Cancer of the Larynx

Mass. Eye and Ear is recognized throughout the medical community as an incubator of innovation in surgical treatment of cancer of the larynx.

The focus is on advanced endoscopic procedures, many of which are offered exclusively at Mass. Eye and Ear – in an effort to avoid traditional cancer surgery whenever possible.

The traditional approach, also known as open or external surgery, involves large incisions in the neck, a mandatory tracheotomy to allow breathing during recovery and difficulty swallowing – usually requiring a feeding tube. The recovery time is weeks, with a seven-to-10 day hospital stay, often followed by intensive voice therapy.

During endoscopic surgery, the doctor uses small telescopes, cameras and remote surgical instruments inserted through the mouth, with the patient under anesthesia. The benefits:

• The surgery itself is much less traumatic, with smaller incisions.
• Endoscopy is generally less damaging to healthy tissue than open surgery. The Laryngology Division is focused on this area of surgical expertise, known as ultra-narrow margin resection.
• The procedure does not change the physical makeup of the voice box, so there is less chance of voice damage.
• No feeding tube is required in most cases.
• With no mandatory tracheotomy, the patient breathes normally after surgery, unassisted.
• Recovery time is significantly reduced.
• The incidence of post-surgical complications is reduced.

Not every patient is a candidate for endoscopic surgery, however. It is most successful in early diagnosis, before widespread cancerous damage. More advanced cancers where masses have grown large will often be better treated with traditional surgery.

Follow-up care is similar to open surgery, with regular checkups decreasing in frequency in the first five years. Some voice rehabilitation is occasionally needed but intensive post-surgery therapy is rarely required.

Dr. Stuart M. Strong pioneered the technique at Boston Medical Center in the 1970s. Further innovations and refinements were accomplished in Europe. Since then, Mass. Eye and Ear has become a world authority on both performing endoscopic procedures and training physicians in the technique.

Mass. Eye and Ear is also conducting important research aimed at improving endoscopic surgery techniques, including:

• Development of Optical Coherence Tomography (OCT) and other micro-imaging technologies to enable the physician to learn how deep cancer has affected the vocal folds before surgery and;
• Genetic investigation of keratosis and leukoplakia or “white patches” in the larynx. Some people have white patches for years without cancer – others develop cancer rapidly after white patches appear. The research aims to discover the difference, working towards developing a test that can accurately predict malignancy.