Use of Radiofrequency Waves to Reduce Nasal Mucosal Swelling (Radiofrequency volumetric tissue reduction: RFVTR)
What is the larynx?
Dr. Uthai Prapamontol, a specialist in head, neck, trachea, and laryngeal surgery at the Ear, Nose, and Throat Center, Phyathai 3 Hospital, explained that the larynx is an important organ located at the front of the neck with three main functions:
- It serves as an airway for breathing
- It prevents food from entering the trachea during eating
- It is an essential part in producing sound
How dangerous is laryngeal cancer?
According to research data, laryngeal cancer accounts for about 2% of all cancers, making it one of the common cancers worldwide. Most cases are detected in elderly people aged 60 and above, and it is found 4-5 times more often in men than women. In Thailand, between 2001-2003, the incidence was about 0.3 cases per 100,000 women and 2.5 cases per 100,000 men.
What are the risk factors for laryngeal cancer?
Dr. Uthai Prapamontol explained that the causes of laryngeal cancer are associated with various risk factors as follows:
- Mostly caused by smoking, which contains substances that damage the larynx and cause cancer
- Alcohol consumption
- Deficiency of certain nutrients, commonly found in people who lack vegetables and fruits in their diet
- Gastroesophageal reflux disease (GERD)
- Chronic exposure to dust from certain substances, such as wood dust or asbestos dust
- HPV virus infection
What are the symptoms of laryngeal cancer?
Warning signs of laryngeal cancer can be observed from the following symptoms:
- Hoarseness
- Sore throat
- Cough with phlegm, possibly with blood
- Ear pain
- When the tumor grows large, it can block the airway, causing difficulty breathing
- Palpable enlarged lymph nodes in the neck, painless
Which stage of laryngeal cancer is the most dangerous?
The progression of cancer is important to understand for symptom observation. The severity depends on the stage of disease spread. Dr. Uthai Prapamontol explained that laryngeal cancer can be divided into 4 stages as follows:
- Stage 1: The tumor is confined to one location within the larynx
- Stage 2: The tumor spreads to two or more locations within the larynx
- Stage 3: The tumor spreads causing vocal cords to be immobile and/or there is one small lymph node in the neck not exceeding 3 cm
- Stage 4: The tumor spreads to the skin and/or thyroid gland and/or esophagus and/or multiple enlarged lymph nodes in the neck and/or lymph nodes larger than 6 cm and/or metastasis to other organs via the bloodstream, commonly the lungs
How is laryngeal cancer treated?
Dr. Uthai Prapamontol explained that there are three main treatment methods for laryngeal cancer:
- Surgery
- Radiation therapy
- Chemotherapy
Surgical treatment of laryngeal cancer
Surgery varies depending on the cancer stage. For early-stage cancer, surgery involves removing only part of the larynx, allowing the patient to still breathe and speak using the remaining larynx. For advanced cancer, total laryngectomy is necessary, where the entire larynx is removed. Patients in this group will have a permanent tracheostomy opening at the front of the neck for breathing and will not be able to speak with a voice.
- Vocal cord stripping: surgery to remove only the outer epithelial layer of the vocal cords, used only for early-stage cancer. Patients can speak and breathe normally after surgery.
- Laser surgery: may be used only for early-stage cancer treatment.
- Cordectomy: removal of one or both vocal cords, which may cause hoarseness after surgery, used only for early-stage cancer.
- Partial laryngectomy: small tumors in the larynx can be treated by removing only part of the tumor and larynx, allowing a chance to speak after surgery.
- Total laryngectomy: used for large tumors or those spreading to adjacent organs. After surgery, a tracheostomy is required for breathing, and the patient will not be able to speak.
- Neck tissue and lymph node dissection: since cancer often spreads to neck lymph nodes, lymph node removal is necessary, with the extent depending on the disease stage.
- Tracheostomy: if the tumor is very large or airway obstruction occurs, the patient needs a tracheostomy with a breathing tube to assist breathing.
- Patients will continue to receive fluids and electrolytes intravenously
- Patients cannot eat by mouth during the first 2 weeks
- Patients will receive liquid nutrition through a nasogastric tube inserted through the nose into the stomach
- If there are no complications, after 10–14 days post-surgery, doctors will start oral feeding
What are the complications after laryngectomy?
Common complications after laryngectomy for cancer treatment include leakage of the repaired esophageal wall (fistula) after larynx removal. In such cases, patients need to stay longer in the hospital for wound care and cleaning and require prolonged tube feeding until the fistula heals completely.
Can patients speak after laryngectomy?
As mentioned, laryngectomy varies depending on the severity and spread of the disease. However, if the patient does not undergo total laryngectomy, after surgery, they can receive speech therapy. Once symptoms improve, patients can learn to speak using three methods:
- Esophageal voice
- Tracheoesophageal prosthesis
- Electrolarynx (electronic speech aid)
Radiation therapy for laryngeal cancer
Dr. Uthai Prapamontol explained that radiation therapy uses high-energy rays to kill cancer cells or shrink tumors. External beam radiation is the main treatment for laryngeal cancer and may be used instead of surgery for small tumors or for patients unsuitable for surgery. Radiation is often combined with chemotherapy. Treatment is usually given 5 days a week for 30-35 sessions.
Side effects of radiation therapy
- Dry mouth
- Difficulty swallowing
- Skin color changes in the radiation area
- Mouth and throat pain causing difficulty eating and weight loss, starting about 2 weeks into radiation and improving about 2 weeks after completion
- Difficulty breathing due to swelling of the larynx after radiation
- Hoarseness
- Reduced taste sensation
Chemotherapy for laryngeal cancer
Chemotherapy is another treatment option depending on symptoms and physician assessment. Common side effects include:
- Nausea, vomiting, fatigue, easy tiredness, loss of appetite
- Hair loss
- Low white blood cell count, increasing infection risk
- Easy bleeding or bruising due to low platelet count
