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Treatment of Laryngeal Carcinoma

According to the results of the audit carried out by the German Cancer Society (DKG) in 2020, the Department of Oto-Rhino-Laryngology of the Medical Center - University of Freiburg has by far the greatest operational expertise of all 63 centers in Germany.

Despite the complexity of the interventions, the rate of revision interventions is around 1% and thus in second place in a comparison of the 63 locations. This article introduces the treatment options for laryngeal carcinoma that are offered by the Department of Oto-Rhino-Laryngology clinic at the Medical Center - University of Freiburg.

Carcinoma of the larynx usually arise from the local mucosa (squamous cell carcinomas) and can be divided into supraglottic (e.g. the epiglottis), glottic (the actual vocal cords) and the rare subglottic carcinomas depending on their place of origin. With increasing size, several areas are usually affected. While glottic laryngeal carcinomas show metastases in the cervical lymph nodes comparatively late, these occur early in supra- and subglottic involvement.

In the therapy of laryngeal carcinoma, it is important to achieve the best possible balancing act between maintaining function and healing. The functional challenge here is that in the human body, the airways and gastrointestinal tract cross one another, so that the function includes not only the voice but also breathing and swallowing. This requires the highest demands on surgical function maintenance and its reconstruction. The individual patient's functional and anatomical conditions affected by the tumor necessitate a wide range of different surgical techniques in order to achieve the best possible result.

The Department of Oto-Rhino-Laryngology offers different surgical techniques tailored to the findings. With transoral laser procedures, access is gained through the mouth and throat to the larynx, eliminating the need for external access. This is particularly suitable for circumscribed tumors (T1 and T2) using a CO2 laser. For superficial carcinoma (carcinoma in situ), the ENT department offers the use of the particularly tissue-friendly TruBlue® laser. If, due to the anatomical conditions or the complexity of the tumor, access via the mouth and throat is not possible, techniques that preserve the larynx (horizontal and vertical partial resection of the larynx) are used, which even allow for the surgical formation of a "new vocal cord".

In advanced tumors (T3 and T4), complete removal of the larynx is usually the surgical treatment of choice. Extensive tumors affecting the deep throat (hypopharynx) can also be successfully controlled using microsurgical transplants.

The central element of the therapy recommendation is decided diagnostics, which comprehensively examines the tumor or the structures affected by it. The combination of clinical examination, computer/magnetic resonance tomography, sonography and above all panendoscopy (examination under anesthesia) is used effectively here.