer or nurse before
you put anything on your skin in the treated area.
•• Avoid rubbing the skin.
•• Avoid wet shaving until a few weeks after your radiotherapy
treatment. You can use an electric razor instead.
•• Avoid the sun and use a high-SPF sunscreen. Your radiographer
can give you more information about this.
If you develop a skin reaction, such as soreness or a change in
skin colour, let the radiotherapy staff know as soon as possible.
They will advise you on the best way to manage it.
Treating laryngeal cancer 41
After your treatment has finished, you’ll need to protect the skin
in the treated area from strong sunshine for at least a year and
cover the area with a light scarf. Once any skin reaction has
settled down, you should use a suncream with a sun protection
factor (SPF) of at least 30.
The radiotherapy staff will advise you on how to look after your
skin. They can prescribe creams for you to use if your skin becomes
very sore. If your skin peels or cracks, you may need a dressing on
the area. A district nurse or practice nurse from your GP surgery
can do this for you or teach you or a friend or relative how to do it.
Fitting a radiotherapy mask
42 Understanding cancer of the voicebox (larynx)
Sore throat and difficulty swallowing
The lining of your throat may become sore and inflamed,
making it difficult to swallow. Your doctor can prescribe liquid
painkillers to help with this. Try to take these before meal times
to help make eating easier.
Your speech and language therapist will talk to you about any
swallowing or eating difficulties that you may have. It’s important
to try to continue to eat and drink for as long as possible during
your treatment.
You may cough when you eat and drink. Sometimes this can
be a sign that food and drink is going down the wrong way
(into the airway). This can cause a chest infection. Your speech and
language therapist can teach you exercises to help with swallowing
and prevent food and drink going down the wrong way.
Your specialist nurse, radiographer, dietitian or speech and
language therapist will give you advice on foods that are easy to
swallow. They may also give you nutritious or high-calorie drinks.
Most people manage to eat soft, moist foods while their throat is
sore. Some people can only manage a liquid diet. The soreness
usually lasts for a few weeks after the radiotherapy has finished,
but may continue for longer, depending on the area treated.
Some people find the soreness stops them eating or drinking
enough. This is more common if you have radiotherapy and
chemotherapy at the same time (chemoradiation). If this happens,
your doctor might suggest you have nutritional support so that you
don’t lose too much weight. This means giving you liquid food that
contains all the nutrients you need, through a feeding tube that
goes into your stomach. You can also have liquids and medicines
through the tube. If your doctors think you might have problems
with eating, they may suggest you have a feeding tube put in
before starting your treatment.
Treating laryngeal cancer 43
Nutritional support can:
•• prevent weight loss
•• make sure you’re getting enough fluids and nutrients
•• help you feel less weak or tired
•• ease the pressure of having to eat
•• allow the sore area to heal
•• allow you to eat smaller amounts when eating is uncomfortable.
The liquid feeds can be given through one of the following:
•• A thin tube that’s passed up your nose and down into your
stomach (called a nasogastric or NG tube). This type of tube is
usually only used if you are an inpatient.
•• A tube that’s put through the skin and into the stomach (called a
percutaneous endoscopic gastrostomy or PEG tube).
Your doctor and dietitian will talk to you about this and explain
which tube is likely to be best for you. You may need help with
nutrition before radiotherapy if you have lost a lot of weight or
have swallowing problems. Having liquid feeds through a tube will
give you enough calories to help prevent any unplanned breaks in
your treatment. Your nurse or dietitian will help you look after your
feeding tube and show you or a relative or friend how to care for
it when you are at home.
Your speech therapist will assess whether you can still swallow
food and fluids safely while you have a tube in. You will still be
encouraged to eat and drink with a tube in place, even if you can
only manage small amounts at a time.
44 Understanding cancer of the voicebox (larynx)
Once your treatment has finished, you are usually encouraged to try
to stop using the tube as soon as possible. It’s important to follow
the advice of your hospital team when you have a feeding tube in.
We can send you more information about nutritional support and
more detailed booklets about diet and coping with eating problems.
Call 0808 808 00 00 or visit be.macmillan.org.uk to order.
Dry mouth or throat
Radiotherapy to the larynx may affect the salivary glands, making
you produce less saliva. The lining of your mouth and throat can
become dry. This can make eating and speaking difficult.
Saliva helps keep your mouth clean. So it’s important to brush your
teeth with a soft toothbrush twice a day and to use mouthwashes
as explained to you by your doctor or nurse. Try drinking sips of
water regularly throughout the day to keep your mouth moist.
Your doctor can prescribe artificial saliva sprays and gels to help.
You are less likely to get an infection if your mouth is moist.
Some people may have a dry mouth for several months after
treatment has finished. For some people, it may be permanent.
It depends on the size of the area being treated. Your doctor will
be able to tell you how likely this is.
We can send you more information about coping with a dry mouth.
Thick, sticky saliva (mucus)
You may have a build-up of sticky mucus in your throat. It’s a
good idea to always have tissues handy, as you might need to
spit often to get rid of this. Rinsing your mouth and drinking water
regularly can help with the mucus. Your doctor or specialist nurse
may suggest that you use a nebuliser. This is a machine that
produces a fine mist of fluid, which you inhale.
Treating laryngeal cancer 45
Voice changes
Your voice may already be hoarse and it may get worse during
radiotherapy. Your doctor will tell you about the risk of permanent
voice changes. Try to rest your voice by not straining it and avoid
smoky places. Your voice should gradually improve and get
stronger after your radiotherapy is over. This may take several
weeks. A speech and language therapist can advise you on
how to look after your voice during treatment and suggest voice
exercises to speed up your recovery.
Loss of appetite
You may not feel like eating if your mouth is sore. This can be at
its worst towards the end of radiotherapy and in the first couple
of weeks after it’s finished. It’s important to try to eat, even if you
don’t feel like it. Sometimes it can help to have painkillers before
you eat if your mouth is feeling very sore. You can also see a
dietitian, who may ask you to have some high-calorie or nutritious
drinks until your appetite returns.
Loss of taste
Your sense of taste may change or you may find everything tastes
the same. This should get better, but it may take a few months
and sometimes up to a year after radiotherapy has finished.
Occasionally, taste can be affected permanently.
Hair loss
Radiotherapy may cause some temporary hair loss over the back
of your head. If you have any facial hair, it may fall out and this
can be permanent.
Breathing problems
Radiotherapy may cause swelling in your throat. Very rarely,
this can lead to breathing problems, which need to be treated
straight away.
46 Understanding cancer of the voicebox (larynx)
If you develop any difficulties with your breathing or if your
breathing sounds different, tell a doctor or contact the hospital as
soon as possible. Very rarely, people need an operation to help
them breathe. This is called a temporary tracheostomy, and it
should be short term (see page 50).
Smoking
If you are a smoker and continue to smoke during a course of
radiotherapy treatment, it can make the radiotherapy less effective
and increase the risk of side effects. Giving up smoking can be
difficult, but there’s lots of support available. Speak to your doctor
or call a stop-smoking helpline for further advice and to find out
where your local stop-smoking service is (see page 108).
Treating laryngeal cancer 47
Surgery
The type of surgery you have will depend on the stage of the
cancer. Surgery is used:
•• if the cancer is small enough to be removed through the mouth
using an endoscope with a laser (high-power light) or small
surgical instruments
•• when the cancer is locally advanced
•• if radiotherapy has not completely got rid of all the cancer
(this is rare)
•• if the cancer comes back after radiotherapy.
Before your operation
The main aim of surgery is to remove the cancer completely.
Your surgeon will also try to reduce any changes that an operation
may have on your speech and swallowing.
Before the operation, the surgeon will explain the procedure to
you. It’s important you understand what it involves and how it will
affect you in the short and long term. You will usually meet other
members of the MDT before your surgery. This can include a
specialist nurse, a speech and language therapist and a dietitian
(see page 28). They can provide support and advice before and
after the operation.
You’ll have some tests to make sure you’re fit enough for the
operation. These are likely to include blood tests, a chest x-ray
and an electrocardiogram (ECG) to check your lungs and heart.
You may have these done at a pre-assessment clinic before you
go into hospital.
48 Understanding cancer of the voicebox (larynx)
Types of operation
There are different operations used to treat cancer of the larynx:
•• Removing the cancer through the mouth (endoscopic resection
or transoral laser microsurgery – TLM).
•• Removing part of the larynx (partial laryngectomy).
•• Removing all of the larynx (total laryngectomy).
Endoscopic resection and transoral laser
microsurgery (TLM)
Your surgeon may be able to remove the cancer through your
mouth if you have early-stage cancer. This type of surgery is
called transoral (through the mouth) surgery and means you
will not have a wound in your neck afterwards. It’s done with a
general anaesthetic and you only need a short stay in hospital.
The surgeon passes an endoscope (a thin, flexible tube with a
camera at the end) into your throat. They use the camera to show
images on a screen in the operating theatre. They then guide small
surgical instruments through the endoscope or use a laser to remove
the cancer.
