Condition & Treatment – Larynx cancer

Know about cancer larynx

  • 9th most common cancer in India (GLOBOCAN 2018)
  • More common in males as compared to females.
  • Strongly related to cigarette smoking.

Clinical signs and symptoms

  • Hoarse voice (or a change in your voice) that doesn’t go away after a few weeks
  • Throat or ear pain
  • A lump in your neck
  • Trouble breathing and swallowing
  • Late symptoms include weight loss, foul breath, Dysphagia and aspiration

Diagnostic work up

Physical Examination
  • Laryngeal mirror examination.
  • Neck examination for lymph nodes.
  • Flexible fibre optic endoscopes are used routinely to complement the laryngeal mirror examination.
  • The flexible fibre optic laryngoscope is inserted through the nose and is useful in more difficult cases.
Radiographic Studies

CT scan with contrast enhancement is the method of choice for studying the larynx
In addition to CT, MR maybe obtained to define subtle exolaryngeal spread or early cartilage destruction.

General
  • History
  • Physical examination
  • Indirect Laryngoscopy
  • Direct Laryngoscopy
  • Biopsies
Radiographic studies
  • Chest x-ray films
  • Computed tomography with contrast enhancement
  • Magnetic resonance imaging (to define subtle exolaryngeal spread or early cartilage destruction)

Treatment options

Three types of standard treatment are used:

  • Surgery: Surgery (removing the cancer in an operation) is a common treatment for all stages of laryngeal cancer. Minimally invasive larynx-preserving surgical techniques to treat patients with early laryngeal cancer include transoral laser microsurgery (TLM) and transoral robotic surgery (TORS).
  • Radiation therapy: Uses x-rays or other types of radiation to kill cancer cells or keep them from growing. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
  • Chemoradiotherapy: Combining radiation therapy with chemotherapy (usually Cisplatin used as radio sensitizer) may kill more tumor cells by making them more sensitive to Radiation therapy.
  • New types of treatment are being tested in clinical trials: Targeted therapy

Functional organ preservation- The aim of treatment

Functional organ preservation is widely recommended and generally utilizes a combination of chemotherapy plus radiation therapy (RT). However, advances in surgical techniques, such as laryngeal preservation surgery and minimally invasive surgery, offer alternative options for larynx preservation in carefully selected patients.

Side Effects

Almost all treatments for laryngeal cancer have side effects like change in voice, red, itchy skin, loss of taste, dry mouth, trouble swallowing and dental problems, if teeth are exposed during radiation.

Follow up

  • History and physical examination: Every one to three months during the first year, every two to four months during the second year, every four to six months during years 3 to 5, and annually after five years.
  • Imaging on follow up is usually done in presence of symptoms or findings on physical examination.
  • Serum thyroid-stimulating hormone (TSH) should be monitored every 6 to 12 months because of the high incidence of hypothyroidism
  • Dental cleaning and examination must be performed at least twice yearly.
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