* How should I treat laryngeal cancer?
Treatment for laryngeal cancer includes surgical resection, radiation therapy and chemotherapy, which can be used alone or in combination to increase the efficacy.
Generally speaking, laryngeal cancer tends to cause hoarseness, so it is often detected early and the prognosis is quite good, while supraglottic cancer has a poorer prognosis due to dense lymphatic distribution. Overall, laryngeal cancer is considered to have a high chance of being cured. Therefore, the principle of treatment is not only to eradicate the tumor, but also to preserve the function of the larynx as much as possible, especially for early stage laryngeal cancer.
For stage I laryngeal cancer, CO2 laser resection or radiation therapy can be considered; for stage II laryngeal cancer, partial laryngeal resection or radiation therapy (without surgery) can be considered; for stage III laryngeal cancer, total laryngeal resection and cervical lymphadenectomy or radiation therapy and chemotherapy (without surgery) can be chosen; for stage IV laryngeal cancer, i.e. the tumor is still confined to the head and neck, comprehensive treatment is appropriate. In addition to total laryngectomy and cervical lymphadenectomy, adjuvant radiotherapy and chemotherapy are also recommended.
Surgery is the most traditional and effective treatment for laryngeal cancer. There are two types: partial laryngectomy and total laryngectomy. For early stage laryngeal cancer, partial laryngectomy is sufficient to preserve vocal function. For more advanced laryngeal cancer, if the cancer cells have spread to the surrounding tissues and lymph nodes in the neck, or if the vocal cords or cartilage have been invaded, total laryngectomy and tracheostomy may have to be performed in order to eradicate the tumor. Patients must use vocal organs for life, which has a great impact on their quality of life, appearance and social life. Therefore, the pre-surgical education and explanation of laryngeal cancer are very important, and the physician should fully respect the patient’s choice.
Voice reconstruction after laryngeal cancer surgery】 Since laryngeal cancer surgery removes part or all of the larynx, the patient’s vocal function will be affected after surgery, so the biggest issue after surgery is to learn new vocal methods. The basic principle of laryngeal vocal method is to create a new vocal source and then introduce this sound into the oral cavity, which is converted into speech.
It can be divided into three main categories: 1. Esophageal vocalization: The upper respiratory outlet of the laryngeal person, usually the so-called tracheostomy port at the lower front of the neck, is completely separate from the swallowing tract. The principle of this vocal method is to train the patient to use the swallowing and injection method to send air from the mouth into the esophagus, and then use the strength of the chest and abdomen to expel the air, when the air is expelled through the esophagus and hypopharynx junction, it will vibrate the mucosa and sound. This sound is transmitted upward to the mouth, and then the usual mouth movements are performed, and this becomes esophageal speech. The success rate is about 50%. Because of its characteristics of not requiring any external instruments or hands, and the advantages of more natural vocalization, this is the most preferred method as long as the patient’s physical condition allows and has enough motivation to learn. 2. Electronic laryngeal vocalization: Electronic laryngeal vocalization is the fastest and easiest method for those without a larynx to learn. It allows patients to quickly get psychological compensation and comfort. Its disadvantages are mechanical sound quality, unnatural, voice is not clear enough, as well as the need to hand-held speaker aid. 3, tracheoesophageal vocal method: is a simple and easy to learn and the sound effect is closest to the normal method. The success rate can reach 70 to 80%, and is currently recognized as the best surgical voice rehabilitation method. However, a surgical fistula (vocal flap) must be made between the esophagus and the trachea, and there is a risk of obstruction of the fistula and of food flowing through it into the trachea. The tracheostomy must be pressed with the finger during speech to allow airflow through the fistula and out of the esophagus to produce sound.