If a laser is used, it‘s called transoral laser microsurgery (TLM).
The surgeon directs the laser beam at the tumour and removes
the cancer and a small margin of healthy tissue. This is to try
to make sure they’ve removed all the cancer cells. They use the
laser to control bleeding during surgery.
Sometimes, instead of holding the instruments themselves,
the surgeon uses a machine that holds the surgical instruments.
The surgeon controls the robotic arms, which can move very
steadily and precisely to remove the tumour through the mouth.
This is called transoral robotic surgery (TORS).
Treating laryngeal cancer 49
After an endoscopic resection
You may have some pain in your throat and difficulty swallowing
for about two days afterwards. You can take painkillers until
this improves.
If the surgery involved a vocal cord, your voice may be hoarse.
Your doctor might ask you to rest it for a few days. Some people
may find they’re left with a permanent change to their voice.
If this happens, your surgeon can refer you to a speech and
language therapist.
Rare side effects of this type of surgery include bleeding, infection
and damage to your teeth. Your doctor or specialist nurse will give
you more information about this before you go home.
Partial laryngectomy
This is where the surgeon makes a cut in the neck and
removes the affected part of the larynx. This operation
is only used rarely, as people are usually offered
radiotherapy or chemoradiation instead.
After a partial laryngectomy, you should be able to speak because
you’ll still have part of your voicebox. However, your voice is likely
to be weak or hoarse.
Removing lymph nodes
During your operation, the surgeon may also remove some lymph
nodes to check for cancer cells, or to remove affected lymph
nodes. This is called a neck dissection. Your surgeon will discuss
this with you before your operation. The nodes that are removed
are sent to a laboratory to be examined for cancer cells.
After the operation, your neck and shoulder may be stiff on the
side where the surgery took place. A physiotherapist can teach
you some exercises to help with this.
50 Understanding cancer of the voicebox (larynx)
Temporary tracheostomy
Sometimes, surgery to the larynx can cause swelling in your neck.
This is temporary, but it can narrow your airway and may affect
your breathing. If this happens, the surgeon will make a small
opening in your windpipe that you can breathe through until the
swelling goes down. This is called a tracheostomy.
The opening at the front of your neck is held open with a small,
plastic tube that’s a few centimetres long. When the swelling goes
down (after about 5 to 7 days) and you can breathe easily, you
will have the tube taken out. The opening heals over naturally.
If you have a tracheostomy, you won’t usually be able to speak
with the tube in place. Your speech and language therapist will
give you advice on how to cope with this.
Your surgeon will tell you in advance if you’re likely to have a
tracheostomy for a short time after your operation. This gives you
time to prepare. You can ask questions before your operation –
this can help reduce any anxiety you might have. The specialist
nurse or speech and language therapist will talk to you about
having a tracheostomy before your operation.
Total laryngectomy
Some people need an operation to remove all of the voicebox in
order to remove all of the cancer. Your doctors may offer this if they
feel that radiotherapy may not cure the cancer. You may also need
to have some lymph nodes in the neck removed (see page 49).
When the surgeon removes the whole larynx, there is no longer
a connection between your mouth, nose and lungs. This means
that you will breathe and speak in a different way. You will breathe
through a hole in your neck, called a stoma. You will no longer
have vocal cords to produce a voice, but will be able to speak using
a choice of different ways to communicate (see pages 58–61).
Treating laryngeal cancer 51
Laryngectomy stoma
A laryngectomy stoma is a permanent hole in the windpipe
made by the surgeon. It will be in the lower part of your neck
and you will breathe through it. The stoma stays open on its own.
Some people need a temporary tube to keep their stoma open for
the first few days after surgery, but this is rare.
Laryngectomy stoma
Gullet
(oesophagus)
Laryngectomy
stoma
Windpipe (trachea):
air goes to and
from the lungs
The thought of having a laryngectomy stoma can be frightening.
But you’ll be given a lot of support and information from your
healthcare team.
52 Understanding cancer of the voicebox (larynx)
You have your stoma for the rest of your life and you breathe
through it from the time of your operation. Your surgeon, specialist
nurse and speech and language therapist will talk to you about
this before your operation. When you’re well enough, your nurse
will teach you how to clean and take care of the stoma. You can
continue to get support from your healthcare team for as long as
you need it.
After your operation
You will usually be taken back to the ward after your operation.
You may be looked after in an intensive-care or high-dependency
unit at first. The doctors and nurses can make sure your breathing
is safe and your pain is well controlled. This is usually only for a
few days.
After your operation, you will be encouraged to start moving
around as soon as possible. This is an important part of your
recovery. It’s important to do regular leg movements and deepbreathing exercises. A physiotherapist will explain these to you.
Breathing and speaking
After a total laryngectomy, you will start to breathe through the
stoma straight away. You may need extra oxygen to help with your
breathing for a short while. The nurses give you oxygen through a
special mask, which fits over your stoma.
You might notice you have mucus in your airway and that you
cough a lot in the beginning. This should settle within a week.
Your nurse will use a thin, flexible tube (suction tube) to remove
the mucus until you get used to the changes in your breathing.
The nurses and physiotherapist will also give you breathing
exercises to help with this.
Treating laryngeal cancer 53
‘Plenty of large, man-size tissues are needed to
begin with, as coughing up mucus is predictable.
I also found open-necked shirts easier so you
can get to the stoma site quicker.’
Chris
You won’t be able to speak at first, but you can communicate
by mouthing words, writing or using a communication chart.
On pages 58–61 we discuss the different ways of communicating
after laryngeal surgery.
Pain
Your doctor or nurse will explain to you how any pain will be
controlled or prevented after your surgery.
You may be given pain relief through a syringe connected to an
electronic pump. The pump is set to give you a continuous dose of
painkiller (analgesia).
You may also have a hand control with a button to press if
you feel sore. This is called patient-controlled analgesia (PCA).
It’s designed so you can’t have too much painkiller, so it’s okay to
press it whenever you’re uncomfortable.
Always let the nurses know if you’re in pain.
Drips and drains
You may have several drips and drains in place for a few days
after surgery. You will be encouraged to get out of bed and move
around from the first day after surgery, so you will be given help
with these.
54 Understanding cancer of the voicebox (larynx)
You will have some thin tubes (wound drains) that drain fluid from
your operation site and allow your wound to heal. Let your doctor
or nurse know if these are uncomfortable. They are usually taken
out 2 to 4 days after surgery.
A drip going into a vein in your arm will give you fluids for a
few days. You will also have a feeding tube for liquid foods and
medicines. You should be able to eat and drink again once your
throat has healed, usually after 1 to 2 weeks. You will need to
build up your eating gradually. The hospital dietitian can give you
advice about this.
Coping and support
It can take time to recover from surgery to the larynx.
Some people are worried about the change in their appearance
after a laryngectomy. You may feel embarrassed about your
stoma. This can affect your confidence and may be distressing.
It often takes time to adjust and come to terms with learning to
speak in a different way and to breathe through a stoma.
‘After I had my laryngectomy, it was a new
world. All that was going through my mind
was, “When was I going to feel like a normal
person again?” But with the help of my speech
therapist and all those who gave me support
at the hospital, I learned to speak again,
which was a huge thing.’
Stewart
Treating laryngeal cancer 55
It can help to let your family and close friends know how you feel.
Your doctor, nurse and speech and language therapist at the
hospital can give you advice and support. They may put you in
touch with someone in your area who has had a laryngectomy.
The National Association of Laryngectomee Clubs and the Cancer
Laryngectomee Trust can put you in touch with your nearest group
and give you information. See page 107 for more information.
Living with a laryngectomy stoma
You’ll be given lots of information and advice about your stoma,
but getting used to it will take time. Try not to worry if it doesn’t
make sense straight away.
Stoma filters
When you breathe in through your stoma, air will go directly
down into your lungs. Because it isn’t warmed and moistened by
your mouth and nose, the cooler, drier air can irritate your lungs.
This can make you produce more mucus (phlegm). You won’t
be able to sniff or blow your nose to clear this. When you cough,
the mucus is coughed up through your stoma, not your mouth.
It’s important to keep the laryngectomy stoma covered with stoma
covers or filters. These are also known as heat and moisture
exchangers (HMEs). You attach them over the stoma to warm and
moisten the air. They help to reduce the amount of phlegm you
produce and prevent coughing and chest infections. Your doctor,
nurse or speech and language therapist can show you how to
use them.
56 Understanding cancer of the voicebox (larynx)
Chest infections
Breathing through a stoma makes you more likely to get chest
infections. If you notice a change in the colour of your phlegm
to green or dark yellow, or have a cough that doesn’t go away,
it’s important to tell your doctor straight away as this may be a
sign of infection. They may prescribe antibiotics for you.
Reduced sense of smell and taste
Your sense of smell and taste may be affected because you no
longer breathe through your mouth. This can improve after a few
months, although some people may have long-term problems.
You may be able to learn the ‘polite yawning technique’, where
you yawn with closed lips. This draws air in through the nose,
allowing you to smell. It can also improve your sense of taste.
