What is Larynx Cancer?
Laryngeal cancer is a type of cancer that affects the larynx (voice box).
The larynx is part of the throat found at the entrance of the windpipe (trachea). It plays an important
role in helping you breathe and speak.
Symptoms of Larynx Cancer include:
- A change in your voice, such as sounding hoarse
- Pain when swallowing or difficulty swallowing
- A lump or swelling in your neck
- A long-lasting cough
- A persistent sore throat or earache
- Difficulty breathing, breathlessness, a high-pitched wheezing noise when breathing
Larynx Cancer can start:
- Above the vocal cords (supraglottis)
- On the vocal cords (glottis)
- Below the vocal cords (subglottis)
There are two stages of Laryngeal Cancer; T stage 1 and T stage 2.
The T stage refers to how far your cancer has spread within the larynx and surrounding tissue.
T stage 1
T stage 1 means both of the following:
The tumour is only in one part of the larynx
The vocal cords are able to move normally
T stage 2
T stage 2 means the cancer has grown into another part of the larynx. It may have started on the
vocal cords (glottis), above the vocal cords (supraglottis) or below the vocal cords (subglottis)
Surgical Approach for Larynx Cancer:
Cancers are the biggest catastrophes which mankind is facing and surgery has always intimidated patients as well as caregivers thus becoming a matter of hurdle in itself. In recent past India has seen rapid growth in the cases of cancer as well as Head and neck cancer which is most common of all the types. With rapid advancement in medical technology, Surgery is emerging as one of the successful and safe treatment options of throat cancer. Trans-oral surgery is an approach to treat laryngeal Cancer with precision and minimal thermal damage to the vocal cords. Over past certain years,Trans-Oral surgery has become an integral part of the treatment paradigm for patients with laryngeal cancer. It is one of the primary treatment options for early-stage laryngeal tumours. Microscopic CO2 laser resection is extensively being used because of excellent oncologic and functional results. The most basic form of a CO2 laser consists of a gas discharge with a total reflector at one end, and an output coupler (a partially reflecting mirror) at the output end. CO2 lasers are the best suited for soft tissue procedures . Advantages include microscopic pre less bleeding, shorter surgery time, less risk of infection, and less post-op swelling.
When to opt for CO2 laser surgery:
The most widely accepted indication for transoral CO2 laser resection of laryngeal/hypo pharyngeal cancer is an early cancer with freely mobile vocal cords, no gross invasion of the para-glottis or the pre-epiglottis spaces and good exposure on suspension laryngoscopy.
The surgeon uses a microscope to visualize the diseased tissue and precisely cuts it out using a designated CO2 laser surgical tool. The resection is performed trans-orally using a suspension laryngoscope and an operating microscope which is coupled with the CO2 laser. An ortracheal tube is used for general anaesthesia. Proper exposure of the lesion is vital to ensure an adequate excision with oncologically safe margins. The laser beam is now focused accurately to a spot-size and manipulated with the help of a micromanipulator to permit precise excision in a relatively bloodless field. For a small lesion that can be visualized in its entirety, Monobloc resection is performed by cutting through normal tissue at the margins of the tumour. A larger lesion is excised in multiple segments as determined by the field of exposure. This method of cutting through tumour tissue, though unconventional in open surgery is the recommended technique. The resection is completed segment by segment; as the tumour is excised in wedges till the supple normal tissue is left behind. The CO2 laser is an excellent cutting tool with limited capability for coagulation. Minor ooze is controlled either with a defocused laser beam or with a cotton soaked in1:100,000 adrenaline solution.
Preservation of speech, swallowing and breathing functions.
- Reduced swelling and a lower risk of infection compared to invasive surgery
- Faster and easier recovery with a rapid return to work and day-to- day tasks
- Improvement in overall quality of life
- A lower risk of side effects, compared to invasive surgery
- Treatment can be repeated and other options remain open in case of incomplete elimination of cancer
- Patients suffer little morbidity, allowing for short hospitalizations.
Patient has to come for regular 3 monthly follow up with fiberoptic laryngoscopic examination.
Figure 1 - Lesion in the Right Vocal Cord
Figure 2- After Resection
Figure 3 - After 1 Year RT Vocal Cord has Healed
CASE – 56 year old gentlemen who was a smoker had hoarseness of voice since 3 months in 2012 underwent endoscopic examination and biopsy . It was diagnosed as early right vocal cord cancer Underwent radiation therapy as treatment , was fine for 4 years ,again developed change in voice
In 2016 was diagnosed was diagnosed recurrent lesion in the right vocal cord as seen in the picture od endoscopic examination and ctscan showed no spread . The was stage1 early cancer, was told to undergo total laryngectomy (operation for removal of full larynx-voice box) but it was early cancer so was managed by us by TRANSORAL ENDOSCOPIC LASER RESECTION , as seen in the 2nd picture.
He is free of disease and comes for regular check up, Another patient , please link to my https://youtu.be/EItfCv2hl6g?t=1 case of cancer of right vocal cord after laser surgery