Overview
It houses the vocal cords, which produce sound through vibration, and plays a crucial role in airway protection and swallowing.
The larynx is divided into three distinct anatomical regions:
• Supraglottis: The area above the vocal cords.
• Glottis: The middle section containing the true vocal cords.
• Subglottis: The lower section connecting the larynx to the trachea (windpipe).
Risk Factors & Clinical Presentation
Synergistic use of tobacco (Cigarettes, Bidis) and alcohol remains the primary risk factor for laryngeal malignancies. Early detection is often possible due to functional changes:
• Glottic Tumours: Often present early with persistent hoarseness or voice changes.
• Supraglottic Tumours: May present later with sore throat, difficulty swallowing (dysphagia), or a painless neck mass.
• Diagnostic Protocol: Flexible fiberoptic laryngoscopy and Direct laryngoscopic /Laser assisted biopsy.
• Imaging : Contrast-enhanced CT or MRI is essential for staging and assessing cartilage invasion.
Treatment Strategies (NCCN & ASCO Guidelines)
Modern oncology prioritizes Functional Organ Preservation, aiming to cure the cancer while maintaining natural speech and swallowing.
1. Early-Stage Disease (Stage I & II) According to NCCN guidelines, single-modality therapy is the standard.
• Radiation Therapy
• Transoral Laser Microsurgery
• While both RT and surgery are effective, the choice is tailored to the patient's vocal needs and tumour accessibility after discussion with the surgeon.
2. Advanced Disease (Stage IV) For advanced disease,
• Primary Surgery (Total Laryngectomy): Usually prior Tracheostomy is made followed by a plan for Total Laryngectomy as there is a bulky, extensive disease when the larynx is already non-functional (dysfunctional larynx). Adjuvant/Postoperative RT or CRT is typically required based on pathology (e.g., positive margins or extracapsular extension).
• Dr SLN Chandra Mohan underwent extensive training at Kidwai, the nation's leader in laryngeal surgery, mastering unique technical maneuvers and preservation protocols rarely found elsewhere in India. This specialized background allows him to offer his patients elite-level expertise in the comprehensive management of voice box and throat malignancies.
Recurrent Disease & Salvage Therapy
In cases of recurrence following initial radiation, Salvage Surgery is the cornerstone of management:
• Minimally Invasive: TLM or Transoral Robotic Surgery (TORS) may be used for small, localized recurrences.
• Open Salvage: Often requires Total laryngectomy with Partial/total pharyngectomy with or without gastric pull up.