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Laryngeal cancer surgery

This operation consists in removing the vocal fold or all the vocal cords... The indication is the presence of a neoplasm in one vocal fold, without impairing its mobility. The operation is carried out as a conventional surgical method, and using a laser. The trauma of chorectomy depends on the stage of the disease. Chorectomy is performed both with local anesthesia and under general anesthesia.

Usually the operation is done with a preliminary tracheotomy to ensure calm breathing after the operation. Possible complications after chorectomy are bleeding during and after surgery, subcutaneous emphysema, and growth of granulations. This operation has a different effect on speech.

Surgery for laryngeal cancer

In some cases, it is possible to perform decortication and chorectomy. using endoscopic laser surgery with good oncological and functional (voice preservation) results. The following is a classification of endoscopic chorectomies developed by the European Society of Laryngologists:

I type. Subepithelial chorectomy: indicated for severe dysplasia and, in some cases, cancer in situ.

II type. Sublingual chordectomy: indicated for vocal fold cancer, when the mobility of the vocal folds is not impaired (T1N0). III type. An extracerebral chorectomy: indicated in cases of a small superficial cancer of the vocal fold, when the mobility of the vocal folds is preserved or when the tumor reaches the vocal muscle without growing deep into it (T2N0).

IV type. Total or complete chorectomy: indicated for cancer corresponding to stage T1, when it infiltrates the vocal fold and is diagnosed before surgery.

V type a-d. Enhanced chorectomy: Excised tissues include the contralateral vocal fold, arytenoid cartilage (which have not yet lost mobility), or tissue of the underlay space 1 cm below the glottis. Surgery may be warranted with a tumor corresponding to stage T2.

VI type. Chordectomy with anterior commissurectomy: the operation involves excising both vocal folds together with the anterior commissure.

Localization of laryngeal tumors and stages of their development according to the TNM system. Classification of Chorectomies:
Subepithelial chorectomy (type I): resection of the epithelium of the vocal fold with capture of the surface layer of its own plate of the mucous membrane.
b Ligament chordectomy (type II): resection of the epithelium, Rainke space and vocal cord.
c Excessive chorectomy (type III): with capture of the vocal muscle, g Total chorectomy (type IV): includes the vocal fold from the vocal process to the anterior commissure.
The depth of resection reaches the perichondrium of the inner surface of the plates of the thyroid cartilage and sometimes includes the perichondrium.
e Extended chorectomy (Va type): resection includes contralateral vocal fold and anterior commissure,
in case of Vb type of chorectomy, resection includes arytenoid cartilage, in Vb type, the backfold space, and in Vb type, the laryngeal ventricle is resected.
e Anterior commissurectomy (type VI): bilateral anterior chorectomy for laryngeal cancer,
emanating from the anterior commissure (but not the infiltrating thyroid cartilage), which can go to one or both vocal folds.

Vertical or horizontal laryngeal resection performed in cancer, when chorectomy alone is not enough due to the prevalence of the tumor or the peculiarities of its localization, and complete laryngectomy is unjustified.Laryngeal resection allows you to maintain voice function and a normal path for air flow.

A prerequisite for the successful outcome of this operations is a thorough assessment of the prevalence of the tumor process and a rigorous surgical technique that guarantees the complete excision of the tumor.

Vertical resection of the larynx: principles of operation. Several methods for resection of the larynx have been developed, but all of them are based on the principle of excision of a wide vertical segment, including, in addition to the tumor, the thyroid and sometimes cricoid cartilage along with soft tissues. With a tumor that does not extend to the opposite side, hemilaryngectomy can be performed - excision of half of the larynx.

Vertical anterolateral resection.
The dashed line indicates the resected area.

Horizontal resection of the larynx: principles of operation. During this operation, the extra-folding space of the larynx is completely removed, preserving the vocal folds and arytenoid cartilage.

After laryngeal resection the functional result (ability to speak) is satisfactory and the normal passage of air flow is maintained. However, the preservation of the voice function depends on the type of resection, the results of which are not the same. Patients may have difficulty swallowing, which in elderly patients are persistent. There is a risk of tumor recurrence at the border of the resection if the preoperative assessment of the degree of spread of the tumor process was inaccurate or if the volume of the resection was insufficient.

Horizontal supraplastic resection. The boundaries of the resection are indicated by a dashed dotted line.
The dotted line outlines the area that must be removed, but which is not visible with laryngoscopy.

Total laryngectomy sometimes combined with excision of the larynx. Such an operation is indicated for tumors that cannot be completely removed by chorectomy or resection of the larynx, and tumors that extend to adjacent anatomical formations, in particular, the tongue, larynopharynx, thyroid gland and trachea. Total laryngectomy is also indicated for a recurrent tumor after radiation therapy or after resection of the larynx.

Operation Technique. The larynx is completely removed from the root of the tongue to the trachea, excising, if necessary, part of the tongue, pharynx, trachea and thyroid gland. If a part of the tongue or pharynx is resected, the resulting defect is replaced with composite flaps cut, for example, from the subcutaneous or pectoral muscles together with the skin, or a forearm flap on the radial artery. After this operation, the patient breathes through a tracheostomy.

After healing wounds swallowing is usually not disturbed, and sounds are reproduced either at the level of the pharyngeal-esophageal segment, causing the mucous membrane of the esophagus to vibrate with a voice prosthesis during belching (esophageal speech, see the article on rehabilitation below) or using an external electronic larynx.

The boundaries of tissue excision with laryngectomy.
The boundaries of the resection can be expanded to include the tongue, larynopharynx, upper trachea, and thyroid gland.
(the boundaries of extended laryngectomy are indicated by a dashed line).

TO complications after laryngectomy include the formation of an external pharyngeal fistula or recurrent tracheobronchitis.

P.S. Removal of a laryngeal tumor by resection of the larynx or laryngectomy must be combined with excision of the lymph nodes of the neck affected by metastases. If there is a high risk of lymph node metastases at a given tumor location, many surgeons perform selective lymph node dissection, even if regional lymph nodes are not palpable. The treatment results are summarized in the table below.

a - Laryngectomy. A horseshoe-shaped incision is made and a cutaneous muscular skin flap based on the subcutaneous muscle of the neck (m. Platysma) is turned upside down on the chin.
The larynx along with the hyoid bone (dashed line at the top) is mobilized, cutting off from the surrounding soft tissues, as well as from the trachea and esophagus (below) and from the larynx.
Excision is carried out from top to bottom. Instead of probe feeding, they switch to feeding through a gastrostomy, superimposed percutaneously using endoscopic surgery.
In the lower part of the figure, the thyroid gland is visible, which is dissected and hemmed to the tissues more laterally.
b - View of the surgical field after removal of the larynx and layer-by-layer suturing of the pharyngeal wall together with the mucous membrane.
c - Patient's neck after completion of laryngectomy. A horseshoe-shaped skin-muscle flap, laid in place, is covered with a newly formed pharynx.
In the inset in the lower left, the dashed line shows the direction of the T-section:
1 - the passage of food is restored, after healing of the surgical wound, swallowing is restored,
2 - a new way for breathing is formed - through the tracheostomy,
3 - closing the tracheostomy with a finger or valve, the patient has the opportunity to speak through the vocal prosthesis, which is established by tracheoesophageal puncture.
Laryngectomy and radical neck lymph node dissection. The area to be excised is indicated by a dashed line.
1 - larynx affected by a tumor, 2 - superficial fascia of the neck, which coincides with the boundaries of radical excision of tissues,
3 - lymphatic vessels of the neck, 4 - internal jugular vein, 5 - carotid artery,
6 - vagus nerve, 7 - deep fascia of the neck, 8 - subcutaneous muscle of the neck.
* Survival is significantly reduced if the regional lymph nodes are affected by metastases,
if the affected lymph nodes are motionless, then the reduction in survival is even more significant.
** The first value indicates relapse-free survival, the second value indicates overall survival.

The clinical picture of laryngeal cancer

A malignant neoplasm develops due to the degeneration of its own normal cells into cancer cells due to various disorders and external influences. These factors are:

  • nicotine addiction,
  • excessive drinking
  • chronic infectious diseases
  • occupational intoxication with harmful substances and reagents,
  • degeneration of a benign neoplasm into a cancerous tumor.

The clinical picture of oncology of the larynx depends entirely on the area and degree of damage:

  • The first sign of the initial stage of laryngeal cancer is voice disturbance. This symptom is characteristic if a malignant tumor is localized in the larynx with the vocal cords. Speech function is also impaired in other localizations of cancer, but at a later stage. A characteristic change is hoarseness and hoarseness, which are constantly present, without periods of remission and exacerbation. In the advanced form of oncology, the voice may disappear completely.
  • One of the clinical manifestations of the disease is a violation of swallowing ability. The patient constantly thinks that he has a foreign body in his throat, and causes not only discomfort when swallowing food, but also pain.
  • Respiratory failure is observed in patients with an affected lower larynx. Usually this is a late manifestation of the process, which can occur only a year after the onset of tumor growth. First, shortness of breath appears during physical exertion, then in a calm state. The lumen of the larynx narrows, making breathing difficult, the body gradually adapts to constant respiratory failure. This is the reason for the development of chronic stenosis. An exacerbation in this case can cause a commonplace ARVI.
  • The oncological patient begins to feel pain with the onset of decay of cancer cells and the formation of ulcers. The pain can be given to the ear and intensified during swallowing, this contributes to the fact that the patient refuses food.At this stage of cancer, people quickly lose weight and deplete their strength.
  • Cough with throat cancer occurs reflexively, and may have a paroxysmal character. Often sputum is separated in the form of mucus with streaks of blood. Often a coughing attack is a protective reaction of the body when food enters the trachea.
  • The general clinical picture is made up of such manifestations as: weakness, pale skin, headache, sharp weight loss, insomnia, low hemoglobin in the blood. All these signs are associated with poisoning the body with toxins released during the decay of a malignant tumor.
  • Metastases spread to the upper and lower jugular lymph nodes, while cancer in rare cases affects regional lymph nodes due to their weak development. It is extremely rare that pharyngeal cancer passes to other internal organs.

An alarming sign is an increase in lymph nodes in the neck, if this is accompanied by a hoarse voice and a sensation of a foreign body, it is necessary to consult a specialist for examination. With the advanced form of laryngeal cancer, surgery is inevitable, and its types depend on the stage of the disease and the area of ​​oncology distribution.

