Do front-line emergency staff appreciate the difference between patients with tracheostomy and those who also had laryngectomy?

In an emergency setting it is vital that the medical staff can appreciate the difference between patients who had laryngectomy and are total neck breathers and those who had tracheostomy for another reason and can still breath from their nose.  This is vital so so that oxygen can be administered in an appropriate manner either to the stoma ( in those who are laryngectomees) or to the nose ( in those who are not).  A survey performed in Birmingham England ascertained the level of emergency healthcare personnel's knowledge with regards to distinguishing between a tracheostomy and a laryngectomy patient, and the emergency management of such patients.

Forty-four accident and emergency medical staff (28 doctors, nine nurses and seven paramedics) completed a questionnaire to ascertain (1) their confidence at differentiating between a laryngectomy and tracheostomy stoma; (2) knowledge of the appropriate site for oxygen delivery if needed; and (3) overall level of training on this subject.

The study published in Journal of laryngology and Otology showed that there were significant gaps in knowledge, particularly with regards to fundamental differences between a tracheostomy and a laryngectomy as less than 5 per cent were able to describe the anatomical difference. Only 41 per cent of the participants were able to correctly identified the route of oxygen administration in laryngectomy patients.

The authors concluded that in In this cohort of emergency staff, the fundamental difference between a laryngectomy and a tracheostomy was poorly understood and that this lack of awareness of front-line emergency staff needs to be addressed in order to maximize patient safety.

A video explaining how to recognize and treat total and partial neck breathers is available.

Individuals with oral cancer are colonized with greater number of bacteria and yeast

Changes in the microbial flora on the oral mucosa after cancerous alteration may lead to both local and systemic infections. Researchers from India assessed the microbial flora associated with the surfaces of oral squamous cell carcinoma and compared the oral microbial contents with healthy mucosa. They also assessed the microbial flora from the saliva culture in subjects with oral squamous cell carcinoma and healthy controls.

The study included 30 subjects with oral squamous cell carcinoma and 30 healthy matched controls. The investigators found that oral squamous cell carcinoma sites harbor significantly more bacteria and yeasts compared to the control group. 

The study clearly indicates that the subjects with oral squamous cell carcinoma harbor significantly more microbial flora. The study's implications are that emphasis has to be made to prevent changes in the microbial flora of the oral cavity. This can be achieved by reducing sugar intake, using probiotics when indicated, avoiding unnecessary use of antibiotics, and maintaining good dental and oral hygiene. 

Microscopic view of oral bacteria and yeast 

New tests may Increase detection of oral cancer

Oral cancer has a poor survival rate linked to late detection. Only 60 percent of patients live beyond five years after diagnosis. Among black males, the survival rate is less than 38 percent. Scientists in Taiwan have already developed a new test to measure the amount of carcinogens attached to our DNA just by testing our spit. Researchers at the University of Texas have developed a new portable probe that could be used to diagnose oral cancer. The probe creates three dimensional images of areas within a tissue surface by illuminating the area with a laser. By taking numerous images and layering them on top of one another, it can deliver a large field of view. 

A study of a potential saliva test for oral cancer is also going to be performed at the Michigan StateUniversity College of Human Medicine's Department of Surgery. It is to be done with collaboration with the Delta Dental of Michigan's Research and Data Institute. The study plan to create a simple, cost-effective saliva test to detect oral cancer. 

The study plans to enroll 100-120 patients with white lesions or growths in their mouths and tonsil areas to test. The researchers will be looking for specific biomarkers that were previously identified by researchers at UCLA. These particular biomarkers have been shown in studies to confirm the presence of oral cancer. 

If the clinical trial is successful in helping create a saliva test to detect the biomarker’s presence, doctors and dentists would have a better idea of which patients actually need  biopsies. The test also has the potential to accelerate health care savings, he added, since the number of biopsies can be dramatically reduced.

A probe to collect saliva and detect oral cancer

A woman recovers her voice after 35 years following larynx surgeries

Jan Christian had a traumatic car accident that fractured her windpipe and voice box at the age of seventeen years. Doctors performed surgery to repair her windpipe and larynx enough to let her breathe and swallow, but they couldn't fix her voice. After that she was unable to speak above a muted whisper. Thirty five years later Christian is finally rediscovering what it feels like to be heard after a series of restorative surgeries that used aerospace engineering theories gave her back the gift of speech. The surgeries were performed by Dr. Khosla, the director of the Voice and Swallowing Center at the University of Cincinnati in Ohio. Dr. Khosla rebuilt Christian's windpipe and larynx. Using laser he had to re-break the cartilage and, replace parts of it. He also had to reconstruct the missing vocal cord, using muscle, tissue and fat tissues from other parts of her body. The vocal cord had to be re-built in order to produce sound.