Your speech and language therapist may be able to teach you
how to do this.
Shower aids
These help prevent water going into your stoma when you shower.
You can ask your specialist nurse or speech and language
therapist about them.
Swimming equipment
You won’t be able to swim without using special equipment to
stop water going into the stoma. The National Association of
Laryngectomee Clubs (see page 107) can give you information
about this. They also provide training to make sure you can use
the equipment safely.
‘For the first six months or so,
I was obsessed with finding
a way to improve my voice.’
Jacob
58 Understanding cancer of the voicebox (larynx)
Speaking after a laryngectomy
Most people who have had a laryngectomy are able to speak
afterwards, but in a different way to before their surgery.
Learning to speak again is likely to feel distressing to start
with and can be difficult to cope with, but alternative ways of
communicating have improved. The type of communication you
use will depend on your individual situation, your type of surgery
and what you would prefer to use.
A speech and language therapist will visit you before your
operation to discuss different ways of communicating. You may
be able to watch videos of people talking after a laryngectomy or
meet someone who has had similar surgery. Some people find
this very helpful, while others prefer to have written information or
to meet someone after they have had the surgery.
We have a video on our website of a speech and language
therapist and someone who has had a laryngectomy. They discuss
different ways to communicate, including using a voice prosthesis
valve. You can watch it at macmillan.org.uk/voicerestoration
Your surgeon and speech and language therapist will talk to
you about putting in a small valve, called a voice prosthesis valve
(see opposite), at the time of your operation. This will allow you to
develop a new voice after your operation.
There are other ways to help you communicate if you don’t have a
valve. These include:
•• an oesophageal voice
•• an electrolarynx
•• a combination of the two methods.
Treating laryngeal cancer 59
Voice prosthesis valve
The surgeon makes a channel between the windpipe and the
gullet (oesophagus). This is called a trachea-oesophageal
puncture (TOP). During the laryngectomy operation or at a later
stage, a small valve (voice prosthesis) is put into the channel.
This connects the windpipe to the gullet. The valve is one-way,
which prevents food and fluids from passing into the windpipe.
The position of the voice prosthesis valve between the
trachea and the oesophagus
Voice sounds
Gullet
(oesophagus)
Finger blocking
laryngectomy stoma
Windpipe
(trachea)
Air from
the lungs
Voice prosthesis
valve
60 Understanding cancer of the voicebox (larynx)
When you breathe out and cover your stoma with a thumb or
finger, air from the lungs passes through the valve. This vibrates
in your throat to produce a sound. As with normal speech, the
movements of your lips, cheeks and tongue can shape the sound
into words. It may take a while to learn how to speak with a
voice prosthesis. The voice can sound quite natural. In women,
it’s usually a lower pitch than before the operation.
Some people may have an external, ‘hands-free’ valve that
allows them to speak without covering the stoma with a finger.
These aren’t suitable for everyone, but you can ask your cancer
specialist or speech and language therapist about using one.
Oesophageal speech
Sometimes, people choose to learn a technique called
oesophageal speech. You can be taught this as you recover
from your laryngectomy.
Air is squeezed into the oesophagus (gullet) from the mouth.
As the air moves up from the oesophagus, it vibrates and can
be used to produce a voice. Movements of the lips, cheeks and
tongue shape the sound into words.
Oesophageal speech has the advantage of not needing any
equipment. Some people find it easy to do but others find it more
difficult. It’s usually best to practise little and often. A speech and
language therapist can help you develop the best speech possible.
They will also help you use your new way of talking for social
situations and on the telephone.
This technique is used less often nowadays.
Treating laryngeal cancer 61
Electrolarynx
There are different types of electronic aids available to help
you produce a voice. You may be given one to use while you
practise developing your new voice. You hold them next to your
neck under the chin and they make sound vibrations that can be
formed into speech. Your speech and language therapist will help
you choose the type that suits you best. They’ll show you how to
use it and look after it.
Electronic keyboards
Some people like to use electronic keyboards (like small
typewriters) to communicate. Mini-laptops, tablets or text
messaging on your mobile phone can also be good. There are
different types of writing device available, too. Your speech and
language therapist can tell you about these.
‘I now depend on my phone and tablet as a way
of communication, for example texting, emails,
and I have an app that will speak what you
type in. I use this as my main way of talking now.’
Chris
Having chemotherapy
Treating laryngeal cancer 63
Chemotherapy
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer
cells. Cytotoxic means toxic to cells. These drugs disrupt the way
cancer cells grow and divide but they also affect normal cells.
The drugs travel around the bloodstream and can reach cancer
cells anywhere in the body.
Chemotherapy can be used to treat laryngeal cancer:
•• at the same time as radiotherapy (chemoradiation)
•• before radiotherapy to shrink larger tumours and make
radiotherapy more effective
•• to help to control the cancer and relieve symptoms
(palliative chemotherapy).
The chemotherapy drugs most commonly used to treat laryngeal
cancer are:
•• cisplatin
•• 5-fluorouracil (also known as 5FU)
•• docetaxel (Taxotere®).
Other drugs that may be used include:
•• carboplatin
•• paclitaxel (Taxol®).
We can send you more information about all of these chemotherapy
drugs. Call us on 0808 808 00 00.
64 Understanding cancer of the voicebox (larynx)
How chemotherapy is given
A nurse will give you chemotherapy as an injection or as a drip
(infusion) directly into a vein (intravenously). It can be given
through a cannula (small tube) into the back of your hand or into
your arm. The cannula is taken out straight after each treatment
session has finished.
It can also be given through a tube called a central line. This is a
fine tube which goes into a vein in your chest. Or you may have a
PICC line. This is a fine tube which goes into a vein in your arm
and is threaded up into a vein in your upper chest. These lines can
be put in as a day patient and stay in until you have finished all
your treatment sessions.
If you have a central or PICC line, you may have one of the
chemotherapy drugs through a small pump that you can carry in
a bag and take home with you. Your nurse will show you how to
take care of the pump and how to look after your line when you
are at home.
While having chemotherapy, you may need to stay in hospital for
a few days or you may be treated as a day patient. Chemotherapy
is usually given as several sessions of treatment. Your doctors will
explain how often you will have treatment.
We can send you more information on central lines and PICC lines.
Call us on 0808 808 00 00.
Treating laryngeal cancer 65
Side effects
Chemotherapy drugs may cause unpleasant side effects, but these
can usually be well controlled with medicines and will usually go
away once treatment has finished. Not all drugs cause the same
side effects and some people may have very few. You can talk
to your doctor or nurse about what to expect from the treatment
that’s planned for you.
The main side effects are described here as well as some ways to
reduce or control them.
We can send you further information about many of the side
effects mentioned here.
Risk of infection
Chemotherapy can reduce your number of white blood cells,
which help fight infection. If the number of white blood cells is low,
you’ll be more prone to infections. A low white blood cell count is
called neutropenia. Always contact the hospital immediately on
the 24-hour contact number you’ve been given and speak to a
nurse or doctor if:
•• you develop a high temperature, which may be over 37.5°C
(99.5°F) or over 38°C (100.4°F) depending on the hospital’s
policy – follow the advice that you have been given by your
chemotherapy team
•• you suddenly feel unwell, even with a normal temperature
•• you feel shivery and shaky
•• you have any symptoms of an infection such as a cold, cough,
passing urine frequently (urine infection) or diarrhoea.
66 Understanding cancer of the voicebox (larynx)
If necessary, you’ll be given antibiotics to treat an infection.
You’ll have a blood test before each cycle of chemotherapy to
make sure your white blood cells have recovered. Occasionally,
your treatment may need to be delayed if your number of white
blood cells is still low.
Anaemia (reduced number of red blood cells)
Chemotherapy may reduce the number of red blood cells
(haemoglobin) in your blood. A low level of red blood cells is
known as anaemia, which can make you feel very tired and
lethargic. You may also become breathless.
Anaemia can be treated with blood transfusions. This should help
you feel more energetic and ease the breathlessness.
Bruising and bleeding
Chemotherapy can reduce the number of platelets in your blood.
Platelets are cells that help the blood to clot. If you develop any
unexplained bruising or bleeding, such as nosebleeds, bleeding
gums, blood spots or rashes on the skin, contact your doctor or
the hospital straight away.
Feeling sick
Some chemotherapy drugs can make you feel sick (nauseated)
or possibly be sick (vomit). Your cancer specialist will prescribe
anti-sickness (anti-emetic) drugs to prevent this. Let your doctor or
nurse know if your anti-sickness drugs are not helping, as there
are several different types you can take.
Tiredness (fatigue)
You’re likely to become tired and have to take things more slowly.
Try to pace yourself and save your energy for things that you want
to do or that need doing. Balance rest with some physical activity
– even going for short walks will help increase your energy levels.
Treating laryngeal cancer 67
Sore mouth
Your mouth may become sore and you may get ulcers. Look after
your mouth by gently cleaning your teeth or dentures every
morning and night and after meals. Use a soft-bristled or children’s
toothbrush and make sure you drink plenty of fluids. Your nurse
might ask you to rinse your mouth regularly or use mouthwashes.
