A 55 years male patient presented with neck swelling Rt. side for the last 7 months with hoarseness of voice. 15 days back it was incised by some witch doctor thinking it , to be an abscess. FNAC has revealed to be metastatic. IDL shows rt. vocal cord fixed. Management?


Ca rt vc with neck node ulcerated.. Go with chemotherapy 3-4 cycles with cddp 5fu followed by chemoradiation. As nodes are ulcerated , ulceration will increase if you directly go for chemoradiation.so ulceration will heal in mean time if you consider induction chemo.and more over huge nodal mass wont regress completely with chemoradiation alone.
agree with u Dr Prashanth sir
Diagnosis: Ca larynx not less than grade 3 as the cord is fixed. Mx: sandwich method, I.e radiation before & after surgery.Trying to preserve the voice should be tried which is dependent on the extension of the growth. Attempt should be MRND with hemilaryngectomy with PMMC reconstruction. Three weeks later radiotherapy should be started. Having said that I am not sure of anterior radiotherapy I.e before surgery since it can make the MRND difficult. Intensity modulated radio therapy can be more handy. RadioOncologist's opinion is vital.. A team of ENT, Surgical Oncologist & a plastic surgeon would then tackle.. Dats really a nice case. Thanx.
I would evaluate this as follows. 1) the vocal cord palsy could be from extrinsic compression or involvement of recurrent laryngeal nerve by the tumour. I would do a CT scan or if affording, a PETCT. A N3 node has a high propensity for distant mets. 2) if localised, I would evaluate the operability. The only point here would be involvement of the common carotid and internal carotid. Considering the location there is a high likelihood of the above vessels being involved. If the above mentioned vessels are free, and if the PET hasn't defined the primary, dl scopy and EUA should be done to document primary. 3)if the carotids are free, would do a formal RND with SOS reconstruction based on defect. 4) if inoperable, I am not sure how much CTRT will help. Radiation may need to more ulceration and fungation. The preferable option maybe just palliative chemo then. Dr. Goyal Sir, I would really like if you could put up the CT /imaging
Correct in sentence *radiation may lead to fungation.... Would add one more point. If operable, can then be consolidated with CTRT. If borderline operable, would consider NACT and evaluation Of course, the prognosis is grim, but if we can remove the nodal mass at least he won't die of a carotid bleed
treatment depends upon primary site but as per clinical picture and fnac report seems to be a head and neck primary. if patient affords do a pet ct or at least a cect head neck chest and abdomen to rule out systemic mets. in present case even if it s only locally advanced disease patient wilk be benefited by neoadjuvant or palliative chemotherapy preferably taxane and platinum based 3 cycles followed by response assessment and management accordingly
Cect neck n metastatic work up to be done. Palliative chemort may not be beneficial to this patient due to large nodes and the underlying tissue hypoxia. I would rather proceed with induction chemo upto3 cycles and then assess for further management based on response.
Hi.. Would like to know the histology of the malignancy. But looking at the tumour and the patient, palliative intent of treatment - pall chemotherapy or best supportive care. Giving any chemotherapy with the sound again will be difficult.
palliative chemotherapy... radiotherapy can be delayed as there is open fungating mass... other general measures like tracheotomy and feeding jejunostomy to improve his status....
N3 nodal mass in the neck in Vocal cord primary is quite unusual !! management: we can still aim at curative treatment as in Chemo-Radiotherapy.
surgical excision along with lymphnode chain goal excision followed by radiotherapy combined chemotherapy
debunking by radio +chemo followed by surgery depends upon extension of disease
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