Hemilaringectomy

This operation involves the removal of half of the larynx affected by the tumor. At the same time, there is a chance of retaining voice. The indication is the presence of a tumor in the middle section of the pharynx and impaired mobility of the vocal fold. A prerequisite is the absence of a malignant commissural process.

The consequences after hemilaringectomy can lead to complete removal of the larynx. Now this method of surgical treatment is rarely used, its main drawback is the inability to assess the boundaries of the tumor, and the doctor is forced to perform the operation blindly.

Total laryngectomy

A total laryngectomy involves the removal of the entire larynx. So that the patient can fully breathe after the operation, a special tube (tracheotome) is inserted into the trachea. This method of surgical treatment of cancer is used when a malignant tumor has spread to the entire larynx, but has not gone beyond it.

In rare cases, at the discretion of the surgeons, a total laryngectomy is performed with an extensive malignant process outside the larynx. Previously, this operation was not performed in elderly patients and diabetics; tuberculosis was also a contraindication.

Most often, the larynx is removed from the bottom up, this method minimizes the penetration of blood and mucus into the respiratory tract, and also avoids asphyxiation in the patient. As a rule, such treatment has a positive prognosis and is by far the most effective. The use of radiation therapy halves the number of patients who recovered compared with surgery.

Gastrostomy

This type of operation is used if it is impossible to swallow food with a cancer patient. It consists in installing a tube to feed the patient into the stomach through the abdominal cavity. All manipulations are performed under general anesthesia using an endoscope.

The tube is installed only for the period of radiation or chemotherapy and is removed after the restoration of the swallowing reflex. Sometimes this operation can be combined with a laryngectomy.

Complications after surgery for laryngeal cancer

After surgery for laryngeal cancer, complications of varying severity may occur:

  • bleeding, can be both after the operation, and during it,
  • infection penetration
  • difficulty breathing
  • swelling of the airways
  • loss of voice
  • mechanical damage to the trachea or esophagus,
  • relapse of malignant neoplasms.

Various factors contribute to the development of complications:

  • excess body weight of the patient,
  • bad habits
  • the patient’s age is over 60,
  • chronic diseases
  • previous throat surgery
  • eating disorders
  • diabetes,
  • a course of chemotherapy or radiation.

Postoperative Recovery

The recovery period after surgery takes from 1 to 3 months, it depends on the age of the patient, his general condition and diagnosis. Immediately after surgery, the patient is in the intensive care unit, his condition is closely monitored by doctors, noting vital signs. The intensive care course includes a number of activities:

  • intravenous droppers
  • antibiotic therapy
  • restorative therapy,
  • monitoring heart rate, as well as respiratory quality,
  • control of blood pressure and body temperature.

In order for the formed mucus to better depart from the respiratory tract, the patient must clear his throat and constantly change his body position. If the patient experiences severe pain, painkillers are given.

The throat heals for at least three weeks, so that this does not interfere with food intake, a nasogastric tube is installed. During the healing period, the patient loses the ability to talk, if the vocal cords have been saved, then a specialist then works with him to restore speech.

It is very important that the patient breathes moist air, this is necessary for the mucous membrane of the trachea. Having spent the rehabilitation period, observing all the recommendations of the doctor, a person can return to their usual lifestyle. It is forbidden to swim, smoke, drink alcohol and hypothermia.

External exposure

The patient is placed in a special chamber where the ionizing beam is directed to the entire region of the cervical zone. Based on this, it can be said that such a technique can provoke the development of many side effects, especially from the side of the thyroid gland, since it is the one that has an increased effect of the rays.

Internal impact

The beam is directed directly to the affected area, where the formed malignant tumor is located. At the same time, healthy tissues are practically not affected.

With this method, various devices can be involved. These are, as a rule, grains or needles, which are installed next to the neoplasm.

Which method to choose, only a specialist decides, given the stage of development of the oncological process.

Indications

As an isolated therapeutic effect, radiation therapy in most cases is used at stages 1 and 2 of cancer of the larynx. Such treatment is most prevalent.

In grade 4 laryngeal cancer, radiotherapy is more often used as an additional method after surgery. This allows you to destroy residual pathological cells that could not be removed during the operation. This treatment tactic can also be used at stage 3 of the disease.

If there is a lesion of the lymph nodes, which are located in hard-to-reach places and cannot be resected, radiation exposure is prescribed in a dose of 75 g.

Contraindications

Despite the fact that oncological pathology has an increased sensitivity to ionized radiation, and also during the procedure there is no damage to healthy tissues, it is not always possible to carry out radiation therapy.

So, among the main restrictions on the radioactive effects, experts identify the presence of chronic diseases that affect the respiratory, cardiovascular, urinary systems, as well as the liver at the time of exacerbation.

In addition, this type of treatment is contraindicated if the cancer begins to grow into the lymph nodes, blood vessels or esophagus.

A contraindication is also a change in blood composition, the breakdown of a malignant neoplasm, which is manifested by bleeding, diseases of an inflammatory or infectious nature of origin, accompanied by an increase in body temperature and a febrile state.

Stages

Patient irradiation should be performed only in the radiotherapy department.The patient must visit the medical institution for 5 consecutive days, after which a break is made for the weekend. The duration of the course of therapy will depend on the size of the neoplasm and its variety.

Before starting therapeutic measures, specialists accurately calculate the dose of radiation and determine the area that will be involved in the treatment. The preparatory phase usually takes from half an hour to several hours.

Before radiotherapy, the patient must undergo computed tomography, due to which it is possible to determine the exact location of the tumor.

During exposure, the patient should be stationary. To maintain this situation, doctors use a special mask that fixes the head and shoulders.

For irradiation, special accelerators are used that revolve around the patient or stand still. In this case, rays to the body come from various directions.

The external type of radiation therapy is not dangerous. Therefore, the patient can safely communicate with other people, including children.

What operations are performed for cancer of the larynx

In some cases, it is possible to perform decortication and chorectomy. using endoscopic laser surgery with good oncological and functional (voice preservation) results. The following is a classification of endoscopic chorectomies developed by the European Society of Laryngologists:

I type. Subepithelial chorectomy: indicated for severe dysplasia and, in some cases, cancer in situ.

II type. Sublingual chordectomy: indicated for vocal fold cancer, when the mobility of the vocal folds is not impaired (T1N0). III type. An extracerebral chorectomy: indicated in cases of a small superficial cancer of the vocal fold, when the mobility of the vocal folds is preserved or when the tumor reaches the vocal muscle without growing deep into it (T2N0).

IV type. Total or complete chorectomy: indicated for cancer corresponding to stage T1, when it infiltrates the vocal fold and is diagnosed before surgery.

V type a-d. Enhanced chorectomy: Excised tissues include the contralateral vocal fold, arytenoid cartilage (which have not yet lost mobility), or tissue of the underlay space 1 cm below the glottis. Surgery may be warranted with a tumor corresponding to stage T2.

VI type. Chordectomy with anterior commissurectomy: the operation involves excising both vocal folds together with the anterior commissure.

Localization of laryngeal tumors and stages of their development according to the TNM system.Classification of Chorectomies:
Subepithelial chorectomy (type I): resection of the epithelium of the vocal fold with capture of the surface layer of its own plate of the mucous membrane.
b Ligament chordectomy (type II): resection of the epithelium, Rainke space and vocal cord.
c Excessive chorectomy (type III): with capture of the vocal muscle, g Total chorectomy (type IV): includes the vocal fold from the vocal process to the anterior commissure.
The depth of resection reaches the perichondrium of the inner surface of the plates of the thyroid cartilage and sometimes includes the perichondrium.
e Extended chorectomy (Va type): resection includes contralateral vocal fold and anterior commissure,
in case of Vb type of chorectomy, resection includes arytenoid cartilage, in Vb type, the backfold space, and in Vb type, the laryngeal ventricle is resected.
e Anterior commissurectomy (type VI): bilateral anterior chorectomy for laryngeal cancer,
emanating from the anterior commissure (but not the infiltrating thyroid cartilage), which can go to one or both vocal folds.

Vertical or horizontal laryngeal resection performed in cancer, when chorectomy alone is not enough due to the prevalence of the tumor or the peculiarities of its localization, and complete laryngectomy is unjustified. Laryngeal resection allows you to maintain voice function and a normal path for air flow.

A prerequisite for the successful outcome of this operations is a thorough assessment of the prevalence of the tumor process and a rigorous surgical technique that guarantees the complete excision of the tumor.

Vertical resection of the larynx: principles of operation. Several methods for resection of the larynx have been developed, but all of them are based on the principle of excision of a wide vertical segment, including, in addition to the tumor, the thyroid and sometimes cricoid cartilage along with soft tissues. With a tumor that does not extend to the opposite side, hemilaryngectomy can be performed - excision of half of the larynx.

Vertical anterolateral resection.
The dashed line indicates the resected area.

Horizontal resection of the larynx: principles of operation. During this operation, the extra-folding space of the larynx is completely removed, preserving the vocal folds and arytenoid cartilage.

After laryngeal resection the functional result (ability to speak) is satisfactory and the normal passage of air flow is maintained. However, the preservation of the voice function depends on the type of resection, the results of which are not the same. Patients may have difficulty swallowing, which in elderly patients are persistent. There is a risk of tumor recurrence at the border of the resection if the preoperative assessment of the degree of spread of the tumor process was inaccurate or if the volume of the resection was insufficient.

Horizontal supraplastic resection. The boundaries of the resection are indicated by a dashed dotted line.
The dotted line outlines the area that must be removed, but which is not visible with laryngoscopy.

Total laryngectomy sometimes combined with excision of the larynx. Such an operation is indicated for tumors that cannot be completely removed by chorectomy or resection of the larynx, and tumors that extend to adjacent anatomical formations, in particular, the tongue, larynopharynx, thyroid gland and trachea. Total laryngectomy is also indicated for a recurrent tumor after radiation therapy or after resection of the larynx.

Operation Technique. The larynx is completely removed from the root of the tongue to the trachea, excising, if necessary, part of the tongue, pharynx, trachea and thyroid gland. If a part of the tongue or pharynx is resected, the resulting defect is replaced with composite flaps cut, for example, from the subcutaneous or pectoral muscles together with the skin, or a forearm flap on the radial artery. After this operation, the patient breathes through a tracheostomy.