An interview of Christian and Dr. Khosla can be watched.

Importance of patient participation using information from the Internet

Patient input and participation in one's care are extremely important. As a physician who was diagnosed with throat cancer I encountered many instances where my physicians failed to diagnose my condition and my input was instrumental in improving my care. That input often came from information I found on the Internet.

One example relates to the blood pressure I developed 16 month after receiving radiation treatment to my neck. I was initially labeled as suffering from “essential hypertension”, the most common cause of high blood pressure in individuals over the age of 65 years. I suspected that the radiation treatment I had received lead to the development of hypertension, but my physicians dismissed it. I started to check my blood pressure myself and noticed that it frequently spiked to over 190/110. After my physicians were unable to come with the correct diagnosis and treatment for this unstable blood pressure, I started searching the Web for answers. I was fortunate to discover a rare entity called “paroxysmal hypertension” that can result from radiation damage to the carotid artery baroreceptors. Only after I contacted the physician who researched that topic did I finally start to receive adequate treatment for this condition.

Another example was a rash I developed while getting treatment with a beta blocker (Inderal). Skin biopsy labeled the rash as psoriasis. Both my cardiologist and dermatologist did not make a connection between the medication I was taking and the rash. While searching Google Images for pictures of a psoriatic rash I found a picture of a rash labeled as “beta-blocker psoriatic like rash” which lead me to suspect a connection between the medication and the rash. When I consulted my dermatologist and cardiologist about this condition they both admitted that they did not think about it because it was very rare. Happily in my rash subsided after I stopped taking the medication.

My experience as a patient taught me the limitations of medical knowledge and experience of many of my colleagues. They simply do not always know all the answers or do not think about them. It is left to patients to help themselves by searching for the right answer. It is also essential to remember that even those of us who have medical knowledge should only assist the experts in treating us and not do it alone.

A new throat cancer gene discovered

Investigators from the King’s College London, England, and Hiroshima University, Japan, have identified a specific gene that is linked to throat cancer in a genetic study of a family with ten members who have developed this type of cancer.

The study, recently published in the American Journal of Human Genetics, uncovered a mutation in the ATR gene, demonstrating the first evidence of a link between abnormality in this gene and an inherited  form of cancer. The ATR (ataxia telangiectasia and Rad3 related) gene encodes a protein critical to the way cells repair their DNA. This finding illustrates the presence of genetic factors linked to throat cancer and encourages further exploration the role of ATR in other types in cancer.

Researchers performed a genome-wide linkage study in a family with an unusual hereditary condition affecting 24 members of the family over five generations. Characteristics include developmental abnormalities of hair, teeth and nails as well as dilated skin blood vessels. Nearly every person with the condition involved in the study had developed throat cancer (oropharyngeal squamous cell carcinoma) in their 20s or 30s. They uncovered a single mutation in ATR  in all the individuals  with the condition and in none of the unaffected people. Ten of the 13 people with this mutation had developed throat cancer.

A piece of the shoulder blade used to save woman's voice

Reconstruction of the voice box using bone obtained from the shoulder blade prevented total  laryngectomy in a patient with a rare form of cancer. This allowed the patient to keep her voice box including the vocal cords. The patient suffered from  a slow-growing cancer in the cricoid cartilage, a ring that supported her voice box. Of the about 50,000 people diagnosed with laryngeal cancer every year in the U.S., less than 1% have this particular form of cancer.

After removing the cancer Dr. Douglas Chepeha at the Univerity of Michigan Hospital in Ann Arbour who performed the surgery used part of the 59 years old patient’s shoulder blade cartilage to reconstruct her voice box in a surgery at University Hospital in Ann Arbor. It is the first time this type of surgery has been done successfully. According to the surgeon this advance could help many other patients, including cancer patients with oral cancer, those who lose their voices and premature babies who end up with ruined voice boxes after being on a tracheotomy tube too long.

                        A picture explaining the procedure performed to save the voice box

Michael Douglas and wife Catherine Zeta Jones at anniversary of "beating" cancer

Michael Douglas and wife Catherine Zeta Jones was vacationing at Michael's anniversary of beating his oral cancer. The couple was photographed on the beach in Panama. It is good to see Michael return to enjoyable activities with his family after his treatment for cancer. He was diagnosed with oral cancer in August 2010 and received treatment with chemotherapy and radiation.  

