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The therapeutic approach of laryngeal cancer should be chosen depending on the location and stage of the tumor and not on the capabilities of the clinic or surgeon.
More than 10 types of surgeries were elaborated to excise the laryngeal cancer. Most of them are carried out without an external incision. The clinic should be able to provide the patient with every opportunity. Radiotherapy, which is often offered in our country, in some cases is simply an indicator of the impossibility of the surgery needed to a person or the lack of knowledge of modern world trends. Radiotherapy is not a conservation therapy. In the long term, radiotherapy can lead to a complete loss of all the functions of the laryngeal: breathing, tracheal protection, voice formation. A timely performed surgery can save and prolong the patient’s life, improve the quality of life, avoid lifelong tracheotomy, preserve the possibility of using radiotherapy in case of a recurrence. An excellent surgeon, who has the opportunity to perform a surgery of any complexity, can perfectly balance on the verge of functionality and complete it by the removal of malignant laryngeal tumors. This is the only approach which can lead to the best result.
The symptoms of laryngeal cancer depend on the stage and location of the tumor. Symptoms may include the following: hoarseness or difficulty swallowing, a feeling that something is stuck in the throat, bad breath.
Smoking, alcohol consumption, age greater than 60 years are the most important risk factors. However, in recent times, there are the changes for the worse. Laryngeal cancer began to be detected in very young people, and the presence of HPV (human papillomavirus) was added to the risk factors.
In early stage laryngeal detection requires the use of high-quality endoscopic equipment. Additional necessary work-up may include stroboscopy, contrast-enhanced computed tomography and MRI.
European and American Association agreed that surgical treatment is the main in the majority of cases. What is more, with the appropriate equipment at hand, an experienced surgeon performs the surgery endoscopically, without external incisions. If needed, surgical treatment should be supplemented by the other types of therapy. However, we have to keep in mind that each case requires a purely individual approach.
Every year professor Puxeddu performs about 250 surgeries to excise the laryngeal cancer.
Laryngeal maintenance in 94% of cases
Complete tumor dissection by single-stage operation in 91% cases
Delaying time to relapse during 5 years in 80% patients
Сancer of the right vocal cord. Clinical observation.
With complaints of hoarseness the patient was fully examined and operated on by endoscopic access, without the need of an external incision or tracheotomy. Due to the spread of the malignant process the removal of the mucous membrane and vocal fold ligament was performed for the complete tumors removal. However, it did not prevent the full vocal rehabilitation. Total tumor excision made it possible to achieve a relapse-free course of the entire observation period.
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To sum up
Vocal folds cancer is still frequently revealed. It is the advanced cancer in the majority of cases, despite the bright symptom in the form of hoarseness. Nowadays doctors tend not only to save the patient’s life but to save its quality. The surgery is the main treatment. An experienced surgeon with a wide number of techniques to excise the tumor is definitely the key element. At the same time, we should not forget about a thorough preoperative and intraoperative examination, including fibrolaringoscopy, stroboscopy, contrast-enhanced computer tomography, MRI if nedeed, narrow-band imaging and contact endoscopy. This is the key to a properly chosen and personalized therapeutic approach.
Assistant Professor, Department of ear, nose and throat disease, Sechenov University, Moscow. ENT-specialist, health centre "Barviha" Presidential Affairs.
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