Cancers and tumors of the "voice box" or larynx can affect speech, swallowing and breathing. Treatment of these tumors, both surgical and non-surgical (chemotherapy and radiation), can also significantly affect these functions. The overall goal of current treatment of these challenging problems is to maximize the cure of the cancer while minimizing the effects of treatment on speech, swallowing and breathing.
Complete removal of the larynx has been highly effective in the treatment of laryngeal cancers and can provide excellent long term cure rates. This surgery is often the best alternative, but not in every situation. Total laryngectomy results in loss of one's natural voice and need to permanently breath through a "stoma" or hole in the lower neck. Fortunately, significant improvements in the rehabilitation of the voice following this procedure have been made over the last few decades.
In an effort to maximally treat cancer of the larynx while concurrently trying to preserve laryngeal function, innovative procedures have been developed to conservatively remove only the involved portions of the larynx. With speech therapy, these procedures also can preserve the patient's voice, swallowing and breathing. Long term cure rates are as good or better than non-surgical therapy for small and medium-size cancers. For larger cancers, partial laryngeal surgery may need to be combined with postoperative radiation therapy.
Conservative laryngeal surgery ranges from removal of only a small segment of the vocal cord to removal of 2/3's of the larynx. A combination of endoscopic laser and external techniques make up the tools available to the head and neck cancer surgeon. Cancers of the upper portion of the voice box or "supraglottis" are removed with a laser via specially-designed endoscopes (see endoscopic laser surgery link) or externally (supraglottic laryngectomy), depending on the specific clinical situation. Both procedures remove the upper half of the voice box, while preserving the vocal cords. Cancers of the vocal cord or mid-portion of the voice box, can be excised with the laser or removal of one side of the larynx (hemi-laryngectomy), again depending on the specific clinical presentation. Using tissues around the larynx, the vocal cord can be reconstructed to yield near-normal voice and swallowing. More extensive cancers requiring excision of both the upper and mid-portion of the larynx are usually amenable to a "supracricoid larngectomy". Postoperative function after removal of the upper 2/3's of the voice box is also very good while still providing excellent treatment of the cancer.
The use of radiation therapy alone or in combination with chemotherapy is also an alternative and a cure can be achieved in many instances, but this therapy also has significant long-term side effects, including impaired voice and swallow or need to breathe through a tracheotomy tube. Therapy frequently requires weekday visits for a period of 6 to 8 weeks consecutively. Additionally, should the cancer recur or persist after this therapy, a total laryngectomy or complete removal of the voice box is almost always required.
The Head and Neck Team in the Department of Otolaryngology-Head and Neck Surgery consists of Drs. Doug Girod, Terance Tsue and Derrick Wallace. They are trained in all aspects of partial laryngeal surgery for the management of cancer. They also work closely with other physicians from Radiation Oncology and Medical Oncology through the Head and Neck Tumor Board to offer non-surgical options for laryngeal cancer.
For more information, contact the clinic of the Department of Otolaryngology-Head and Neck Surgery at (913) 588-6701.