The Indian Council of Medical Research (ICMR) has issued the draft consensus document for management of larynx and hypopharynx cancers. The document provides details about how to manage laryngeal and hypopharyngeal cancers such as diagnostic work up, staging, treatment, stage-wise treatment and consensus statement on practice. Laryngeal cancer is the second most common head and neck cancer with 1,59,000 new cases and 90,000 cancer deaths world wide and it forms 2 per cent of all cancers. Laryngeal cancers are more common among men with a higher incidence in South Asia. Conservative surgery or radiotherapy (RT) offers equal cure rates in its early stage although RT is more popular worldwide.
For intermediate and advanced staged tumours, total laryngectomy with post operative RT was the standard of care until the Veterans Administration Larynx Study in 1991and other subsequent organ preservation trials which established the role of combination of chemotherapy with radiation in the upfront treatment of locally advanced laryngeal cancers (stage III and early IV a). Hypopharyngeal cancers although managed in the same lines, are more aggressive and liable for treatment failure and low survival. The incidence of hypopharyngeal cancers is relatively high in India (approximately 11 per cent against one per cent worldwide, among males).
According to the document’s approach to laryngeal carcinoma, detailed history should include hoarseness, difficulty in breathing, (stridor), choking spells (aspiration), difficulty in swallowing (dysphagia) or pain while swallowing (odynophagia), foreign body sensation and ear ache. Presence of tracheostomy tube or nasogastric tube needs to be documented. Proper documentation of performance and nutrition status is needed. Detailed clinical examination of primary and neck should be carried out in addition to a general examination. ENT evaluation includes mirror examination and endoscopic evaluation.
The ICMR has invited suggestions and comments from stakeholders on the draft document before November 26, 2014.