Laryngeal Cancer: Treatment Options and Risks of Inaction

Q: Laryngeal Cancer: Treatment Options and Risks of Inaction

Dear Ms. <br>Chen： First, we need to know your father's treatment schedule, the radiation dosage, the locations of the two recurrences, and the intervals between them in order to provide you with accurate advice. <br>Generally, the recommendations are as follows： Laryngeal cancer

Laryngeal cancer: Risks of treatment and non-treatment?

Hello, Doctor! My father is 63 years old.
He was diagnosed with laryngeal cancer in September 2014, classified as glottic type, with the tumor located on the vocal cords.
There was no metastasis, but the doctor did not specify the stage of the cancer.
In 2014, he underwent radiation therapy and has been returning for monthly follow-ups.
Recently, in November of this year, the doctor used an endoscope and observed some redness and swelling.
A biopsy, along with nuclear magnetic resonance and positron emission tomography scans, revealed that the tumor has regrown in the same location.
The doctor mentioned that since he had already undergone radiation therapy and the cancer has recurred, they may need to reassess the effectiveness of the radiation treatment.
If it proves ineffective, they will consider surgery as a last resort.
My father found the previous radiation therapy very painful and unbearable, so he does not want to undergo it again, and he is also reluctant to have surgery, as it would significantly impact his daily functioning.

I would like to ask if, without further treatment and continuing with regular monitoring, it is possible to manage the tumor by performing microsurgery (similar to polyp removal) each time it grows back, as long as there is no metastasis.
I understand that ignoring the tumor could lead to it growing large enough to affect swallowing and breathing, which is not acceptable.
Is this approach feasible? Additionally, aside from the risk of metastasis, are there other risks associated with laryngeal cancer if no treatment is pursued under the current circumstances?

NICOLE, 30~39 year old female. Ask Date: 2015/11/09

Dr. Lai Yicheng reply Oncology

Dear Ms.
Chen: First, we need to know your father's treatment schedule, the radiation dosage, the locations of the two recurrences, and the intervals between them in order to provide you with accurate advice.
Generally, the recommendations are as follows: Laryngeal cancer typically begins with radiation therapy.
If the treatment fails or recurs, surgical intervention may be considered.
Sometimes, a combination of radiation therapy and chemotherapy is used as the primary treatment modality instead of surgery.
If cancer cells are located in the glottis, treatment options may include one of the following: 1.
Radiation therapy 2.
Surgical removal of the vocal cords 3.
Surgical removal of part or all of the larynx 4.
Laser surgery.
If the tumor is not addressed, it may grow large enough to affect swallowing or cause respiratory difficulties, potentially leading to multiple organ failure.
Treatment options for recurrent laryngeal cancer should take into account the initial treatment approach.
If the patient has only undergone radiation therapy, additional radiation therapy or surgery may be considered at this time; if neither surgery nor radiation therapy is effective, the physician may recommend chemotherapy to treat the recurrent cancer cells.

Reply Date: 2015/11/09

More Info

Laryngeal cancer, particularly when it involves the vocal cords (glottic laryngeal cancer), presents unique challenges in terms of treatment and management. Your father's situation, having been diagnosed with laryngeal cancer and undergoing radiation therapy, raises important considerations regarding the effectiveness of treatment options and the potential risks of inaction.

Firstly, it’s essential to understand that laryngeal cancer can be staged based on its size, location, and whether it has spread to nearby lymph nodes or other parts of the body. While the specific stage of your father's cancer has not been mentioned, the recurrence of the tumor after radiation therapy indicates that the cancer may be more aggressive or resistant to treatment. The fact that the tumor has reappeared in the same location suggests that careful monitoring and further intervention may be necessary.

Regarding the treatment options, if your father is reluctant to undergo another round of radiation therapy due to the pain and discomfort experienced previously, it is crucial to discuss alternative approaches with his healthcare team. Surgical options, such as a laryngectomy or a less invasive procedure to remove the tumor, could be considered. However, surgery carries its own risks and potential complications, including changes in voice, swallowing difficulties, and the need for rehabilitation.

In terms of your question about the possibility of using microsurgery to remove the tumor as it grows, this approach can be feasible in certain cases. If the tumor is localized and does not invade surrounding tissues significantly, excisional surgery may be an option. However, this would require careful evaluation by an otolaryngologist (ear, nose, and throat specialist) to determine the tumor's characteristics and the potential for complete removal without compromising surrounding structures.

It is important to note that while monitoring the tumor and opting for surgery only when necessary may seem like a reasonable approach, there are inherent risks involved. Laryngeal cancer can lead to complications such as airway obstruction, which can be life-threatening. Additionally, untreated cancer can grow and invade deeper structures, making future treatments more complicated and less effective. The risk of metastasis, while currently absent, remains a concern, as cancer can spread to nearby lymph nodes or distant organs over time.

Moreover, the psychological impact of living with a cancer diagnosis and the fear of progression should not be underestimated. Regular follow-ups and imaging studies are essential to monitor the cancer's status, but they can also contribute to anxiety and stress for both the patient and the family.

In summary, while it may be tempting to adopt a watchful waiting approach with periodic excisions of the tumor, it is crucial to weigh the risks of inaction against the potential benefits of more proactive treatment. Engaging in open discussions with your father's healthcare team about his concerns, treatment preferences, and the implications of various options will be vital in making informed decisions. Ultimately, the goal should be to balance effective cancer management with maintaining your father's quality of life.

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