A 55-year-old known smoker for 25 years presents with a low pitched voice. Endoscopy shows a mass limited to the vocal cord on the left. A biopsy is suggestive of laryngeal cancer type T1N0. Treatment of choice would be -
Ans. is 'b' i.e., Radiotherapy Treatment of glottic cancero Stage-dependent treatment include:-i) Carcinoma in situ (CIN):- Best treated by transoral endoscopic CO2 laser. If the laser is not available stripping of vocal cord is done and the tissue is sent for biopsy. If the biopsy shows invasive carcinoma, radiotherapy is given otherwise regular follow up is done?ii) T1 carcinoma:- Radiotherapy is the treatment of choice. Surgery is used only after they recur.# T1 carcinoma with extension to anterior commissure:- The treatment of choice is radiotherapy. If it is unavailable, frontolateral partial laryngectomy is done with regular follow up. If it fails, total laryngectomy is performed.# T1 Ca with extension to arytenoid:- Treatment is same as above but surgery is preferrediii) T2 carcinoma:- Treatment depends on- i) Mobility of vocal cords, and ii) Involvement of anterior commissure and/or arytenoid:a) If the mobility of the cord is not impaired (cord is mobile) and anterior commissure and/or arytenoid not involved.# Radiotherapy is the treatment of choice. In case of recurrence total laryngectomy or partial vertical laryngectomy is doneb) If the mobility of cord is impaired or anterior commissure and/or arytenoid involved:- Voice preserving conservative surgery such as vertical hemilaryngectomy or frontolateral laryngectomy is done. Total laryngectomy is done if there is recurrence on follow up.iv) T3 and T4 carcinoma:- Total laryngectomy is the treatment of choice; combined with neck dissection if the nodes are palpable. More advanced lesions are treated by combined therapy, i.e., surgery with postoperative radiotherapy.
Vertical partial hemilaryngectomy
Radiotherapy
Chemotherapy
Total laryngectomy with cervical lymph node dis section