LARYNGEAL CANCER TREATMENT IN GERMANY

Laryngeal cancer. In 90% of cases, laryngeal cancer is diagnosed as squamous cell carcinoma. The risk factors for this disease are: smoking, alcohol abuse, low socio-economic status of those affected, male sex and age > 60 years. Early diagnosis of laryngeal cancer is possible with tumours of the vocal cords, an early symptom of which is hoarseness. However, tumours located above and below the vocal cords often present at a fairly late stage, as they can remain asymptomatic for a long time. The diagnosis is made on the basis of laryngoscopy and tissue biopsy. Treatment of early-stage laryngeal cancer consists of radiotherapy and surgical removal of the tumour. At advanced stages of the tumour process, chemotherapy and radiotherapy are used more often. Surgery is used only for palliative purposes. After a total laryngectomy (complete removal of the larynx), voice restoration measures are carried out.

Several types of pharyngeal and laryngeal cancer are distinguished depending on the location and type of the tumour:

• nasopharyngeal cancer;

• oropharyngeal cancer;

• cancer of the vocal cords.

A localised tumour is diagnosed in 60% of patients; in 25% metastases are detected in the course of the tumour process, and in 15% of cases, with progressive disease, both regional and distant metastases may be found. Metastases to the lymph nodes are observed more often with supraglottic and subglottic tumours than with glottic cancer. Distant metastases are most often found in the lungs and the liver.

The most common locations are the true vocal folds (the glottis) and the supraglottic space. Cancer is least often located in the subglottic space (1%). Verrucous carcinoma is a rare form of squamous cell cancer, most often located in the area of the glottis, and it has a more favourable prognosis compared with squamous cell carcinoma.

Symptoms of laryngeal cancer

• hoarseness of the voice (when the carcinoma is located on the vocal folds);

• airway obstruction (in patients with subglottic cancer);

• dysphagia (swallowing difficulties in patients with supraglottic cancer);

• pain on swallowing;

• long-lasting ulcers (sores) in the oral cavity;

• long-lasting red or white patches on the mucous membrane of the oral cavity or the pharynx;

• otalgia (pain in one or both ears);

• development of a tumour (swelling) in the neck area;

• a muffled voice.

As the disease progresses, the process involves the cervical lymph nodes. Lymph node enlargement lasting 3-4 weeks — a reason to see a doctor.

Treatment of laryngeal cancer

• at early stages (T1 and T2): surgery or radiotherapy;

• at moderately advanced stages (T3): radiotherapy and, in some cases, chemotherapy;

• at advanced stages (T4): radiotherapy and, in some cases, chemotherapy.

According to the statistics, laser resection, radiotherapy or open laryngeal surgery performed at early stages achieves 5-year survival in 85–95% of cases. Endoscopic laser resection and irradiation make it possible to preserve the patient's voice. Whether surgery or radiotherapy is used to treat early-stage laryngeal cancer depends on the recommendations of the doctors at the treating institution.

At advanced stages of vocal fold carcinoma, chemotherapy or radiotherapy is indicated. If the patient's tumour has spread beyond the larynx or has invaded cartilage tissue, extensive laryngectomy (removal of the larynx) provides the best results; in individual cases, endoscopic laser resection of the tumour or open partial laryngectomy may be used. Extensive laryngectomy is also used in difficult situations to save the patient's life.

At early stages of carcinoma of the supraglottic part of the larynx, radiotherapy or partial resection of the larynx are the most effective. The use of laser resection at early stages of squamous cell carcinoma also shows quite good results. If the patient's vocal cords are affected as well, a laryngectomy above the cartilage or a total laryngectomy is required. Most advanced stages of supraglottic cancer are initially treated with chemotherapy and radiotherapy.

For carcinoma of the lower part of the pharynx, treatment is the same as for laryngeal cancer. At early stages, the lesions are usually treated with radiotherapy alone, or with endoscopic resection as an alternative. However, in most patients with hypopharyngeal cancer, progression is associated with the asymptomatic nature of the disease and frequent local spread through the lymphatic system; such patients are treated mainly with chemotherapy and radiotherapy, and surgically — for life-saving indications.

Rehabilitation in laryngeal cancer

Rehabilitation may be required after any type of treatment. Usually the most serious difficulties with swallowing food arise after chemotherapy or radiotherapy; if narrowing (stenosis) develops, balloon dilation of the oesophagus can make swallowing easier, and in more severe cases – pharyngeal reconstruction or the placement of a gastrostomy. If surgery impairs swallowing, the swallowing passages may need to be widened. In addition, surgery has a stronger effect on voice function. After a total laryngectomy, the patient needs a new voice to be created by means of:

• oesophageal speech;

• a tracheo-oesophageal puncture;

• an electronic larynx (electrolarynx).