eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Glottic Cancer: Follow-up

Author: William M Lydiatt, MD, Professor and Division Director, Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center
Coauthor(s): Daniel D Lydiatt, DDS, MD, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center; Mary C Snyder, MD, Associate Professor, Division of Plastic Surgery, University of Nebraska Medical Center
Contributor Information and Disclosures

Updated: Jan 2, 2009

Outcome and Prognosis

The overall 5-year survival rate for early glottic carcinoma (ie, T1, T2) independent of treatment modality is 85-95%, which is quite encouraging. Nodal metastases in early disease decrease survival rates closer to 60%. T3 tumors without neck disease are associated with a 65% 5-year survival rate, which drops to 50% when nodal metastases are present. Invasive glottic tumors (ie, T4) are associated with a 40% 5-year survival rate in the absence of nodal disease and a 10-30% survival rate with nodal metastases, depending on the extent of disease.

Future and Controversies

Initially described over 125 years ago, total laryngectomy is the current criterion standard for the treatment of advanced glottic carcinoma. Since that time, great advances have been made in the preservation of the larynx in early-stage disease and in moderately advanced cancers. Future directions in the treatment of early glottic malignancy will likely involve further definition of the role of endoscopic resections and innovative radiation protocols, with further emphasis on preservation of the voice. Advanced disease may continue to require total laryngectomy for control, but combined modality treatment and chemoradiation protocols are being defined that could improve survival and potentially preserve the larynx in select patients.

Several recent studies have used quality-of-life surveys to evaluate the impact of treatment of laryngeal carcinoma. Communication and swallowing disorders were found to result in a decreased quality of life. The 2 main factors in determining quality of life are cancer control and survival; therefore, in order to compare quality of life between procedures, survival must be equivalent. Because several options for treatment of laryngeal cancer exist, many of which have similar effectiveness, future patient quality-of-life evaluations may help define the ideal treatment for this disease. Comparing different modalities of therapy is very difficult because each diminishes quality of life but in different ways. Disturbing data from the SEER data base suggest that, since 1990, the survival rate associated with larynx cancer has decreased. This may suggest that current attempts at larynx preservation may be at a cost in terms of life. Clearly, future research needs to address this possibility.

Gene therapy, which involves the introduction of genes into the body with the goal of treating a disease, is an exciting new field. Both genetic and acquired disease can be treated theoretically with gene therapy. Gene therapy in the treatment of cancer involves the introduction of genes into cells to direct the production of proteins that target malignant cells. These proteins are released at a specific location within the body to target diseased tissues and minimize toxicity to normal tissues. Gene therapy is still in experimental stages but holds promise for the treatment of head and neck cancer.

 


More on Glottic Cancer

Overview: Glottic Cancer
Workup: Glottic Cancer
Treatment: Glottic Cancer
Follow-up: Glottic Cancer
References
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Further Reading

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Keywords

glottic cancer, cancer, laryngeal carcinoma, laryngeal cancer, glottic tumors, squamous cell carcinoma, glottic cancer staging, glottis cancer, cancer of the glottis, head and neck cancer

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Contributor Information and Disclosures

Author

William M Lydiatt, MD, Professor and Division Director, Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center
William M Lydiatt, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, and Nebraska Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Daniel D Lydiatt, DDS, MD, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center
Disclosure: Nothing to disclose.

Mary C Snyder, MD, Associate Professor, Division of Plastic Surgery, University of Nebraska Medical Center
Mary C Snyder, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, and American Rhinologic Society
Disclosure: Nothing to disclose.

Medical Editor

Mimi S Kokoska, MD, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences; Chief, Department of Otolaryngology-Head and Neck Surgery, Central Arkansas Veterans Healthcare System
Mimi S Kokoska, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American College of Surgeons, American Head and Neck Society, and Arkansas Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Nader Sadeghi, MD, FRCS(C), Associate Professor of Surgery, Director of Head and Neck Surgery, Division of Otolaryngology, George Washington University
Nader Sadeghi, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Federation of Medical Specialists in Quebec, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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