Diagnosis
An examination of the larynx typically reveals the lesion, and a biopsy, performed under general anaesthesia, confirms the diagnosis. Staging of the cancer involves examining the tumour's extent during the biopsy as well as by through imaging techniques.
Glottic tumours are often detected at an early stage due to voice changes caused by even the small tumour growths on the vocal cords. In comparison, supraglottic cancers are generally more advanced when detected.
Treatment options
The treatment of laryngeal cancer depends on both the location and the
stage of the disease. Early-stage cancers may be addressed with radiation
therapy or surgery, including laser operations.
For advanced laryngeal cancer, a combination of chemotherapy and radiation is
commonly prescribed. Patients presenting with lymph node enlargement in the
neck, appearing as neck lumps, may achieve favourable outcomes through
minimally invasive surgery to preserve voice or by radiation therapy.
Similarly, advanced tumours may also respond well to surgery combined with
radiation and/or chemotherapy.
Historically, radiation, with or without chemotherapy, has been the standard
treatment for these tumours, aiming to cure while preserving the vital
functions of speech and swallowing.
Radiation
therapy has proven effective for early-stage laryngeal cancers, with 5-year
survival rates exceeding 80% for Stage I and II when this treatment is
employed. Voice quality generally remains satisfactory, and swallowing function
is typically unaffected.
The side effects of radiation can include oral dryness and painful ulcers that interfere
with eating and drinking. However, with newer techniques, such as
intensity-modulated radiation therapy (IMRT), have reduced these side effects.
Recurrences are generally managed by surgery rather than with a second course
of radiation.
Trans-oral laser resection is another treatment for early-state laryngeal cancers.
The
tumour is accessed and removed via a laryngoscope, avoiding external incisions,
and excised with a carbon dioxide laser.
This modality is particularly beneficial for small vocal cord lesions. Patients
often require no more than a two-day hospital stay. Although the voice may
initially be weak, it tends to recover quickly and remain clear. Swallowing
can often be resumed the day after surgery, and tracheostomy is typically
unnecessary.
The success rates for this method are comparable to those of radiation, with patients
usually returning to work within two to three weeks.
Trans-oral
laser resection may not be suitable for every patient with early laryngeal
cancer. For those with an anteriorly
positioned larynx or tumours extending beyond the larynx, this method may not
be suitable. The quality of voice post-treatment can vary, generally
correlating with the volume of tissue removed.