LARYNGECTOMY FAQ'S

What about the Laser Surgery Option?
(from the MAYO CLINIC - Health Oasis)

LASER SURGERY FOR THROAT CANCER 
New treatment easier on patients 
12.16.97 

New, minimally invasive laser surgery to treat some throat cancers is less risky than conventional surgery and offers people a better quality of life afterward, including improved preservation of voice function and the ability to swallow. 

The new technique has been used to treat more than 1,200 people in Germany, where it was pioneered. Surgeons in the United States have been trained in the technique and have used it to treat more than 100 patients; nearly a third of those operations have been performed at Mayo Clinic in Jacksonville, Fla., by Bruce W. Pearson, M.D., an otorhinolaryngologist (head and neck specialist). He calls the procedure "the most dramatic upgrade of this decade in what we do for cancer of the larynx and pharynx." 

Types of cancers treatable with the laser

Many types of so-called head and neck cancer can be treated using the new laser technique. "Most types of cancer of the larynx (voice box), the hypopharynx (the swallowing passage just above the larynx), the oropharynx (the tonsil area that connects the mouth to the hypophrarynx) and the mouth, especially the sides of the tongue and floor of the mouth, can be treated with the laser," Dr. Pearson says." Cancers of the maxillary sinus and the hard palate (roof of the mouth) can sometimes be treated. Cancer of the esophagus is one of the only regions we can't treat with this technique."

The decision to use the new laser surgery depends on the stage of the cancer. "Minimally invasive laser surgery has long been used for untreated small, localized (stage I) cancer," notes Dr. Pearson. "It's in the more advanced untreated tumors that laser excision offers an important new option."

Most tumors that are treated with a laser started from surface cells but may have spread to deeper tissues. "The laser is an excisional tool — that is, it's used to cut out (excise) tissue."

People whose cancer hasn't been treated with radiation therapy are usually the best candidates for the new procedure. "About 75 percent of people with new larynx cancers and 50 percent of those with new mouth or pharynx cancers may be eligible for laser surgery," Dr. Pearson says. People who have recurrent cancer are not likely to benefit.

How it works

With the new technique, the surgeon uses natural passageways, such as the mouth, rather than an incision to reach the tumor. Special fiberoptic videoscopes and a "micromanipulator" mechanism allow the surgeon to guide the laser beam around the edges of the tumor with pinpoint accuracy. Magnification allows the surgeon to distinguish visually between cancerous and healthy tissue. "You can see exactly where the tumor is and identify clearly the tissue that can be spared," says Dr. Pearson. "The laser beam is then used as a cutting and sealing tool, precisely following the margins of the tumor." 

"We've seen superior results with preservation of speech and airway," Dr. Pearson says. "There seems to be less early post-operative pain, less scarring and fewer wound problems including infection. This means a shorter hospital stay and lower costs for care." 

Sometimes laser surgery allows one large operation to be reduced to two smaller and more tolerable procedures. For example, the conventional near-total removal of the larynx and lymph nodes in the neck normally requires 2 weeks of hospitalization, and more if there are complications. Laser surgery can achieve the same or better results with two separate 4-day stays, each of which may be easier to undergo, especially for older people or those with a chronic illness. 

Laser surgery avoids invasive, disfiguring surgery so often required in the past to treat cancer of the larynx or pharynx. "The major improvement this option offers is in quality of life," Dr. Pearson says. Problems such as trouble eating and tasting, progressive difficulty swallowing, loss of voice or speech, neck and shoulder disfigurement, and/or a permanent, surgically-constructed, external opening to the windpipe (stoma) usually can be avoided. Radiation therapy and chemotherapy are often used in combination with surgery to treat mouth and throat cancers. In previously untreated cancer, the laser technique preserves these important options.

Mouth and throat cancer common among tobacco users

Cancers of the head and neck, including the larynx, pharynx and mouth, make up about 5 percent of cancers in the United States. Risk factors include cigarette, cigar and pipe smoking. Use of smokeless tobacco and excessive use of alcohol also are significant risk factors. Because men tend to have these habits in greater numbers than women, they make up the majority of mouth and throat cancer patients. However, as more women become smokers, their share of these cancers is rising.

Dentists and primary care physicians are often the first to detect cancer of the mouth and pharynx. Signs and symptoms may include a sore in the throat that doesn't heal; a white patch in the mouth; or a lump that persists in the neck. Difficulty chewing, swallowing or moving the tongue often comes later. Cancer of the larynx usually causes a voice change like persistent hoarseness. Sometimes it causes a sore throat that doesn't go away, pain with swallowing, pain in the ear or a lump in the neck. 

Mouth and throat cancers take a long time to develop, so a typical patient is usually over age 40. However, even people in their teens and twenties may be at risk. 

New treatment broadens options

Dr. Pearson views the laser technique as a major new treatment option in a battle so far waged chiefly with radiation and surgery. These conventional treatments remain important weapons. But minimally invasive laser surgery now offers a brighter outlook for people with mouth and throat cancer.