It’s important to follow any advice you are given. Tell your nurse or
doctor if you have any problems. They can prescribe medicines to
prevent or treat mouth infections and reduce any soreness.
Loss of appetite
Some people find that they lose their appetite during chemotherapy,
especially if they are also having swallowing difficulties. Your
doctor can arrange for you to see a dietitian, who will give you
advice and may prescribe high-calorie drinks for you to have
until your appetite comes back. Your doctor can arrange for a
speech and language therapist to assess and advise you on any
swallowing difficulties you may have.
Our booklet Eating problems and cancer has some
helpful hints on how to eat well when you are feeling
ill. You can order a free copy at be.macmillan.org.uk
Hair loss
Some chemotherapy drugs may cause hair loss. Some people
may have complete hair loss including eyelashes and eyebrows.
Others may only experience partial hair loss or thinning.
It depends on what chemotherapy drugs you are having (your
doctor or nurse can tell you more about what to expect). If you
do experience hair loss your hair should start to grow back within
about 3 to 6 months of the end of treatment. It may grow back
straighter, curlier, finer, or a slightly different colour than it was
before. Your nurse can give you advice about coping with hair loss
and how to look after your scalp.
68 Understanding cancer of the voicebox (larynx)
Numbness or tingling in the hands or feet
The chemotherapy drugs cisplatin and docetaxel can cause
tingling or numbness, or a sensation of pins and needles.
This is known as peripheral neuropathy.
It’s important to let your doctor or nurse know if this happens.
They may need to change the chemotherapy drug if it gets worse.
Usually, peripheral neuropathy gradually gets better when
chemotherapy is over, but sometimes it’s permanent. We can
send you more information about peripheral neuropathy.
Diarrhoea
Some chemotherapy drugs can cause diarrhoea. This often starts
several days after treatment. If you’re taking chemotherapy tablets
or capsules at home, it’s important to let your doctor or nurse
know if you have diarrhoea, as your treatment may need to be
interrupted. Medicine can be prescribed to help. It’s important to
drink plenty of fluids if you have diarrhoea.
Sore hands and feet
5FU may cause redness or soreness of the palms of the hands
or soles of the feet. This is known as palmar plantar erythema.
It’s usually temporary and improves when the treatment
is finished.
Using unperfumed moisturising creams can often help with the
symptoms. It can also help to keep your hands and feet cool and
to avoid tight-fitting clothing such as socks, shoes and gloves.
Your doctor may prescribe creams if needed.
Our booklet Understanding chemotherapy discusses
this treatment and its side effects in more detail.
Call us on 0808 808 00 00 or visit be.macmillan.org.uk
to order a free copy.
Treating laryngeal cancer 69
Chemoradiation
Certain chemotherapy drugs, such as cisplatin, may make
radiotherapy work better. Chemotherapy given at the same
time as radiotherapy is called chemoradiation. It can be given
instead of surgery or after surgery to reduce the risk of the
cancer coming back.
However, giving the two treatments at the same time also
increases the immediate side effects and risk of late effects
(see pages 79–80).
70 Understanding cancer of the voicebox (larynx)
Targeted therapies
Targeted therapies work differently from chemotherapy. Each drug
works in a different way, but they all treat cancer by affecting the
way cancer cells grow or divide.
A drug called cetuximab (Erbitux®) can be used to treat some
people with cancer of the larynx. It’s given as a drip (infusion)
into a vein. This type of targeted therapy is known as a
monoclonal antibody.
Cetuximab targets specific proteins (receptors) on the surface of
the cancer cells, called epidermal growth factor receptors (EGFR).
Cetuximab blocks the receptors, which prevents the cells from
growing and dividing. It can also make cancer cells more sensitive
to the effects of radiotherapy.
It can be used to treat some people with laryngeal cancers that
have started to spread. It is usually given with radiotherapy but
can also be given with chemotherapy.
Cetuximab may only be available in some situations. Your cancer
doctor can tell you if it’s appropriate for you.
If a drug isn’t available on the NHS, there may be different ways
you are still able to have it. Your cancer doctor can give you advice.
We have further information on what to do if a treatment isn’t
available. Call us on 0808 808 00 00 or visit our website.
Treating laryngeal cancer 71
Side effects
The side effects of cetuximab are usually mild. Some people have
flu-like symptoms such as a headache, fever, chills or dizziness
when the infusion is being given. You’ll be given medication
before the infusion to reduce the risk of this happening.
The most common side effect is a skin rash. This can be a mild,
acne-like rash, but some people may have a more severe skin
reaction in the area where they have had their radiotherapy.
You’ll be given advice on how to look after your skin while you’re
having cetuximab.
We can send you more information about cetuximab. Call us on
0808 808 00 00.
72 Understanding cancer of the voicebox (larynx)
Research – clinical trials
Cancer research trials are carried out to try to find new and better
treatments for cancer. Trials that are carried out on patients are
known as clinical trials. These may be carried out to:
•• test new treatments, such as new chemotherapy drugs or
targeted therapies
•• look at new combinations of existing treatments, or change
the way they are given to make them more effective or reduce
side effects
•• compare the effectiveness of drugs used to control symptoms
•• find out how cancer treatments work
•• find out which treatments are the most cost effective.
Trials are the only reliable way to find out if a different type of
surgery, chemotherapy, hormone therapy, radiotherapy or other
treatment is better than what is already available.
Taking part in a trial
Trials help to improve knowledge about cancer and develop new
treatments. You may be asked if you would like to take part in
a treatment research trial. There can be benefits to doing this.
You will be carefully monitored during and after the study.
Usually, several hospitals around the country take part in these
trials. It’s important to consider that some treatments that
look promising at first are often later found not to be as good
as existing treatments, or to have side effects that outweigh
the benefits.
Treating laryngeal cancer 73
If you decide not to take part in a trial, your decision will be
respected and you don’t have to give a reason. However, it can
help to let the staff know your concerns so that they can give you
the best advice. There will be no change in the way that you’re
treated by the hospital staff, and you’ll be offered the standard
treatment for your situation.
Blood and tumour samples
Blood and tumour samples may be taken to help make the right
diagnosis. You may be asked for your permission to use some
of your samples for research into cancer. If you take part in a
trial you may also give other samples, which may be frozen and
stored for future use when new research techniques become
available. Your name will be removed from the samples so you
can’t be identified.
The research may be carried out at the hospital where you are
treated, or at another one. This type of research takes a long time,
and results may not be available for many years. The samples
will be used to increase knowledge about the causes of cancer
and its treatment, which will hopefully improve the outlook for
future patients.
We have a booklet called Understanding cancer
research trials (clinical trials). You can also visit our
website, which has links to clinical trials databases at
macmillan.org.uk/clinicaltrials
‘Twelve months on, I have
rebuilt myself. I’ve learned
to swallow and eat again,
and took up running.’
Jacob
After your treatment 75
After your
treatment
Follow-up76
After treatment
77
76 Understanding cancer of the voicebox (larynx)
Follow-up
Once your treatment has finished, you will have regular check-ups
at the hospital. These will continue for several years. You may also
have scans from time to time. It’s important you tell your specialist
about any new symptoms you have or any symptoms that aren’t
improving. Don’t wait until your next appointment to report any
new symptoms.
If you can’t attend a follow-up appointment, contact your doctor
or clinic to arrange another one.
For people whose treatment is over apart from
regular check-ups, our booklet Life after cancer
treatment gives useful information. Call us on 0808 808
00 00 or visit be.macmillan.org.uk to order a free copy.
After your treatment 77
After treatment
Making positive choices after treatment
Coming to the end of your cancer treatment can be a time of
mixed emotions. You’ll probably feel relieved, but there can also be
feelings of anxiety and uncertainty. It can take time to rebuild your
confidence and to come to terms with what you’ve been through.
It may take time to recover from treatment. There may be physical
changes in the way you look, and possibly changes in some
areas of your daily life, such as the way you speak or what you
can eat. There will also be emotional changes to deal with, so it’s
important to give yourself time to adjust.
You may want to think about making changes to your lifestyle and
find out more about healthy living. Perhaps you followed a healthy
lifestyle before your cancer and you’re keen to carry on making the
most of your health. There are things you can do to help your body
recover. These can also help improve your sense of well-being and
lower your risk of getting other illnesses and cancers.
The laryngectomy organisations listed at the back of this booklet
can also provide support to help you adjust after treatment.
Smoking
If you’re a smoker, it’s important to try to give up. Smoking is the
main cause of head and neck cancers. Stopping smoking reduces
the risk of your cancer coming back and the risk of developing a
second cancer. It also reduces the risk of other conditions, such as
heart disease. Giving up smoking can be difficult, but there’s lots
of support available. Speak to your doctor or specialist nurse, or
call a stop-smoking helpline for further advice and to find out
where your local stop-smoking service is (see page 108).
