Laryngeal and hypopharyngeal cancer

Over 90% of these malignancies are squamous cell carcinoma. The remaining malignancies arise from minor salivary gland or from supporting tissue such as fibrosarcoma, chondrosarcoma and rhabdomyosarcoma. Early stage squamous cell carcinoma of the larynx is usually treated by external radiation. Early or intermediate stage supraglottic laryngeal carcinoma can be treated by conservation surgery (supraglottic subtotal laryngectomy) and localized glottic carcinoma can be treated by hemilaryngectomy. When there

Hypopharyngeal Cancer
Figure 20.18. Patient with obstructing pyriform fossa squamous cell carcinoma requiring pharyngolaryngoesophagectomy and bilateral neck dissections. Surgical specimen revealed a synchronous oesophageal second primary.

is cord fixation or extension of disease into the hypopharynx or when hypopharynx cancer causes fixation of the hemilar-ynx, total laryngectomy is usually required. Hypopharyngeal cancer requires partial or total pharyngectomy in addition to laryngectomy. Reconstruction of the pharyngeal defect is by regional myocutaneous flap (based on the latissimus dorsi or the pectoralis major muscle), free forearm flap (Fig. 20.14), free jejunal segment or gastric pull up. Extrathoracic gastric pull up or colon interposition is required to reconstruct the oesophagus when total oesophagectomy is carried out for upper cervical oesophageal disease (Fig. 20.18). Voice rehabilitation is by learning oesophageal speech, use of an elec-trolarynx or by creation of a tracheo-oesophageal fistula for insertion of a Blom-Singer prosthesis. Advanced stage laryn-geal/hypopharyngeal cancer often requires concomitant neck dissection for a clinically positive neck followed by postoperative radiotherapy. Induction chemotherapy with 5-fluorouracil and cis-platinum in selected patients may allow preservation of the larynx since complete response to chemotherapy may allow the patient to proceed to radiotherapy without undergoing surgery.

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