After healing wounds swallowing is usually not disturbed, and sounds are reproduced either at the level of the pharyngeal-esophageal segment, causing the mucous membrane of the esophagus to vibrate with a voice prosthesis during belching (esophageal speech, see the article on rehabilitation below) or using an external electronic larynx.

The boundaries of tissue excision with laryngectomy.
The boundaries of the resection can be expanded to include the tongue, larynopharynx, upper trachea, and thyroid gland.
(the boundaries of extended laryngectomy are indicated by a dashed line).

TO complications after laryngectomy include the formation of an external pharyngeal fistula or recurrent tracheobronchitis.

P.S. Removal of a laryngeal tumor by resection of the larynx or laryngectomy must be combined with excision of the lymph nodes of the neck affected by metastases. If there is a high risk of lymph node metastases at a given tumor location, many surgeons perform selective lymph node dissection, even if regional lymph nodes are not palpable. The treatment results are summarized in the table below.

a - Laryngectomy. A horseshoe-shaped incision is made and a cutaneous muscular skin flap based on the subcutaneous muscle of the neck (m. Platysma) is turned upside down on the chin.
The larynx along with the hyoid bone (dashed line at the top) is mobilized, cutting off from the surrounding soft tissues, as well as from the trachea and esophagus (below) and from the larynx.
Excision is carried out from top to bottom. Instead of probe feeding, they switch to feeding through a gastrostomy, superimposed percutaneously using endoscopic surgery.
In the lower part of the figure, the thyroid gland is visible, which is dissected and hemmed to the tissues more laterally.
b - View of the surgical field after removal of the larynx and layer-by-layer suturing of the pharyngeal wall together with the mucosa.
c - Patient's neck after completion of laryngectomy. A horseshoe-shaped skin-muscle flap, laid in place, is covered with a newly formed pharynx.
In the inset in the lower left, the dashed line shows the direction of the T-section:
1 - the passage of food is restored, after healing of the surgical wound, swallowing is restored,
2 - a new way for breathing is formed - through the tracheostomy,
3 - closing the tracheostomy with a finger or valve, the patient has the opportunity to speak through the vocal prosthesis, which is established by tracheoesophageal puncture.
Laryngectomy and radical neck lymph node dissection. The area to be excised is indicated by a dashed line.
1 - larynx affected by a tumor, 2 - superficial fascia of the neck, which coincides with the boundaries of radical excision of tissues,
3 - lymphatic vessels of the neck, 4 - internal jugular vein, 5 - carotid artery,
6 - vagus nerve, 7 - deep fascia of the neck, 8 - subcutaneous muscle of the neck.
* Survival is significantly reduced if the regional lymph nodes are affected by metastases,
if the affected lymph nodes are motionless, then the reduction in survival is even more significant.
** The first value indicates relapse-free survival, the second value indicates overall survival.

Rehabilitation

The recovery period after a course of radiotherapy for laryngeal cancer can take from four to six weeks. Over time, side effects disappear.

In order for recovery to be successful, patients are advised to adhere to special nutrition. Plant and protein foods should predominate predominantly in the diet. There is a need in small portions up to 6 times a day.

In addition, during rehabilitation after radiation therapy of the larynx, the patient should spend at least three hours on rest. It is also important to take walks in the fresh air and do light physical exercises.

It is also necessary to exclude smoking and drinking from a lifestyle. It is recommended to take a shower without using soap.

Side effects and effects

After radiation therapy, the likelihood of various complications is not excluded.

Their severity will depend on the duration of the course and dosage of radiation.

Experts identify a number of the most common undesirable consequences.

Efficiency

The prognosis of treatment will largely depend on what stage it was identified. In addition, the localization of a malignant neoplasm, its size, degree of damage, and also the level of sensitivity to radioisotopes play an equally important role.

As a rule, if radiation therapy was used at stages 1-2 of the oncological process, survival for five years is observed in 80-95 percent of cases. With the fourth degree, these indicators are reduced to 35 percent.

With early diagnosis of laryngeal cancer, the chances of successful treatment are significantly increased. In addition, after radiation therapy, there is a likelihood of lowering the risks of re-development of the disease. However, it is worth remembering that this type of therapeutic intervention can provoke a large number of complications.

Symptoms

Laryngeal cancer is characterized by a variety of symptoms. Symptoms depend on where the tumor is located and on the stage of its development. You need to know that symptoms of a cold or an allergic reaction may be the first symptoms of throat cancer.

The main symptoms of the initial stage of laryngeal cancer include:

  • Hoarseness of voice
  • Discomfort when swallowing,
  • Cough and sore throat,
  • · labored breathing,
  • Sore throat or ear,
  • Swelling in the neck,
  • Lump in the larynx
  • · Weight loss.

Depending on the stage of throat cancer, the patient's condition worsens. In a later stage of laryngeal cancer, the symptoms of the disease appear as:

  • · Changes in voice, up to its complete loss,
  • Persistent chronic dry cough,
  • Painful swallowing with fluid and food,
  • The appearance of bad breath
  • · Visible enlargement of the cervical lymph nodes,
  • Sensations in the throat of discomfort and the presence of a coma,
  • Difficulty breathing and shortness of breath,
  • · Sharp pain in the ears and hearing difficulties,
  • Weight loss
  • Hemoptysis.

Four stages of throat cancer are distinguished:

  • · Stage I - the tumor spreads within the same part of the larynx and affects the mucous membrane and submucosal layer.
  • · Stage II - the tumor completely affects one section of the larynx, while metastases are not determined.
  • · Stage III - the tumor spreads to the surrounding tissues and neighboring parts of the larynx, while metastases develop in the cervical lymph nodes,
  • · Stage IV - the tumor affects most of the larynx, grows into other organs, distant metastases are observed.

Causes

It is scientifically proven that laryngeal cancer is a disease of smokers and malicious alcohol users. However, there are many other reasons that can lead to the development of cancer.

The causes that cause throat cancer include:

  • Tobacco smoking
  • Excessive consumption of alcoholic beverages,
  • · Harmful production associated with sulfuric acid, nickel,
  • · Labor activities associated with constant contact with wood dust, asbestos and paints,
  • Weakened immune system
  • Papilloma virus infection.

Diagnostics

Diagnosing laryngeal cancer is a complex process. To establish a diagnosis of laryngeal cancer, the doctor needs to collect a medical history of the patient, examine the patient and conduct a series of studies.

The following diagnostic methods are used to determine throat cancer:

  • Laryngoscopy (a method that is used for early diagnosis and allows you to establish the presence of a tumor with its small size),
  • · Biopsy (a method based on microscopic examination of a piece of laryngeal tissue and used to morphologically confirm the diagnosis),
  • · Computed tomography (a method that allows you to get a series of x-rays, which determine the prevalence and size of the tumor).

Treatment

The treatment method for laryngeal cancer is determined by the attending physician - an oncologist. It is important when choosing a treatment method to take into account the type of tumor, the degree of spread, the condition of the patient, his age and other related diseases.

Like any malignant tumor, laryngeal cancer is subjected to combined treatment using standard methods:

  • · Chemotherapy is a treatment method using special medicines that kill cancer cells and inhibit the growth of a malignant tumor. This cancer treatment is used before and after surgery. Chemotherapy is believed to be a very aggressive method, since healthy cells are destroyed along with cancer cells. The most effective method of chemotherapy for cancer of the larynx stage III-IV, when the tumor is located in the upper throat. The method is less effective in localizing a cancerous tumor in the middle and lower sections.Chemotherapy is mainly used in complex treatment, since its combination with radiation or surgical methods significantly improves the results.
  • · Radiation therapy - a method of radioactive irradiation of a tumor. The effectiveness of the method lies in the fact that cancer cells are very sensitive to the effects of ionizing radiation, especially if they are located in the middle part of the larynx. In laryngeal cancer of the I-II stage with the spread of the tumor in the upper or lower section, radiation therapy is used as the initial stage of treatment. In smokers, radiation therapy is most effective when the patient quits smoking before starting treatment.
  • · Surgical method - the main method of treatment for cancer of the larynx, aimed at removing the cancerous tumor. Depending on the stage of laryngeal cancer, various surgical interventions are performed:

The consequences of radiation therapy for cancer of the larynx (radiation)

Radiation therapy can cause some common side effects. Their degree of manifestation depends on the radiation dose and duration of therapy. And also the undesirable consequences are amplified if radiotherapy is carried out in combination with chemotherapy.

Side effects usually begin to develop after two weeks of exposure. They can increase within 7-10 days after the end of therapy before the condition begins to gradually improve. Most people believe that this happens after the completion of exposure after 4-8 weeks or complex therapy.

Before starting radiation therapy for throat cancer, the attending physician or nurse will tell you about the possible side effects and measures to control them.

Skin changes

The skin on the front of the neck gradually turns red or darkens. If the patient is swarthy, she may acquire a blue or black tint. In addition, pain and itching are sometimes observed, as with tanning. Changes usually occur about two weeks after radiation therapy for laryngeal cancer and last about a month after completion.

A radiologist or nurse will tell you how to care for skin in the treated area. The following recommendations are suggested:

  1. Maintain cleanliness, gently wash with warm water and odorless soap, use a soft towel.
  2. Avoid using fragrant products on the treated area, as they can cause irritation.
  3. When taking a shower, use a weak stream of warm water.
  4. Prefer a simple, odorless moisturizer such as a gel cream.
  5. Wear loose cotton clothing without tight collars. While outdoors, wear a scarf to protect your skin from the sun or cold wind.
  6. Procedures such as shaving, waxing, and depilatory creams should be postponed until several weeks after the completion of radiation therapy for laryngeal cancer, and any reactions on the skin will heal. During treatment, an electric razor can be used instead.
  7. Radiotherapy staff will advise the patient on skin care separately. Creams may be prescribed if the skin is very inflamed. If peeling or cracks appear, a dressing may be required on this area. The nurse will provide the necessary assistance.
  8. At least a year after radiation therapy for throat cancer It is important to protect the treated area from exposure to strong sunlight. Even after this time, the skin will become more tender, so additional measures will have to be taken.
  9. You must use a sunscreen with a high sun protection factor (SPF 30 or higher) and cover this area with a light scarf.