78 Understanding cancer of the voicebox (larynx)
Alcohol
Cutting back on alcohol is also important. If you can’t stop
drinking alcohol completely, it’s best to avoid drinking spirits.
Eating well
It’s important to have a nutritious and well-balanced diet with
plenty of fresh fruit and vegetables, even if your appetite and
interest in food have been reduced. Eating small meals often can
make eating easier. You may need to continue seeing a dietitian
until you have reached a healthy weight and are able to eat a
well-balanced diet without support. Your dietitian can advise you
on ways to eat well and help with any problems you may have.
They may prescribe high-calorie drinks to help you build up your
diet. You may also need support from a speech and language
therapist if you are having difficulty with swallowing.
Physical activity
This can be an important part of your recovery after treatment.
It can help you feel better in yourself and help build up your
energy levels. It also reduces the risk of heart disease, stroke and
diabetes. Talk to your cancer specialist or GP before you start
exercising. Start slowly and increase your activity over time.
Exercise doesn’t have to be particularly strenuous. You can start
gently and build up the amount of physical activity you do.
Whatever your age or physical health, there will be some kind
of exercise you could try, such as walking, hiking, cycling or
swimming. Activities like gardening, dancing and playing sport
are also good.
You can read more about exercise and its benefits in
our booklet Physical activity and cancer.
After your treatment 79
Late effects of treatment
Some side effects that develop during treatment can take time
to improve. Sometimes side effects may become permanent.
Other side effects may develop some time after treatment has
finished (late effects). You may not experience any late effects,
or they may range from being mild to more troublesome.
Always let your doctor or specialist nurse know about any
problems you have. There may be ways of treating or managing
late effects if they happen.
Problems swallowing
This can be caused by thickening of the wall of the gullet
(oesophagus), narrowing of the gullet, or loss of sensation
when swallowing. A speech and language therapist can give
you help and advice with swallowing problems.
Dry mouth
Radiotherapy can damage your salivary glands, leaving you with
a dry mouth. This effect may be temporary, but sometimes can
be permanent. Having a dry mouth can make eating difficult.
You may need to carry water with you, or eat softer foods with
plenty of sauces and gravies, which will be easier to swallow.
Some people find having a humidifier by their bed at night can
help keep the mouth and throat less dry. Some people keep a
glass of water by the bed to sip if they wake up. You can use
mouthwashes and protective gels to coat the lining of your mouth,
which can help. Your cancer specialist or GP can prescribe these
for you and you can talk to the staff at the radiotherapy outpatient
department about ways to cope with a dry mouth.
We can send you more information about coping with a dry mouth.
Call us on 0808 808 00 00.
80 Understanding cancer of the voicebox (larynx)
Dental problems
If you have a dry mouth, you’re more at risk of problems with your
teeth, as saliva protects your teeth from decay. It’s important to go
for regular check-ups every 3 to 6 months with your dentist and
oral hygienist and follow a regular daily mouth care routine to
prevent tooth decay. Your dentist may prescribe fluoride products
and will advise you on how to brush your teeth and keep your
gums healthy.
We have more information about mouth care and
preventing tooth decay following treatment in our
booklet Managing the late effects of head and neck
cancer treatment.
Low levels of the thyroid hormone, thyroxine
(hypothyroidism)
Surgery or radiotherapy treatment can affect the thyroid gland,
which is near the larynx. The thyroid gland may produce less
of the thyroid hormone, thyroxine. You will have blood tests to
monitor your thyroid hormone levels. Symptoms of hypothyroidism
include tiredness and weight gain. If you develop this condition,
you will be given thyroxine tablets.
Lymphoedema
This is a collection of a fluid called lymph that causes swelling
in the neck. It can develop when lymph nodes have been
removed or damaged by surgery or radiotherapy. The earlier that
lymphoedema is diagnosed, the easier it is to treat, so always let
your doctor or nurse know if you have any swelling. They may
refer you to a lymphoedema specialist.
We have a booklet about lymphoedema, which you may find
helpful if it affects you. You can order it at be.macmillan.org.uk
After your treatment 81
Complementary therapies
Complementary therapies may help you feel better and reduce
any stress and anxiety.
Relaxation, counselling and psychological support are available at
many hospitals. Some hospitals also offer visualisation, massage,
reflexology, aromatherapy and hypnotherapy. But it is important
not to have massage directly over a tumour or lymph nodes
(glands) affected by cancer. Therapies are sometimes available
through cancer support groups or your GP. Many complementary
therapists also have private practices.
Not all complementary therapies are suitable for people
who have just finished radiotherapy, so it’s important to
check with your healthcare team first if you’re thinking of
having one.
Our booklet Cancer and complementary therapies
tells you about different therapies and gives advice
on choosing a therapist.
‘In general, I am
continually moved by
people’s response when
I explain my whisper.’
Jacob
Your feelings and relationships 83
Your
feelings and
relationships
Your feelings
84
If you are a relative or friend
89
Relationships90
Talking to children
92
Who can help?
93
84 Understanding cancer of the voicebox (larynx)
Your feelings
It’s common to feel overwhelmed by different feelings when you’re
told that you have cancer. We refer to some of these here. Partners,
family and friends may also have some of the same feelings.
Cancer of the larynx can affect people both emotionally and
practically. If treatment has affected the way you breathe or
speak, it can affect the way you feel about yourself and how you
live your life. You might have different reactions to the ones we
describe here. There is no right or wrong way to feel. You’ll cope
with things in your own way. Talking to people close to you or
other people affected by cancer can often help.
Shock and disbelief
You may find it hard to believe it when your doctor tells you
that you have cancer. It’s common to feel shocked and numb.
You may not be able to take in much information and find that
you keep asking the same questions again and again. At first,
you might find it hard to express yourself to family and friends
about the cancer. This usually gets easier as the shock wears off
and it becomes more real to you. You may find you can’t think or
talk about anything but the cancer. This is because your mind is
trying to process what you’re going through.
Fear and anxiety
People can be very anxious or frightened about whether treatment
will work and what will happen in the future. This uncertainty can
be one of the hardest things to cope with. It can help to try to
focus on what you can control.
Your feelings and relationships 85
You may want to find out more about the cancer, its treatment
and how to manage side effects. It can also help to talk about
your feelings and to take time to do things that are important to
you and that you enjoy.
Doctors often know roughly how many people can benefit from
a type of treatment. But they can’t be sure what will happen to an
individual person. Although they may not be able to answer your
questions fully, they can usually talk through any problems with
you and give you some guidance.
Avoidance
Some people cope by not wanting to know very much about the
cancer and by not talking about it. If you feel like this, let your
family and friends know that you don’t want to talk about it right
now. You can also tell your doctor if there are things you don’t
want to know or talk about yet.
Occasionally, this avoidance can be extreme. Some people may
not believe that they have cancer. This is sometimes called being
in denial. It may stop them making decisions about treatment.
If this happens, it’s very important for them to get help from
their doctor.
Sometimes, avoidance is the other way around. Family and
friends may seem to avoid you and the fact that you have cancer.
They may not want to talk about it or they might change the
subject. This is usually because they are also finding the cancer
difficult to cope with, and they may need support too. Try to let
them know how this makes you feel and that talking openly with
them about your illness will help you.
86 Understanding cancer of the voicebox (larynx)
Anger
You may feel angry about your illness and sometimes resent other
people for being well. These are normal reactions, especially
when you feel frightened, stressed, out of control or unwell.
You may get angry with the people close to you. Let them know
that you are angry at your illness and not at them. Finding ways
to help you relax and reduce stress can help with anger. This can
include talking about or writing down how you feel, gentle
exercise, breathing or relaxation therapy, yoga or meditation.
Guilt and blame
Some people feel guilty or blame themselves or others for the
cancer. You may try to find reasons for why it has happened to
you. Most of the time, it’s impossible to know exactly what has
caused a person’s cancer. Over time, several different factors may
act together to cause a cancer. Doctors don’t fully understand all
of these factors yet. Instead, try to focus on looking after yourself
and getting the help and support you need.
Feeling alone
Some people feel alone because they don’t have enough support.
Family and friends may live far away, have other commitments
or feel uncomfortable because of their own fears about cancer.
Try to let your family and friends know how you feel and how they
could support you more.
It’s normal to have times when you want to be left alone to sort
out your feelings. But if you find you’re avoiding people a lot of
the time, then try to talk to your doctor or nurse.
Your feelings and relationships 87
If you need more support, you can call the Macmillan Support
Line free on 0808 808 00 00 and talk to one of our cancer
support specialists. You may find it helpful to write down how you
feel and contact them via email. Or you may want to wait until
your voice has adjusted after the treatment if you would like to
speak to one of our cancer support specialists.
Talking about your feelings
Talking about your feelings can help reduce feelings of stress,
anxiety and isolation. There are lots of different ways to do this.
Try to let your family and friends know how you’re feeling so that
they can support you.
If you have a mobile phone or tablet, this might help you
communicate if your voice is not strong enough. It’s possible to
download programs that convert text to speech that will speak out
what you type in. It is also possible to get a textphone landline.
