Erken Evre Larenks Kanserleri
Özet
Erken evre larenks (gırtlak) kanserleri, yüksek tedavi edilebilirlik oranlarına sahip olup, çoğunlukla skuamoz hücreli karsinom olarak karşımıza çıkar. Tütün ve alkol kullanımı ile doğrudan ilişkili olan bu kanser türünde, erken tanı hayati önem taşır. Glottik tümörler genellikle erken evrede ses kısıklığı ile belirti verirken, supraglottik ve subglottik tümörler sinsi seyrederek ileri aşamalarda saptanır. Tanı, endoskopik biyopsi ve görüntüleme yöntemleriyle (BT ve MRG) konur. Evre 0, I ve II'yi kapsayan erken evre hastalıkta, ses kalitesi, yutma fonksiyonu ve hasta tercihi doğrultusunda cerrahi veya radyoterapi (RT) gibi tek modaliteli tedaviler seçilir. Cerrahi seçenekler arasında açık parsiyel tekniklerin yanı sıra trakeostomi gerektirmeyen, hastanede kalış süresini kısaltan transoral lazer ve robotik cerrahiler öne çıkmaktadır. Glottik lezyonlarda lenf nodu metastazı nadir olduğundan elektif boyun tedavisi gerekmezken, supraglottik tümörlerde yüksek metastaz riski nedeniyle bilateral selektif boyun diseksiyonu veya RT standarttır. Subglottik kanserler ise genellikle ileri evrede yakalanır ve agresif kombine tedaviler gerektirir. Tedavi sonrası hastaların nüks açısından beş yıl boyunca endoskopik ve radyolojik olarak takibi zorunludur.
Early-stage laryngeal cancers possess high cure rates and are predominantly histopathologically classified as squamous cell carcinoma. Heavily linked to tobacco and alcohol consumption, early detection remains critical for survival. While glottic tumors present early with persistent hoarseness, supraglottic and subglottic lesions develop insidiously and are diagnosed at advanced stages. Diagnosis relies on endoscopic biopsy alongside imaging modalities like CT and MRI. For early-stage disease (Stages 0, I, and II), single-modality treatments—either surgery or radiotherapy (RT)—are leveraged based on voice quality, swallowing function, and patient preference. Surgical approaches encompass classic open partial techniques or transoral laser and robotic microsurgeries, which offer shorter hospital stays and minimize the need for tracheostomy. N0 glottic tumors rarely present with occult metastasis, negating elective neck treatment; conversely, supraglottic tumors exhibit a high propensity for regional spread, necessitating bilateral selective neck dissection or RT. Subglottic cancers are typically caught late, requiring aggressive combined approaches like total laryngectomy and RT. Post-treatment, patients must undergo comprehensive endoscopic and radiological follow-up for five years to monitor potential recurrence.
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