Throat Cancer: Stages, Treatment Options, and Family Support - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Laryngeal cancer: Is surgery necessary? There is much debate, and opinions among physicians vary.
The stage of laryngeal cancer can only be determined through clinical examination.
Diet and bodily diseases are closely related, and it is advisable to consult various literature on the subject.

Laryngeal cancer can be detected early.
The larynx is the human voice organ, composed of cartilage and soft tissue, located at the upper end of the trachea.
Its main functions are breathing, swallowing, and phonation.
In Taiwan, approximately 500 people are diagnosed with laryngeal cancer each year, making it rank among the top 1-5 cancers.
The most common age group affected is between 40 and 60 years, with a higher prevalence in males.
The most likely causes of laryngeal cancer are habitual smoking and alcohol consumption.
Additionally, frequent exposure to certain carcinogens may also contribute to the disease.
However, laryngeal cancer is a type of cancer that can be detected early.
Typically, stage I and II laryngeal cancers can be cured, and most patients can retain all functions of the larynx.
Symptoms of laryngeal cancer include persistent hoarseness, which may be an early sign.
Difficulty breathing, pain while swallowing, and difficulty swallowing may occur if the tumor invades the esophagus or affects the base of the tongue or pharyngeal tissues, with pain potentially radiating to the same side of the ear.
A neck mass may indicate metastasis of cancer cells to the cervical lymph nodes.
Supraglottic and glottic cancers are more likely to metastasize to the neck, while subglottic cancer is less common.
Coughing up blood-stained sputum may result from ulceration and inflammation of the tumor tissue, leading to increased secretions that can accumulate in the trachea and pharynx.
Classification of laryngeal cancer: The assessment of tumor size and location before treatment significantly impacts the treatment approach and prognosis.
Laryngeal cancer can generally be classified into glottic, supraglottic, and subglottic types, with glottic cancer being the most common, accounting for over half of cases and being the easiest to detect early.
Supraglottic cancer follows, while subglottic cancer is rare.
The cure rate for laryngeal cancer is high; early-stage glottic tumors often present with hoarseness, and early-stage patients have an 80% chance of cure, while late-stage patients' cure rates drop to around 50%.
Examination for laryngeal cancer: The common examination method in outpatient settings is indirect laryngoscopy, where a physician uses a small mirror with a long handle inserted into the mouth to visualize the tumor's location and size.
If visualization is difficult, a flexible fiberoptic scope can provide clearer images with minimal discomfort.
However, a definitive diagnosis requires a microlaryngoscopy under general anesthesia, where suspicious tumor tissue can be biopsied and sent for pathological examination.
Radiation therapy: The main treatment methods for laryngeal cancer are radiation therapy and surgical intervention.
Generally, if the tumor is small and has not caused fixation of one vocal cord, either surgery or radiation therapy can be performed.
Radiation therapy is preferred because it preserves laryngeal function, and survival rates are comparable to surgical treatment.
If radiation therapy fails or the cancer recurs, surgery may then be necessary.
Radiation therapy involves using a specific energy level of radiation to destroy tumor tissue while causing minimal damage to surrounding normal cells.
Side effects during treatment may include dry skin, redness, nausea, vomiting, and fatigue, but with proper nutrition and rest, recovery is usually swift.
Surgical treatment: For late-stage laryngeal cancer, if vocal cord fixation has occurred and cartilage is invaded, surgical treatment combined with radiation therapy may be necessary.
Some patients may only require partial laryngectomy to retain laryngeal function, but most late-stage laryngeal cancers necessitate total laryngectomy, which removes the entire larynx.
This procedure disconnects the airway between the oropharynx and trachea, preventing air from entering and exiting the lungs.
To address breathing issues, a stoma is created in the neck, connecting the trachea to the external environment, allowing air to pass directly to the lungs.
After surgery, drainage tubes are placed for about three to four days, and they can be removed once the daily drainage is less than 10 cc.
Patients will temporarily require feeding through a nasogastric tube for ten days before resuming normal eating, but they must breathe and cough through the stoma.
Combined radiation and surgical treatment: In early glottic cancer, there is minimal lymphatic spread to the neck due to the absence of lymphatic vessels on the vocal cords.
However, supraglottic and subglottic cancers have abundant lymphatics, leading to rapid lymphatic spread.
Besides total laryngectomy, patients may require neck lymph node or hypopharyngeal resection and preoperative or postoperative radiation therapy for better treatment outcomes.
How to speak after laryngectomy: Speaking is the primary means of human emotional expression.
Patients who undergo total laryngectomy often fear losing their voice and may refuse surgery, delaying treatment opportunities.
However, advancements in technology and surgical techniques have gradually overcome the challenges of post-operative speech.
With guidance from speech therapists, most cognitively intact patients can learn to speak fluently again.

There are three main methods: The first method involves injecting air into the upper esophagus, which causes muscle contractions in the esophagus and pharynx, producing sound known as esophageal speech.
With regular mouth movements, patients can learn to produce short phrases within three months and speak fluently within ten months, although about half may not succeed in training.
The second method uses artificial voice devices, which almost every patient can utilize.
These devices, including pneumatic and electronic voice prostheses, can assist patients learning esophageal speech.
The third method involves placing a tracheoesophageal voice prosthesis, where a small hole is made between the trachea and esophageal wall.
After two days, the prosthesis is inserted, allowing air from the lungs to pass through the prosthesis into the esophagus and pharynx, producing sound.
This method allows for quicker learning and louder speech compared to traditional esophageal speech, but the prosthesis must be cleaned daily, and a backup tube must be inserted immediately when removed to prevent the stoma from narrowing.
Returning to normal life: Most patients who undergo total laryngectomy initially struggle to adapt to changes in breathing and speaking methods, leading to psychological barriers and feelings of depression or anxiety.
However, with support from family and healthcare providers, most patients can return to work and resume normal outdoor activities and social lives.
Participation in "laryngectomee clubs" for regular meetings, where physicians, speech therapists, and nurses share the latest healthcare knowledge and conduct follow-ups, can help patients realize they are not alone and connect with others facing similar challenges.

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Reply Date: 2005/08/24