Your specialist nurse, speech and language therapist (SALT) or
one of the laryngectomy organisations on page 107 might be
able to advise you on what programs are most helpful.
Support groups
Self-help or support groups offer a chance to talk to other people
who may be in a similar situation and facing the same challenges
as you. Joining a group can be helpful if you live alone, or don’t
feel able to talk about your feelings with the people around you.
Not everyone finds talking in a group easy, especially if you are
adjusting to new ways of communicating. Try going along to see
what the group is like before you decide whether or not to take
part. The National Association of Laryngectomee Clubs may be
able to find a group local your area (see page 107).
88 Understanding cancer of the voicebox (larynx)
You can call us on 0808 808 00 00 or visit macmillan.org.uk/
supportgroups for more information about groups across the UK.
Online support
Even though each person’s experience is very individual,
some people find online support a useful way to ask questions
and share experiences. You may find this a helpful way to
communicate after your treatment if your voice has been affected.
Our online community (macmillan.org.uk/community)
is a social networking site where you can talk to people in
our chat rooms, blog about your journey, make friends and
join support groups.
If you need more help
These feelings can be very difficult to cope with and sometimes
people need more help. This happens to lots of people and
doesn’t mean you’re not coping.
If you feel anxious, panicky or sad a lot of the time, or think you
may be depressed, talk to your doctor or nurse. They can refer you
to a doctor or counsellor who can help. They may also prescribe
medicine to help with anxiety or an anti-depressant drug.
Our booklet How are you feeling? The emotional
effects of cancer discusses the feelings you may have
in more detail, and has suggestions for coping with them.
Your feelings and relationships 89
If you are a relative or friend
Some people find it hard to talk about cancer or share their
feelings. You might think it’s best to pretend everything is fine,
and carry on as normal. You might not want to worry the person
with cancer, or you might feel you’re letting them down if you
admit to being afraid. Denying strong emotions can often make
it even harder to talk, and may lead to the person with cancer
feeling very isolated.
Partners, relatives and friends can help by listening carefully to
what the person with cancer wants to say. It may be best not to
rush into talking about the illness. Often it’s enough just to listen
and let the person with cancer talk when they are ready.
You may find some of the courses on our Learn Zone website
helpful. There are courses to help with listening and talking, to
help friends and family support their loved ones affected by
cancer. Visit macmillan.org.uk/learnzone to find out more.
Our booklet Talking with someone who has cancer has more
suggestions if you have a friend or relative with cancer. If you’re
looking after a family member or friend with cancer, you may
find our booklet Looking after someone with cancer helpful.
It’s based on carers’ experiences and has lots of practical tips
and information.
We also have more information about supporting someone with
cancer at macmillan.org.uk/carers
90 Understanding cancer of the voicebox (larynx)
Relationships
The experience of cancer may have improved your relationships
with people close to you. The support of family and friends may
have helped you cope. But cancer is stressful, and this can have
an effect on relationships. Any problems usually improve over
time, especially if you can communicate openly about them.
‘I have adjusted to my new voice level and
in close proximity can enjoy excellent
communication. Loud environments, especially
kids’ parties, can be very challenging, but
family and friends are most understanding.’
Jacob
Your partner
Some couples become closer through a cancer experience.
However, cancer can put a lot of strain on a relationship.
Problems sometimes develop, even between couples who’ve been
together for a long time. If a relationship was already difficult,
the stress of a major illness may make things worse. This can be
made even harder if you are having problems communicating.
Even couples that are close may not always know how their
partner is feeling. Finding a way to communicate openly about
your feelings and listening to each other can help you understand
each other. This may mean writing down how you feel if your
voice is in the process of adjusting.
Your feelings and relationships 91
Our booklets Cancer, you and your partner, Sexuality and
cancer – information for men and Sexuality and cancer –
information for women have more information that may help.
Family and friends
Your family and friends may not always understand if you aren’t
feeling positive about getting on with things, and may not know
how big an effect treatment is having on your life. Talking about
how you feel will help them give you the support you need.
Our booklet Talking about your cancer has more useful tips
and can give you ideas about how to express yourself.
92 Understanding cancer of the voicebox (larynx)
Talking to children
Deciding what to tell your children or grandchildren about your
cancer is difficult. An open, honest approach is usually best.
Even very young children can sense when something is wrong,
and their fears can sometimes be worse than the reality.
How much you tell your children will depend on their age and
how mature they are. It may be best to start by giving only small
amounts of information and gradually tell them more to build up
a picture of your illness.
Teenagers
Teenagers can have an especially hard time. At a stage when
they want more freedom, they may be asked to take on new
responsibilities and they may feel over-burdened. It’s important
that they can go on with their normal lives as much as possible
and still get the support they need.
If they find it hard to talk to you, you could encourage them to
talk to someone close who can support and listen to them, such
as a grandparent, family friend, teacher or counsellor. They may
also find it useful to look at the website riprap.org.uk, which
has been developed especially for teenagers who have a parent
with cancer.
Our booklet Talking to children and teenagers
when an adult has cancer includes discussion about
sensitive topics. There’s also a video on our website that
may help, at macmillan.org.uk/talkingtochildren
Your feelings and relationships 93
Who can help?
There are people available to help you and your family.
District nurses work closely with GPs and make regular visits to
patients and their families at home if needed.
The hospital social worker can give you information about
social services and benefits you may be able to claim, such as
meals on wheels, a home helper or hospital fares. The social
worker may also be able to arrange childcare for you during
and after treatment.
In many areas of the country, there are also specialist nurses
called palliative care nurses. They are experienced in assessing
and treating the symptoms of advanced cancer. Palliative care
nurses are sometimes known as Macmillan nurses. However,
many Macmillan professionals are nurses who have specialist
knowledge in a particular type of cancer. You may meet them
when you’re at a clinic or in hospital.
Marie Curie nurses help care for people approaching the end
of their lives in their own homes. Your GP or hospital specialist
nurse can usually arrange a visit by a palliative care or Marie
Curie nurse.
There’s also specialist help available to help you cope with the
emotional impact of cancer and its treatment. You can ask your
hospital doctor or GP to refer you to a doctor or counsellor who
specialises in supporting people with cancer and their families.
Our cancer support specialists on 0808 808 00 00 can tell you
more about counselling and can let you know about services in
your area.
Work and financial support 95
Work and
financial
support
Financial help and benefits
96
Insurance98
Work99
96 Understanding cancer of the voicebox (larynx)
Financial help and benefits
If you are struggling to cope with the financial effects of cancer,
help is available.
If you cannot work because you are ill, you may be able to get
Statutory Sick Pay. Your employer will pay this for up to 28 weeks
of sickness. If you qualify for it, they cannot pay you less. Before
your Statutory Sick Pay ends, or if you do not qualify for it, check
whether you can get Employment and Support Allowance (ESA).
This benefit is for people who cannot work because they are ill or
disabled. There are two different types of ESA:
•• contributory – you can get this if you have made enough
national insurance contributions
•• income-related – you can get this if your income and savings
are below a certain level.
From October 2013, a new benefit called Universal Credit is
replacing income-related ESA. This is for people who are looking
for work or who are on a low income.
Personal Independence Payment (PIP) is a new benefit
for people under 65 who find it difficult to walk or look after
themselves (or both). You must have had these difficulties for at
least three months, and they should be expected to last for the
next nine months. Since April 2013, PIP has started to replace a
similar older benefit called Disability Living Allowance.
Attendance Allowance (AA) is for people aged 65 or over who
find it difficult to look after themselves. You may qualify if you
need help with things like getting out of bed, having a bath or
dressing yourself. You don’t need to have a carer, but you must
have needed care for at least six months.
Work and financial support 97
If you are terminally ill, you can apply for PIP, DLA or AA under
the ‘special rules’. This means your claim will be dealt with quickly
and you will get the benefit you applied for at the highest rate.
Help for carers
Carers Allowance is a weekly benefit that helps people who
look after someone with a lot of care needs. If you don’t qualify
for it, you can apply for Carer’s Credit. This helps you to build
up qualifying years for a State Pension.
More information
The benefits system can be hard to understand, so it’s a
good idea to talk to an experienced welfare rights adviser.
You can speak to one by calling the Macmillan Support Line on
0808 808 00 00. We’ve just listed some benefits here, but there
may be others you can get.
You can find out about state benefits and apply for them online
at gov.uk (England, Wales and Scotland) and nidirect.gov.
uk (Northern Ireland). These websites have information about
financial support, your rights, employment and independent
living. You can also get information from the relevant Department
for Work and Pensions helplines (see page 111) or Citizens Advice
(see pages 110–111). In Northern Ireland, you can call the Benefit
Enquiry Line Northern Ireland on 0800 220 674.
Our booklet Help with the cost of cancer has more
detailed information. You might also find our video at
macmillan.org.uk/gettingfinancialhelp useful.
98 Understanding cancer of the voicebox (larynx)
Insurance
People who have, or have had, cancer may find it hard to get
certain types of insurance, including life and travel insurance.
