Treatment
Of Throat CancerStage I requires surgery with microsurgery or laser surgery,
but can alternatively be treated with radiotherapy. The more bulky the cancer,
the less successful radiotherapy will be, and in this case a surgery might be
combined with radiotherapy. Stage II is treated with radiation. Stage III has
to be treated with radical surgery consisiting of a "total laryngectomy".
This is at first a shock to the patient, but it is the only way known to lead
to acceptable longterm cure rates. In stage IV a total laryngectomy is combined
with a radical neck dissection to remove as much as possible of all of the visible
cancer tissue. Then postoperative radiation is given to eradicate the remaining
cancer cells. The patients following stage III and IV surgery will need speech
rehabilitation as they no longer have a voice box. However, prior to surgery the
details of the surgery and the sonsequences to speech is already explained. After
surgery these classes and individual instructions continue. Patients are taught
how to use an electrovibratory device for speech production, which will enable
them to produce a speech similar to a computer voice generated from the vibrations
of the upper air ways using this device. With proper training and eventual acceptance
of their condition emotionally these patients can adjust remarkably well. Here
are the average 5-year survival rates:
| 5-year
survival rates for throat cancer (laryngeal cancer) |
| Stage: | survival:
| Comments regarding
therapy: | | I | 90
% | surgery or radiation |
| II | 75%
| radiaton |
| III | 60
% | total laryngectomy |
| IV | 30 % | total
laryngectomy + neck dissection + post operative radiation |
These survival figures are not as good for supraglottic cancer.
The 5-year survival rates are about 10% to 15 % lower on average. Lately,
with newer techniques where debulking surgery and radical laryngectomy is done
after initial chemotherapy and next followed up with radiotherapy, and if necessary
with chemotherapy , 5-year cure rates of 60 to 65% for stage III and IV have been
achieved in some centres (Ref.1 and 2). Most specialists favor surgery for stage
III larynx cancer, but Jackson et al. (Ref. 3) showed that with radiotherapy excellent
survival without recurrence can be achieved (65% at 5 years). However, there can
be significant side effects from the therapeutic procedures such as esophageal
strictures from the radiotherapy etc.
Summary:
As has been emphasized above, throat cancer can be treated fairly
aggressively and hopefully gets diagnosed from voice changes early on. This way
a diagnosis should be possible in stage I with 5-year survivals of 90%. The more
advanced the throat cancer is at the time of diagnosis, the more aggressive the
therapy must be, as experience has taught us with stage III and IV cases, involving
two or three treatment modalitites in combination. Emphasis must be put
on prevention as earlier mentioned. This includes smoking
cessation (use of self hypnosis cassettes ), moderation around alcohol consumption,
avoidance of voice strain and avoidance of exposure to known airway irritants
and radiation. Chronic throat infections must be attended to by the ENT specialist
as there could be premalignant polyps that are the cause of it and that can be
taken care of through minor surgery. Even the "disaster" of a total
laryngectomy is no death sentence. The grief can be worked through, depression
can be treated and post-laryngectomy classes can help the patient find a new life
after this radical surgery. |
