The treatment methods of laryngeal cancer include surgery, radiotherapy, chemotherapy and biological therapy, etc. At present, most of them advocate a comprehensive treatment mainly based on surgery.
(I) Surgery is the main treatment for laryngeal cancer. Its principle is to preserve or reconstruct the function of larynx as much as possible under the premise of complete removal of tumor, so as to improve the survival quality of patients. Surgery for laryngeal cancer includes various kinds of partial laryngectomy and total laryngectomy.
1.Partial laryngectomy
Partial laryngectomy is a kind of surgery to restore all or part of laryngeal functions after reconstruction by safely preserving the remaining normal parts of larynx under the premise of complete removal of laryngeal cancer. Due to the different factors such as the site of laryngeal cancer, the scope of invasion and the patient’s systemic condition, there are many types of partial laryngectomy, and the procedure is selected according to the specific conditions of different patients.
(1) Microscopic CO2 laser laryngeal surgery: it is suitable for early stage (T1, T2) acoustic and supraglottic laryngeal cancer.
(2) laryngeal laceration vocal fold resection: it is suitable for those who have cancer of one side of vocal fold (Tis, T1a) without involving anterior union or vocal fold prominence and normal vocal fold movement. This procedure has been replaced by CO2 laser treatment.
(3) Vertical partial laryngectomy: It is suitable for those whose vocal cord cancer approaches forward and involves the anterior union with normal vocal cord movement, or invades the laryngeal ventricle or vocal cord upward, or involves the subglottis downward, with normal or limited vocal cord movement.
(4) Frontal partial laryngectomy: It is suitable for laryngeal carcinoma of larynx involving the anterior commissure and the anterior 1/3 of the contralateral vocal folds, and invading the anterior part of the subglottis no more than 1 cm, without invading the vocal fold prominence and with normal vocal fold movement.
(5) Enlarged vertical partial laryngectomy: It is suitable for laryngeal cancer involving the whole length of the vocal folds on one side and involving the vocal fold prominence posteriorly.
(6) Supraglottic horizontal partial laryngectomy: it is suitable for supraglottic laryngeal carcinoma of epiglottis, ventricular zone or aryepiglottic folds, which does not involve the anterior commissure, laryngeal ventricle or aryepiglottic cartilage.
(7) Horizontal vertical partial laryngectomy: also known as 3/4 laryngectomy, it is suitable for supraglottis laryngeal carcinoma invading the vocal cords, while the laryngeal ventricles, vocal folds and arytenoid cartilage on one side are normal.
(8) Partial laryngectomy on cricoid cartilage: It mainly includes cricoid cartilage lingual epiglottis fixation and cricoid cartilage lingual fixation, etc.
(9) Subtotal laryngectomy or subtotal laryngectomy: including Tucker subtotal laryngectomy and Pearson subtotal laryngectomy, etc.
2.Total laryngectomy
The scope of resection includes the hyoid bone and all laryngeal structures, and the main indications are
(1) Those who are not suitable for partial laryngectomy due to the extent of the tumor or the patient’s general condition;
(2) Those who failed in radiation therapy or whose tumor recurred after partial laryngectomy;
③T4 laryngeal cancer has involved and penetrated the cartilage;
④Primary subglottic carcinoma;
(5) Those who have radiation osteomyelitis after laryngeal cancer radiotherapy or those who have difficulty in correcting laryngeal malfunction after partial laryngectomy; (6) Those who cannot preserve laryngeal function after laryngopharyngeal cancer.
3.Laryngeal function reconstruction after total laryngectomy
The loss of laryngeal function after total laryngectomy has a great negative impact on the survival quality of patients. At present, the commonly used methods of articulation reconstruction are mainly as follows.
(1) Esophageal articulation method: The principle is that after training, the patient flushes out the air swallowed into the esophagus from the esophagus to produce sound, which is then regulated by the pharyngeal cavity and oral action to constitute language. Its disadvantage is that the pronunciation is intermittent and the speech is more laborious.
(2) Artificial larynx and electronic larynx: Artificial larynx is to draw the airflow from the trachea to the oral cavity while impacting the rubber membrane and pronouncing the sound, and then the oral cavity is adjusted to constitute the language, the disadvantage is that it is inconvenient to wear and carry. The electronic larynx uses an audio oscillator to emit a continuous tone, which can be placed on the patient’s chin or neck to make speech movements. However, the sound produced is less natural.
(3) Esophagotracheostomy: A fistula is created between the posterior wall of the trachea and the anterior wall of the esophagus, and an articulatory button is inserted or a muscle mucosal flap is sutured to form a tube. This includes the Blom-Singer articulating button method, Provox articulating button method and Amatsu surgery method.
4.Cervical lymph node dissection: It is an effective method to treat laryngeal cancer with cervical lymph node metastasis, and is an important part of surgical treatment for certain laryngeal cancer patients. Depending on the primary site of laryngeal cancer, the extent of lesion and cervical lymph node metastasis, elective cervical dissection, modified cervical dissection, classical cervical dissection and expanded cervical dissection are used. For details, please refer to Chapter 35.
(II) Radiation therapy
1.Simple radiotherapy is mainly applicable to
(1) Early vocal cord cancer, which does not invade the anterior commissure in the forward direction, does not invade the vocal cord prominence in the backward direction, and has good vocal cord activity;
(2) Supraglottic carcinoma located at the free edge of the epiglottis, which is relatively limited;
③Poor general condition, not suitable for surgery;
④For advanced tumors, palliative radiotherapy can be used for cases at all stages that are not suitable for surgical treatment.
(2) Pre-operative radiotherapy For tumors with extensive lesions, affecting the larynx and poorly differentiated, radiotherapy plus surgery is often used. The purpose of preoperative radiotherapy is to shrink the tumor and suppress the vitality of cancer cells, which is more conducive to complete surgical resection.
(3) Postoperative radiotherapy
(1) The primary tumor has invaded to the outer larynx or soft tissues of the neck;
②Multiple cervical lymph nodes metastasis or the tumor has invaded through the lymph node envelope;
(3) Post-operative radiotherapy can be used if the surgical margin is very close to the tumor margin (less than 5 mm) or the pathology confirms that there is tumor residue at the margin.
(C) Chemotherapy Mostly adopts induction chemotherapy plus radiotherapy or simultaneous radiotherapy and chemotherapy. Chemotherapy can be the first choice in the treatment of laryngeal cancer.
(iv) Other treatments include biological therapy, Chinese medicine, etc.