Sore throat and difficulty swallowing

The mucous membrane of the throat can be affected by an inflammatory process that makes swallowing difficult. To alleviate this condition, liquid painkillers are prescribed that are taken before eating.

A nurse or radiologist will recommend foods that are easy to swallow. Nutritious or high-calorie drinks are also advised. Most patients prefer soft and moist foods until soreness subsides. This usually occurs a few weeks after the end of radiation therapy for laryngeal cancer, sometimes lasts longer.

Some patients in some cases because of this side effect do not receive enough food. Most often this is noted with chemoradiation treatment. If this happens, the doctor may recommend artificial nutrition so that significant weight loss does not occur. Liquid and medicines will also come with food.

  • prevent weight loss
  • will provide a sufficient amount of fluid,
  • relieve pressure to eat.

It can be carried out in the following ways:

  • With the help of a thin tube going through the nose into the stomach - a nasogastric tube.
  • Gastrostomy - a tube that is inserted into the hole created during percutaneous endoscopic gastrostomy in the stomach.

The attending physician and nutritionist determine the most suitable option for each patient. But even if artificial nutrition is used, the patient should try to swallow everything that he can.

Sometimes patients need help with meals before throat cancer exposurebecause they have lost a lot of weight or have serious problems with the swallowing process. Artificial nutrition provides enough calories to prevent any unplanned breaks in treatment.

Laryngeal Cancer Exposure may affect the salivary glands, decreasing saliva production. The mucous membranes of the mouth and throat will become dry. This will create difficulties for the food and speech process.

Saliva helps to maintain cleanliness in the oral cavity, so it is very important to brush your teeth with a soft toothbrush twice a day and use mouthwash regularly. It is recommended to constantly drink sips of water throughout the day to maintain humidity. The doctor may prescribe artificial saliva preparations in the form of sprays and gels.

Sometimes this side effect is noted within a few months after the completion of laryngeal cancer exposure. For some people, it becomes permanent.

Voice changes

The voice may already be hoarse, radiation therapy for throat cancer can aggravate the situation. The doctor informs the patient about the risk of constant voice changes. The patient will need to give rest to the voice without straining it and avoiding smoky places. Gradually, the condition will improve. The speech therapist recommends special exercises that will speed up the healing process.

Loss of appetite

The patient does not experience sensations during the meal if there is pain in the oral cavity. The situation may worsen by the end of throat cancer exposure and in the first couple of weeks after its completion. It’s still important to try to eat. The nutritionist recommends high-calorie and nutritious drinks until the appetite is restored.

Hair loss

When the throat is irradiated, the scalp does not suffer. However, if there is facial hair, then its loss will be observed.

Impaired respiratory function

With radiation therapy, the development of throat edema is not excluded. If this complication occurs, it is important to immediately take measures to eliminate it.

Efficiency

The prognosis of treatment will largely depend on what stage it was identified. In addition, the localization of a malignant neoplasm, its size, degree of damage, and also the level of sensitivity to radioisotopes play an equally important role.

As a rule, if radiation therapy was used at stages 1-2 of the oncological process, survival for five years is observed in 80-95 percent of cases. With the fourth degree, these indicators are reduced to 35 percent.

With early diagnosis of laryngeal cancer, the chances of successful treatment are significantly increased. In addition, after radiation therapy, there is a likelihood of lowering the risks of re-development of the disease. However, it is worth remembering that this type of therapeutic intervention can provoke a large number of complications.

Laryngeal cancer

Description

Laryngeal cancer (throat cancer) is a malignant disease characterized by the formation of tumor cells in the tissues of the larynx.

Symptoms

Laryngeal cancer is characterized by a variety of symptoms. Symptoms depend on where the tumor is located and on the stage of its development. You need to know that symptoms of a cold or an allergic reaction may be the first symptoms of throat cancer.

The main symptoms of the initial stage of laryngeal cancer include:

  • Hoarseness of voice
  • Discomfort when swallowing,
  • Cough and sore throat,
  • · labored breathing,
  • Sore throat or ear,
  • Swelling in the neck,
  • Lump in the larynx
  • · Weight loss.

Depending on the stage of throat cancer, the patient's condition worsens. In a later stage of laryngeal cancer, the symptoms of the disease appear as:

  • · Changes in voice, up to its complete loss,
  • Persistent chronic dry cough,
  • Painful swallowing with fluid and food,
  • The appearance of bad breath
  • · Visible enlargement of the cervical lymph nodes,
  • Sensations in the throat of discomfort and the presence of a coma,
  • Difficulty breathing and shortness of breath,
  • · Sharp pain in the ears and hearing difficulties,
  • Weight loss
  • Hemoptysis.

Four stages of throat cancer are distinguished:

  • · Stage I - the tumor spreads within the same part of the larynx and affects the mucous membrane and submucosal layer.
  • · Stage II - the tumor completely affects one section of the larynx, while metastases are not determined.
  • · Stage III - the tumor spreads to the surrounding tissues and neighboring parts of the larynx, while metastases develop in the cervical lymph nodes,
  • · Stage IV - the tumor affects most of the larynx, grows into other organs, distant metastases are observed.

Causes

It is scientifically proven that laryngeal cancer is a disease of smokers and malicious alcohol users. However, there are many other reasons that can lead to the development of cancer.

The causes that cause throat cancer include:

  • Tobacco smoking
  • Excessive consumption of alcoholic beverages,
  • · Harmful production associated with sulfuric acid, nickel,
  • · Labor activities associated with constant contact with wood dust, asbestos and paints,
  • Weakened immune system
  • Papilloma virus infection.

Diagnostics

Diagnosing laryngeal cancer is a complex process. To establish a diagnosis of laryngeal cancer, the doctor needs to collect a medical history of the patient, examine the patient and conduct a series of studies.

The following diagnostic methods are used to determine throat cancer:

  • Laryngoscopy (a method that is used for early diagnosis and allows you to establish the presence of a tumor with its small size),
  • · Biopsy (a method based on microscopic examination of a piece of laryngeal tissue and used to morphologically confirm the diagnosis),
  • · Computed tomography (a method that allows you to get a series of x-rays, which determine the prevalence and size of the tumor).

Treatment

The treatment method for laryngeal cancer is determined by the attending physician - an oncologist. It is important when choosing a treatment method to take into account the type of tumor, the degree of spread, the condition of the patient, his age and other related diseases.

Like any malignant tumor, laryngeal cancer is subjected to combined treatment using standard methods:

  • · Chemotherapy is a treatment method using special medicines that kill cancer cells and inhibit the growth of a malignant tumor. This cancer treatment is used before and after surgery. Chemotherapy is believed to be a very aggressive method, since healthy cells are destroyed along with cancer cells. The most effective method of chemotherapy for cancer of the larynx stage III-IV, when the tumor is located in the upper throat. The method is less effective in localizing a cancerous tumor in the middle and lower sections. Chemotherapy is mainly used in complex treatment, since its combination with radiation or surgical methods significantly improves the results.
  • · Radiation therapy - a method of radioactive irradiation of a tumor. The effectiveness of the method lies in the fact that cancer cells are very sensitive to the effects of ionizing radiation, especially if they are located in the middle part of the larynx. In laryngeal cancer of the I-II stage with the spread of the tumor in the upper or lower section, radiation therapy is used as the initial stage of treatment. In smokers, radiation therapy is most effective when the patient quits smoking before starting treatment.
  • · Surgical method - the main method of treatment for cancer of the larynx, aimed at removing the cancerous tumor. Depending on the stage of laryngeal cancer, various surgical interventions are performed:

The consequences of radiation therapy for cancer of the larynx (radiation)

Radiation therapy can cause some common side effects. Their degree of manifestation depends on the radiation dose and duration of therapy. And also the undesirable consequences are amplified if radiotherapy is carried out in combination with chemotherapy.

Side effects usually begin to develop after two weeks of exposure. They can increase within 7-10 days after the end of therapy before the condition begins to gradually improve. Most people believe that this happens after the completion of exposure after 4-8 weeks or complex therapy.

Before starting radiation therapy for throat cancer, the attending physician or nurse will tell you about the possible side effects and measures to control them.

Skin changes

The skin on the front of the neck gradually turns red or darkens. If the patient is swarthy, she may acquire a blue or black tint. In addition, pain and itching are sometimes observed, as with tanning. Changes usually occur about two weeks after radiation therapy for laryngeal cancer and last about a month after completion.

A radiologist or nurse will tell you how to care for skin in the treated area. The following recommendations are suggested:

  1. Maintain cleanliness, gently wash with warm water and odorless soap, use a soft towel.
  2. Avoid using fragrant products on the treated area, as they can cause irritation.
  3. When taking a shower, use a weak stream of warm water.
  4. Prefer a simple, odorless moisturizer such as a gel cream.
  5. Wear loose cotton clothing without tight collars. While outdoors, wear a scarf to protect your skin from the sun or cold wind.
  6. Procedures such as shaving, waxing, and depilatory creams should be postponed until several weeks after the completion of radiation therapy for laryngeal cancer, and any reactions on the skin will heal. During treatment, an electric razor can be used instead.
  7. Radiotherapy staff will advise the patient on skin care separately. Creams may be prescribed if the skin is very inflamed. If peeling or cracks appear, a dressing may be required on this area. The nurse will provide the necessary assistance.
  8. At least a year after radiation therapy for throat cancer It is important to protect the treated area from exposure to strong sunlight. Even after this time, the skin will become more tender, so additional measures will have to be taken.
  9. You must use a sunscreen with a high sun protection factor (SPF 30 or higher) and cover this area with a light scarf.

Sore throat and difficulty swallowing

The mucous membrane of the throat can be affected by an inflammatory process that makes swallowing difficult. To alleviate this condition, liquid painkillers are prescribed that are taken before eating.

A nurse or radiologist will recommend foods that are easy to swallow. Nutritious or high-calorie drinks are also advised. Most patients prefer soft and moist foods until soreness subsides. This usually occurs a few weeks after the end of radiation therapy for laryngeal cancer, sometimes lasts longer.

Some patients in some cases because of this side effect do not receive enough food. Most often this is noted with chemoradiation treatment. If this happens, the doctor may recommend artificial nutrition so that significant weight loss does not occur. Liquid and medicines will also come with food.

