Although surgical removal of the larynx can improve the survival odds for someone with advanced cancer of the voice box, the huge cost is their losing the ability to speak. Now, however, a skilled ENT team at a Cape Town hospital is changing that, reigniting the patient’s hopes and means to verbally communicate again by implanting a special speech valve during the same complex procedure, writes MedicalBrief.
Ear, nose and throat (ENT) surgeon Dr Vincent Pretorius, who practises at Netcare N1 City Hospital, and Dr Matthew White, a specialist otorhinolaryngologist and head and neck surgeon with a particular focus on complex surgery and head and neck oncology, recently teamed up to perform a highly complex laryngectomy and neck dissection for a patient diagnosed with advanced stage T4 laryngeal cancer.
The first noticeable signs of cancer of the voice box, or larynx, include persistent hoarseness lasting longer than two to three weeks, often with referred ear pain on the same side as the tumour, said Pretorius in a Netcare press release.
“GPs should regard these symptoms, especially in men over 60 with a history of smoking and/or excessive alcohol use, as requiring further investigation for a non-benign lesion of the larynx,” he said.
Removing the larynx can significantly boost the chances of survival, but comes at the cost of the natural ability to speak, he added. However, by implanting a speech valve at the same time, ENT surgeons can also help the person to speak again – to a certain degree.
In the recent ground-breaking procedure, radio-imaging and a tissue biopsy with histological confirmation had revealed squamous cell carcinoma of the patient’s larynx. Tumour size, or T stage, and location, predict the possibility of spread to nearby lymph node groups, and in this case, there was an estimated 15% to 20% chance of regional spread.
“Advanced cancers likes these tend to require multimodal treatment, combining surgery with chemotherapy, radiotherapy or, in some cases, both, to offer the best chance of a cure,” Pretorius noted.
In this instance, the person’s vocal cord on one side was affected by the tumour, and their voice box would never regain its function.
White’s experience with complex head and neck surgery in a team that regularly performs advanced procedures, including total and partial laryngectomy, oropharyngeal surgery, neck dissection and microvascular reconstructive surgery, was particularly valuable for this intricate operation.
He leads a multidisciplinary head and neck service at Netcare UCT Private Academic Hospital, as well as leading the surgical head and neck subspecialty discipline at the University of Cape Town (UCT), based at Groote Schuur Hospital. With Professor Johan Fagan, White runs a subspecialist fellowship programme at UCT to develop the next generation of head and neck surgeons.
Pretorius explained the surgery in the context of multimodal treatment.
“There is a limit to how much radiotherapy a person can have in their lifetime. When cancer has progressed to this extent, the amount of chemotherapy and radiotherapy needed for curative treatment can be minimised by removing the dysfunctional voice box and the lymph nodes that drain it. This leaves open the possibility of a second round of therapy if the cancer were to recur in future.”
As with all surgery, the possible risks, pros, and cons of laryngectomy and neck dissection are discussed with the patient and his or her family first, allowing them to decide whether to go ahead with the surgery.
“Although it can be lifesaving, the side effects include breathing through a stoma in the neck rather than through the nose and mouth after surgery, meaning the person loses the ability to smell and taste, and generally the ability to speak too,” Pretorius said.
“With the advanced stage of this type of cancer, the voice is already severely impaired due to the cancer, and normal voice will never be regained, irrespective of the form of treatment chosen.”
For most people, the prospect of losing their natural voice is understandably one of the most difficult aspects of facing this surgery. Being able to communicate verbally again can therefore make an important difference to their adjustment and quality of life after treatment.
“With the first procedure of this kind at Netcare N1 City Hospital, we were able to implant a tracheoesophageal speech valve, making it possible to produce sound from the throat and mouth as the person exhales,” he said. “With rehabilitation and speech therapy, the patient can potentially communicate verbally again.”
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Cancer patient third US person to have larynx transplant
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