As mentioned above, for stage I to III laryngeal cancer, the treatment can be either open or radiation therapy. The latter has the greatest benefit of preserving the structure and function of the larynx, allowing the patient to speak naturally, and the treatment rate is similar to that of surgery. Radiation therapy is a good choice for patients who value appearance and have special needs in their career. Radiation therapy is the use of a certain amount of radiation to destroy tumor tissue in order to destroy cancer cells. Of course, during the treatment process, the surrounding normal cells, especially the mucous membrane tissue, will inevitably suffer some degree of damage, resulting in side effects such as pain in the throat, difficulty in swallowing, dryness and redness of the skin, as well as nausea, vomiting and fatigue. When combined with chemotherapy, although the efficacy of the treatment is increased, the side effects mentioned above will become more severe. Fortunately, most of the discomfort is temporary and will disappear after the treatment is completed. Therefore, it is important to be psychologically prepared in advance, and to pay special attention to nutrition and adequate rest during the treatment period, so that we can overcome the difficulties.
Combination of radiation therapy and other treatments】 For advanced patients with large tumors, especially stage IV laryngeal cancer, in addition to total laryngeal and cervical lymphadenectomy, postoperative radiation therapy and chemotherapy are often required to achieve better treatment results. If patients do not want to undergo total laryngeal and cervical lymphadenectomy, they can receive simultaneous radiation therapy and chemotherapy or targeted therapy, which can achieve similar therapeutic effects.
Chemotherapy Although chemotherapy is not the main treatment modality for laryngeal cancer, it is often used together with radiation therapy in clinical practice to enable more patients whose cancer is still confined to the head and neck to successfully preserve the organs and functions of the larynx and maintain a better local tumor control rate and prognosis. However, in this case, chemotherapy is mainly an adjunct to radiation therapy. One should not put the cart before the horse and refuse to undergo more important surgery or radiation therapy when chemotherapy is seen to be good. However, if the cancer has metastasized distantly, chemotherapy becomes the main treatment modality because it is a systemic treatment, in order to shrink the tumor or reduce the symptoms caused by the tumor, thus prolonging life.
In the past, chemotherapy was often used as an intensive treatment after surgery in the hope of reducing the recurrence rate, improving local control and reducing the chance of remote metastasis. In recent years, due to the advancement of drugs and the emphasis on preserving organ function, many patients have received radiation therapy in combination with chemotherapy directly without surgery, and have achieved similar results as surgery. Even for very large localized tumors, chemotherapy can be considered to reduce the size of the tumor before surgery or radiation therapy, which can also reduce the scope and difficulty of surgery. Commonly used chemotherapeutic agents for head and neck squamous carcinoma include 5-FU (5-fluorouracil), cisplatin (cisplatin), bleomycin (bleomycin), mitomycin (mitomycin), and methotrexate (methotrexate), all of which are commonly used to treat other tumors. Some new drugs, such as paclitaxel (paclitaxel taxol, tamsulosin), docetaxel (doxorubicin taxotere tamsulosin), gemcitabine (gemcitabine gemzar kenzo,), vinorelbine (vincristine navelbine, noviben), capecitabine ( Capecitabine (capecitabine xeloda, Xeloda) and others also have superior efficacy, but are only costly. Among them, 5-FU (5-fluorouracil) combined with cisplatin (cisplatin) is probably the most widely used combination therapy and is often used as the standard of care. However, both 5-FU and radiation therapy can cause damage to the oral mucosa, so when used together, special attention should be paid to the fact that this side effect may be very obvious, and appropriate treatment or dose reduction should be given.
Targeted therapy is a new type of tumor treatment. Unlike traditional chemotherapy, most of these drugs work on the specific growth factors or special growth factors of cancer cells, and by inhibiting or blocking the growth factors, they affect the growth or survival of cancer cells and further lead to apoptosis to achieve the goal of cancer control. Recent studies have shown that some targeted drugs, when combined with radiation therapy or chemotherapy, can increase their efficacy, even when used alone. One of the more commonly used targeted therapies for head and neck cancers (including laryngeal cancer) is a drug called “cetuximab” (cetuximab Erbitux), which is a single antibody agent that inhibits the epidermal growth factor receptor. In the treatment of locally advanced oral or pharyngeal cancer, Erbitux in combination with radiation therapy is significantly more effective than radiation therapy alone and can prolong the survival of patients.