  • prevent weight loss
  • will provide a sufficient amount of fluid,
  • relieve pressure to eat.

It can be carried out in the following ways:

  • With the help of a thin tube going through the nose into the stomach - a nasogastric tube.
  • Gastrostomy - a tube that is inserted into the hole created during percutaneous endoscopic gastrostomy in the stomach.

The attending physician and nutritionist determine the most suitable option for each patient. But even if artificial nutrition is used, the patient should try to swallow everything that he can.

Sometimes patients need help with meals before throat cancer exposurebecause they have lost a lot of weight or have serious problems with the swallowing process. Artificial nutrition provides enough calories to prevent any unplanned breaks in treatment.

Laryngeal Cancer Exposure may affect the salivary glands, decreasing saliva production. The mucous membranes of the mouth and throat will become dry. This will create difficulties for the food and speech process.

Saliva helps to maintain cleanliness in the oral cavity, so it is very important to brush your teeth with a soft toothbrush twice a day and use mouthwash regularly. It is recommended to constantly drink sips of water throughout the day to maintain humidity. The doctor may prescribe artificial saliva preparations in the form of sprays and gels.

Sometimes this side effect is noted within a few months after the completion of laryngeal cancer exposure. For some people, it becomes permanent.

Thick, sticky saliva (mucus)

There may be a buildup of viscous mucus in the throat. Regular rinsing and spitting will benefit. The doctor will give detailed advice on this issue.

Voice changes

The voice may already be hoarse, radiation therapy for throat cancer can aggravate the situation. The doctor informs the patient about the risk of constant voice changes. The patient will need to give rest to the voice without straining it and avoiding smoky places. Gradually, the condition will improve. The speech therapist recommends special exercises that will speed up the healing process.

Loss of appetite

The patient does not experience sensations during the meal if there is pain in the oral cavity. The situation may worsen by the end of throat cancer exposure and in the first couple of weeks after its completion. It’s still important to try to eat. The nutritionist recommends high-calorie and nutritious drinks until the appetite is restored.

Loss of taste

Sometimes there are changes in taste.Gradually, the condition normalizes, it can take up to several months after the completion of radiation therapy for laryngeal cancer.

Hair loss

Irradiating the throat does not lead to hair loss on the head. But if there is facial hair, it can fall out and no longer grow.

Breathing problems

Radiation therapy for laryngeal cancer can cause swelling in the throat. Very rarely leads to breathing problems, but if this happens, it is necessary to treat immediately. If difficulties arise, consult a doctor as soon as possible. Surgery is extremely rare.

Get a treatment program

Effective radiation of larynx (throat) cancer in Israel

The medical service “Tlv.Hospital” offers a professional organization for the treatment of laryngeal cancer in Israel with the best specialists of the country.

Israeli doctors have successfully applied modern methods of radiotherapy in the treatment of laryngeal cancer, such as radiation therapy with intensity modulation and proton therapy. High skill of radiation oncologists allows you to accurately direct the radiation to a malignant tumor of the larynx, delivering the maximum amount of radiation to it and ensuring minimal damage to healthy cells.

Radiation therapy for laryngeal cancer in Israel

Often, radiotherapy is preferred as the primary treatment for this disease in Israel. Most patients with early stages of laryngeal cancer are cured using this method. Doctors may recommend radiation or endoscopic surgery. Both methods are effective and help keep your voice.

How suitable radiation therapy for cancer of the larynx in each case depends on the volume and location of the neoplasm, is determined by its depth of germination in the tissue of the organ.

In the early stages of the disease, in most cases, treatment is prescribed five times a week, from Monday to Friday for three to seven weeks. The radiation therapist calculates the total dose of larynx cancer for the entire course, and then divides it into fractions. This separation can reduce the undesirable effects of treatment.

Recent studies have shown that chemotherapy before radiotherapy can reduce swelling and increase radiation efficiency. This method is called neoadjuvant chemotherapy.

Radiation therapy for laryngeal cancer after surgery

This type of treatment is called adjuvant therapy. It helps reduce the likelihood of a disease return. Doctors at an Israeli clinic recommend radiation therapy after surgery for a number of reasons. The patient is prescribed irradiation of laryngeal cancer if the disease can return, because:

  1. The tumor is difficult to remove.
  2. The surgeon believes that the cancer cells remained in the body because it was not possible to obtain the necessary volume of the surgical edge.
  3. A malignant tumor has grown into the wall of the larynx.
  4. Cancer cells were found in the lymph nodes or in the outer wall of the lymph nodes.

Treatment is carried out daily, from Monday to Friday for four to six weeks - these are 20-30 fractions.

Intensity Modulated Radiation Therapy (IMRT)

This type of radiotherapy is widely used when the radiation coincides in shape with the tumor. The dose in the treatment area is different. This is effective when radiation therapy is given simultaneously to several different groups of lymph nodes. Since less effect is exerted on healthy tissue, the patient will have fewer side effects, or they will be less serious.

IMRT can be prescribed separately, or in combination with chemotherapy or biological therapy for locally advanced laryngeal cancer.

Studies show that IMRT reduces the risk of such unwanted effects as dry mouth due to a lower dose of salivary gland radiation therapy.

Proton therapy

Clinics in Israel can offer the most advanced radiation method - proton therapy.It delivers high doses of radiation directly to the tumor, causing minimal damage to adjacent healthy tissues.

Such technology is available only in a few medical centers around the world - an important tool in the treatment of head and neck tumors.

In some patients, proton therapy provides improved disease control with fewer side effects.

Radiation therapy with chemotherapy or biological therapy

For locally advanced laryngeal cancer, stages 3-4 may be recommended radiotherapy with chemotherapy or biological therapy. In the course of research, it was found that sometimes these methods work better when applied in combination. Cytostatics or targeted therapy may be useful in reducing the size of the tumor and in controlling the disease.

Irradiation of laryngeal cancer to alleviate cancer symptoms

Radiotherapy can attenuate manifestations of the disease. This type of treatment is called palliative. A tumor can cause difficulty in swallowing, or by pressing on the trachea, create difficulties in the breathing process.

Irradiation can reduce the size of the tumor for a while and mitigate the manifestations of the disease, as well as reduce pain. To achieve this goal, fewer procedures are prescribed over several days.

Larynx cancer radiation planning process

Before starting treatment, the team of radiation oncologists carefully plans remote radiation therapy. The radiation dose is calculated and the treatment site is determined. The preparation process can take from 30 minutes to several hours. The patient undergoes a CT scan, with the help of which the tumor and the structures around it are displayed.

Which doctor should I go to?

Any disease, even as severe as oncology, is better treatable in the initial stages. Laryngeal cancer may, after surgery, go into prolonged remission. With timely treatment, the chances of success are very high. The doctor will select the optimal therapeutic regimen:

Usually, suspicions of throat cancer are first voiced by the otolaryngologist. After a series of examinations, he will be able to either dispel doubts, or, in case of confirmation of fears, transfer the patient to the oncologist's account. Before conducting further diagnostics, the doctor will try to maximize the clinical picture. To do this, he will ask the patient the following questions:

  1. What specific symptoms became the reason for going to the doctor?
  2. How long have they been manifesting?
  3. How fast are they progressing?
  4. What survey results did the previous specialist get?
  5. What diseases of the upper respiratory tract did the patient have?
  6. Was there any treatment?
  7. What other health problems are observed?

After that, a series of laboratory and hardware examinations will be carried out, which include a clinical and biochemical blood test, ultrasound, MRI, laryngoscopy. The most effective method is a biopsy of the throat tissue.

Types of operations for laryngeal cancer

The choice of the method of surgical intervention always depends on a number of individual characteristics of the body and the course of the development of the disease. The key role is played by the location of the tumor, its size and the presence of metastases. Depending on these factors, the specialist may choose one of the surgical methods. These include:

  • Chorectomy It is carried out in the field of vocal cords and folds that surround them. Depending on the stage of the pathology, all tissues or only a part of them can be removed.
  • Hemilaringectomy. It consists in the removal of laryngeal tissue. It is carried out in cases when the tumor is located in the middle section and interferes with the mobility of the vocal cords.
  • Upper laryngeal laryngectomy. It is performed when the tumor is located at the outer edge of the organ. Most often, it is possible to save the vocal cords and the ability to speak for the patient.
  • Total laryngectomy.It is carried out with a large tumor and its extension beyond the larynx. In this case, complete removal of the organ and the formation of an artificial respiratory gap are necessary.
  • Laser surgery It is possible only in cases when the tumor is in the upper parts of the larynx and has a small size. The safest method, however, it has very limited indications.

Most often, surgical intervention is accompanied by drug therapy, a system of droppers of chemicals and radiation exposure. In this case, there is a need to install a gastrostomy tube, which is inserted into the abdominal cavity to provide nutrition with the difficulty of carrying it out naturally.

Is relapse possible after surgery?

In the vast majority of cases, oncological diseases are not completely cured, but pass to the stage of remission, the duration of which depends on many factors. Even with timely, full-fledged treatment, the risk of relapse cannot be completely ruled out. To reduce its likelihood, you should adhere to such recommendations:

  • conduct all necessary treatment courses, including repeated ones,
  • to support the body’s immunity in a natural way and with drugs,
  • undergo regular preventive examinations,
  • monitor overall health,
  • to refuse from bad habits,
  • monitor the regimen of the day, physical activity and food quality.

With successful treatment, the disease can go into remission for a period of more than twenty years. However, none of the patients is immune from complications - disorders of the vocal cords and respiratory tract, side effects of chemo and radiotherapy. Moreover, any consequences of treatment are transferred by the body much easier than the unhindered development of the disease, which will invariably lead to death.

Laryngeal cancer: is surgery necessary?

Among all oncological diseases, this feed is the most common. Malignant tumors can be localized in various parts of the throat and develop at an uneven speed. This largely depends on what became the prerequisites for the formation of the disease, and what measures to combat it were taken. Often the only way to influence the ailment is surgery. Depending on at what stage the tumor was detected, the methods for its conduct will be uneven. Surgery is an effective treatment method only in combination with medication and radiation exposure.

How does radiation therapy for throat cancer go?

