Head and Neck Cancer

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Questions to Ask Your Doctor about Head and Neck Cancer
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Laryngeal Cancer Treatment

Supraglottis
For all lesions in this region, whether the neck is clinically negative or positive, some form of therapy should be delivered to the neck(s) due to the high probability of occult (undetectable) or overt involvement of the lymph nodes.

For early stage lesions, either surgery or radiation therapy is acceptable. With small lesions, it may be necessary to choose between radiation therapy and a surgical procedure called supraglottic laryngectomy, which preserves vocal and swallowing functions. If the surgery is performed first, but fails to eliminate all traces of cancer or prevent its spread (local failure), the situation may still be salvaged by means of radiation therapy. However, if radiation is utilized first, local failure must often be salvaged by a total laryngectomy (surgical removal of the larynx), which means the loss of normal vocal and swallowing functions.

In more advanced stages, surgery (total laryngectomy) is preferred over radiation alone, due to the decreasing rate of local control afforded by radiation for large lesions. Nevertheless, medical advances over the years involving the combined modality treatment of lesions with chemotherapy and radiation have made it possible, in some cases, to preserve the larynx of patients afflicted with advanced-stage cancers.

Glottis
Carcinoma in situ of the true vocal cord is high curable by several different methods, such as microexcision, laser vaporization or radiation therapy. The procedure of choice for carcinoma in situ generally is surgery, due to the ease with which the surgical procedure can be done. In more advanced cancers of the glottis (T1, T2), partial laryngectomy or radiation therapy can achieve very good local control rates. For more advanced lesions (T3), surgery is usually the treatment of choice, although in selected cases an attempt may be made at organ preservation.

As with supraglottic tumors, the treatment consists of induction chemotherapy, followed by radiation therapy for those who responded to chemotherapy. With advanced (T4) lesions, there are several different ways to approach the treatment plan. Discussion with a physician is imperative and should be initiated and maintained throughout the treatment regimen.

Factors to take into account when devising a treatment plan for T4 tumors are:

• presence or absence of bulky disease in the neck, and
• extent (size, depth of penetration) of primary tumor.

Strategies may range from induction chemotherapy with radiation therapy, for those whose tumors respond favorably to chemotherapy, to surgical resection.

Subglottis
Despite the availability of modern combination therapy, the overall cure rate for these tumors is poor, due the advanced stage at which they are often found. Some experts recommend that patients with such tumors consider volunteering for treatment in a clinical protocol study.

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