The Roentgen Diagnosis and Treatment of Carcinoma of the Larynx and Pharynx

Abstract

CANCER of the larynx, next to cancer of the skin, breast, mouth, and uterus, gives to us probably the greatest hope of cure with our present knowledge, providing the diagnosis is made early and the lesion is treated skillfully and thoroughly from the beginning. The diagnosis in its earliest and most curable stage is probably not best made by the roentgen rays. The earliest diagnosis I believe can best be made by direct or indirect laryngoscopy. This requires that the patient be brought under the supervision of a skillful laryngologist or bronchoscopist at the onset of the symptoms. The earliest symptoms are hoarseness or local discomfort. These may or may not be associated with pain, soreness, or tenderness. It should be our aim, therefore, to have these patients obtain this expert opinion by the end of two weeks if there is no improvement during this time. Intermittent hoarseness may be due to carcinoma. It is well known that if the diagnosis is made while the lesion is still intrinsic, and the patient is operated upon skillfully, as high as 85 per cent of the intrinsic group has been reported as cured by laryngofissure (Jackson and Jackson, Tucker, Clerf, Gluck, Sorenson, and others). Tucker, in a study of 200 consecutive cases of carcinoma of the larynx, estimated that at the beginning, 72 per cent were intrinsic, and, therefore, operable. However, as patients now come to the expert laryngologists, the great majority has become extrinsic. Of 280 cases operated upon and reported by Nager, Schinz, and Zuppinger, only 23 (8 per cent) were recorded as intrinsic. This would represent a much lower percentage if the inoperable cases are included. Of the 280 cases operated upon, only 11 survived operation from one to nine years (4 per cent). Of these 11 recovered cases, six were classed as intrinsic. Of the cases treated by irradiation (involving a more advanced and usually inoperable group), about 25 to 28 per cent should recover. On this point, Chevalier L. Jackson, in a personal letter, says, “Between the years 1930 and 1937, we saw 347 cases of cancer of the larynx. Of these, 71 (11 per cent) were thought to be of the very early and limited intrinsic sort which are regarded as suitable for the conservative operation of laryngofissure. An additional 79 were operated upon by laryngectomy, but some of these cases were not really suitable cases for surgery, perhaps.” Jackson and Jackson find more and more indications for treatment by irradiation, and say, “The greatly increased efficiency of irradiation indicates that laryngectomy should now be limited to good surgical subjects of good general expectancy.” In this small early group of cases, therefore, it is not likely that the radiologist will be needed for either diagnosis or cure. It is possible, however, to cure even the early cases by irradiation (Schinz, Stewart-Harrison, Torrigiani, and Palumbo), but it is probably not the most economical nor the most efficient method of treatment.