Michael Douglas and wife Catherine Zeta Jones 

Oral Cancer is more common in men and smokers

Human papillomavirus (HPV) infection is the main cause of a distinct form of oropharyngeal squamous cell carcinoma that is increasing in prevalence a in the USA.

A recent study By Gillison et al. published in the Journal of American Medicine Association (JAMA) determined the prevalence of oral HPV infection in the USA.

Oral rinses from 5579 men and women aged 14 to 69 years were evaluated by polymerase chain reaction and type-specific hybridization.

The overall prevalence of oral HPV infection was about 7%. The prevalence was three times higher among men than among women as 10.1 % of men were infected orally, compared with 3.6 % of women.  Only 1% (projected estimate of 2 million Americans), were infected with HPV 16, the strain linked to throat cancers and many cases of cervical cancer. Since only less than 10,000 cases of throat cancer caused by HPV 16 are diagnosed every year, most individuals with the oral HPV virus infection do not develop cancer.  

The researchers found a high prevalence of oral HPV at 2 periods of life – between the age 30 to 34 years and 60 to 64 years.  Oral HPV infection was more common among those with a history of any type of sexual contact, increased with number of sexual partners and cigarettes smoked per day.

The increased risk associated with smoking may be due to the weakening of the immune system by smoking which may increase the susceptibility of smokers to infection. Furthermore smoking may also make transmission more likely by damaging the lining of the mouth.

Vaccination against HPV was shown to prevent cervical cancer.  Even though there is no proof yet that HPV vaccination prevent oral cavity oropharyngeal cancer, these findings underscore the importance of vaccination against HPV virus of both males and females.
For more on HPV click this link.

"My voice-a physician's personal experience with throat cancer" was obtained by the University of Southern California Head and Neck Cancer Support Group for their members.

                    

 Members of the University of Southern California Head and Neck Cancer Support Group with the book at their February 4 , 2012 meeting.

Oral, Head and Neck Cancer Awareness Week and the early detection of head and neck cancer

The 15th annual Oral, Head and Neck Cancer Awareness Week occur April 22-28, 2012.  This weeklong series of events is aimed to educate the public about these potentially life-threatening but eminently treatable cancers and to promote prevention, screening and early detection. It is highlighted by the free screenings and related activities held at participating medical centers across the country. The screenings are quick, painless, and designed to advance early diagnosis, which can lead to better outcomes. The locations of the free screening sites are available at the Head and Neck Cancer Alliance internet site which also sponsors the event.

According to the American Cancer Society, an estimated 40,250 new cases of cancer of the oral cavity and throat, and an estimated 7,850 deaths from these cancers, are expected in 2012. 

Most oral cancers arise on the lips, tongue or the floor of the mouth. They also may occur inside your cheeks, on your gums or on the roof of your mouth.

Some signs and symptoms include:

·        A sore in your mouth that doesn't heal or that increases in size

·        Persistent pain in your mouth

·        Lumps or white, red or dark patches inside your mouth

·        Thickening of your cheek

·        Difficulty chewing or swallowing or moving your tongue

·        Difficulty moving your jaw, or swelling or pain in your jaw

·        Soreness in your throat or feeling that something is caught in your throat

·        Pain around your teeth, or loosening of your teeth

·        Numbness of your tongue or elsewhere in your mouth

·        Changes in your voice

·        Bad breath

·        A lump in your neck

Tobacco (including smokeless tobacco) and alcohol use are the most important risk factors for oral, head and neck cancers, particularly those of the tongue, mouth, throat and voice box.  People who use both tobacco and alcohol are at greater risk for developing these cancers than people who use either tobacco or alcohol alone.

Anyone can develop thyroid cancers, although a family history or exposure to radiation is often a factor. Salivary gland cancers do not seem to be associated with any particular cause.

The increase of oral cancer incidence in young adults, a group traditionally at low risk, is attributed to the rise of the human-papillomavirus (HPV), a cancer-causing virus that can be transmitted through oral sex.  Currently 70% of oropharyngeal cancers are caused by HPV infection. According to researchers, patients with HPV-positive oral cancers are more responsive to treatment and have better survival rates than HPV-negative patients. 

