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Vocal cords paralysis

Question
39 out of 58
 

The treatment of choice for stage I cancer larynx is: (DNB June 2012)



A Radical Surgery

B Chemotherapy

C Radiotherapy

D Surgery followed by radiotherapy

Ans. C Radiotherapy Ref. Dhingra 5th/ed p 329-330; Mohan.f3ansal p 504

Friends remember 2 very important concepts regarding laryngeal Ca:

a. If the site of larynx caner viz supra glottis, glottis or subglottis is not mentioned, the cancer should be considered glottic (since it is the M/C variety)

b. Generally stage I, II, III, IV means stage T" T2' T3, T4 respectively.

According to Dhingra

c. Radiotherapy is the treatmnt of choice for all stage I cancers of larynx, which neither impair mobility nor invade cartilage

or cervical nodes.

The greatest advantage of radiotherapy over surgery in Ca larynx glottic cancer is - preservation of voice.

It does not give good results:

If cords are fixed

In subglottic extension - . stages T3 and T4

In cartilage invasion

If nodal metastasis is present

But according to Current otolaryngology 21e pg-445. Current Recommendations by the American Society of Clinical Oncology are that all patients with stage T, or T2 laryngeal cancer, should be treated initially with the intent to preserve the larynx.

Microlaryngeal Surgery

endoscopic removal of selected larynx by operating microscope and microlaryngeal dissection instruments is used for treating early stages of cancer larynx.

The advantages of surgery compared to radiation are:

a. A shorter treatment period (compared to 6 - 7 weeks for radiation)

b. Saving the option of radiotherapy for recurrence Drawback of Surgery - Poor Voice Quality

c. Hence from above discussion it can be concluded that microlaryngoscopic surgery / Radiotherapy is the TOC for stage I of

d. laryngeal cancer.

e. In the option - Surgery and not microlaryngoscopic surgery is given.

f. Hence Radiotherapy is being taken as the correct option.

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