Laryngeal cancer


Introduction

 

Laryngeal cancer is 2-4% of all cancers, and about 40% of head and neck cancers. In men, cancer of the larynx is located on the 4th place among all cancers, after lung cancer, stomach, prostate, and in women in the 27 position. The main risk factors for laryngeal cancer include smoking and alcohol consumption, especially of high-proof. It is believed that these two factors are responsible for over 90 % of cancers of the larynx. Smoking itself increases 30-times risk of developing cancer of the larynx, and at the same time smoking and drinking of high-proof alcohol – 330-times.

 

Symptoms

 

The predominant symptoms of laryngeal cancer include hoarseness, shortness of breath, pain when swallowing. They are dependent on the development of cancer and its stage. The early symptoms can be very discrete and similar to many acute and chronic diseases of the larynx. Even with the minor symptoms that do not subside after 2-3 weeks, despite proper treatment, the patient always need to be consulted at ENT Clinic. However, symptoms such as pain, thickening of the larynx, inspiratory dyspnea, enlarged firm lymph node in the neck, require immediate expertise evaluation.

 

Diagnostics

 

The final diagnosis of laryngeal cancer is based on the result of the histopathological examination of specimens taken during microdirectoscopy (direct laryngoscopy) which is usually performed under general anesthesia. Direct laryngoscopy (especially mikrodirectoscopy) allows the assessment of the location and extent of the tumor and biopsy for histopathological examination, as well as to visualize the structures of the larynx, which are difficult to assess during indirect laryngoscopy (watching in laryngeal mirror). In some cases, we carry out ultrasound examination, computed tomography, magnetic resonance imaging, positron emission tomography, bronchoscopy, ezofagoscopy.

 

Treatment

 

The main, independent, larynx cancer treatments are surgery and radiation therapy as a combination of treatment or as a complementary method to treat failures. Chemotherapy is not used as an independent method for the treatment of cancer of the larynx.

Before treatment, always take into account :

 

  • severity of the tumor,
  • histopathological examination,
  • general condition of the patient,
  • the patient's consent to the proposed treatment.

 

Early cancers of the larynx can be treated with surgery or radiotherapy. Large tumors of the larynx in most cases are treated surgically by complete removal of the larynx (total laryngectomy) usually followed by radiation therapy. Patients after total laryngectomy are deprived of the natural organ of speech which is the larynx. Only rehabilitation, so the hard work of the patient, phonatrician, speech therapist – provide an opportunity for the resumption of communication. There are the following techniques of voice and speech rehabilitation:

 

  • esophageal voice generation,
  • surgically formed broncho-esophageal fistula,
  • electronic artificial larynx (artificial larynx).

 

Each of these methods has its advantages and disadvantages, and indications and contraindications. After removal of the larynx ingestion and respiratory tracts are separated from each other permanently. Breathing is done by tracheostomy (derived and sewn trachea into the skin of a neck). There may be disturbances of smell and taste, sometimes chronic nose blockage. After surgery, complications may occur as bleeding, swelling of the face, wound infection, shortness of breath due to drying secretions in the airways and throat cutaneo-esophageal fistula.

 

Postoperative

 

In the first week after the operation compression bandage around the neck is assumed:

 

  1. Nutrition is done by esophageal tube,
  2. During surgery, silicone tracheostomy tube with a cuff is assumed into the trachea which on the second day is exchanged for a metal tracheotomy tube.
  3. In order to eliminate the drying of secretion in the respiratory tract, careful toilet of tracheostomy is performed, inhalations (5-6 times a day), tracheostomy tube suctioning
  4. Drainage of wound is held by 2-3 days, stitches are removed from the skin in 7-8 day after surgery, and form the trachea in 9-10 day.

 

To perform the operations it is required that each patient is familiar with aware consent form and signed it. Detailed information about the possible course of the operation, the chances of achieving aim of the surgery, postoperative care and the risk of complications may be obtained from your doctor and / or the head of the operating team and the course of anesthesia, from the anesthesiologist.

 

Follow-up

 

All patients being treated for cancer of the larynx are covered by systematic screening. Recommended follow-up dates are as follows:

 

  • every month in the first year after treatment
  • every two months during the second year after treatment
  • every three months to five years after treatment
  • every 6 months in the following years

 

The purpose of the follow-up is:

 

  • Examination for recurrence of the cancer,
  • Examination for lymph node metastases,
  • Examination for the existence of a second outbreak of cancer.

 

Prognosis

 

Forecasting in laryngeal cancer is relatively good. The prognosis depends on the location of the tumor, the stage, the coexistence of metastatic regional lymph nodes and/or distant metastases, the general condition of the patient and the coexistence of other diseases.

Diagnosed and treated  laryngeal cancer at its early stage gives a high percentage of cures.

 

Anthony Bruzgielewicz MD