68-year-old Haryana man's throat cancer removed through the mouth with laser surgery

A 68-year-old man from Haryana had been feeling persistent discomfort in his throat. He had no idea that it could be caused by cancer. Tests found cancer in the lower part of the throat, the hypopharynx, and at an early stage. The hypopharynx is the part of the throat that lies behind the larynx.

Cases of hypopharyngeal cancer are higher in India than in many parts of the world. Tobacco and alcohol use are important risk factors for this cancer.

Radiation therapy is an important option in treating such cancers. For it, patients may have to visit a cancer centre five days a week for several weeks. In some cases chemotherapy is given along with radiation, and these treatments can have considerable side effects.

This patient was offered another option, transoral laser microsurgery, a delicate surgery done through the mouth with the help of a laser. The information was given by Dr Kanav Kumar, consultant surgical oncologist at the Head and Neck Cancer Institute of India (HNCII).

It is a minimally invasive surgery. A carbon dioxide (CO2) laser is used through the mouth with the help of an operating microscope. The microscope shows the tumour larger and clearer, so it can be removed very precisely while sparing as much of the surrounding normal tissue as possible.

In some early-stage cancers of the larynx (the voice box) and the hypopharynx, this technique can make it possible to remove the cancer without significantly affecting vital functions such as speaking and swallowing.

A practical advantage of this surgery, if the right patients are chosen, is that it can avoid the need to go to hospital every day for several weeks. The cancer can be treated with a single operation. This option can be especially useful for patients who live far from a cancer centre, or for whom finding weeks of time away from work and household responsibilities is difficult.

The surgery is done through the mouth, without making an incision on the outside of the neck. Many patients can start eating soon after the operation, and they do not necessarily need artificial nutrition or breathing support for a long time.

Another possible advantage is that in selected patients, if the cancer returns, it can sometimes be treated with a second laser surgery. In contrast, if cancer returns after radiation, treatment can be more complicated. Depending on the site and spread of the cancer, some patients may also need a major operation.

Transoral laser microsurgery is not necessarily suitable for every cancer of the throat or larynx. Before choosing between surgery and radiation, the nature of the tumour and the patient's condition must be carefully evaluated. The procedure requires special equipment, an operating microscope and an experienced surgeon trained in this technique. HNCII has the facilities and expertise to offer this treatment to the right patients.

Dr Kanav Kumar said, "In this case, the cancer was removed through the mouth without making an incision on the outside of the neck. After the operation the patient started eating soon, and about 24 hours later, on the morning of the second day, he was sent home from hospital. His health was found to be good in later check-ups."

For this patient, the treatment meant more than removing the cancer. It also aimed to preserve vital functions such as speaking and swallowing as far as possible, and to give him the chance to return to his normal routine with minimal disruption to daily life.