Irradiation accelerators are large machines. They can be in one position or rotate around the body, delivering rays from different directions. Before starting treatment, radiologists will explain in detail what to expect for the patient.

The procedure takes several minutes. It is important to be in the same position that experts have developed, each time so that radiation therapy is as effective as possible. After the doctors help the patient to take the correct position, treatment begins.

External radiation therapy does not make the patient radioactive, it is completely safe when communicating with other people, including children, throughout the course of treatment.

Potential side effects

Adverse effects of radiation therapy for throat cancer usually occur gradually. Most people have certain side effects in the head and neck. As a rule, they worsen by the end of the course of therapy. Within 2-3 weeks after treatment, they will gradually decrease. This time period can reach six weeks before the pain is completely gone.

Radiation therapy for laryngeal cancer leads to the death of abnormal cells, but it also affects healthy ones in the treatment area, even if steps are taken to prevent this effect. Radiation can have a different effect on different tissues and organs.

Smoking and drinking alcohol during radiotherapy exacerbate side effects and reduce the effectiveness of treatment.

It is very important to notify the team of doctors about the appearance of undesirable effects of therapy, since many of them can be prevented or managed with medications, changes in the diet, or other measures. Experts also evaluate how serious side effects are. In some cases, the procedures can be adjusted if side effects are severe.

  1. Skin reactions are a consequence of the passage of an external radiation beam through the skin to the treated object. The skin in this area may turn red, dry or change color (it will darken or look more tanned). Most of these reactions appear in the first two weeks of treatment and disappear a few weeks after its completion. Doctors advise the patient on the care and protection of the skin during therapy, as it becomes more sensitive.
  2. Fatigue is often observed in patients during radiation therapy for throat cancer. It can be caused by depression, anemia, or poor appetite. In the process of irradiation, the body spends a lot of energy to heal itself, so rest does not always help get rid of this condition. The degree of this symptom can increase during therapy, after it ends, it gradually disappears.
  3. Radiation therapy is able to invoke stomatitis or oral mucositis, since it provokes irritation of the mucous membranes of the mouth, throat and esophagus. This effect develops if the irradiation of the throat cancer affects the oral cavity, or if chemotherapy is carried out simultaneously with radiation therapy. Doctors advise on careful and regular care that can prevent inflammation and reduce the risk of infection.
  4. Difficulty swallowing or heartburn can occur if the throat or esophagus is exposed to radiation in throat cancer. Radiation can cause inflammation of the pharynx (pharyngitis) or esophagus (esophagitis), which will cause problems in the process of swallowing. Doctors at an Israeli clinic may offer antacids or painkillers. You may have to make changes to the diet - give preference to soft or liquid foods, start taking dietary supplements. If the patient cannot completely swallow the food, a temporary gastrostomy may be required, with the help of which the food will go directly to the stomach.
  5. Xerostomia (insufficient salivation) may be due to damage to the salivary glands in the oral cavity. This symptom appears in the first 2-3 weeks of treatment, may worsen during therapy. Recovery sometimes takes months or years. In some cases, the problem becomes permanent. It is important to follow the oral care instructions given by doctors.

Radiation therapy for cancer of the laryngopharynx: cost, contraindications, price in Moscow

Free consultation on treatment in Moscow. Call 8 (800) 350-85-60 or fill out the form below:

Radiation Therapy (RT) for Larynxopharyngeal Cancer used in combination with chemotherapy and surgery.

Unfortunately, not a single therapeutic technique used independently for this type of oncopathology gives a positive result.

This is due to the anatomical complexity and high susceptibility of the tumor to metastasis to the deep lymph nodes, despite the fact that squamous cell carcinoma is hypersensitive to ionizing radiation.

If you or your loved ones need medical care, contact us.Site specialists will advise a clinic where you can get effective treatment:

When is radiation therapy used for laryngeal cancer

Radiotherapy is indicated in such situations:

  • • as a palliative measure in case of advanced disease,
  • • if the patient refuses surgery,
  • • before and after resection,
  • • the first and second stages of the process are rare cases, since laryngopharynx neoplasia is practically not detected at the early stages,
  • • multiple metastases to the lymph nodes,
  • • large size of the focus.

When exposed to gamma rays, atypical cells lose their ability to reproduce due to the destruction of their DNA. As a result, the growth and spread of the neoplasm stops.

These principles are the basis of radiation therapy for cancer of the larynx.

Oncocytes are inactivated both before division and after it, but some of them, which are at rest, do not die, therefore treatment is not limited to one session.

Types of operations used in laryngeal cancer

The operation on the vocal cords is performed using a laryngoscope, which allows tissue sampling for subsequent histological analysis. The voice after such an intervention is usually retained. Laser exposure is used to treat stage 0 or stage 1 larynx cancer. An endoscope is inserted into the throat, which detects the tumor and destroys it with a directed laser beam. The disadvantage of this method of treatment is the evaporation of the affected tissues, which is why it is impossible to perform a histological examination.

When you delete part of the vocal cords, you can change the tone of the voice.

Chordectomy - partial or complete removal of the vocal cords. Indications for such surgical intervention are stage 1 larynx cancer or interepithelial tumors of the vocal cords. How this operation will affect voice formation depends on the amount of intervention. With partial removal of the vocal cords, hoarseness appears, when completely removed, a person loses his voice. Laryngectomy is an operation to remove parts of the larynx. Partial removal is performed for small tumors.

There are several types of such surgical interventions that are performed for the sole purpose of drastically removing a malignant neoplasm with maximum preservation of healthy tissues.

Upper laryngeal laryngectomy involves the removal of the upper sections of the larynx, and the voice is preserved after such an operation. Hemilaryngectomy - removal of one of the vocal cords, is carried out at stages 1-2 of the cancer, which helps preserve speech. With complete removal of the larynx, a stoma is formed in the neck area, to which the trachea is connected. A person loses his voice, but the ability to breathe and eat remains.

Pharyngectomy - partial or complete removal of the pharynx is performed for malignant neoplasms in this area. Often, the pharynx is removed along with the larynx. Reconstructive surgery is performed to improve the ability to swallow food after a pharyngectomy.

Reconstructive surgery for laryngeal cancer

They are carried out to restore the normal appearance and functions of the distant parts of the larynx. As a material for the formation of a new larynx, musculoskeletal tissue obtained from areas located close to the larynx, for example, the chest, is used. Modern developments in the field of plastic surgery have allowed to start using tissues from other parts of the body - the intestines, forearms.

Laryngeal cancer can metastasize to regional lymph nodes. The operation to remove them is called cervical dissection and is performed simultaneously with the removal of the malignant neoplasm. The nature of the damage to the lymph nodes is assessed based on the size of the primary lesion and the type of cancer.

Cervical dissection can be selective or total.With complete removal of all lymph nodes, salivary glands, muscles and blood vessels. This operation allows you to remove all tissues containing atypical cells.

An indication for such an operation is the presence of a large number of metastases. The operation leads to disability of the patient.

Tracheostomy - a surgical procedure in which a respiratory hole is formed. After partial pharyngectomy or laryngectomy, a temporary tracheostomy is done, which protects the upper respiratory tract in the early postoperative period. A tube is inserted into the hole, which ensures the passage of air flow and the removal of accumulating mucus. After complete removal of the larynx, a constant stoma is formed, the edges of the trachea are sutured with the edges of the incision on the neck. With large sizes of malignant neoplasms that block the airways, the stoma is placed around the tumor, which allows the patient to breathe normally.

Laryngeal cancer often spreads to the esophagus, making nutrition impossible. Gastrostomy - an operation to create an entrance to the cavity of the stomach through the abdominal wall with the installation of a tube. Intervention involves the use of endoscopic equipment and is performed under general anesthesia. Often, a gastrostomy is performed simultaneously with the removal of a malignant neoplasm.. Using a tube, food is delivered directly to the stomach. In some cases, the gastrostomy is superimposed for a certain period of time to ensure proper nutrition during irradiation and chemotherapy. After restoration of the functions of the esophagus, the tube is removed.

Laryngeal Cancer Complications

Any operation does not go without consequences for human health. The risk of developing thrombosis and pneumonia, the addition of a bacterial infection increases. After complete or partial removal of the larynx, many patients lose their voice. Speech may be impaired with less radical operations.

The laryngeal stenosis that develops after surgery can lead to breathing problems, which necessitates a tracheostomy.

The most serious complication of laryngectomy is rupture of the carotid artery. Surgical treatment of laryngeal cancer can lead to impaired thyroid function. Changes in the work of the parathyroid glands affect the absorption of calcium, leading to the development of convulsive syndrome and arrhythmia. Such effects are eliminated through drug treatment. Often, surgery to remove the larynx affects the ability to swallow food and fluid. This affects the choice of feeding method - there is a need to install a permanent feeding tube. Complete and partial removal of the pharynx can lead to the formation of fistulas, which are eliminated by additional surgical intervention.

How is radiation therapy for cancer of the larynxopharynx

Before the procedures, the patient is forbidden to smoke, good nutrition, refusal of heavy physical labor is recommended, drugs are prescribed that increase the sensitivity of cancer cells to radiation.

A otolaryngologist, oncologist, radiologist draws up a detailed plan of measures, selects the device, modes, and calculates the dosage with mathematical precision. Sometimes premedication is performed.

Laryngopharynx cancer is irradiated on both sides of the organ mainly by the remote method. A man is on a couch in a special chamber. Everything goes quickly and painlessly.

With internal exposure, a radioactive wire or other devices are brought to cancer formation. An eight-week course leads to a decrease in the primary focus by half.

Next, the following cycles are carried out if persistent positive dynamics is observed.

The greatest effectiveness of radiation therapy for cancer of the larynxopharynx is achieved after chemotherapy. However, taking cytostatics and radiotherapy cause much more side effects that are more difficult to eliminate.

Laryngeal cancer surgery

Laryngeal cancer is a malignant tumor located in the upper or lower part of the throat, the disease is prevalent mainly among smoking men. The signs and clinical picture of the disease may vary depending on the location of the neoplasm and the area of ​​the lesion. If laryngeal cancer is diagnosed, surgery is the best treatment for oncology.

Consequences and rehabilitation after radiation therapy (radiation) for cancer of the larynx

The disadvantage of RT is the negative effect not only on the tissue, but also on healthy organs. In addition, with combined treatment, side effects are inevitable, especially if the patient has a tracheostomy.

