Facts and figures about laryngopharynx
Much higher incidence in men, majority of tumours occurring in patients aged 55-70 years age. Risk factors include smoking, heavy alcohol consumption and nutritional deficiencies.
- Pain/difficulty in swallowing (dysphagia).
- Sore throat.
- Cough/ Occasionally blood stained sputum.
- Swelling/lumps in the neck.
- There are few early symptoms so therefore tends to be diagnosed late, some patients present with breathing difficulties.
Diagnosis of laryngopharynx
Investigations may include:
- Physical examination.
- Blood tests.
- Chest x-ray.
- Laryngoscopy – tissue samples may be taken from the affected area.
- Fine needle aspiration (FNA) - if there are any lumps/swelling in the neck which could indicate possible node involvement) a thin needle may be used to collect cells from the area for analysis.
- CT scan.
- PET-CT scan.
- MRI scan.
- Ultra sound scan.
Depends on several factors:
- The size and position of the tumour.
- The stage of the cancer.
- General health.
Surgery has been used in early stage operable cases; however, this has involved removal of the larynx (laryngectomy) and part of the pharynx (pharyngectomy) and neck dissection followed by reconstruction and post-operative radiotherapy in most cases. However, this is in decline in order to preserve speech and swallowing function as non-surgical options are achieving equally effective tumour control. These include Intensity Modulated Radiotherapy, advances in supportive care and targeted therapy. Laser surgery is proving effective for early stage as long as surgical margins are clear.
Radiotherapy may be used as the primary treatment, particularly if the tumour is inoperable or the patient is not fit for surgery and larynx/pharynx preservation can be achieved without prejudicing curative intent.
Intensity Modulated Radiotherapy (IMRT) has proved to increase the effectiveness of treatment by enabling the disease to be targeted very accurately hence reducing dose to healthy tissue and reducing side effects. Image guided radiotherapy (IGRT) also enables the radiotherapy to be precisely delivered to the intended area which reduces potential radiation dose to healthy tissues and allows the radiography team to monitor any changes in the patients shape. This is important as head and neck patients often lose weight during treatment which can affect the aligning of the radiotherapy treatment. In some cases, it may be necessary to make a new headshell and replan the patient’s radiotherapy treatment. It is important to achieve precise alignment for accuracy in delivering radiotherapy, therefore in most cases it is necessary for a ‘headshell’ to be produced.
This is achieved by using a specialised thermoplastic material which can be heated in warm water and then is laid over the patient’s face to form an accurately fitting customised shell which can then be used for the planning CT scan and for all the radiotherapy treatments. It is a painless procedure which is clearly explained by the radiographers prior to the procedure.
Chemotherapy in combination with radical radiotherapy (chemoradiation) appears to be proving successful, although this is still under evaluation. Also, cisplatin and 5 fluorouracil (5FU) are commonly used in those presenting with advanced disease to improve loco regional control and shrink tumours prior to surgery or radiotherapy.
Cetuximab is a biological therapy referred to as a monoclonal antibody which acts by blocking areas on the surface of the cancer cells to restrict their growth. It is being used in combination with radiotherapy for early stage hypopharyngeal patients and combined with chemotherapy drugs such as cisplatin for more advanced cases.