Living With a Stoma After Throat Cancer

The larynx, or voice box, is the structure in the throat through which air passes on the way to and from the lungs. Air passing out over the vocal cords allows us to speak, and a part of the larynx called the epiglottis closes off the airway when we swallow to prevent choking. In some types ofthroat cancer, if the larynx is not functioning, an opening in the front of the neck is made to let air get to the lungs. This opening is called astoma, and the surgical procedure to make the opening is called atracheostomy.

"Tracheostomy is usually performed when there is concern about difficulty breathing due to airway obstruction associated with a throat cancer or treatment side effects," says Scott McLean, MD, director of thehead and neck cancerprogram at Henry Ford Hospital in Detroit. "Radiation and chemotherapy can cause swelling. Usually this is due to cancer of the voice box or the area just above the voice box and is only needed for advanced tumors."

Living with a Temporary Stoma

"Early after placement of a stoma, there is a small risk of bleeding or infection," explains Dr. McLean. "Patients will require frequent suctioning to clear secretions from the tracheostomy site. They will need to learn how to keep the small tracheostomy tube that keeps the stoma open clean and secure. Once the cancer has been treated, many patients will be able to have the tracheostomy removed. The tube is simply removed and the stoma heals without the need for surgery."

Stoma: Advice for Long-Term Issues

In cases where the larynx has been removed or is too damaged from treatment, a permanent stoma is needed. Speech and other functions will be affected.

"Simple things like not being able to blow my nose or blow out birthday candles bother me most," says George Huck of Royal Oak, Mich., who has lived with a stoma for 10 years. He advises anyone who is going to live with a stoma to carry a card that explains they are a neck breather. "Most paramedics and ER rooms don't see very many neck breathers, and if you should need an oxygen mask they want to put it over your nose or mouth," Huck says.

These ideas will make the adjustment easier to manage:

• Work with a speech specialist.Melissa Witsil, a speech and language pathologist at Beaumont Health Center in Royal Oak, works with stoma patients. "It takes many sessions to teach a person with a stoma to speak again. One option is called esophagealspeech. Air is swallowed and then used to form words in the mouth. This is hard to learn and not everyone is successful," Witsil says. "A newer option is called tracheoesophageal speech, where a puncture is made between the windpipe and the esophagus to get air into the mouth. Most of the people I work with try this option. Another option is an artificial larynx, which is held against the side of the neck and gives understandable but mechanical-sounding speech."

  Huck says: "When I was waiting for my puncture to heal, I used an artificial larynx. It only took me a couple of days to learn to talk once the puncture was ready."

• Learn how to replace the role your nose played.Air breathed through a stoma bypasses the nose, which has several jobs. In addition to giving you the sense of smell, the nose moisturizes and filters air before it gets to the lungs. "You have to learn to protect your stoma with stoma filters. This keeps moisture in the lungs and filters out dust and debris," says Witsil. She also recommends the use of a humidifier in the winter and says there are techniques that can be learned during speech therapy to gain some sense of smell.
• 保护气孔。通常保护airw的喉ay from food or liquid when you swallow. If you have a stoma, you need to be careful to keep water and small particles away from it. "Everyone is familiar with the anecdote of a person with a stoma drowning in the shower. Although I have never heard of it really happening, it does bring up the importance of being really careful when bathing. If you have a stoma, some types of activities, like boating or fishing, can be risky," notes Witsil. Also, you can't hold your breath with a stoma, so avoid straining to lift heavy objects.
• Join a support group."There are some excellent support groups for people living with a stoma. You should think about joining one in person or online. I’m always amazed at how well people adjust to living with a stoma," says Witsil.

Though living with a stoma will take getting used to, Witsil tells her patients to stay positive. "My advice is to resume your hobbies and work activities. Most activities can be adapted for a person with a stoma. Live life!" she says.

"Someone just starting out will have to get used to it, but they can still live a normal, productive life," adds Huck.