Tumors of The Larynx
Cancers of the Voice Box (larynx)
The larynx is important for many reasons. Speech, swallowing and breathing are its most important functions. Benign and malignant tumors of the larynx destroy the lining, deep muscle tissue and cartilage and no matter what the treatment is we cannot undo that. But most patients can still be very functional. Benign tumors are usually excised with surgery. Some rare tumors may occasionally be observed and followed closely in certain select patients. For cancers, the most common is squamous cell carcinoma. As for all squamous cell carcinomas, radiation and surgery are the treatment modalities that have the potential to cure them. Chemotherapy may help radiation work better in advanced cancers or non-surgical candidates. Squamous cell carcinoma of the larynx is potentially curable in many cases as long as it has not spread outside the head and neck region. We perform imaging (PET scan, CT, MRI) to determine if it has.
Generally, cancers involving larynx are usually treated with chemotherapy and radiation and surgery is reserved only for cases where it does not work. The reason for this is the cure rate is equivalent but the expected side effects of chemoradiation are better than those of surgery for cancers at this site. Surgery is reserved for large obstructing cancers, those with cartilage destruction and radiation failures. Radiation therapy is generally given daily as on outpatient five days a week for 6-8 weeks (exact amount determined by radiation oncology). Chemotherapy, if given, is done intermittently again on an outpatient basis. Surgery focuses on two things equally: removing the cancer and reconstruction. Once the cancer is removed, we then focus on reconstruction. You must have separation of the throat (contains food, saliva, bacteria) from the sterile deep underlying neck tissues. We try to close the lining tissues on itself but, if there is not enough tissue then, depending on how much tissue is needed, we will bring in tissue (a transplant where tissue with its blood supply is brought into the head and neck to provide healthy tissue with a blood supply) from somewhere else in the body. The site of the tissue transplanted depends on the volume needed and could be from the forearm, chest wall, back skin or thigh skin. Generally, it is necessary to remove some lymph nodes from the neck (neck dissection) due to risk of spread to this area.
The cure rate obviously will improve as the cancer is picked up earlier. Immunotherapy has had an increasing but not perfectly well-defined role as an adjunctive treatment. Most patients are able, once healed, to eat by mouth and speak. Speaking is usually done with speaking valves (TEP, trachea esophageal prosthesis).