Targeted therapies generally do not cause nausea, vomiting, or bone marrow suppression (decreased immunity), which are common with chemotherapy, and are not likely to increase the incidence or severity of the side effects of chemotherapy or radiation when combined with radiation or chemotherapy. “The most common side effects of Epiduo are skin reactions and allergic reactions. Skin reactions include dry skin, red rash, and acne, which can be improved by asking the physician to give appropriate medication according to the severity of the symptoms.
* Facing the storm of laryngeal cancer
Patients with laryngeal cancer often hesitate once they hear that they have to undergo surgery to remove their throats. Some of them turn to traditional medicine or local treatment, but this delays their illness. Therefore, the best choice is to face the cancer bravely once it is diagnosed and to accept the treatment suggested by the physician actively. Most of the patients, after the surgery, are more or less unable to adapt to the change in breathing and speaking style, and they may become decrepit.
The two common problems of laryngeal cancer patients are as follows.
1. Afraid to undergo surgery: They think that they cannot eat or speak after surgery. In fact, after surgery, not only can life be saved, but also most of the previous life style and interests can be restored, although the function of speech and swallowing will inevitably cause some inconvenience.
2. After total laryngectomy, patients are reluctant to learn to speak or completely isolated from the outside world and unwilling to interact with others because of low self-esteem or embarrassment. In fact, most patients can return to work and resume their normal leisure activities and social life with the assistance of their family and medical team. * The prognosis for laryngeal cancer is quite good among all cancers, and most laryngeal cancers can be managed or cured. For patients who receive combined radiation and chemotherapy, it would be a shame to give up due to too many side effects. Generally speaking, the five-year survival rate of laryngeal cancer can be as high as 90% in stages 1 and 2, 70% in stage 3, and still about 50% even in stage 4, so once cancer is detected, it should be treated as early as possible. During the treatment period, there will definitely be unbearable side effects such as pain and difficulty in swallowing, which are unavoidable for every patient, but considering that laryngeal cancer is a tumor with a high cure rate, it is worthwhile to have short-term discomfort in exchange for once-and-for-all control. Your physician will do his best to provide symptom relieving medications to ease your discomfort, and your family, friends and medical team will be with you through this dark period of treatment!
There are simple and direct ways to prevent throat cancer.
1. Quit smoking. According to the World Health Organization, one-fifth of all human deaths and one-third of all cancers are directly or indirectly related to “smoking”. The number of people who suffer from chronic lung disease, cardiovascular disease, or respiratory allergies in children because of “smoking” is incalculable. If you love your family and care about your friends and colleagues, please start by not smoking yourself, and be brave enough to advise those who smoke around you to quit smoking. *Facing nasopharyngeal cancer
When your doctor diagnoses you with nasopharyngeal cancer or when you start to face the treatment of nasopharyngeal cancer, I believe you and your family must have faced a lot of shock, here we encourage you to “face it bravely”. At this point, you do not need to rush to decide on the treatment, you can take the initiative to ask questions and fully discuss with your physician, and there is a wealth of information available on the website to help you decide the best treatment for you. For patients with nasopharyngeal cancer, if they can actively accept the challenges of the disease, receive complete treatment, and adapt to the life changes brought about by the disease, most of them can return to normal life and enjoy a good quality of life at the end of the treatment course. In addition, it is important for your partner or family to be with you during the course of your illness. But they, like you, will be shocked by the disease and will feel stressed in the process of care. Spend as much time as possible to have a good talk with your family and understand each other’s needs, because family support is very important in the fight against cancer! Tian Wendong, Department of Otolaryngology-Head and Neck Surgery, Southern Hospital of Southern Medical University
*After the storm of nasopharyngeal cancer