The effect of surgeon and hospital volume on short-term outcomes and cost of care of laryngeal cancer

The increase of use of chemotherapy and radiation in the treatment of laryngeal cancer has increased in the past two decades. The decline in surgery may affect the experience of performing surgeries in many centers and consequently the outcome and costs of the procedures. A study by Gourin and Frick sought to characterize the contemporary patterns of laryngeal cancer surgical care and the effect of volume status on surgical care and short-term outcomes.


Using the Nationwide Inpatient Sample database, the investigators evaluated the temporal trends in laryngeal cancer surgical care in 78,478 cases performed between 1993 to 2008. Relationships between volume and mortality, complications, length of stay, and costs were evaluated in 24,856 cases performed in 2003 to 2008 using regression analysis, with adjustment for patient and provider characteristics.

Laryngeal cancer surgery in 2001 to 2008 was done more often in high-volume hospitals. The author noted also s significant decrease in partial and total laryngectomy procedures, an increase in flap reconstruction, prior radiation, comorbidity, and wound complications, compared to 1993 to 2000. High-volume hospitals and high volume surgeons were significantly associated with more partial laryngectomy and flap reconstruction. The length of hospitalization and cost of hospitalization were both lower at a high-volume hospital.

These data reflect changing trends in the primary management of laryngeal cancer, with meaningful differences in the type of surgical care provided by high-volume providers. It also illustrates a shorter hospitalization time in hospitals that perform more laryngeal surgeries.

 

 

Can erectile dysfunction drugs ( Cialis, Viagra ) cure head and neck cancer?

Preliminary studies at John Hopkins suggest that an erectile dysfunction drugs (e.g. Cialis, Viagra) can stimulate the immune systems of patient’s with head and necks cancers so they can better battle cancer cells. This is interesting information because it is a new approach of treatment with agents so far not used to treat cancer.

Studies performed so far were test tube ones done in blood samples collected from patients. Although the results are promising, clinical studies are needed to evaluate if the administration of erectile dysfunction drugs can be helpful in treating head and neck cancers.

A new study demonstrate that Cialis (tadalafil) augments general and tumor-specific immunity in patients with head and necks cancers and has therapeutic potential in head and necks cancers. Evasion of immune surveillance and suppression of systemic and tumor-specific immunity is a significant feature of head and neck cancer development. This study demonstrates that a PDE5 inhibitor, tadalafil, can reverse tumor-specific immune suppression in patients with head and neck cancer, with potential for therapeutic application.

These results are very preliminary and more research is needed.  However, they offer hope for new type of treatment in the future.

Are individuals with human papillomavirus associated head and neck cancer still carrying the virus in their throat after treatment?

Oral human papillomavirus (HPV) infection a virus spread during oral sex is now the main cause of head and neck squamous cell carcinoma (HNSCC) in people under 50. Oral HPV infection is a concern for patients with HPV-positive HNSCC and their partners. Recent studies showed that the virus can stay in the throat of patients with NNSCC associated with the virus even after the cancer is treated by radiation and surgery.  (Agrawal et al, Clinical Cancer Research 2008). However, most individuals with the oral HPV virus infection do not develop cancer. After treatment, cases with HPV16-positive tumors had an estimated 14-fold increase of oral HPV16 infection when compared to cases with HPV16-negative tumors. The odds of a diagnosis of an HPV16-positive versus negative HNSCC increased with lifetime number of oral sexual partners.

This finding illustrates that many patients with this type of cancer are still carrying the virus in their body and can potentially spread it to others. However, since this virus is very prevalent in individuals ( can be found in almost half of adults ) the significance of this information is unclear.

The effect of the introduction of HPV vaccination (introduced to prevent cervical cancer) to girls and boys on the potential of development of HNSCC is unknown at present and requires further studies.

Oral HPV infection

The high incidence of suicide in head and neck cancer patients is highlighted in recent studies

The suicide rate in cancer patients is twice of that found in the general population according to recent US studies. These studies clearly point to the urgent need to recognize and treat psychiatric problems like depression and suicidal ideation in patients.

Suicide rates varied by type of cancer: The third highest rates are among patients with head and neck cancer, including the oral cavity, pharynx, and larynx. A high prevalence of depression or distress was found among patients with these types of cancers. This is explained by the devastating effects of the illness on patients’ quality of life, the effect on one's appearance and essential functions such as speaking, swallowing, and breathing.

Most studies have found high incidence of depressive mood disorders associated with suicide among cancer patients. In addition to major and minor depressive disorders, there is also a high rate of less severe depression in elderly cancer patients that is sometimes under recognized and treated. Even though studies have shown that in about half of all suicides among people with cancer, major depression was present, there are other important contributory factors. These include anxiety, lack of social support systems, and demoralization.

