After a Laryngectomy

A laryngectomy is a major surgery. It takes many months for recovery and a future life with serious challenges – finding a new way of speaking and managing a neck stoma. 
Many laryngectomees benefit from a clear goal such as getting back to work or developing the ability to continue key aspects of their life despite the changes after surgery. Fred’s passion was cycling, here is how he coped as he worked to return to what was his “normal”

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When I was initially diagnosed with cancer of the larynx I was treated with Radiotherapy at the Royal Berks hospital.  I decided that once I was recovered, I would try climbing Mount Teide in Tenerife.  It proved to be quite a challenge, but I did achieve the goal.

Unfortunately, the cancer returned and the team at the Royal Berks referred me to Professor Winter at the Churchill in Oxford.  Professor Winter asked what was important to me.  Amongst other things I talked about my passion for cycling.  He thought it would be worthwhile attempting a partial laryngectomy which, if successful, would enable me to return to cycling at a similar level to before.  A full laryngectomy would affect the volume of air I could process and my diaphragm would be weaker so power to the legs would be reduced.  That would particularly affect me going uphill.

In the end, the radiotherapy had done so much damage to the tissue that the partial laryngectomy kept leaking.  Eventually, we opted for a full laryngectomy.

It took quite a while to recover from the surgery, I had been in and out of hospital for three months.  When I first got on the bike, on my turbo trainer, the amount of power I could produce was pitiful.  I kept persevering and power output gradually increased.  Some cycling buddies accompanied me on my first ventures out on the road.  It was just so good to be out in the fresh air riding again!

As I got stronger, I started riding with my cycling club with the retired riders group.  I could generally keep up on the flat, but not on the hills, I still struggle on the hills.  We regroup at the top of a climb which allows stragglers to catch up.

I had an opportunity to go to Italy on an organised and supported trip to climb the mountains which the Giro d’italia often climbs in northern Italy.  I just love the mountains, nothing quite like it, the challenge, the amazing views, the sense of achievement at the summit and of course the reward of the descent.  We climbed the iconic climbs of the Passo dell Stelvio at 2758m the second highest paved pass in the alps, the Gavia 2621m, Col Du Petit Saint Bernard, 2188m etc.

It is important to recognise your limits when you have had a laryngectomy.  The other riders did two big climbs a day, to my one.  They will be riding hard but within themselves whilst I was at my maximum.  That takes more recovery, which is why  I only did 1 climb a day.  That was a very rewarding holiday.

Since then, I have been on two trips to Puerto Polliensa in Majorca with my cycling club, Reading CC.  It is quite a mixed ability group but there were enough of us so that there was a suitable group to ride with each day.  On the flat it was fine, but as usual I couldn’t keep up on the climbs.  I used to worry about spoiling my clubmates’ rides by them having to wait at the top of a climb, or when I have to stop to clear my stoma.  In fact, they are very supportive and appreciative of the fact that I am still riding.

It’s not all a bed of roses, when I’m cycling I find it difficult to talk, I can hear the chatter in the peloton which I can’t join in. At the lunch stop It’s not easy to talk whilst eating ( I did have a pharyngeal pouch which may be the reason)  and it takes time to recover.

I try and live the same life as I did before cancer, go out socially, take part in my chosen sport of cycling and talk to anyone who wants to know about living with a laryngectomy.  When I meet new people, I generally explain about my need to periodically clear my secretions, when cycling, I have to do this at the side of the road, so they know what to expect.  It is no good being embarrassed about our disability or its side effects.  We have to live and enjoy life to the full.

 

 

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AI and Larynx Cancer

Every year around 2400 people are diagnosed with cancer of the larynx. Fortunately, on a small fraction of these patients will need to have their larynx surgically removed with a laryngectomy. Treatment decisions after diagnosis have a crucial effect on progression of the disease.

Mr Amar Rajgor is a Registrar at Newcastle’s Freeman Hospital and a NIHR Doctoral Research Fellow in Ear Nose and Throat Surgery. He is carrying out research to improve the treatment of larynx cancer. Artificial Intelligence is being used to analyse scans such as CT scans. Cutting-edge software examines the images looking for patterns that cannot be seen by the naked eye and this sort of analysis of images is called radiomics.

Mr Rajgor said “Radiomics can be seen as a super-powered magnifying glass for medical images, like CT scans. It carefully examines every tiny detail, even the ones that are hard to see. By doing this, it can find patterns and irregularities that cannot be seen by a human or might otherwise be missed.”

The analysis can reveal markers that indicate the likely progression of the disease and provide better indicators than the conventional ones, such as age and the stage of the tumour.

Mr Rajgor added: “These developments are very exciting, as this research could play a big role in guiding treatment and delivering precision medicine in the future. It could ensure that patients get the right treatment for them, based on what their tumour looks like and how it behaves. I hope this will also help patients make more informed decisions about their treatment journey.

“Another positive is that this method does not change the patient pathway but enhances it, by analysing medical images in a way that cannot be done by a human. Currently, much of the information from scans is not being fully utilized, but this allows us to unlock its full potential.”

Mr Rajgor’s work has recently been published in the journal of Laryngology and Otology.

( With thanks to the Newcastle Chronicle )