The five-year survival rate of patients in the early stage of nasopharyngeal cancer can reach more than 90%. Once the diagnosis of nasopharyngeal cancer is proven, please receive treatment as soon as possible and do not delay, so as not to affect the effect of treatment. The more the tumor invades into the brain and orbit, or the larger the neck mass, the worse the prognosis. “Early diagnosis and early treatment” is an important principle to enhance the success rate of treatment. Nowadays, the effectiveness of radiation therapy is improving, and the chance of recurrence and side effects of nasopharyngeal cancer are significantly reduced. However, once recurrence occurs, it is often metastasis to distal organs. Therefore, regular nuclear medicine scans of bones, liver ultrasound and chest X-ray are absolutely necessary. Other follow-up programs include interrogation, visualization, nasopharyngoscopy and computed tomography or magnetic resonance imaging. In addition, the EBV serum index of a small number of patients decreases after the cure of nasopharyngeal cancer, but increases again when the cancer recurs, so EBV serum can also be used as a response indicator for recurrence of nasopharyngeal cancer. In addition, try to maintain the best physical condition possible. From now on, please set aside time to walk with your partner or family to enhance your emotions and train your physical strength. If you feel very tired, try to rest as much as possible. While undergoing treatment, every patient will experience inflammation and ulcers in the oral mucosa, resulting in painful swallowing movements that feel like a knife cut, and even severe dehydration due to the inability to eat. When pain medication does not allow the patient to eat effectively, the physician will recommend the placement of a nasogastric tube or the insertion of a gastrostomy tube to allow the healthy stomach to absorb nutrients through the tube. After treatment, it is also important to remember to implement a balanced diet, such as a moderate ratio of rice, meat, fruits and vegetables. For those who are prone to dry mouth, they can eat liquid food. It is important to remember that the only way to overcome the disease is to have enough nutrition! Nasopharyngeal cancer is a disease unique to the Chinese people, and doctors have accumulated a wealth of experience in treating it. We sincerely hope that every patient with nasopharyngeal carcinoma can understand more about nasopharyngeal carcinoma, face the facts, and not believe in prescriptions, so that they can grasp the first opportunity for treatment and create more hope for themselves!
*How to treat nasopharyngeal cancer?
The location of nasopharynx is exactly in the center of the head, adjacent to the skull base, and there are important blood vessels and nerves passing nearby, and it is very easy to have lymph node metastasis in the neck, so it is difficult to remove the tumor completely by surgery.
Radiotherapy is a very effective treatment for nasopharyngeal carcinoma. Early stage (stage I and II) radiation therapy alone has good results, but patients with advanced stage (stage III and IV) or recurrence may need to be treated with chemotherapy and surgery. As a result of regular treatment, the five-year survival rate is about 60% for all patients, up to 80% or more for early stage patients, and more than 30% for advanced stage patients.
Except for a few patients who have distant metastases at the beginning of treatment, whose disease is difficult to control, nasopharyngeal carcinoma is not a terminal disease, but a cancer that can be controlled and cured. After regular treatment, most patients can recover and continue to work.
*Radiation therapy for nasopharyngeal cancer
The first treatment is the best opportunity to treat nasopharyngeal carcinoma. NPC cells have excellent response to radiation therapy, and the early cure rate can be over 90%. External radiation therapy is a radical treatment and is the current standard of care. The entire radiation treatment takes about seven weeks to two months.
The area to be irradiated: from the base of the skull to the top of the lungs.
Treatment tools: In the early days, cobalt 60 was the main treatment, but the side effects caused by this instrument were so great that most of them have been eliminated and replaced by linear gas pedals.
Treatment type: Most of the treatments are done by external irradiation, in which the radiation penetrates the subcutaneous tissue and destroys the tumor cells.
Treatment modality: The commonly used radiation therapy can be divided into.
? Conventional segmentation method: i.e. continuous irradiation method, 5 days per week, 1 time/day, DT 1.8-2GY/time. Radical dose DT 70-80GY/35-40 times/7-8 weeks. If we take the total irradiation dose of 70GY as an example, we will irradiate 2GY per day, once a week from Monday to Friday, for a total of seven weeks.
? Super-split irradiation method: Take 5 consecutive days per week, irradiate twice a day, once in the morning and once in the afternoon, each time more than 4-6 hours apart, DT 1.1-1.2GY/time, DT 2.2-2.4GY/day, the total amount can reach DT 77-84GY/70 times in 7 weeks. The advantage is that the total number of days of treatment can be shortened, but the side effects produced early on can be greater and more difficult to tolerate.
? Three-dimensional conformal radiotherapy: It is a treatment modality that uses multiple angles in space in order to avoid the surrounding normal organs.
