LARYNGECTOMY FAQ'S

What makes you send a larynx cancer patient for post-op radiation?
(by Glenn E. Peters M.D., Director, Division of Otolaryngology
Head and Neck Surgery, University of Alabama at Birmingham,
Birmingham, Alabama, USA)

When we do surgery for cancer of the larynx or any other head and neck site we look to the pathology report for some very important information. The report contains information about the primary tumor and the lymph nodes if they were removed. Let's talk about the primary site. First of all we look at the status of the margins of normal tissue which surrounds the malignancy. This is the "get it all" that everyone wants to know about. In surgery we use our senses of sight and feel to determine how much extra tissue we need to take to see if our initial margins are clear. However, there are times when cancer CELLS extend well beyond what we can see and feel at the operation. We will often do FROZEN SECTIONS at the time of surgery to check the margins and take more tissue if needed. The problem is that frozen sections are not a 100% guarantee of clear final margins, so the PERMANENT SECTIONS may come back positive several days later. In this setting we recommend radiation. Secondly, if the tumor is invading deeply into cartilage or bone then we would recommend radiation. Lastly, if there is evidence of the tumor extending into the neighboring blood vessels, lymphatics, or nerves, then we would recommend radiation.

Now, let's talk about the lymph nodes. The decision to remove the lymph nodes is based on whether there is a high likelihood that they contain metastatic cancer. Obviously, if there is an enlarged node at the outset then the decision to remove then is clear. If there are no nodes present, either on physical examination or on CT scan, then the decision to take them out depends on the size and the site of the primary tumor. Having said all of that, what we look for in the path report is the number of involved nodes (greater than one) and whether the cancer has extended outside the capsule of the node. If either of these exist then we would add post operative radiation therapy.

So why do we add radiation? Radiation is given to control microscopic disease that may remain after surgery. It is designed to cut down on the chance of cancer recurrence in the HEAD AND NECK. It has NO effect on cutting down on the chances of cancer showing up somewhere else such as the lungs, liver or the bones. Most patients that die of head and neck cancer do so from a recurrence in the head and neck and not from distant disease, so the utility of radiation therapy becomes obvious.