TREATMENT
Laryngeal cancer is always treated and treatment is divided into either curative or palliative. The principles of treatment are the following, to decrease disease, to preserve function, to increase survival and to minimize side effects with decrease recurrence rate. There are three forms of management, Surgery, Chemotherapy or Radiotherapy or a combination of the above. Surgery can either be a total Laryngectomy or various forms of a partial Laryngectomy. The surgery can either be open or closed and be done with removal of the neck nodes if indicated.
The history of carcinoma of the larynx treatment is interesting with the first Laryngectomy having being done in 1873 with about 40% mortality. After 1922 there were excellent outcomes with a good survival rate for total Laryngectomies. Before 1990, surgery was the main form of treatment mainly being a total Laryngectomy. After 1990, organ preservation treatment with or without concurrent Chemoradiotherapy became in vogue.
Organ preservation surgery included using the laser, endoscopic surgery and partial Laryngectomies. Despite advances in management, the survival rates have not improved significantly in the last 30 years.
LARYNGECTOMY
The total Laryngectomy is the gold standard in more advanced disease. But there are many problems with this technique such as voice, aspiration, swallowing disorders, lack of smell and no humidity for the lungs. There are ways of overcoming these problems such as the voice. Three ways are potentially used. The first is esophageal speech where the patient essentially swallows air and releases air back through the mouth articulating words. An electro-larynx can be used on the side of the neck and there is also a one-way valve that pushes air from the lungs up into the trachea and out through the mouth.