Cancer of the Larynx- Management Challenges in Calabar, South-South Nigeria.

Abstract

Aims: To review the management challenges and outcome of advanced carcinoma of the larynx associated with patient treatment preference regardless of available or clinically appropriate treatment modality. Materials and methods: This was a retrospective review of the records of patients with laryngeal cancer managed in the Otorhinolaryngology department of the University of Calabar Teaching Hospital, Calabar South eastern Nigeria. The period under review was April 2001 to march 2011. The age, sex, presentation, history cigarette smoking and alcohol consumption, histopathological diagnosis, patient treatment preference and outcome of management, were analysed. Results: There were 10 patients, all males in the age range 42 to 75 years. Hoarseness was the initial symptom in all the patients (100%) with stridor and difficulty in breathing in 8(80%) at presentation. There was history of recent or past cigarette smoking in all but 2 (20%) of the patients. Tumour was transglottic in 7 (70%) patients, glottic in 2 (20%) and supraglottic in 1 (10%). Emergency tracheostomy was done in 8 (80%) cases as the first line of treatment to relieve upper airway obstruction. The histological diagnosis was exclusively squamous cell carcinoma of variable degrees of differentiation in 9 (90%) cases and carcinoma in situ in a case (10%) patient. Clinical staying was T3 No in 8(80%) of cancer. Nodal staging was not confirmed by CT or MRI scans. There was biased to any form of laryngeal surgery as treatment option because of societal believes and ignorance. Chemoradiation therapy without surgery preferred by all the patients regardless of advanced stage of disease. There was high morbidity including disease recurrence within 1 year in 7(70%) patients and dependence on tracheotomy in 8(80%), feeding gastrostomy, intractable pain and pharyngocutaneus fistula. Voice optimisation was achieved only in the 2 patient with early glottic tumours. Mortality within 1 year was recorded in 5 patients despite Chemoradiation Therapy (CRT). Mortality was attributable to liquid morphine overdose/toxicity in 1 patient. Prognosis was abysmally poor.Conclusion: Treatment of Ca larynx in Calabar South eastern Nigeria is a management challenge with considerable morbidity and mortality. Cure rate and prognosis are very poor because of late presentation and patient’s preference for inappropriate treatment modality in advanced disease. Refusal of laryngeal surgery as treatment option even when conservative non-surgical options have failed was because of Beliefs and ignorance. There is need for public enlightenment on the possibility of high cure rates and voice preservation in early laryngeal cancer. Cost of oncology care should be subsidized by government while an oncology centre should be established in each of the six geopolitical zones in Nigeria.