See also:
- Management Consideration Radiation Induced Malignancy in the Head and Neck
- Laryngeal leukoplakia white plaques on vocal cords
Case Example
- September 2011 First Oto Clinic Visit with dysphonia for preceding 1 year. Moderate dysphonia (G2R2B1A0S2)
- Self-rated negative impact of voice problem on life = "6" out of 6 (0 = no negative impact; 6 = profound negative impact)with elevated reflux symptom index + tobaccao use (greatest amount = 1 pack per week)
- Differential diagnosis: Chronic laryngitis. Possible laryngopharyngeal reflux, possible laryngeal candidiasis, possible vocal fold hemorrhage
- Prescription: Reflux precautions, reflux medications, trial of diflucan
- November 2011: Follow-up clinic visit 6 weeks later. Moderate dysphonia persists. Imaging similar.
- Differential diagnosis: Chronic laryngitis. Rule out papillomatosis vs cancer.
- November 2011: Microdirect laryngoscopy under general anesthesia
- Biopsy: left vocal cord = invasive moderately differentiated squamous cell cancer
- Subsequently evaluated (paraffin embedded specimen) as positive for high risk HPV
- Slightly irregular Z-line (G-E junction) biopsied: 'mild non-specific chronic inflammation'
- February 2012 Follow-up clinic visit last day of XRT (63 Gy)
- Dysphagia and dysphonia; modify omeprazole to liquid; maintaining weight
- March 2012 Follow-up clinic visit 6 weeks after completion of radiation
- Vocal quality improved "better than before irradiation"
- November 2012: Follow- up including voice clinic appt with dysphonia only mild (G1R1B0A0S0)
- Self-rated negative impact of voice problem on life = "1" out of 6 (0 = no negative impact; 6 = profound negative impact)
Yearly Long-Term Follow-up
Out to 11 years and 5 months post-irradiation in Gallery
Diagnosis, Treatment Planning, and Response to Treatment |
|---|
Diagnosis made from bx at time of microdirect laryngoscopy |
Treatment planning |
Larynx seen in clinic on last day of XRT and one year later |
Appearance of neck on last day of irradiation and one year later |
Larynx before irradiation and 15 months after |
