PHARYNX & LARYNX CANCER

• The larynx is the place where the voice is produced. So it is also called the voice box. The pharynx is the common passage for food and air. It is also known as the throat. So cancers in this site primarily affect speech and swallowing.

• The tumours in the larynx and pharynx are the 9th most common cancer among all cancers in India.

• Tobacco


• Alcohol


• Human papilloma virus


• Poor Nutrition


• Head and Neck Radiation


• Workplace exposure to Asbestos, Metal, Paint Industry.


• Gastroesophageal Reflux disease.

• Tobacco


• Hoarseness of voice ( voice change)
• Foreign body sensation in the throat
• Persistent sore throat
• Constant cough
• Breathing difficulty
• Ear pain
• Swelling in the Neck

A detailed clinical history and a thorough clinical examination are made for each patient.

• Endoscope & Biopsy
  An endoscope is passed through the patient's throat to examine the pharynx and the larynx to look out for any protruding tumour or an ulcer in the patient's throat. If there is any lesion in the pharynx and larynx, then a biopsy would be taken. This tissue is sent to the pathology department. The characteristics of the tissue are seen through the microscope, and we diagnose whether the lesion is benign or malignant.


• CT Scan/MRI Scan
  A CT scan/MRI scan for the neck is done to evaluate the extent of the tumour and know how much the lymph nodes are involved.


• FNAC
  A FNAC ( Fine Needle Aspiration Cytology) of the affected lymph nodes is done to know whether the lymph nodes are involved or not.

The possibility of survival depends on the cancer stage, site of involvement, grade of the tumour and the patient's compliance with the treatment. The survival of patients with cancer is generally denoted as 5-year survival, wherein the percentage of people surviving at the end of 5years after a cancer diagnosis is noted down. This is given in the tabular column below.

5 year survival rate for Laryngeal and Pharyngeal Cancers.

• Treatment options For Pharyngeal tumours
• Oropharyngeal and Hypopharyngeal cancers are commonly treated by definitive radiation in the early stage and by chemoradiation in the advanced stage. Surgery for these patients is used in very select situations in early lesions amenable for robotic resection and advanced stage as a part of salvage therapy.

• The pharynx is excised with a margin of apparently normal tissue. Depending on the tumour size, the tumour in the pharynx may be excised along with the larynx ( Laryngopharyngectomy) or maybe excised along with the oesophagus (Laryngopharyngo oesophagectomy). The defect is then immediately reconstructed as a free flap from the thigh or the intestines.


• Neck dissection
  Malignant tumours in the pharynx and larynx spread to the lymph nodes in the neck. So, along with the tumour, the lymph nodes in the neck are also removed. This is called lymph node dissection. The lymph nodes removed are sent for biopsy to know whether they are involved in malignancy. This lymph node dissection helps remove the affected lymph nodes and allows us to decide on the subsequent treatment whether chemotherapy or radiotherapy is needed.

The adverse effects of radioactive iodine therapy usually subside in a few days

• Tracheostomy
  A hole is made in the neck through the windpipe through which the patient can easily breathe and prevent the food from entering the windpipe. The tracheostomy will be permanent in the case of total laryngectomy and temporary when partial laryngectomy is done.


• Gastrostomy / Feeding tube-
  Since the significant part of the surgery involves the food pipe and windpipe, the patient will not be able to eat immediately due to pain. We would also need time for the surgical wound to heal. Hence, we pass a tube through the nose into the stomach or directly into the stomach for feeding purpose and improve nutrition since it will also enhance healing. It will be removed once the patient can eat normally.

The adverse effects of radioactive iodine therapy usually subside in a few days

• Ladies are advised not to get pregnant 6 to 12 months after radioactive iodine treatment as the ovarian follicles may not be mature.


• Lactating mothers are advised to postpone the radioactive iodine treatment and done after lactation.


• Men are advised not to beget children for 3 months as the sperms may not be mature.

The possibility of survival depends on the cancer stage, site of involvement, grade of the tumour and the patient's compliance with the treatment. The survival of patients with cancer is generally denoted as 5-year survival, wherein the percentage of people surviving at the end of 5years after a cancer diagnosis is noted down. This is given in the tabular column below.

5-year survival rate for Thyroid cancers.

	Papillary	Follicular	Medullary	Anaplastic
Limited to thyroid	100%	100%	100%	31%
Beyond thyroid or Nodal disease	99%	96%	90%	12%
Distant spread	78%	63%	39%	4%

• TSH ( Thyroid stimulating Hormone) is a hormone produced in the body that helps grow thyroid cancers. This production of TSH can be suppressed by giving higher doses of thyroxine hormones. The TSH level is monitored in frequent intervals, and the dose is adjusted accordingly.

TSH ( Thyroid Stimulating Hormone)

• TSH is a hormone produced in the body that can facilitate the growth and spread of thyroid cancers. We would like to keep it at a low level. We would like to monitor this level every 3 months for the first 2 years and then periodically lifelong.


• Thyroglobulin & Anti thyroglobulin antibody These are tumour markers that help to identify thyroid cancer recurrence early.