Summary
In Austria, around ten new cases of laryngeal cancer can currently be expected per 100.000 persons each year whereas three out of 100.000 men develope hypopharyngeal cancer. Among women, the incidence in both types of carcinoma is lower by a factor of around 5. All in all, the rate of new cases seems to have been constant or to have slightly decreased in the last few years. Approximately 70% of all laryngeal cancer are glottic cancer, that is to say originating from the vocal cords. About 30% are supraglottic tumours, true subglottic cancers are very rare. The majority of hypopharyngeal tumours originate from the piriform sinuses.Vocal cord tumours lead to a typical symptom that can be early detected: hoarseness. Thus, voice problems in adults that persist for several weeks should therefore always checked by laryngoscopy. This leads to there being a real possibility of early diagnosis of laryngeal cancer, which means that today, approximately 60% of all laryngeal tumours can be diagnosed in stage I or II according to UICC or as intraepithelial lesions (former carcinoma in situ). In glottic cancer about 75% are diagnosed in these early stages, whereas in supraglottic tumours the rate is only about 30% and in hypopharyngeal cancer it is less then 15%. Surgery, radiation therapy, chemo- or immunotherapy are the principal types of oncological treatments currently available. The following conditions generally need to be met for curative surgical treatment options:
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Local tumour, no systemic metastasis
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Tumour has to be resectable in healthy margins
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mortality/morbidity
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Surgery must not lead to unreasonable mutilation
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Lack of other therapeutic alternatives having an equal or lesser impact
In the following pages, indications for the surgical treatment of laryngeal and hypopharyngeal cancer will be discussed and the results of surgical therapy will be summarised briefly.
Zusammenfassung
In Österreich ist bei Kehlkopfkarzinomen derzeit jährlich mit etwa zehn Neuerkrankungen pro 100.000 Einwohner und bei Hypopharynxkarzinomen mit etwa drei Neuerkrankungen bei Männern zu rechnen. Bei Frauen sind die Inzidenzen etwa um den Faktor 5 geringer. Insgesamt scheint die Rate der Neuerkrankungen den letzten Jahren konstant oder leicht rückläufig zu sein. Etwa 70 % aller Kehlkopfkarzinome sind glottische, also von den Stimmlippen ausgehende Neoplasien. Etwa 30 % sind supraglottische Tumoren, echte subglottische Karzinome sind sehr selten. Die Mehrzahl der Hypopharynxkarzinome geht von den Sinus piriformes aus. Stimmlippentumore führen zu einem typischen und klinisch erkennbaren Frühsymptom: Heiserkeit. Über Wochen hinweg persistierende Stimmstörungen bei Erwachsenen müssen daher stets laryngoskopisch abgeklärt werden. Hierdurch eröffnet sich eine echte Möglichkeit der Früherkennung von Kehlkopfkarzinomen, so dass heute etwa 60 % aller Larynxkarzinome in den klinischen Frühstadien I und II nach UICC bzw. als intraepitheliale Neoplasie (früher so genanntes Karzinoma in situ) diagnostiziert werden können. Bei glottischen Karzinomen werden sogar etwa 75 % in diesen Frühstadien diagnostiziert, bei supraglottischen Tumoren dagegen nur etwa 30 %, bei Hypopharynxkarzinomen unter 15 %. Prinzipiell stehen Chirurgie, Strahlentherapie und medikamentöse Therapie als onkologische Ansätze zur Verfügung. Voraussetzung für den sinnvollen kurativen Einsatz chirurgischer Therapieoptionen ist in der Regel die Erfüllung folgender Bedingungen:
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Lokal begrenzte Tumorkrankheit, keine systemische Metastasierung
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Tumor muss operationstechnisch in gesunden Grenzen resezierbar sein
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Vertretbare perioperative Mortalität/Morbidität
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Operation darf nicht zu unzumutbaren Verstümmelungen führen
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Fehlen gleichwertiger und weniger beeinträchtigender therapeutischer Alternativen
Im Folgenden sollen die Indikationen zur chirurgischen Behandlung von Larynx- und Hypopharynxkarzinomen diskutiert und die Ergebnisse der chirurgischen Therapie kurz zusammengefasst werden.
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Eckel, H., Schröder, U., Jungehülsing, M. et al. Indikationen zur chirurgischen Therapie von Larynx- und Hypopharynxkarzinomen. Wien Med Wochenschr 158, 255–263 (2008). https://doi.org/10.1007/s10354-008-0530-2
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DOI: https://doi.org/10.1007/s10354-008-0530-2