The consequences of radiation therapy for neoplasm of the larynx:

  • • excessive dry mouth, decreased salivation,
  • • sore throat,
  • • change in taste, smell,
  • • violation of voice formation,
  • • digestive upset, lack of appetite,
  • • inflammation of the esophagus,
  • • irritation of the oral mucosa,
  • • skin burns in the neck,
  • • anxiety, emotional instability.

Recovery after a course of radiation therapy lasts a long time, its duration depends on many factors: the degree and type of neoplasia, treatment methods, dosage, proper planning of treatment for cancer of the larynx, age of the patient, his general health. An important component of recovery is the correct positive attitude. Relatives should help this person. If necessary, help is provided by a psychologist.

If a tracheotomy was performed, then fractional nutrition is recommended. Food should be soft, warm, semi-liquid. It is subjected to thorough heat treatment so as not to mechanically injure the larynx.

Receiving a large amount of fluid per day (up to one and a half liters) will accelerate the elimination of toxins and decay products of destroyed cells. Alcohol, fatty and fried foods, marinades, coffee, sweets are excluded. No smoking. Unfortunately, without adequate therapy, patients with such a diagnosis quickly die.

With good care and treatment, almost 100% survive at the zero stage, up to 90% in the first and second, half in the third, and 15% in the fourth.

Laryngeal cancer treatment after radiation therapy

  • The coding of malignant neoplasms of the larynx according to the ICD - 10 - code C32.
  • Laryngeal cancer is a malignant neoplasm and is very dangerous, because for a long time it can be asymptomatic or with minor manifestations that are similar to the symptoms of an onset cold.
  • Malignant tumors in the larynx originate from cells of the mucous epithelium, which mutate under the influence of various factors, lose their functions, and can only multiply uncontrollably.

What does laryngeal cancer look like? Initially, there is a slight compaction in the upper layer of the mucous membrane or a small, almost imperceptible erosion. Outwardly, most cancers resemble a protrusion above the mucous membrane, a white spot or a small area of ​​damage to the mucous membrane.

Gradually, laryngeal cancer progresses - a tumor or erosion covers a large area and penetrates into the deeper layers of the epithelium. Some tumors germinate in neighboring tissues, encompassing muscle and bone structures.

Others grow in the lumen of the larynx, disrupting breathing and swallowing. In the absence of treatment, the malignant process passes to the lymph nodes, blood vessels and spreads to remote areas of the body.

Types and classification of laryngeal cancer

The most common type of laryngeal cancer is squamous, formed from flat cells of the mucous epithelium. According to statistics, it develops in 95% of cases of all malignant tumors of the throat.

Squamous cell carcinoma of the larynx is divided into two types:

  1. Keratinizing - is formed from epithelial cells, prone to keratinization. It is characterized by slow growth and low probability of the spread of metastases. Keratinizing cancer of the larynx is a formed tumor with clear boundaries. Well treatable, especially in the early stages.
  2. Non-keratinized - characterized by the formation of unformed erosion having an uneven shape. It quickly spreads to surrounding tissues and quickly spreads metastases.

Other malignant tumors in the larynx occur in 1-2% of cases. These include sarcomas, basal cell and glandular neoplasms. In isolated cases, mixed forms of cancer are found.

According to histology, the degree of differentiation is determined - how much cancer cells differ from healthy epithelial cells:

  1. GX - it is impossible to determine the degree of differentiation.
  2. G1 is a high degree.
  3. G2 - medium (moderate) degree.
  4. G3 is a low-grade cancer.
  5. G4 - undifferentiated tumors.

The lower the degree of differentiation, the more aggressive the tumor and the disease prognosis is not favorable. Undifferentiated cancer is rapidly progressing, responds poorly to treatment, and often recurs.

The international classification of TNM allows you to assess the degree of laryngeal cancer and predict the further course of the disease.

The first indicator T - describes the size and location of the primary tumor:

  • TX - not enough data.
  • T0 - no signs of cancer.
  • Tis - damage to one layer of the epithelium, the earliest stage.
  • T1 - a small seal of one section of the larynx.
  • T2 is a medium-sized neoplasm, limited to one area of ​​the larynx.
  • T3 - a malignant process has spread to several sections of the larynx.
  • T4 - the tumor went beyond the organ:
  1. T4a - Cancer has grown into the thyroid cartilage.
  2. T4b - tumor covers arteries, prevertebral and thoracic.

The second indicator N - indicates the involvement of regional lymph nodes in the process:

  • NX - Not enough data.
  • N0 - no signs of cancer in the lymph nodes
  • N1 - one node is affected from the side of the tumor, the size of the cancer tissue is up to 3 cm.
  • N2 - the size of malignant tissues 3-6 cm:
  1. N2a - in one node from the primary neoplasm.
  2. N2b - in two or more lymph nodes from the side of the cancerous tumor.
  3. N2c - cancer has spread to the lymph nodes on both sides.
  4. N3 - a focus of cancer in the lymph nodes more than 6 cm.

The third indicator M - characterizes distant metastases:

  • MX - insufficient data to determine the presence of metastases.
  • M0 - no distant metastases.
  • M1 - metastases spread to distant parts of the body.

The TNM classification allows a more accurate description of the stage of laryngeal cancer. Only three values ​​will tell any specialist about the incidence of cancer and the severity of the disease.

Possible complications

  1. Cyberknife treatment, as a rule, takes place without any undesirable consequences.
  2. Combined therapy using chemotherapy and radiation increases the intensity of side effects of each of the methods, which is taken into account by the oncologist when planning courses of chemotherapy and radiotherapy.

  • Side effects of radiation therapy include:
    • Dry mouth. It is recommended to drink more water, sometimes artificial saliva is used, sore throat, prolonged healing after dental treatment. That is why it is recommended to undergo a dentist examination and the necessary treatment before conducting a course of radiation therapy, Caries. To prevent the development of this complication, it is enough to observe oral hygiene, fatigue, voice changes, changes in the perception of odors or taste, changes in the skin at the site of irradiation.

    The most dangerous consequence of laryngeal cancer is the formation of metastases that affect the thyroid gland, gastrointestinal tract and bone structures.

    The prognosis of survival depends on the number and location of secondary tumors.

    Other complications of laryngeal cancer are expressed by respiratory depression, stenosis, speech dysfunctions, up to a complete loss of voice. Patients who have lost speech after removal of the cancer have to adapt to speech loss and the inability to communicate with other people. Therefore, patients become depressed, which only exacerbates their condition.

    How to recognize the first signs of laryngeal cancer in the photo?

    The manifestation of the tumor in the first stages of the oncological process

    The first signs of laryngeal cancer can appear at any stage of the disease. But more often appear at stages 2-3 of the cancer, when the tumor begins to grow in size and cover a larger number of tissues.

    It is difficult to recognize the first symptoms of laryngeal cancer - they are similar to the manifestation of other diseases, such as pharyngitis, tracheitis or laryngitis. Many patients do not take the first signs for a long time, which leads to the progression of the disease and the growth of the tumor to significant sizes.

    Laryngeal cancer at an early stage can only be recognized by an otolaryngologist during laryngoscopy. But not every specialist will pay attention to minor changes in the epithelium, especially if the tumor does not protrude above the mucous membrane.

    Laboratory diagnosis of laryngeal cancer

    Diagnosis of laryngeal cancer is a comprehensive examination of the patient, without which it is impossible to assess the prevalence of the malignant process.

    To make a diagnosis and stage of the disease requires a set of instrumental and laboratory tests:

    1. Laryngoscopy
    2. Endoscopic examination.
    3. Ultrasound of the neck.
    4. MRI scan
    5. Roentgenography.
    6. PET / CT.
    7. Blood tests.
    8. Biopsy.

    Recently, doctors have prescribed blood tests for tumor markers - tests that determine the likelihood of developing cancer. Two tumor markers, SCC and CYFRA 21-1, are used to determine the likelihood of laryngeal cancer. They are also prescribed during treatment to assess the risks of relapse.

    Conduct a general clinical examination.

    The consequences of larynx removal

    When planning an operation, you need to know about probable complications. These include infection, bleeding, excessive swelling, shortness of breath, blood clots, aphonia (inability to speak), damage to the esophagus or trachea, and relapse of the disease.

    Factors that can increase the risk of complications are noted: obesity, smoking, previously existing pathologies, advanced age, previous surgery in the larynx, poor nutrition, diabetes, radiation and chemotherapy. Before a laryngectomy, these risks are discussed with the doctor.

    The cost of an operation to remove the larynx in Israeli clinics is from $ 15,000.

    Preparation for larynx surgery

    Surgical intervention is preceded by a set of diagnostic measures in Israel: examination of the larynx, biopsy for accurate diagnosis, laryngoscopy, laboratory tests (blood, urine), chest x-ray, ECG, in some cases CT or PET-CT to study the prevalence of malignant process.

    In the case of a complete laryngectomy, a consultation with a specialist in speech pathologies is carried out.

    Before surgery, a doctor discusses ways to restore speech in the future.

    The course of the operation to remove the larynx in Israel

    With total laryngectomy, the surgeon performs an incision in the neck, separates the muscles attached to the larynx. During the operation, the larynx and surrounding tissue will be removed.

    The oncological effectiveness of partial laryngectomy surgeries is very high, over 90% of patients are cured.

    An opening or stoma is created in the neck area, to which the trachea will be attached, which will allow the patient to breathe. Sometimes for the same purpose a tracheostomy tube is used, inserted into the hole. The surgeon installs drainage pipes that drain fluid and blood. At the end of the operation, the skin and muscles are sutured or stapled.Surgery to remove the larynx can last about 5-9 hours. The hospitalization period is 7-14 days.

    In the case of partial laryngectomy in the early stages of laryngeal cancer, the surgeon removes the tumor with part of the larynx using open or endoscopic surgery.

    1. The endoscopic method (by mouth) of the treatment of laryngeal cancer is the most commonly used, is performed on an outpatient basis, hospitalization is one day. The operation requires modern equipment (microscope, surgical laser), technology, experience and qualifications of doctors, which, of course, provide clinics in Israel. The main goal is to completely remove the tumor. Patients undergo partial laryngectomy endoscopically quite easily.
    2. Open resections are performed using an incision on the neck and suggest the imposition of a temporary tracheostomy for 3-5 days. Then the tracheostomy is removed, and the hole closes on its own after 1-2 weeks. The advantage of this operation is its very high reliability.

