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PHARYNX & LARYNX CANCER


What are the larynx and pharynx?



The larynx is the place where the voice is produced. So it is also called the voice box. The pharynx is the common passage for food and air. It is also known as the throat. So cancers in this site primarily affect speech and swallowing.


How common are laryngeal and Pharyngeal cancers?


The tumours in the larynx and pharynx are the 9th most common cancer among all cancers in India.


What are the risk factors of laryngeal and pharyngeal cancers?


  • Tobacco
  • Alcohol
  • Human papilloma virus
  • Poor Nutrition
  • Head and Neck Radiation
  • Workplace exposure to Asbestos, Metal, Paint Industry.
  • Gastroesophageal Reflux disease.

  • Can laryngeal and pharyngeal cancers be prevented?


    Human papillomavirus vaccines can prevent the cancers that are caused due to the virus.


    How do pharyngeal and laryngeal tumours present?



  • Tobacco
  • Hoarseness of voice ( voice change)
  • Foreign body sensation in the throat
  • Persistent sore throat
  • Constant cough
  • Breathing difficulty
  • Ear pain
  • Swelling in the Neck

  • How to diagnose laryngeal and Pharyngeal cancers?


    A detailed clinical history and a thorough clinical examination are made for each patient.


  • Endoscope & Biopsy
    An endoscope is passed through the patient's throat to examine the pharynx and the larynx to look out for any protruding tumour or an ulcer in the patient's throat. If there is any lesion in the pharynx and larynx, then a biopsy would be taken. This tissue is sent to the pathology department. The characteristics of the tissue are seen through the microscope, and we diagnose whether the lesion is benign or malignant.
  • CT Scan/MRI Scan
    A CT scan/MRI scan for the neck is done to evaluate the extent of the tumour and know how much the lymph nodes are involved.
  • FNAC
    A FNAC ( Fine Needle Aspiration Cytology) of the affected lymph nodes is done to know whether the lymph nodes are involved or not.

  • What is the survival of Laryngeal and pharyngeal cancers?



    The possibility of survival depends on the cancer stage, site of involvement, grade of the tumour and the patient's compliance with the treatment. The survival of patients with cancer is generally denoted as 5-year survival, wherein the percentage of people surviving at the end of 5years after a cancer diagnosis is noted down. This is given in the tabular column below.



    5 year survival rate for Laryngeal and Pharyngeal Cancers.

    Laryngeal and Pharyngeal
    Localized 60-90%
    Nodal Metastasis 40-60%
    Distant Metastasis 25-40%

    What are the treatment options for laryngeal and pharyngeal cancers?


    Treatment options For Pharyngeal tumours


    Oropharyngeal and Hypopharyngeal cancers are commonly treated by definitive radiation in the early stage and by chemoradiation in the advanced stage. Surgery for these patients is used in very select situations in early lesions amenable for robotic resection and advanced stage as a part of salvage therapy.


    Treatment options For Laryngeal cancers

    Early-stage treatment options include surgery or radiotherapy, selected based on which option will give the best functional outcome in terms of voice. In the advanced stage, chemoradiation is commonly used since it provides the best functional outcome. Surgery is used in the advanced stages when the thyroid cartilage is involved, recurrence after radiotherapy and a dysfunctional larynx.


    What surgeries are done ?


    Larynx-
    Chordectomy, Partial laryngectomy, Total laryngectomy.
    Chordectomy
    Chordectomy involves the removal of a part of the vocal cord under magnification with a microscope. LASER is generally used for extra precision
    Partial Laryngectomy
    Partial laryngectomy involves the removal of a part of the larynx. As a result, there will be a change in voice. After that, however, the patient will be able to speak.
    Total Laryngectomy
    Total Laryngectomy involves total removal of the voice box. A hole is made through the windpipe (Tracheostomy) for breathing. The patient will however lose his voice and need additional procedures or training or devices to produce sound.


    Pharynx
    Wide excision, Laryngopharyngectomy with reconstruction, Laryngopharyngo esophagectomy with reconstruction.


    The pharynx is excised with a margin of apparently normal tissue. Depending on the tumour size, the tumour in the pharynx may be excised along with the larynx ( Laryngopharyngectomy) or maybe excised along with the oesophagus (Laryngopharyngo oesophagectomy). The defect is then immediately reconstructed as a free flap from the thigh or the intestines.
    Neck dissection
    Malignant tumours in the pharynx and larynx spread to the lymph nodes in the neck. So, along with the tumour, the lymph nodes in the neck are also removed. This is called lymph node dissection. The lymph nodes removed are sent for biopsy to know whether they are involved in malignancy. This lymph node dissection helps remove the affected lymph nodes and allows us to decide on the subsequent treatment whether chemotherapy or radiotherapy is needed.


    What other procedures might be done at the time of surgery?


    Tracheostomy
    A hole is made in the neck through the windpipe through which the patient can easily breathe and prevent the food from entering the windpipe. The tracheostomy will be permanent in the case of total laryngectomy and temporary when partial laryngectomy is done.
    Gastrostomy / Feeding tube-
    Since the significant part of the surgery involves the food pipe and windpipe, the patient will not be able to eat immediately due to pain. We would also need time for the surgical wound to heal. Hence, we pass a tube through the nose into the stomach or directly into the stomach for feeding purpose and improve nutrition since it will also enhance healing. It will be removed once the patient can eat normally.