Laryngeal cancer continues to kill nearly 4,000 people per year in the United States, despite stricter bans on smoking, increased public awareness, and improved treatment modalities. In India head and neck cancer is among the most common cancers seen and laryngeal cancer constitutes a large proportion of these. The ultimate goal of every clinician treating laryngeal cancer is total removal of the tumour with maintenance of function i.e. voice and swallowing. Most early glottic and supraglottic cancers can easily be treated without affecting speech. The options for treatment in early stage larynx cancer are conservative voice preserving surgery or radiation therapy.
Advances in partial laryngeal surgery, which includes near-total, subtotal, extended partial laryngectomy and endoscopic resection of tumour, can remove the cancerous tissue without overly aggressive resection of the larynx and pharynx, thereby maintaining voice. This concept of removing the cancerous tissue while retaining functionality of the phonatory mechanism is the driving force behind conservational laryngeal surgery. The advantage of surgery over radiotherapy is that many of the patients of head and neck cancers are at risk to develop a second primary in the head and neck area. So radiotherapy can be kept as a reserve for treating any new malignancies that may arise in a given patient. The other advantage is patient will be spared some of the side effects of radiotherapy like mucositis, xerostomia etc., which can be very troublesome and effect the quality of life.
The case is a 60 year old man who came to Dharamshila Hospital and Research Centre with change in voice and throat irritation of 3 months duration. Flexible Direct Laryngoscopy revealed a growth in the epiglottis measuring 3×2 cms. The vallecula was free of tumour. CT scan Neck revealed a mass in the epiglottis with no extension of the growth into the preepiglottic space .Biopsy done was diagnosed at a moderately differentiated squamous cell carcinoma. Chest X ray was normal. His pulmonary function tests were normal which is a perquisite for voice conserving surgery. Both option of surgery and radiotherapy were given to the patient and the advantages and disadvantages of each mode of therapy were explained to him in detail. The patient chose to have surgery provided his voice could be preserved. Voice preserving Supraglottic laryngectomy was planned.
His tumor was removed with negative margins which were confirmed on frozen sections. Patient’s hyoid bone, preepiglottis space, epiglottis, upper half of thyroid cartilage (Fig. I) were excised as a part of the supraglottic laryngectomy and a bilateral neck dissection was performed .The pharyngeal defect was reconstructed using a base of tongue flap. During this procedure care was taken to preserve the superior laryngeal nerve. Histology revealed a moderately differentiated squamous cell carcinoma 3.5x3cm (Fig. II), all margins were free of tumour and dissected lymph nodes were negative. Patient was decannulated after 15 days On the last follow up visit (11 months after surgery) he has no locoregional evidence of disease and has a normal voice and speech. Therefore, we feel that conservative laryngeal surgery is a valid option for early and advanced laryngeal cancers with good oncological outcome provided surgeons with adequate expertise are available, like they are at Dharamshila Hospital.
DR.MUDIT AGARWAL
MS, MRCS(UK), MCh., UICC Fellow,
CONSULTANT SURGICAL ONCOLOGIST
DR. NOOPUR GUPTA
MBBS, DNB (Pathology)
Senior Resident
