The traditional larynx cancer treatment, the sixth most frequent on males, has been surgical and not much more than 40 years ago it consisted in the total resection of the larynx.
Nowadays this therapy is practised less regularly and is usually replaced by other surgical techniques that respect the organ of the respiratory system and the vocal apparatus and its functions.
- Transoral con microtransoral resection by microendoscopy assisted by a CO2 laser
One of these surgical alternatives is a transoral resection by microendoscopy assisted by a CO2 laser, a cost-effective technique with small tumours in early stages (since the patients only stay one day at the hospital) compared to radiotherapy, which causes side effects on the oral cavity and the larynx. With this technique the probabilities of success are of the 95%.
When the tumour is more advanced it is a reliable alternative to radical open surgeries like laryngectomy and total laryngectomy. Patients have a better life quality since the tracheotomy is avoided.
In those cases treated with microsurgery the results and survival are very good, just as or better than those of other procedures based on total laryngectomy or massive radiotherapy and chemotherapy (which often lead to surgery and a total laryngectomy).
Withal, conventional surgery is still needed in some circumstances and, although total laryngectomies are not as used now as they were, they still have to be performed in some cases.
The first two or three years are very important. If within this time there is no local recurrence, approximately 90% of the patients will be recovered. Nevertheless, a long-term control must take place, since even though the tumour might be completely removed there is still a chance of recurrence or of formation of a second primary tumour.
It consists on the use of drugs to destroy tumoral cells. Such drugs can be administrated orally, intramuscularly or intravenously. This therapy can be used in 3 different ways:
- As an induction treatment to reduce the size of the tumour and thus making it accessible through surgery and/or radiotherapy.
- Chemo-radiotherapy: used alongside with radiotherapy to kindle the radiosensitivity.
- Palliatively, stopping the growth of the tumour already radiated and inextirpable or extended to other organs.
It consists on using high energy radiation to destroy the tumours. It can be used in 3 different ways:
- Alone as first treatment.
- Combined with chemotherapy
- As a complement to surgery, usually combined with chemotherapy. It increases the possibilities of recovery since it prevents the microscopic presence of the illness in the surrounding tissues.
- Open surgery
Traditional surgery. It removes the tumour and the surrounding portion of healthy tissue by means of different surgical techniques:
- Cordeoctomy: Removal of the affected vocal cord. It requires temporal tracheotomy.
- Hemilaryngectomy or partial laryngectomy: Part of the larynx is removed. Requires temporal tracheotomy.
- Total laryngectomy: total removal of the larynx.
- Total pharyngolaryngectomy: total removal of the larynx and pharynx.
The last two procedures suppose a permanent tracheotomy. The patient may be able to talk again by:
- Esophageal speech: The speaker pushes air into and band back up the esophagus to articulate sounds.
- Placement of a phonation valve.
- Laser surgery
Through the natural mouth orifice the surgeon reaches the tumour and using a surgical microscope (which amplifies the image) the surgeon uses the CO2 laser to remove the tumours from the oral cavity, tongue, pharynx and larynx with less effects on healthy tissues, thus altering less the anatomy and achieving the same oncologic results of open surgery but often preventing tracheotomy, jaw sectioning, external scars and reducing the function (swallowing, talking) recovery time and the time of hospitalization, which translates to saving money.
Laser surgery can be performed again if the tumour reappears. Microsurgery requires a long formation: the surgeon first of all needs to have mastered traditional open surgery in case the tumour is not accessible through the mouth (anatomic problems, extension of the tumour to vital tissues, etc.). The surgeon must also develop their abilities in the use of the surgical microscope with highly amplified images that help to tell the healthy tissues apart from the tumoral tissues (which allows to sear the tumour adjusting with more precision the resection of the surrounding healthy tissues)
This surgery requires a learning curve (with a gradual increase of the difficulty of the case): the more experience and ability the surgeon possesses, the more complicated cases that surgeon will be able to solve.
- Surgical treatment of the neck ganglions
Cervical ganglion removal: Always through open surgery, a dissection is performed of every muscular, vascular and nervous structure of the neck and the fat and fascia of the neck ganglions is removed.
There are different removals depending on the localisation of the tumour and the existence of metastasis in the ganglions, on the area of the neck and the structures that show invasion of the tumour.
- What does the patient have to do one the treatment is over?
Once the treatment is over the patient must have periodic checks made in order to detect relapses as soon as possible in order to treat them immediately.
Imaging techniques performed by the oncologist may be needed alongside with the usual medical explorations.
Dr. Máiz has a wide experience in the treatment of larynx tumours both by conventional surgery and CO2 laser transoral microsurgery.
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