Laryngeal cancer

Laryngeal cancer

Head and neck cancers focused on otolaryngology are thought to be about 5% of all cancers, but they include lips and oral cancer, nasal and sinus cancer, nasopharyngeal cancer, oropharynx Cancer, hypopharyngeal cancer, laryngeal cancer, salivary gland carcinoma, thyroid carcinoma · · ·, and so on. Among them, occupying about 30%, the most frequent occurrence is laryngeal cancer. Recent statistics are about 3 to 4 people per 100 thousand population, men have smoking history more than 10 times and more than 90% of women, and are representatives of tobacco-related cancer.

Conversely, if you do not smoke it will be almost a cancer that will not be affected, but people who have a lot of opportunities to passive smoking also need attention. It is also known that cancers in the upper gastrointestinal tract are likely to be duplicated, as with other head and neck cancers.
Laryngeal cancer is divided into glottic cancers that can be made in the vocal cords, glottic tops that can be made on the mouth side than that, and vocal canards that can be made on the trachea side. Percentage is about 60% of glottic cancers and about 50% of glottic cancers About 30%, the occurrence of subgroup cancer is slight. It is a transnasal endoscope photograph of each. Since vocal cords produce voices by vibrations of the left and right vocal cords, glottic cancers are diagnosed at an early stage and often diagnosed, but on glottic tops, it progresses relatively, and pain and swelling of the throat when feeling swallowed It is often found after the symptoms such as the swelling of the lymph nodes that metastasized to the neck is the initial symptom. I do not have symptoms until GOOM further progress, so it is an impression that often breathing difficulties have already come at the time of consultation. (It is hard to understand in the photograph because it is developing on the back of the vocal cord, but there is actually a considerable spreading.) Tracheotomy is necessary for breathing difficulties. If there is abnormality like a photograph at the outpatient visit, we pick up the tissue on the spot and confirm the diagnosis (It takes about one week.). For diagnosis of progress degree, image inspection such as MRI and CT is performed.


Treatment of laryngeal cancer is performed mainly by surgery or radiotherapy, depending on the progress of the larynx cancer, in a way that combines them with anticancer drug treatment alone or in combination. As shown in the figure the larynx is framed by several cartilage centered on thyroid cartilage and cricoid cartilage which is palpated as a throat Buddha.


As with cancer in other areas, TNM classification detailed in the handling regulations is stipulated for degree of progression, but roughly invasion into this framework or progressive disorder of vocal cords progresses Cancer, those not going to that point may be thought of as early cancer. If lymph node metastasis or distant metastasis occurs in the neck, it will be advanced only. The cure rate of the laryngeal cancer as a whole is 7 to 80%, which is higher in head and neck cancers, but this is often found at an early stage, and even if locally advanced cancer is comparatively metastatic It is because it is few. There is no curative treatment in the case of distant metastasis, anticancer drug treatment and so on according to the situation. In cases where it is limited to lymph node metastasis in the cervical region, it can often be expected that cure can be achieved by treating the primary lesion with treatment based on surgery such as cervical lymphadenectomy. I will describe the treatment of the primary lesion.
In cancer surgery, it is said that curability is high enough to largely cut the tissue around the cancer. However, if such an operation is performed on the laryngeal cancer, there is a problem that it not only hinders speech but also makes it easy to aspirate, so as not to cause these as much as possible, It is important. The most invasive surgery for laryngeal cancer is a total laryngectomy that resects the larynx with the whole frame of the cartilage and can eradicate many cancers but in this case it not only loses the sound source , A hole called a permanent trachea hole is made in the anterior neck for breathing.

As the airway and the esophagus are separated, the risk of aspiration disappears, but there is a danger of drowning due to the action that water can enter the permanent tracheostomy such as bathing, inconvenience comes to life. It still falls under the disabled person. As much as possible, it is not necessary to take out the entire larynx, and it is necessary to select a treatment so that cancer can be cured.

For early cancer, T1 and T2 will be taken from the shallow one, but for these, 8 to 90% of the radiation alone can obtain a cure of 5 to 70%. Although radiotherapy is usually done at hospital, the greatest advantage is that there is no exacerbation of speech. A disadvantage is that there is a risk of complications due to radiation, but it may be that it takes a treatment period of nearly two months. If you do not feel comfortable you need surgery. For surgery for early cancer, there is a technique to remove a portion of the laryngeal framework, but there are many cases to choose laser surgery under a direct mirror that is performed by oral operation without damaging the framework. Although it is difficult to do depending on the extent of the progress of the lesion, the treatment effect is similar to radiotherapy, close to the operation of benign lesions such as vocal cord polyps, and in our department we usually go to hospital for 2 nights and 3 days. The disadvantage is that there is a possibility that the voice may worsen because there are many cases where the vocal cords are excised.

For advanced cancers, it is difficult to cure radiation alone, so we usually use multiple anticancer drugs in combination. Side effects of anticancer drugs often appear strongly, and the control rate is further deteriorated, so surgery will be mainly focused on. Among them, total laryngectomy is often selected, and further enlarged resection is sometimes required, but on the other hand, there is a subtotal laryngectomy as a technique that has been relatively popular in the country recently . It is a method of resecting cancer in a mass with thyroid cartilage which is the center of the laryngeal framework. Completely resected to one side of the arytenoid cartilage is made possible and after a lesion resection, it is a slightly rough seeming operation that severely fixes the hyoid bone and cricoid cartilage, but the greatest advantage is that it does not form a permanent tracheostomy It is a point.
This method was devised and improved in France in the 1950s, but it is said that about 30% of cases that had previously performed a total laryngectomy is subject to this surgery. The problem is that the local edema after surgery becomes stronger, the tracheostomy hole temporarily placed can not be closed easily, it takes time to be able to swallow successfully, so the length of stay in hospital becomes as long as about 2 months (In the case of our department of total laryngectomy, it is within 3 weeks at the shortest.). Also, even if cancer can be cured, it is expected that aspiration will come afterwards, and it seems that sufficient follow-up observation is necessary. For this reason it is not recommended for elderly people.

Although we will lose vocal cords after total laryngectomy, there are several alternative voicing methods such as artificial larynx use and esophageal vocalization. Among them, there is a method that uses a voice button with a one-way valve formed by forming a tracheoesophageal fistula and allowing it to easily acquire relatively good voice. Push your trachea with your fingers and send the expiration toward the oral cavity. There is no intonation voice, but there are people who speak on the phone. Because the voice button gets dirty, it is necessary to change it about once a year in a clinic.
In our department, we have chosen patients to inform patients about the disadvantages of the treatment regimen. In the three years since fiscal 2011, 47 people who underwent treatment in our department, 43 of those who had the initial anticancer treatment, the treatment of the primary tumor was 13 radiation alone therapy, radiation There were 4 chemotherapy, 16 laser surgery, 1 laryngectomy and 9 laryngectomy.