? Intensity Modulated Radiation Therapy (IMRT): This is the newest form of treatment. Although it is still a once-daily treatment for seven weeks, it has a more flexible dose intensity distribution, thus reducing the damage to the surrounding tissues, such as salivary glands.
Side effects of radiation therapy
The side effects of radiation therapy become apparent with the accumulation of dose. The following is a list of common side effects of radiation therapy and ways to prevent them.
? Dry mouth: Due to the destruction of salivary glands, the amount of water in the mouth gradually decreases, resulting in xerostomia (dry mouth), which usually occurs one week after the start of treatment. This is a permanent side effect, so you should take plenty of water, rinse your mouth or use ice cubes or vitamin C tablets to promote saliva secretion and keep your mouth moist.
? Dermatitis: Redness, darkening or peeling of the skin may occur during the treatment process, mostly in the first four to five weeks after the start of the treatment, and will gradually recover one month after the completion of the treatment. During the treatment, it should be noted that the skin at the irradiated area should be less irritated, avoid sunlight, and reduce the chance of rubbing directly with the collar.
What are the risks? Inflammation and ulceration of oral mucosa: Because radiation treatment will damage the mucosa in the mouth and throat, it usually appears two to three weeks after the treatment starts and will continue until two weeks after the treatment is completely finished. During the treatment, you should keep your mouth clean, rinse your mouth regularly, and take mild, easy-to-digest and avoid irritating food.
? Difficulty in swallowing: Painful swallowing due to mucosal ulceration, it is recommended to adopt a liquid diet and use pain-relieving and anti-inflammatory drugs to reduce discomfort.
? Loss of taste sensation: As the treatment will destroy the taste buds on the tongue, the sensation of sweet taste will be reduced, which usually can be recovered two to four months after the treatment, but some patients cannot recover completely. It is advisable to avoid irritating, cold and hot foods at this time.
What are the risks? Fluid in the middle ear: Since the treatment may disrupt the function of the eustachian tube, the ENT physician will administer medication, or use a fine needle to extract the fluid or install a ventilation tube to control the symptoms.
? Atrophic rhinitis and sinusitis: Since treatment can damage the nasal mucosa and cause nasal crust, nosebleed and pus, you should make a habit of self-cleaning the nasopharyngeal cavity, or ask your ENT doctor to remove it regularly.
What is the reason? Radioactive caries: Because the treatment will destroy the salivary glands and prevent the normal secretion of saliva, it is easy to form the ring cavity at the root of the tooth or accelerate the damage of the existing tooth decay. Because the main side effects of the treatment will be concentrated in the vicinity of the oral cavity, so when it is determined that radiation treatment is needed, it must be evaluated by a professional dentist first, and if there is any calculus, it should be removed first, and if there is any cavity, it should be filled.
Late complications after radiotherapy
Most of them are sequelae that occur months to years after treatment. These symptoms do not occur in everyone, but once they appear, they are not easy to recover from.
? To prevent dental closure and neck stiffness: This is caused by fibrosis of the temporomandibular joint and masticatory muscles of the oral cavity, and is prevented by doing more oral chewing, mouth opening, and shrugging and head turning exercises during treatment. In order to prevent the teeth from closing, you should start to open your mouth about two weeks after the treatment, you can buy a tongue depressor from the pharmacy to help you. First, fold the tongue depressor one by one and tie it firmly with gauze (first smooth the edges with sandpaper to avoid stabbing the mouth or tongue), about as wide as the maximum width of the upper and lower row of teeth can be opened. Bite the tongue depressor continuously for a few hours a day, and slowly add another tongue depressor every two or three days until you can open your mouth to three fingers wide. Remember not to be too hasty, if you feel that your teeth are sore after a bite, it means that it is too much, and you should immediately reduce the tongue depressor to avoid causing injury.
? Sensorineural deafness: It usually occurs about one year after the end of the treatment, and the symptom is that it is not easy to hear the high frequency sounds.
? Radiation osteonecrosis: It is a rare occurrence. The main reason for this is the failure to treat tooth decay before radiation treatment, which causes infection in the decayed area and leads to jaw bone necrosis. Therefore, it is important to have regular oral check-ups by the dentist every 3-6 months after the radiation treatment is completed.
