Nalyse, discuss and justify the Oncological Management of a patient with carcinoma of the larynx.

Summative Essay Guidance 2013 2014
52 year-old male ceased smoking cigarettes 9 months ago and swapped to
e-cigarettes. Two weeks later the man complained of a hoarse voice and a cough. GP prescribed a course of anti-biotics. After the first course of anti-biotics the symptoms had not improved and the hoarseness had worsened.
Patient returned to his GP who prescribed a second course of anti-biotics. The second course of anti-biotics cleared the suspected chest infection, however hoarseness continued.
Past Medical History
Poor respiratory function due to COPD for past year, worsening with episodes of pneumonia and chest infections.
Current Medications
Beta-agonist inhaler & antimuscarinic inhaler
Allergies: No known drug allergies
Family History: Father died of lung cancer aged 73.
Mother: still alive, living in sheltered accommodation.
Social history:
Patient is married, with three young children in primary school. Wife suffers from MS and the patient works from home as a journalist and househusband.
Life long heavy smoker, until swap to e-cigarettes 9 months ago.
Daily consumption of between 2 -3 pints plus brandy.
Physical Exam:
Clinical examination using an endoscope:
Showed a lesion on the right vocal cord. Vocal cords were both still mobile.
Thoracic examination revealed hyperinflation, wheezing,
Diffusely decreased breath sounds, hyper resonance on percussion and prolonged expiration. BMI17.
Current Pertinent Tests:
CT scan of the head and demonstrated 2cm lesion limited to the right vocal cord.
Biopsies were obtained and demonstrated invasive squamous cell carcinoma.
He was therefore staged as a T1N0 superficial squamous cell cancer of the right vocal cord.

When reviewing the information for your case study you need to consider the following in the content:

Identify the epidemiology, aetiology and histology of your patient

Describe the presenting signs and symptoms and the clinical
investigations that enabled the diagnosis.

Explain the methods of spread and staging for your patient.

Identify the possible oncological management of the disease (surgery, chemotherapy and radiotherapy)

Identify the radiotherapy patient positioning and immobilisation methods for your patient.

Describe the radiotherapy pre-treatment preparation of the patient and the localisation procedure.

Identify the radiotherapy techniques that may be employed in the treatment of your patient.

Identify the dose limiting structures in close proximity to the treatment volume and their tolerance doses.

Describe the potential side effects of the disease treatment including the daily management of patient.

Referencing Requirements:
Neal, A. J., Hoskin, P. J. (2009). Clinical Oncology: basic principles and practice. 4th. Edition. London: Hodder and Arnold.

Chera, B. S., Amdur. R. J., Morris, C.G., Kirwan, J. M., and Mendenhall, W. M. (2010). T1N0 to T2N0 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy. Internation Journal of Radiation Oncology* Biology* Physics, 78(2), 461-466.

Mendenhall, W. M., Strojan, P., Silver, C. E., Owen, R. P., Rinaldo, A., Shaha, A. R., ... & Ferlito, A. (2013). When is radiation therapy in head and neck squamous cell carcinoma not indicated?. European Archives of Oto-Rhino-Laryngology, 1-2. [Online]. Available from: 2014].

Koonce, S. L., Garas, G., Hinni, M., Grant, D. G., & Grant, D. (2012). Endoscopic laser surgery for early glottis cancer: a contemporary review of decision-making and treatment choices. J. ENT Masterclass, 5, 70-74.[Online.] Available from: /

Schultz, P. (2011). Vocal fold cancer. European annals of otorhinolaryngology, head and neck diseases, 128(6), 301-308.[Online]. Available from: 03/2014].

Galletti, B., Freni, F., Cammaroto, G., Catalano, N., Gangemi, G., & Galletti, F. (2012). Vocal Outcome After CO sub 2/sub Laser Cordectomy Performed on Patients Affected by Early Glottic Carcinoma. Journal of Voice, 26(6), 801-805. [Online]. Available from: 03/2014].

Czecior, E., Orecka, B., Pawlas, P., MrA?wka-Kata, K., NamysA owski, G., SkA adowski, K., & Sowa, P. (2012). Comparative assessment of the voice in patients treated for early glottis cancer by laser cordectomy or radiotherapy. Otolaryngologia Polska, 66(6), 407-412. [Online]. Available from: 03/2014].

Kouloulias, V. E., Zygogianni, A., Mosa, E., Platoni, K., Georgakopoulos, J., Antypas, C., ... & Kouvaris, J. (2013). Evaluation of acute/late toxicity and local recurrence in I¤1-I¤2 glottic carcinoma treated with accelerated hypofractionated 3D-conformal external beam radiotherapy (3D-CRT). Radiology and oncology, 47(2), 185-191. [Online]. Available from: raon-2013-0020.xml [Accessed: 08/03/2014].

Tong, C. C., Au, K. H., Ngan, R. K. C., Cheung, F. Y., Chow, S. M., Fu, Y. T., ... & Law, S. C. K. (2012). Definitive radiotherapy for early stage glottic cancer by 6 MV photons. Head & neck oncology, 4(1), 1-10. [Online]. Available from: 2014].

Jenckel, F., & Knecht, R. (2013). State of the Art in the Treatment of Laryngeal Cancer. Anticancer research, 33(11), 4701-4710. [Online]. Available from: 03/2014].

Barrett, A., Dobbs, J., & Roques, T. (2009). Practical Radiotherapy Planning Fourth Edition. CRC Press. London: Hodder and Arnold.