A financial adviser can help you look at your needs and find the
best deal for you. You can find a financial adviser by contacting
one of the organisations on pages 110–111.
Our booklets Insurance and Getting travel
insurance may also be helpful. You can order free
copies at be.macmillan.org.uk
Work and financial support 99
Work
You may need to take time off work during your treatment and
for a while afterwards. It can be hard to judge the best time to go
back to work, and this will depend mainly on the type of work you
do and how much your income is affected. It’s important to do
what’s right for you.
Getting back into your normal routine can be very helpful, and
you may want to go back to work as soon as possible. It can be
helpful to talk to your employer about the situation – it may be
possible for you to work part-time or job share.
On the other hand, it can take a long time to recover fully from
cancer treatment, and it may be many months before you feel
ready to return to work. It’s important not to take on too much,
too soon. Your consultant, GP or specialist nurse can help you
decide when and if you should go back to work.
Employment rights
The Equality Act 2010 protects anyone who has, or has had,
cancer. Even if a person who had cancer in the past has been
successfully treated and is now cured, they are still covered by
the act. This means their employer must not discriminate against
them for any reason, including their past cancer. The Disability
Discrimination Act protects people in Northern Ireland.
Our booklets Work and cancer, Working while caring
for someone with cancer and Self-employment and
cancer have more information that may be helpful.
There’s also more information at macmillan.org.uk/work
Further information 101
Further
information
About our information
102
Other ways we can help you
104
Other useful organisations
107
Your notes and questions
113
102 Understanding cancer of the voicebox (larynx)
About our information
We provide expert, up-to-date information
about cancer. And all our information is free
for everyone.
Order what you need
Other formats
You may want to order more
We also provide information
leaflets or booklets like this one. in different languages and
Visit be.macmillan.org.uk or
formats, including:
call us on 0808 808 00 00.
•• audiobooks
We have booklets on different
cancer types, treatments and
side effects. We also have
information about work,
financial issues, diet, life after
cancer and information for
carers, family and friends.
All of our information is also
available online at macmillan.
org.uk/cancerinformation
There you’ll also find videos
featuring real-life stories
from people affected by
cancer, and information
from health and social
care professionals.
•• Braille
•• British Sign Language
•• Easy Read booklets
•• ebooks
•• large print
•• translations.
Find out more at macmillan.
org.uk/otherformats
If you’d like us to produce
information in a different
format for you, email us at
cancerinformationteam@
macmillan.org.uk or call
us on 0808 808 00 00.
Further information 103
Help us improve
our information
We know that the people
who use our information are
the real experts. That’s why
we always involve them in
our work. If you’ve been
affected by cancer, you can
help us improve our
information.
We give you the chance to
comment on a variety of
information including booklets,
leaflets and fact sheets.
If you’d like to hear more
about becoming a reviewer,
email reviewing@macmillan.
org.uk You can get involved
from home whenever you like,
and we don’t ask for any
special skills – just an interest
in our cancer information.
104 Understanding cancer of the voicebox (larynx)
Other ways we can help you
At Macmillan, we know how a cancer
diagnosis can affect everything, and we’re
here to support you. No one should face
cancer alone.
Talk to us
If you or someone you know
is affected by cancer, talking
about how you feel and sharing
your concerns can really help.
Macmillan Support Line
Our free, confidential phone
line is open Monday–Friday,
9am–8pm. Our cancer support
specialists can:
•• help with any medical
questions you have about
your cancer or treatment
•• help you access benefits and
give you financial guidance
•• be there to listen if you need
someone to talk to
•• tell you about services that
can help you in your area.
Call us on 0808 808 00 00
or email us via our website,
macmillan.org.uk/talktous
Information centres
Our information and support
centres are based in hospitals,
libraries and mobile centres.
There, you can speak with
someone face to face.
Visit one to get the information
you need, or if you’d like a
private chat, most centres
have a room where you can
speak with someone alone
and in confidence.
Find your nearest centre
at macmillan.org.uk/
informationcentres or call
us on 0808 808 00 00.
Further information 105
Talk to others
Online community
Thousands of people use our
No one knows more about the
online community to make
impact cancer can have on your friends, blog about their
life than those who have been
experiences and join groups
through it themselves. That’s
to meet other people going
why we help to bring people
through the same things.
together in their communities
You can access it any time
and online.
of day or night. Share your
experiences, ask questions,
Support groups
or just read through people’s
Whether you are someone
posts at macmillan.org.uk/
living with cancer or a carer,
community
we can help you find support
The Macmillan
in your local area, so you
healthcare team
can speak face to face with
people who understand.
Our nurses, doctors and
Find out about support groups
other health and social care
in your area by calling us or
professionals give expert care
by visiting macmillan.org.uk/
and support to individuals and
selfhelpandsupport
their families. Call us or ask
your GP, consultant, district
nurse or hospital ward sister
if there are any Macmillan
professionals near you.
‘Everyone is so supportive on the online community,
they know exactly what you’re going through. It can
be fun too. It’s not all just chats about cancer.’
Mal
106 Understanding cancer of the voicebox (larynx)
Help with money worries
Having cancer can bring extra
costs such as hospital parking,
travel fares and higher heating
bills. If you’ve been affected in
this way, we can help.
Financial guidance
Our financial team can give
you guidance on mortgages,
pensions, insurance, borrowing
and savings.
Help accessing benefits
Our benefits advisers can
offer advice and information
on benefits, tax credits, grants
and loans. They can help you
work out what financial help you
could be entitled to. They can
also help you complete your
forms and apply for benefits.
Macmillan Grants
Macmillan offers one-off
payments to people with
cancer. A grant can be
for anything from heating
bills or extra clothing to a
much-needed break.
Call us on 0808 808 00 00
to speak to a financial guide or
benefits adviser, or to find out
more about Macmillan Grants.
We can also tell you about
benefits advisers in your area.
Visit macmillan.org.uk/
financialsupport to find out
more about how we can help
you with your finances.
Help with work and cancer
Whether you’re an employee,
a carer, an employer or are
self-employed, we can provide
support and information to help
you manage cancer at work.
Visit macmillan.org.uk/work
Macmillan’s My
Organiser app
This free mobile app
can help you manage
your treatment, from
appointment times
and contact details,
to reminders for when
to take your medication.
Search ‘My Organiser’
on the Apple App
Store or Google Play
on your phone.
Further information 107
Other useful organisations
There are lots of other organisations that can give
you information or support.
Laryngeal cancer
support organisations
Cancer Laryngectomee Trust
PO Box 618,
Halifax HX3 8WX
Tel 01422 205 522
Email [email protected]
www.cancerlt.org
Provides support to people
who are about to have, or
have had, a laryngectomy.
They can send you a free copy
of the book Laryngectomy
is not a tragedy, suitable for
patients, their families and
healthcare professionals.
Changing Faces
The Squire Centre,
33–37 University Street,
London WC1E 6JN
Tel 0300 0120 275
Email
[email protected]
www.changingfaces.org.uk
Offers information, advice
and support to people living
with a changed appearance or
disfigurement. Can also refer
people for skin camouflage.
This service is run by specially
trained volunteers, who can
teach people how to self-apply
specialist cover creams.
National Association of
Laryngectomee Clubs
Suite 16, Tempo House,
15 Falcon Road,
London SW11 2PJ
Tel 020 7730 8585
(Mon–Fri, 9am–4pm)
www.laryngectomy.org.uk
Aims to promote the welfare
of people who have had a
laryngectomy, and their families.
Produces videos, DVDs and a
range of booklets, including
a handbook for people who
have had a laryngectomy.
Supports 100 local clubs and
can arrange hospital visits
before and after your operation.
108 Understanding cancer of the voicebox (larynx)
Support to stop smoking
NHS Smoking Helpline
(Mon–Fri, 9am–8pm,
Sat–Sun, 11am–5pm)
England 0300 123 1044
Scotland 0800 84 84 84
Wales 0800 085 2219
Northern Ireland
0800 85 85 85
www.nhs.uk/smokefree
This phone service and the
Smokefree website offer free
information, advice and support
to people who are giving up
smoking, and those who have
given up smoking and do not
want to start again.
NHS Asian Tobacco Helpline
(Mon–Fri, 9am–8pm,
Sat–Sun, 11am–5pm)
Urdu 0800 169 0881
Punjabi 0800 169 0882
Hindi 0800 169 0883
Gujarati 0800 169 0884
Bengali 0800 169 0885
General cancer
support organisations
Cancer Black Care
79 Acton Lane,
London NW10 8UT
Tel 020 8961 4151
Email
[email protected]
www.cancerblackcare.org.uk
Offers information and support
for people with cancer from
ethnic communities, and their
families, carers and friends.
Cancer Focus
Northern Ireland
40–44 Eglantine Avenue,
Belfast BT9 6DX
Helpline 0800 783 3339
(Mon–Fri, 9am–1pm)
Email [email protected]
www.cancerfocusni.org
Offers a variety of services
to people affected by cancer,
including a free helpline,
counselling and links to
local support groups.
