Download Cancer of the larynx, also known as laryngeal cancer, is a common

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Trans-oral Laser Resection of Laryngeal Cancer
An Alternative Treatment Modality
By Associate Professor Thomas Loh, Head and Senior Consultant, Department of Otolaryngology,
National University Hospital
Cancer of the larynx, also known as laryngeal cancer, is a common head and neck cancer in
Singapore. It usually affects males who are smokers. Divided into three areas, the larynx
comprises the glottis, supraglottis and subglottis. In Singapore, the two most common sites of
laryngeal cancer are the supraglottis and glottis.
Symptoms of Laryngeal Cancer
Very often, the first symptom the patient experiences is hoarseness. This is especially so if the
lesion arises from the glottis. The hoarseness is persistent and will increase in severity.
Occassionally, the patient is able to ignore the change in voice, which presents itself only during
breathlessness. Throat pain, or referred otalgia (pain originating outside of the ear) is not a
common symptom.
An examination of the larynx will reveal the lesion, and diagnosis is confirmed by biopsy. This is
performed under general anaethesia. Staging of the cancer is performed by examining the
tumour extent during the biopsy as well as by imaging. Most glottic tumours are discovered in the
early stage of the disease because even the smaller tumours arising from the vocal cords will
cause a change in voice quality. In comparison, supraglottic cancers are usually more advanced.
Traditional Treatment
Traditionally, treatment of these tumours is by radiation, with or without chemotherapy. The goal
is to cure and preserve organ function, namely that of speech and swallowing. Radiation has
clearly been an effective treatment option for early cancers of the larynx. The 5-year survival
rates for early cancers (Stage I and II) are in the range of above 80 percent when radiation is
used. The voice quality remains good and swallowing is not significantly affected.
However, treatment takes more than a month to complete and patients experience the side
effects of radiation. The side effects vary, but often patients are disturbed by the dryness of
mouth as well as ulcers, causing pain when swallowing food and fluids. With more recent
techniques, such as intensity-modulated radiation therapy (IMRT), these side effects are reduced.
Recurrences in these patients are usually treated by surgery rather than a second course of
radiation.
Trans-oral Laser Resection Treatment
Trans-oral laser resection of laryngeal cancers can also be used to treat newly diagnosed
patients. Over the past five to eight years, it has gained popularity in some centres around the
world to treat head and neck cancers. As the laryngeal tumour is accessed and visualized via a
laryngoscope, there is no external incision. It is excised using a carbon dioxide laser.
This modality is especially useful for small lesions on the vocal cords. Patients normally do not
have to stay in the hospital more than two days. While the voice is poor initially, it recovers
quickly and is largely intelligible. Swallowing can commence on the first day after operation. A
tracheostomy, a surgical procedure to open a direct airway to the windpipe through an incision on
the neck, is not necessary in these patients.
The cure rate is similar to that attained by radiation, and patients can return to work after two to
three weeks. If recurrences do occur, these patients can be treated by a second laser surgery,
an open surgery or radiation.
Suitability of Patients
Not every patient with early laryngeal cancer is suitable to undergo trans-oral laser resection. For
patients who have a very anterior larynx, accessing and visualizing the lesion may be extremely
difficult. Tumours extended outside of the larynx are not suitable for laser resection. As voice
quality is dependent on the amount of tissue removed, this is expected to be poorer in patients
with a larger volume of the disease.
Overall, it is a viable treatment option for patients with early laryngeal cancer, and is useful for
those with small volume tumours at suitable areas. The recovery time for these patients is
generally quick.
More reading articles:
What is Nasopharyngeal Cancer?
In Singapore, the most common head and neck cancer occurs at the junction of the back of the
nose, and the top of the throat (pharynx) called Nasopharyngeal Cancer (NPC). Read more.
(hyperlink to document “Cancer Info - Nasopharynx Cancer”)