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Other Cancer Surgeries

Some head and neck cancer patients will need surgery to help with breathing and swallowing. If a tumor hurts your loved one’s ability to breathe or eat, or if the cancer removal surgery or recovery causes temporary or permanent difficulties, a feeding tube or a tracheotomy may be needed.

Feeding tubes

A feeding tube is a tube that enters the stomach, replacing the mouth to deliver nutrition. The decision to insert a feeding tube is not taken lightly. It is important to know that a feeding tube is temporary in many cases. Once your loved one is through with treatment and starts eating enough by mouth, the tube can easily be removed in the office without any surgery.

Feeding tubes would be recommended because:

  • Tumor blocks swallowing: If a tumor in the throat or esophagus is preventing your loved one from getting enough nutrition by mouth, the doctors might recommend a feeding tube. Your loved one needs to be as healthy as possible to go through surgery and treatment, and getting enough nutrition is important.
  • Side effects of treatment: Some side effects of chemotherapy and radiation that might require a feeding tube placed include strictures as well as mucositis and pain with swallowing.
  • Aspiration: When eating by mouth, if some food and/or liquids cause a cough or enter the lungs, there is a risk of developing aspiration pneumonia—infection in the lungs. A feeding tube will help stop the chance of aspiration and may be temporary, or permanent if the reason for aspiration does not get better.
  • After surgery: After a surgery in the mouth and/or throat, the surgeon will want to make sure the patient does not eat or drink anything by mouth until everything heals. There is a risk of saliva and liquids leaking out into the neck and causing an infection after surgery, and eating by mouth increases that risk. To get nutrition as the wounds heal, a feeding tube may be placed.

There are several types of feeding tubes.

  • Nasogastric feeding tube (NG Tube):

This is a long, thin tube placed through one nostril, into the throat and esophagus and passed down into the stomach. This type of tube is typically used right after surgery when a feeding tube might be needed for only one or two weeks until the surgeon says it is clear to take food and liquids by mouth. It can stay in longer, but it is a little more uncomfortable and cannot be hidden like a gastric feeding tube.

  • Gastric feeding tube (G-tube):

This type of tube is placed directly through the abdominal wall into the stomach. It is typically used if your loved one will need a feeding tube for more than two or three weeks. In some cases, the doctor might approve eating a little by mouth but might require the use of the gastric tube for additional nutritional intake. A few days after it is first placed, it becomes less uncomfortable and can be hidden underneath clothes.

  • Jejunal feeding tube (J-tube)

A jejunal feeding tube (J-tube) is basically the same as a G-tube, but instead of placing a hole in the wall of the stomach, the opening is made in the second part of the small bowel called the jejunum. With a J-tube, your loved one cannot have large amounts of tube feeds at once (bolus tube feeds). This means the patient will be connected to a pump providing tube feeds over time instead of just loading up four times a day.

Risks of feeding tube

As with any procedure, there are risks to placing a feeding tube, but the risks associated with nasogastric tubes are low.

Tracheotomy

A tracheotomy is a tube placed directly into the windpipe, or trachea, through the neck to help with breathing as well as suctioning and cleaning the lungs.

In head and neck cancers, a tracheotomy might be done because:

  • Upper airway obstruction: If breathing is blocked by a large tumor or swelling in the mouth and/or throat, your loved one might require a tracheotomy so air can bypass that tumor by going directly into the lungs through the opening in the neck. This is reversible and can easily be taken out once the obstruction is treated.
  • Cleaning the lungs: Some people have a lot of mucous in their lungs, possibly from aspiration, or are too weak to effectively cough and clear their lungs of mucous and infection. In this case, a tracheotomy would clear out the lungs and keep them clean.
  • Prolonged oral intubation: If a breathing tube is needed for a long period (more than a week), the doctors might recommend changing from a breathing tube placed through the mouth and into the trachea to a tracheotomy tube. A tracheotomy tube is more comfortable, and it avoids the problems of a tube sitting in the voice box for a long time.

There is a bit of a difference between a tracheotomy and a tracheostomy. A tracheotomy is a hole through the skin and into the trachea where a tube is passed. The tracheotomy is completely and easily reversible. The tracheostomy is reversible depending on why it is done. After removing the larynx, there is no connection between the mouth and the lungs. Breathing is done completely through the tracheostomy via the neck, and this is not reversible.

Is the tracheotomy tube removable?

Yes. A tracheotomy is temporary, and the tube can be taken out when the time is right. A tracheostomy following a total laryngectomy cannot be reversed. When the doctor says it is time to have the tracheotomy tube removed, a fairly quick process, the hole in the neck is covered and should close within days. Your loved one will need to keep a finger over the hole any time to speak or cough to help the hole heal more quickly.

Can a person speak with a tracheotomy tube in place?

People often ask if it is possible to speak with a tracheotomy tube. The answer is yes. The doctors will put a tube into the airway small enough for air to get around the edges, up through the vocal cords and out of the mouth for your loved one to speak with a tracheotomy tube in place. In order for your loved one to speak, the opening on the tracheotomy tube must be closed off, so your loved one will put a finger or a cap over the opening to speak.

Caring for the tracheotomy

The tracheotomy tube needs to be kept clean. This stops it from getting blocked and might prevent infections. In most cases, your loved one will go home with a suction machine that helps keep the tube clear, and his or her caretaker will be shown how to use it.

Humidified (moist) air is important when breathing through a tracheotomy tube. This normally happens as air passes through the nose and throat on its way down to the trachea and lungs. Because a tracheotomy tube goes around those structures, it is important to have a humidifier in the home.

Risks of a tracheotomy

In any procedure, there are risks. Risks of bleeding and infection are always present. Bleeding can be caused by many factors, such as a little irritation along the wall of the trachea or a hole in a major blood vessel that runs just in front of the trachea. The risk of the tube getting clogged can be devastating if your loved one requires the tube to breathe due to an upper obstruction.