Further information 109
Cancer Support Scotland
The Calman Centre,
75 Shelley Road,
Glasgow G12 0ZE
Tel 0800 652 4531
Email info@
cancersupportscotland.org
www.cancersupport
scotland.org
Runs cancer support
groups throughout Scotland.
Also offers free complementary
therapies and counselling to
anyone affected by cancer.
Irish Cancer Society
43–45 Northumberland Road,
Dublin 4, Ireland
Tel 1800 200 700
(Mon–Thu, 9am–7pm,
Fri, 9am–5pm)
Email [email protected]
www.cancer.ie
National cancer charity offering
information, support and care
to people affected by cancer.
Has a helpline staffed by
specialist cancer nurses.
Maggie’s Centres
The Gatehouse,
10 Dumbarton Road,
Glasgow G11 6PA
Tel 0300 123 1801
Email enquiries@
maggiescentres.org
www.maggiescentres.org
Provides information about
cancer, benefits advice,
and emotional or
psychological support.
Tenovus
Head Office,
Gleider House,
Ty Glas Road,
Cardiff CF14 5BD
Helpline 0808 808 1010
(Mon–Sun, 8am–8pm)
Email
info@
tenovuscancercare.org.uk
www.tenovus.org.uk
Aims to help everyone get equal
access to cancer treatment
and support. Funds research
and provides support such as
mobile cancer support units, a
free helpline, an ‘Ask the nurse’
service on the website and
benefits advice.
110 Understanding cancer of the voicebox (larynx)
Counselling and
emotional support
British Association
for Counselling and
Psychotherapy (BACP)
BACP House, 15 St John’s
Business Park, Lutterworth,
Leicestershire LE17 4HB
Tel 01455 883 300
Email [email protected]
www.bacp.co.uk
Promotes awareness of
counselling and signposts
people to appropriate
services. You can search
for a qualified counsellor
at itsgoodtotalk.org.uk
Equipment and advice on
living with disability
Assist UK
Redbank House, 4 St Chad’s
Street, Manchester M8 8QA
Tel 0161 832 9757
Email
[email protected]
www.assist-uk.org
A UK-wide network of Disabled
Living Centres. Staff can give
advice about the products,
which are designed to make
life easier for people who have
difficulty with daily activities.
British Red Cross
UK Office, 44 Moorfields,
London EC2Y 9AL
Tel 0344 871 11 11
Email
[email protected]
www.redcross.org.uk
Offers a range of health and
social care services, such as
care in the home, a medical
equipment loan service and
a transport service.
Financial or legal advice
and information
Benefit Enquiry Line
Northern Ireland
Helpline 0800 220 674
(Mon–Wed and Fri, 9am–5pm,
Thu, 10am–5pm)
Textphone 028 9031 1092
www.nidirect.gov.uk/
money-tax-and-benefits
Provides information and advice
about disability benefits and
carers’ benefits.
Citizens Advice
Provides advice on a variety
of issues including financial,
legal, housing and employment
issues. Find details for your
local office in the phone book
or on one of these websites:
Further information 111
England and Wales
www.citizensadvice.org.uk
Scotland
www.cas.org.uk
Northern Ireland
www.citizensadvice.co.uk
You can also find advice online
in a range of languages at
www.citizensadvice.org.uk/
resources-and-tools/
languages
Department for Work
and Pensions (DWP)
Personal Independence
Payment Helpline
0345 850 3322
Textphone 0345 601 6677
Carer’s Allowance Unit
0345 608 4321
Textphone 0345 604 5312
www.gov.uk/
browse/benefits
Manages state benefits in
England, Scotland and Wales.
You can apply for benefits
and find information online
or through its helplines.
GOV.UK
www.gov.uk
Has information about social
security benefits and public
services in England, Scotland
and Wales.
Support for carers
Carers Trust
Email [email protected]
www.carers.org
Provides support, information,
advice and services for people
caring at home for a family
member or friend. You can
find details for UK offices
and search for local support
on the website.
Carers UK
Helpline (England, Scotland,
Wales) 0808 808 7777
(Mon–Fri, 10am–4pm)
Tel (Northern Ireland)
028 9043 9843
Email
[email protected]
www.carersuk.org
Offers information and
support to carers across the
UK. Can put people in contact
with support groups for carers
in their area.
112 Understanding cancer of the voicebox (larynx)
Support for older people
Age UK
Tavis House,
1–6 Tavistock Square,
London WC1H 9NA
Helpline (England and
Wales) 0800 169 2081
Helpline (Scotland)
0800 470 8090
Helpline (Northern Ireland)
0808 808 7575
(Daily, 8am–7pm)
www.ageuk.org.uk
Provides information and advice
for older people across the UK
via the website and advice line.
Also publishes impartial and
informative fact sheets and
advice guides.
You can search for more organisations on our
website at macmillan.org.uk/organisations
or call us on 0808 808 00 00.
Your notes
and questions
114 Understanding cancer of the voicebox (larynx)
Disclaimer
We make every effort to ensure that the information we provide is accurate and
up-to-date but it should not be relied upon as a substitute for specialist professional
advice tailored to your situation. So far as is permitted by law, Macmillan does not accept
liability in relation to the use of any information contained in this publication, or third-party
information or websites included or referred to in it. Some photos are of models.
Thanks
This booklet has been written, revised and edited by Macmillan Cancer Support’s
Cancer Information Development team. It has been approved by Dr Chris Alcock,
Consultant Clinical Oncologist and Macmillan Chief Medical Editor. With thanks to:
Dr Matthew Beasley, Consultant Clinical Oncologist; Daphne Carpenter, Macmillan
Speech and Language Therapist; Debbie Elliott, Head and Neck/Thyroid Clinical
Nurse Specialist; Mr Churunal Hari, Consultant ENT Head and Neck Surgeon;
Julia Pockett, Macmillan Speech and Language Specialist; the people affected by
cancer who reviewed this edition; and those who shared their stories.
Sources
We’ve listed a sample of the sources used in this booklet below. If you’d like
further information about the sources we use, email us at bookletfeedback@
macmillan.org.uk
British Association of Head and Neck Oncologists (BAHNO). BAHNO standards 2009.
Ear, Nose and Throat (ENT) UK. Head and neck cancer: multidisciplinary management
guidelines. 4th edition. 2011.
HSCIC (Health and Social Care Information Centre). National head and neck cancer
audit 2014.
National Institute for Health and Care Excellence (NICE). Improving outcomes in head
and neck cancers: evidence update. May 2012.
Society of Radiographers. Skin care advice for patients undergoing radical external
beam megavoltage radiotherapy. February 2015.
Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO clinical practice
guidelines 2010.
Tobias J, Hochhauser D. Cancer and its management. 2010. Wiley-Blackwell.
Can you do something to help?
We hope this booklet has been useful to you. It’s just one of our
many publications that are available free to anyone affected by
cancer. They’re produced by our cancer information specialists
who, along with our nurses, benefits advisers, campaigners and
volunteers, are part of the Macmillan team. When people are
facing the toughest fight of their lives, we’re there to support
them every step of the way.
We want to make sure no one has to go through cancer alone,
so we need more people to help us. When the time is right for you,
here are some ways in which you can become a part of our team.
5 ways
you can someone
hElP with
cAncer
Share your cancer experience
Support people living with cancer by telling your story,
online, in the media or face to face.
Campaign for change
We need your help to make sure everyone gets the right support.
Take an action, big or small, for better cancer care.
Help someone in your community
A lift to an appointment. Help with the shopping.
Or just a cup of tea and a chat. Could you lend a hand?
Raise money
Whatever you like doing you can raise money to help.
Take part in one of our events or create your own.
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Please cut out this form and return it in an envelope (no stamp required) to:
Supporter Donations, Macmillan Cancer Support, FREEPOST LON15851,
89 Albert Embankment, London SE1 7UQ 27530
More than one in three of us will get cancer.
For most of us it will be the toughest fight we
ever face. And the feelings of isolation and
loneliness that so many people experience
make it even harder. But you don’t have to
go through it alone. The Macmillan team
is with you every step of the way.
We are the nurses and therapists helping you
through treatment. The experts on the end of
the phone. The advisers telling you which benefits
you’re entitled to. The volunteers giving you a hand
with the everyday things. The campaigners improving
cancer care. The community there for you online,
any time. The supporters who make it all possible.
Together, we are all Macmillan Cancer Support.
For cancer support every step of the way,
call Macmillan on 0808 808 00 00
(Mon–Fri, 9am–8pm) or visit macmillan.org.uk
Hard of hearing? Use textphone
0808 808 0121, or Text Relay.
Non-English speaker? Interpreters available.
Braille and large print versions on request.
© Macmillan Cancer Support, June 2016. 10th edition. MAC11650.
Next planned review 2018. Macmillan Cancer Support, registered
charity in England and Wales (261017), Scotland (SC039907) and the
Isle of Man (604). Printed using sustainable material. Please recycle.