The results of these and other studies underscore the significant psychosocial impact of cancer. It is hopeful that health care providers will continue to be vigilant for signs of depression and suicidal thoughts and remain open to discussion of these topics. This will allow patients’ mental health needs to be addressed more readily, with referral to mental health specialists when appropriate.

To read more about these issues see the psychological issues page on this Blog.

A gift of a voice

The story “A gift of a voice” about my efforts to speak again was posted in the Georgetown University Homepage as a feature story. 

I hope that you will find it inspirational.
To read it click here.

  Dr Brook lectures at East Virginia School of Medicine on "Life as a laryngectomee" Nov 2009

Dr. Brook lectures to the University of Southern California Head and Neck Cancer Support Group August 2011 
 

Dr Brook lectures at Bnai Zion Medical Center at Haifa Israel on Jan 2, 2012

A patient with cancer receives an artificial tracheal transplant seeded with his own stem cells

The windpipe (trachea) transplanted into a terminal cancer patient in the Sweden is a major medical breakthrough. It promises the potential of perhaps other airway transplants in the future (such as larynx or voice box). The surgery is the first time that a trachea grown from a patient’s stem cells that were seeded onto a synthetic (plastic polymer), rather than a donor, structure has been transplanted in a human. This procedure was performed in a 36-year-old man who had tracheal cancer. 


The Karolinska University Hospital in Stockholm said the surgery was performed June 9, and that the patient is on his way to a complete recovery. The patient, whose late stage cancer had almost fully blocked his windpipe, had no other options since no suitable donor for a windpipe was available.

To perform the surgery, an international team lead by Professor Paolo Macchiarini seeded a synthetic scaffold shaped as a trachea the patient's own stem cells. The new cells lined and covered the windpipe were grown on the scaffold for two days before it was transplanted into the patient. Because the cells used to regenerate the trachea were the patient's own, there was no rejection of the transplant and the patient does not have to take immunosuppressive anti-rejection drugs.

There were previous surgeries where donor’s windpipe and the patients' own stem cells were transplanted. However, the latest surgery is the first to use a man-made artificial organ. Several years ago, the same surgical team used a patient's bone marrow stem cells to coat a patient's new trachea, which was damaged from tuberculosis. A few years ago Belgian surgeons had implanted a donor windpipe into their patient's arm to restore its blood supply and grow new tissue before implanting it into her throat. In both transplants, because the patients' own cells were used to coat the windpipes, no anti-rejection medicines were required.

   

Artificial trachea

The medical and psychological effects of alcohol consumption after laryngectomy

Alcohol consumption after laryngectomy can cause medical and psychological problems. Danker and colleagues of the University of Leipzig, studied the drinking behavior in 225 laryngectomized patients and its effects on their quality of life and mental health.

Alcohol dependency was found in 7% of the patients. Half of the respondents showed a constant consumption of alcohol and only 6% of the patients wanted to change their consumption. Patients with alcohol dependence had increased anxiety, more problems in coping with illness, and increased psychosocial care needs, fatigue, shortness of breath, diarrhea and a worse emotional functioning level .

Alcohol intake was independent of tumor stage , employment status, social class, the time interval since laryngectomy, and type of voice substitute.

The authors concluded that alcohol dependency is associated with adverse psychosocial and medical consequences, which require treatment. Because socio-demographic and medical parameters do not assist in evaluating patients' alcoholism risk, an individual exploration of the patients' drinking behavior is needed which could prepare the ground to specific treatment.

The study was published in the June 2011  Clinical Otolaryngology.

Smoking and drinking did not effect survival from head and neck cancer but reduced overall survival

Head and neck squamous cell carcinomas are known to be associated with tobacco use and alcohol consumption. Farshadpour and colleagues from the Department of Otolaryngology, University Medical Center Utrecht, the Netherlands, evaluated the effects of these substances on patient’s survival. The prognostic relevance of these substances was evaluated in 1829 patients with and 183 without substance use.

The investigator found that head and neck squamous cell carcinoma-specific survival (death due to primary-or recurrent cancer) were not significantly different for patients who smoked and drank alcohol and those who did not. However, overall survival was significantly affected and was shorter in those who smoked and consumed alcohol.

