* 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 completely 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 mucous membrane and vocalize. 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, redness and swelling of the skin on the body surface, 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 difficult to estimate. 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 around you who smoke to quit.
2. Quit drinking. Alcohol consumption is also an important factor leading to the occurrence of throat cancer. It has been found that long-term intake of alcohol 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.