![]() The end result is that the maximum amount of normal, non-cancerous tissue on the affected vocal fold(s) is saved, without sacrificing oncologic effectiveness. The KTP laser photoablation technique precisely “maps” a vocal fold cancer (in a relatively bloodless field) along its entire deep surface and periphery, with ultra-narrow margins. There is commonly avisually identifiable, variable length zone of pre-cancer (dysplasia) at the surface perimeter but treatment in these areas need not be over-aggressive if voice is to be maximally preserved. Provided that they have not been previously treated, glottic SCC’s are essentially contiguous masses that are deepest at their epicenter but become increasingly superficial as they approach the peripheral boundary with normal, healthy vocal fold tissue. The KTP laser photoablation technique capitalizes on the fact that most early stage glottic SCC’s are not a uniform depth over the entire surface area of their disease. The physics of the KTP laser allow it to preferentially target tissues that have an increased blood vessel content, like cancer. Nevertheless, with these pre-requisites in place, the KTP laser can be used to methodically vaporize (photoablate) early stage glottic squamous cell carcinoma (SCC), as opposed to the traditional method of cutting around it with a margin of normal tissue, as is typically been done with the carbon dioxide (CO2) laser or sometimes “cold” microinstruments (for smaller cancers). On its own, the KTP laser is simply a tool, and optimal oncologic and voice outcomes in treating glottic cancer still require meticulous operative laryngoscopy, high-powered magnification at all times, and prudent surgical judgment. ![]() How is the KTP laser different from other surgical treatments? Cancers that meet these criteria are stage I if T1a or T1b, and stage II if T2. T3 = cancer limited to the larynx with vocal cord fixation or paraglottic space involvement, or minor thyroid cartilage erosion (eg inner cortex)Īn early stage vocal fold cancer is one with a T stage including T1a, T1b, or T2 and no lymph node metastases to the neck (N0) and no distant metastases (M0). T2 = either cancer extension to other portions of the larynx (supraglottis or subglottis), and/or impaired vocal fold mobility T1b = cancer involves both vocal folds (but not supraglottis or subglottis) with both vocal folds fully mobile T1a = cancer limited to one vocal fold (but not supraglottis or subglottis), with both vocal folds fully mobile Glottic cancer T stage depends on geographic cancer distribution along one or both vocal folds, whether the cancer has spread to the laryngeal tissues above the vocal folds (supraglottis) or laryngeal tissues below the vocal folds (subglottis) ,and whether the normal opening / closing capabilities of the vocal folds during breathing and speaking are preserved or absent. Early stage cancer is considered stage I or stage II. Overall stage is a combination of T, N, and M status – ranging from I (earliest) – IV (highest). The T stage ranges from T1 (lowest) to T4 (highest). Like other cancers, vocal fold cancer is staged by the TNM Staging System:
0 Comments
Leave a Reply. |