The authors concluded that although tobacco and alcohol use are the main risk factors for development of head and neck squamous cell carcinomas, cancer outcome was comparable in patients who did or did not use these substances. They also emphasize the importance of substance use cessation because tobacco and alcohol use affected overall survival.

The study was published in the June 2011 issue of Head and Neck.

Adequate protein intake can reduce the severity of oral mucositis in patients with head and neck cancer receiving radiation therapy.

A study by Zhan and colleagues from the University of New Mexico Cancer Center, Albuquerque evaluated the relationship of caloric and protein intake to the severity of oral mucositis in 40 patients with head and neck cancer receiving radiation therapy over 2 years.   

 The researchers found that patients who met protein-related goals during radiotherapy had less severe oral mucositis. This was the only nutritional factor that effected the severity of mucostis. They recommended that patients with head and neck cancer receiving radiation get nutritional counseling during radiotherapy, with emphasis on protein.

The study was published in Head Neck in Jun 2011.

Touched by another human touch-the power of a hug

A short essay that I wrote entitled : "Touched by another human touch" was published in the My Turn section of the Los Angeles Times.  The assay describes my personal experience as a patient where I discovered the power of a hug in comforting an ailing patient.


To read it click here.

A new publication: A Physician’s Experience as a Cancer of the Neck Patient: The Importance of Patient Participation

Journal of Participatory Medicine has posted a new paper I wrote, 'A Physician’s Experience as a Cancer of the Neck Patient: The Importance of Patient Participation '

My hope is that relating my experiences as a physician who experienced medical care from the other side of the stethoscope will help other patients, their family members, and caregivers recognize the importance of active involvement in their own care. Active involvement can help prevent medical errors and facilitate recovery.

Dr Brook lectures to Veterans at the Veteran Administration Medical Center in Philadelphia

I gave a lecture at the Veteran Administration Hospital Laryngectomee Club in Philadelphia on April 15, 2011 about life challenges as a laryngectomee.

Catherine Zeta-Jones plight: the impact of cancer on a care giver

The recent revelation that Catherine Zeta-Jones  the wife of the actor Michael Douglas sought treatment for bipolar disorder underscores the potential impact of cancer on other family members. Michael Douglas was recently diagnosed and underwent radiation and chemotherapy treatment for base of the tongue cancer.

Being a caregiver for a loved one with a serious illness such as head and neck cancer is very difficult. It can be extremely hard to watch their loved one suffer especially if there is little that they can do to reverse the illness. It can be physically and emotionally very taxing.

Caregivers often fear the potential death of their loved one and life without them. This can be very anxiety provoking and depressing. Some cope by refusing to accept the diagnosis of cancer and believe that their loved ones illness is less serious in nature.

                                                   

Caregivers often sacrifice their own well being and needs to accommodate those of the person they care for. They often have to calm down their loved one’s fears and support them despite being often the target of their vented anger, frustrations and anxieties. These frustrations may be exaggerated in those with head and neck cancer who have often difficulties in expressing themselves verbally. Caregivers frequently suppress their own feelings and hide their own emotions so as not to upset the sick person. All of this is very taxing and difficult.

Unfortunately the well being of caregivers is frequently ignored as all the attention is focused on the sick individual. It is essential, however, that the needs of the caregivers are not ignore. Getting physical and emotional support through friends, family, support groups, and mental health professionals can be very helpful for the caregiver. Professional counseling can be an individual or joint one with other family members and or the patient.  They should find time for themselves to “recharge” their own batteries. Having time dedicated to their own needs can help them continue to be a source of support and strength for their loved ones. 

Treatment of recurrent laryngeal cancer following initial nonsurgical therapy

A recent study (Agra et al. 2011) found surgery to be the preferred modality for curative treatment of recurrent laryngeal cancer after failure of nonsurgical treatments. Patients with initial early-stage cancer experiencing recurrence following radiotherapy often have more advanced-stage tumors by the time the recurrence is recognized. About one third of such recurrent cancers are suitable for conservation surgery. Endoscopic resection with the laser or open partial laryngectomy. Transoral laser surgery is currently used more frequently than open partial laryngectomy for treatment of early-stage recurrence, with outcomes equivalent to open surgery but with less associated morbidity. Laser surgery has also been employed for selective cases of advanced recurrent disease, but patient selection and expertise are required for application of this modality to rT3 tumors. In general, conservation laryngeal surgery is a safe and effective treatment for localized recurrences after radiotherapy for early-stage glottic cancer. Recurrent advanced-stage cancers should generally be treated by total laryngectomy.