What are the risks? Hormonal imbalance: Due to the irradiation site of radiation therapy, the pituitary gland function is sometimes affected, which usually occurs about six months to one year after the treatment.
? Dysphagia: Radiation therapy irradiation is quite extensive, covering the tongue, pharynx and larynx, which are related to swallowing movement. The degree of fibrosis in these tissues will accumulate over time, causing some patients to develop dysphagia after five or six years of treatment; in mild cases, food may enter the nasal cavity by mistake and cause choking, while in severe cases, aspiration pneumonia may result. The treatment mainly relies on swallowing exercises, but for the few patients who do not have good results, it is recommended to give up eating by mouth and replace it with nasogastric tube or gastric tube.
*Chemotherapy for nasopharyngeal carcinoma
In addition to radiation therapy, chemotherapy is another common treatment modality for nasopharyngeal carcinoma, which is also very sensitive to chemical cancer treatment drugs. In addition, recent medical studies have reported that, in addition to radiation therapy, the treatment of nasopharyngeal carcinoma has a better disease control rate and survival rate than radiation therapy alone if chemotherapy is given simultaneously.
What are the benefits of concurrent radiation and chemotherapy? Concurrent chemoradiotherapy: The use of radiation therapy and chemotherapy together. Although the side effects of concurrent radiation and chemotherapy are more severe, such as oral mucosal ulcers and suppression of bone marrow hematopoiesis, studies have shown that the use of the chemotherapy drug “Cisplatin” or the addition of “5-Fluorouracil” (5-Fluorouracil) is more effective. However, studies have shown that the use of the chemical “Cisplatin” (Cisplatin) or “5-Fluorouracil” (5-FU) in combination with radiation irradiation, together with the use of leukocyte growth factor and antiemetics, can improve the chemotherapeutic effect on the patient’s tumor cells and result in a meaningful increase in overall survival.
? Neoadjuvant chemotherapy (Induction chemotherapy): Two to three courses of chemotherapy are given prior to primary radiation therapy.
? Adjuvant chemotherapy: “Adjuvant chemotherapy” given after primary radiation therapy.
? Neoadjuvant and adjuvant chemotherapy: Neoadjuvant chemotherapy is given to patients first, followed by radiation therapy, and then adjuvant chemotherapy, in order to maximize the therapeutic effect and thus prolong the patient’s life span.
Chemotherapy for nasopharyngeal carcinoma is based on combination chemotherapy containing cisplatin, which has a response rate of 50% to 90%. In addition, chemotherapy for nasopharyngeal carcinoma is often combined with Docetaxel (Taxotere), Paclitaxel (Taxol), Gemcitabine (Gemzar), and 5-Fluorouracil 5-FU, which may cause side effects such as diarrhea, inflammation of oral mucosa, nausea, vomiting, and abnormal kidney function. side effects such as abnormal kidney function.
*Targeted therapies commonly used for nasopharyngeal carcinoma
Clinical trials of targeted therapies for nasopharyngeal carcinoma have been conducted and results have been published. According to preliminary studies presented at the 2008 American Society of Clinical Oncology Annual Meeting, the use of (cetuximab Erbitux, Epiduo) in combination with radiation therapy and chemotherapy for patients with locally advanced nasopharyngeal carcinoma can improve tumor response rates, with a 100% tumor response rate in a limited patient analysis, making it a viable treatment modality. However, this drug is currently expensive. The side effects of cetuximab Cetuximab are mainly skin rash, fatigue, chills and fever, hypomagnesemia, etc.
2. Quit drinking alcohol. Alcohol consumption is also an important factor in the occurrence of laryngeal cancer. It has been found that long-term alcohol intake can damage the laryngeal mucosa epithelium. If a person drinks alcohol and smokes at the same time for a long time, it will accelerate the possibility of cancer. Patients like these are mostly men aged 50-70 years old, with a smoking history of more than 30-40 years, and they basically have a history of chronic pharyngitis. Moreover, the longer the smoking history, the heavier the smoking and the heavier the alcohol consumption, the more severe the disease will be when it becomes laryngeal cancer, and more patients have metastasis and spread in the neck.