ENT oncology - Laryngeal cancer
ENT oncology - Laryngeal cancer
Laryngeal cancer is the most common oncology of ENT organs. One of the earliest signs is a change in voice (dysphonia).

Audio diagnostics allow us to note that about 55% of tumors are local, 30% are locally distributed (involving lymph nodes), 15% are metastatic (usually with metastases in the lungs).
Most cancers of the larynx are squamous cell carcinoma.

Risk factors are smoking and drinking. The most frequent localization of the tumor is directly to the pharynx (vocal cords).

Anatomical boundaries of the larynx: laryngeal pharynx - incidence of cancer: 35% epiglottis, aryepiglottic fold, arytenoids, ventricles of Morgagni, false vocal cords.

Pharyngeal larynx: incidence of cancer - 65%. Vocal cords, anterior commissure, posterior commissure.

Subpharyngeal larynx: incidence of cancer - 1%. From 0.5 cm under the vocal cords to the first ring of the trachea.

Metastases in the cervical lymph nodes are usually found in most diagnosed patients.
The results of an additional examination are required: CT of the cervicothoracic section with iodine contrast injection.
Panendoscopy of the upper digestive tract and pulmonary fibroscopy are performed under general anesthesia.
A biopsy of the primary tumor and / or aspiration with a thin needle of one of the suspected lymph nodes confirms or refutes the alleged diagnosis.
A dental examination of the oral cavity is also carried out with extreme caution.

The patient is invited to be accompanied by a nutritionist, because patients often experience a change in general condition with severe weight loss. Surgical treatment is suggested if the tumor is operable. There are different types of partial laryngectomy. Endoscopic laser surgery or cordial stripping for T1 tumors.
A cordectomy can also be proposed; there are various surgical methods for this surgery.
Radiosurgery can be offered in the case of a small tumor (T1, T2 glottis, not affecting the subglottic level), without involvement of the lymph nodes, which allows excellent local tumor control, and most importantly with the preservation of the voice. Radiotherapy can be carried out according to the scheme of 20 sessions in hypofractional mode or in 33 or 35 sessions of normal fractionated mode.

Irradiation of the lymph nodes is considered depending on the size of the tumor, lesions of various structures of the larynx and the presence of affected lymph nodes. Typically, pharyngeal laryngeal cancer does not have a lymphatic drainage mechanism.

In the case of a tumor in the pharyngeal larynx or a clear expansion of the tumor in the direction of the pharyngeal larynx, irradiation of the regions of the lymph nodes is carried out.
For stage III laryngeal cancer, induction chemotherapy using the TPF protocol is performed, docetaxel-cisplatin-fluorouracil followed by radiotherapy showed a survival of 2 years, under the condition of general laryngectomy, followed by adjuvant radiation therapy.

If this scheme works, then chemotherapy is carried out with an assessment of the therapeutic response and if the answer is favorable, then radiation therapy - chemotherapy - a protocol for preserving the larynx follows. That is, work and evaluation are being carried out for the possible conservation of the organ. In the event of an adverse therapeutic response to induction chemotherapy and in the absence of vocal cord mobility, a complete laryngectomy operation is performed. In fact, in the case of a non-functional larynx (immobility of the vocal cords), surgical treatment will be preferable, but it will be necessary to protect the airways from further ingestion of food!

If a surgery like total laryngectomy with bilateral removal of the lymph nodes is proposed, adjuvant radiotherapy (after the surgery) is performed in a total dose of 66 Gy in the operated area (where the tumor was located) in 33 sessions of 2 Gy and a dose of 45 to 50 Gy for lymph nodes and draining areas of the tumor. Cisplatin (100 mg / m2) every 3 weeks is chemotherapy, which is taken simultaneously with radiotherapy sessions, this is suggested in the case of positive edges of surgical resection or if there is an extracapsular rupture on the lymph nodes.

Unlike progressive lesions of the oropharynx, surgery to excise progressive tumor lesions of the larynx is required to maintain respiratory and swallowing functions, especially in the case of immobility of the vocal cords. General laryngectomy with bilateral excision of the cervical lymph nodes is usually performed with adjuvant radiotherapy, more or less in conjunction with chemotherapy.
 
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