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Laryngeal carcinoma (Cancer of the larynx)
  1. The allopathic definition:

The laryngeal carcinoma represents malignant epithelial growth of cells that emanate from the larynx.

  1. How frequently does this type of cancer occur (incidence rate) in Germany (USA appr. x 3)?

Pharyngeal and laryngeal cancer: app. 7,200 men and 2,500 women annually. Men over 60 are most frequently affected.

  1. Subdivisions:

Depending on the locatoin of the carcinoma: Supraglottis, subglottis or glottis.

Depending on the type of cancer: in up to 95% of cases squamous epithelial tumors are involved. Small cell tumors, adenocarcinomas, or carcinosarcomas are quite rare.

Depending on the type of cellular differentiation: (i.e. similarity to healthy cells): G1 (highly differentiated), G2 (medium differentiation), G3 (poorly differentiated).

 

Supraglottis

T1: Tumor limited to one subsite* of supraglottis with normal vocal cord mobility

T2: Tumor invades mucosa of more than one adjacent subsite* of supraglottis or glottis or region outside the supraglottis (e.g., mucosa of base of tongue, vallecula, medial wall of pyriform sinus) without fixation of the larynx

T3: Tumor limited to larynx with vocal cord fixation and/or invades any of the following: postcricoid area, pre-epiglottic tissues, paraglottic space, and/or minor thyroid cartilage erosion (e.g., inner cortex)

T4a: Tumor invades through the thyroid cartilage, and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of the neck including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus)

T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures

 

Glottis

T1: Tumor limited to the vocal cord(s) (may involve anterior or posterior commissure) with normal mobility

T1a: Tumor limited to one vocal cord

T1b: Tumor involves both vocal cords

T2: Tumor extends to supraglottis and/or subglottis, and/or with impaired vocal cord mobility

T3: Tumor limited to the larynx with vocal cord fixation and/or invades paraglottic space, and/or minor thyroid cartilage erosion (e.g., inner cortex)

T4a: Tumor invades through the thyroid cartilage and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck, including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus)

T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures

 

Subglottis

T1: Tumor limited to the subglottis

T2: Tumor extends to vocal cord(s) with normal or impaired mobility

T3: Tumor limited to larynx with vocal cord fixation

T4a: Tumor invades cricoid or thyroid cartilage and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck, including deep extrinsic muscles of the tongue, strap muscles, thyroid, or esophagus)

T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures

 

  1. How is this type of cancer diagnosed by allopathic practitioners?

Groups at risk are smokers, and particularly people who smoke, and who drink excessive amounts of alcohol. Difficulty swallowing, hoarseness, nodes, and pain. Laryngeal inspection, laryngoscopy, fiberendoscopy, CT or magnetic resonance tomography, stroboscopy (to evaluate vocal cord vibration), sonography, x-ray, ultrasound, bone scintigraphy.

What are the allopathic therapy concepts?
Surgery

Operation is the absolute first choice. In this process first the attempt is made to save the larynx. Here stripping of one or both vocal cords (decortitation) can be used, or the vocal chords can be removed completely (cordectomy). In addition only parts of the larynx, or the entire larynx can be removed (laryngectomy). For this major intervention the end of the trachea is sowed into the skin of the neck and the pharynx is closed.

More and more physicians are starting to operate from the inside, primarily for smaller tumors, in order to spare the patient as much damage as possible. Here the chance speech restoration remains intact, and the patient does not have to suffer an artificial breathing opening (tracheotomy), which has a major effect on the quality of life. Basically any operation involves a great risk of later and greater readjustments relative to speech and breathing. Just breathing through the artificial breathing opening, represents a great challenge for many patients. Since there is no data that radical operations produce a significant improvement of survival time, the consequences should be weighed very carefully prior to such intervention.

Chemotherapy

Although to this date there is not a single study that can demonstrate a significant extension of life through a chemotherapy (combination), this therapy is still being offered to patients. Often it is offered with palliative (alleviating) afterthoughts. In these cases every physician and every patient should ask themselves whether chemotherapy really is the right way for a person to spend the last days of his life. I cannot agree with this opinion.

Usually patients are offered a sole chemotherapy with cisplatin, carboplatin, (both have the most serious side effects), 5-FU, or mitomycin, or  they are also offered a combination of the previously-cited preparations. Every doctor who recommends chemotherapy to his patients, should either justify in writing, that the chemotherapy he uses has demonstrated successes relative to extension of life (not reduction of the tumor!) or he should make it clear to his patients that the measure is being employed for palliative purposes. This is the only way to give the patient a chance to protect himself against such a therapy. Otherwise the psychological pressure placed on the patient would be much too high, and this is neither in the interest of the physician nor the patient. If your physician should have a different opinion here, then request a detailed discussion in this regard and ask him what his motivations are.

Supraglottis carcinomas have a particularly extensive lymphatic network, and for this reason lymph node metastases are very frequent here, often even on both sides. In this case patients are also recommended to undergo a neck dissection (cleaning out the neck with removal of the lymph nodes).

Irradiation

In my experience irradiation is recommended for almost all patients in later stages. However if a person sifts the medical literature, there are few hard facts which can prove that irradiation contributes to significant extension of life for people with laryngeal carcinomas. Usually in these cases this means that through irradiation (with 60-70 Gy) better voice quality can be achieved; that it would be advantageous to irradiate the lymph drainage areas and naturally that this can prevent metastasis. But where are the proofs for these theories? Which studies show that irradiation really offers major advantages relative to survival time in comparison with “operation only treatment”?

Additional therapies like hormones, antibodies, etc.

Hormonal therapies, but also other therapies like cytokine therapies (Interleukin, Interferon ... or monoclonal antibodies) either do not play a role, or to this date have not supplied proof of being an effective alternative. If one of these therapies is offered to you, then be aware that you are being offered a chance to participate in a study.

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