    Based on the diagnosis, the doctor chooses the most optimal method, the ultimate goal of which is to cure cancer and preserve breathing, swallowing and acceptable voice quality. A degree of hoarseness is a consequence of surgical treatment. It depends on many factors, for example, on the size of the tumor. The larger the malignant neoplasm, the more likely the pronounced voice deterioration due to the removal of a large volume of tissue.

    Medication for laryngeal cancer

    It should be noted that the surgical intervention performed after a full dose of radiation therapy is fraught with the danger of developing postoperative complications leading to the formation of fistulas, arteries of the great vessels, significantly prolonging the postoperative period and making it difficult to manage.

    Laser surgery

    In cancer with superficial localization of the tumor, operations are performed using a laser. This type of treatment practically does not give complications, but it is indicated for a limited number of patients.

    Complications after surgery for laryngeal cancer

    After surgery for laryngeal cancer, complications of varying severity may occur:

    • bleeding, can be both after the operation, and during it,
    • infection penetration
    • difficulty breathing
    • swelling of the airways
    • loss of voice
    • mechanical damage to the trachea or esophagus,
    • relapse of malignant neoplasms.

    Various factors contribute to the development of complications:

    • excess body weight of the patient,
    • bad habits
    • the patient’s age is over 60,
    • chronic diseases
    • previous throat surgery
    • eating disorders
    • diabetes,
    • a course of chemotherapy or radiation.

    Postoperative Recovery

    The recovery period after surgery takes from 1 to 3 months, it depends on the age of the patient, his general condition and diagnosis. Immediately after surgery, the patient is in the intensive care unit, his condition is closely monitored by doctors, noting vital signs. The intensive care course includes a number of activities:

    • intravenous droppers
    • antibiotic therapy
    • restorative therapy,
    • monitoring heart rate, as well as respiratory quality,
    • control of blood pressure and body temperature.

    In order for the formed mucus to better depart from the respiratory tract, the patient must clear his throat and constantly change his body position. If the patient experiences severe pain, painkillers are given.

    The throat heals for at least three weeks, so that this does not interfere with food intake, a nasogastric tube is installed. During the healing period, the patient loses the ability to talk, if the vocal cords have been saved, then a specialist then works with him to restore speech.

    It is very important that the patient breathes moist air, this is necessary for the mucous membrane of the trachea. Having spent the rehabilitation period, observing all the recommendations of the doctor, a person can return to their usual lifestyle. It is forbidden to swim, smoke, drink alcohol and hypothermia.

    Surgery for laryngeal cancer

    Cancer of the larynx is most often affected by smoking men over forty. They make up more than 80% of all patients. Diagnosis of the disease is difficult. Often, a malignant neoplasm is mistaken for chronic laryngitis or cough. caused by smoking, therefore, more than 50% of cases of oncological diseases of the larynx are diagnosed when the disease has already entered the third or fourth stage. Nevertheless, modern methods of treatment make it possible to effectively treat laryngeal cancer and significantly increase the life expectancy of patients.

    In the treatment of oncology of the larynx, radiation and surgical methods are usually combined, as well as chemotherapy. The choice of location and method of surgery for laryngeal cancer depends on the location of the tumor and the stage of the cancer. This is always decided individually, depending on the specific case.

    Types of surgery for laryngeal cancer

    Surgical treatment is most effective in the first and second stages, and if the tumor is small. Usually, doctors try to carry out organ-saving surgery, but, unfortunately, this is not possible in all cases. We list the main types of surgery for laryngeal cancer.

    Chorectomy

    This operation consists in removing the vocal fold or all the vocal cords... The indication is the presence of a neoplasm in one vocal fold, without impairing its mobility. The operation is carried out as a conventional surgical method, and using a laser. The trauma of chorectomy depends on the stage of the disease. Chorectomy is performed both with local anesthesia and under general anesthesia.

    Usually the operation is done with a preliminary tracheotomy to ensure calm breathing after the operation. Possible complications after chorectomy are bleeding during and after surgery, subcutaneous emphysema, and growth of granulations. This operation has a different effect on speech.

    Hemilaringectomy

    With this operation, half of the larynx is removed. The patient's voice may persist.

    The operation is performed if the tumor is located in the middle part of the larynx and makes the vocal fold immobilized. In this case, the malignant process should not affect the commissure. Indications for this operation are quite limited, because in its consequences hemilaryngectomy often approaches complete laryngectomy. Sometimes, after a hemilaryngectomy, a reconstructive operation is performed, but this is not always possible.

    Upper Guttural Laryngectomy

    In this case, only the upper part of the larynx is removed. Indication for surgery is the localization of the tumor in the upper part of the larynx. The doctor removes the upper part of the larynx, while the vocal folds remain intact.

    With such surgical intervention, the patient’s voice remains. After surgery, the patient should wear a tracheostomy for some time to ensure airway patency.

    Total laryngectomy

    With total laryngectomy, the entire larynx is removed. In order for the patient to breathe, a special hole (tracheotome) is made in the trachea. This operation is indicated when the pathological process spread to the entire larynx, but did not go beyond it. Sometimes the operation is carried out when the tumor process has spread further.. At present, advanced age, tuberculosis and diabetes are no longer contraindications for a complete laryngectomy.

    This operation removes the vocal folds, the folds of the vestibule, the hyoid bone, two or three rings of the larynx, the cricoid cartilage. Other sections may be resected depending on the spread of the tumor.The technique of this surgical intervention has many options, depending on the location of the tumor and its spread. Most often, two methods are used. In the first case, the larynx is removed from top to bottom. In the second case - from bottom to top. In the first method, less blood and mucus enter the respiratory tract, however, there is a high risk of asphyxiation and it is difficult to determine the extent of the tumor. Therefore, the second method is more often chosen.

    Gastrostomy

    In this operation, an artificial access to the stomach cavity is made through the anterior abdominal wall. A special feeding tube is placed in the stomach. This is usually done with endoscopy with general anesthesia, which is called percutaneous endoscopic gastrostromia. Another option is to install the tube during a laryngectomy.

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    Laser surgery

    This type of surgical intervention is performed if the malignant lesions are superficially located. Laser surgery is well tolerated, rarely gives complications, but, unfortunately, indications for its use are very limited..

    Recovery period after larynx removal

    After the operation, the patient in Israel is in the intensive care unit for some time, where he is given an intravenous infusion, and his pulse, blood pressure and respiration are monitored. Doctors recommend that the patient breathes deeply, clears his throat and turn in order to improve the discharge of sputum accumulated in the lungs. In order to remove accumulated fluid, the patient undergoes several sanations. Pain relievers are given to relieve pain.

    The healing process of the throat tissue lasts about 2-3 weeks. The patient takes food using a nasogastric tube. The ability to talk is also absent, the speech pathology doctor helps with adaptation. Air passing through the stoma in the trachea cannot be humidified. Therefore, to prevent drying of the mucous membrane of the trachea, the patient breathes moistened air. Doctors teach how to properly care for a tracheostomy. The full recovery period after removal of the larynx takes approximately one month.

    Most patients return to work and normal life, with the exception of swimming. Doctors fully advise on showering, bathing, and the effects of water on the site of surgery.

    Total surgery involves the complete removal of cancer cells. After surgery, adjuvant therapy is possible - radiation and chemotherapy. These methods are aimed at the destruction of possible remaining malignant cells.

    Quitting smoking is a positive value, which significantly reduces the risk of relapse. Husky voice is an early sign of laryngeal cancer and requires a mandatory visit to the ENT doctor.

    Voice restoration after larynx removal

    One of the most serious consequences of total surgery is the lack of voice along with the lack of nasal breathing. The methods of voice rehabilitation are divided into three types.

    1. The esophageal voice is the oldest way, a complex of processes creating a new compensatory phonation organ and changing the conditioned reflex connections in the central nervous system. Its essence boils down to the fact that the patient learns to swallow air to pronounce a word or phrase, and not inhale, as it happens under normal conditions.After the air is "ejected" in the opposite direction into the throat and esophagus, their walls take on the role of vocal folds, their vibration forms a voice. Specialists from the field of oncology, physiotherapy exercises, speech therapy and psychology work with the patient. The advantage of this method is that for voice formation, special devices and the help of hands are not needed. The disadvantages include a fairly long training (several months), while only 60-80% of patients master it, there is a possibility of developing esophageal stenosis and reflux esophagitis due to the possible throwing of the contents of the stomach into the esophagus. The phrases are short, the voice is relatively monotonous and quiet.

    2. The electronic larynx involves the use of a special voice-forming device - a laryngophone, which is brought, for example, to the chin. It converts the vibration of the muscles of the oral cavity into electrical vibrations. As a result, the voice is monotonous, robotic, but with a certain skill it is possible to achieve expressiveness in speech and intonation. This method requires the participation of hands and training. We can name such manufacturers as Griffin (USA), Servox Digital (Germany), Chronos (Russia), etc.

    3. Voice prosthetics involves the creation of a shunt (hole) between the trachea and pharynx, where the voice prosthesis is installed, a special implant. Currently, tracheoesophageal and tracheopharyngeal bypass grafting is used. The latter, in fact, is a valve with patency in only one direction: from the trachea to the pharynx. The mechanism is as follows: the patient takes a breath, covers the tracheostomy with his finger and speaks. Air (from the lungs, as in healthy people) is sent through the prosthesis to the pharynx, leading to fluctuations in the mucous membrane, which mimics the movement of the vocal cords. The advantages include: long phrases, a loud voice, over time they acquire an emotional tone, easy learning (success is achieved in 90-95% of cases). Among the shortcomings can be noted the participation of hands, the need for careful care, wear of the prosthesis (on average, the life is from 6 to 18 months), which requires repeated surgical intervention.

    Doctors in Israeli clinics prefer and actively use organ-saving techniques in the treatment of cancer. They use the slightest opportunity to preserve to the fullest extent the functions of organs that are affected by the malignant process.

    Watch the video: Surgical Treatment for Advanced Cancer of the Larynx (February 2020).

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