Larynx cancer, also known as laryngeal cancer, is a type of cancer that affects the tissues of the larynx, or the voice box. The larynx is a complex structure that plays an essential role in speech and breathing, and larynx cancer can have serious consequences for the patient’s quality of life and overall health [1].

The use of lasers in the treatment of cancer is a relatively new development, and the first laser was approved for use in cancer treatment in the early 1990s. The development of laser technology has allowed for more precise and effective treatment of larynx cancer, and the use of lasers has become increasingly common in recent years [2].

There are several different types of laser technologies used in the treatment of larynx cancer, each with its own unique advantages and disadvantages [3]. The most commonly used types of lasers include carbon dioxide (CO₂) lasers, potassium-titanyl-phosphate (KTP) lasers, and neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers.

CO₂ lasers (10,600 nm) are the most commonly used type of laser for larynx cancer treatment. This type of laser uses a high-energy beam of light to vaporize the cancerous tissue, making it an effective option for removing large or deep tumors. However, CO₂ lasers can also cause damage to healthy tissue, so the procedure must be performed with great care and precision.

KTP lasers (532 nm) are similar to CO₂ lasers, but they use a longer wavelength of light that is less likely to cause damage to healthy tissue. This makes KTP lasers a good option for removing small or superficial tumors.

Nd:YAG lasers (1,064 nm) are the least commonly used type of laser for larynx cancer treatment. This type of laser uses a different type of light energy that is less effective at removing cancerous tissue, but it is less likely to cause damage to healthy tissue.

Traditionally, larynx cancer has been treated with a combination of surgery, radiation therapy, and chemotherapy. However, in recent years, laser treatment has become a promising alternative for the treatment of larynx cancer [4]. Laser treatment for larynx cancer involves the use of high-energy light beams to precisely remove the cancerous tissue while minimizing damage to the surrounding healthy tissue [5]. Laser treatment for larynx cancer can be performed using a number of different techniques, including laser excision, laser ablation, and laser microsurgery. Each of these techniques has its own advantages and disadvantages, and the best technique for a particular patient will depend on a number of factors, including the size and location of the cancerous tissue, the patient’s overall health, and the patient’s individual preferences [6].

Laser excision is one of the most common techniques used for the treatment of larynx cancer. During laser excision, the cancerous tissue is removed using a laser beam. The laser beam is directed precisely at the cancerous tissue, allowing the surgeon to remove only the cancerous tissue while leaving the surrounding healthy tissue intact. This helps to preserve the function of the larynx and reduce the risk of complications (Fig. 1).

Figure 1. (A) Image showing a patient with the diagnosis of glottic squamous cell carcinoma. (B) Immediate post-op, after removal of the tumor. (C) Results 6 months after the surgery was performed. Reused from the article of Rubinstein and Armstrong (Lasers Med Sci 2011;26:113-24) [5] with original copyright holder’s permission.

Laser ablation is another technique used for the treatment of larynx cancer. During laser ablation, the cancerous tissue is destroyed using a laser beam. Unlike laser excision, laser ablation does not involve the removal of the cancerous tissue. Instead, the cancerous tissue is destroyed, and the body’s natural healing process takes over to remove the dead tissue over time. Laser ablation can be used to treat early-stage larynx cancer, and it can be a less invasive alternative to surgery.

Laser microsurgery is a more complex technique that is used for the treatment of more advanced larynx cancer. During laser microsurgery, the cancerous tissue is removed using a laser beam and a microscope. This technique allows the surgeon to precisely remove the cancerous tissue while minimizing damage to the surrounding healthy tissue. Laser microsurgery is typically reserved for more advanced cases of larynx cancer, as it is a more complex and time-consuming procedure. In addition to these techniques, laser treatment for larynx cancer can also be used in conjunction with other treatments, such as radiation therapy or chemotherapy, to help to improve the outcomes of these treatments (Fig. 2).

Figure 2. Schematic depiction of how the tumor of the larynx is removed. It is removed by cutting through the tumor and removing it in sections. Reused from the article of Rubinstein and Armstrong (Lasers Med Sci 2011;26:113-24) [5] with original copyright holder’s permission.

Despite its many benefits, laser treatment for larynx cancer is not without risks. As with any surgical procedure, there is a risk of bleeding, infection, and other complications [7]. In addition, laser treatment can result in scarring and permanent changes in the appearance or function of the larynx. One of the most common complications of laser treatment for larynx cancer is damage to the vocal cords. The vocal cords are a critical component of the larynx, and any damage to these structures can result in permanent changes to the patient’s voice [8]. In some cases, this can result in complete loss of voice. Another potential complication of laser treatment for larynx cancer is airway obstruction. This can occur if the laser beam damages the surrounding tissue and causes it to become inflamed or swollen. Airway obstruction can make it difficult for the patient to breathe, and can be life-threatening in some cases. Additionally, there is a risk of recurrence with laser treatment for larynx cancer. In some cases, the cancer may return after treatment, and the patient may require additional treatment or surgery.

To minimize the risk of complications, it is important to choose an experienced and skilled surgeon who has a good track record of successfully treating larynx cancer using laser techniques. Patients should also carefully consider all of their treatment options and discuss the risks and benefits of each option with their doctor.

Laser treatment for larynx cancer offers several advantages over traditional surgical techniques, including:

Faster recovery time: laser treatment is a minimally invasive procedure that typically requires a shorter hospital stay and a faster recovery time compared to traditional surgical techniques.

Less scarring: laser treatment results in less scarring and disfigurement than traditional surgical techniques, making it a good option for patients who are concerned about the appearance of their larynx after the procedure.

Fewer complications: laser treatment is less likely to cause complications such as bleeding, infection, or difficulty swallowing compared to traditional surgical techniques.

Laser treatment for larynx cancer, also known as transoral laser microsurgery, has proven to be an effective treatment option for certain cases. However, it also has its limitations. Here are some limitations of laser treatment for larynx cancer:

Tumor size and location: laser treatment is most effective for small and localized tumors. Large or extensive tumors may not be suitable for laser treatment alone and may require additional therapies such as radiation or chemotherapy.

Depth of tumor invasion: laser treatment is generally more effective for superficial tumors that have not invaded deeply into surrounding tissues. If the tumor has penetrated deeply into the larynx or adjacent structures, laser treatment alone may not be sufficient to remove all cancer cells.

Limited access: the laser can only reach areas that can be accessed through the mouth or throat. Tumors located in certain parts of the larynx may be difficult to access with a laser, requiring alternative treatment approaches.

Risk of recurrence: while laser treatment can effectively remove visible tumors, there is still a risk of cancer recurrence. It is essential to closely monitor patients after laser treatment and provide appropriate follow-up care to detect and address any recurrence early.

Functional outcomes: depending on the extent of the tumor and the required surgical intervention, laser treatment may impact voice quality, swallowing function, and breathing. Preservation of laryngeal function is a primary goal, but there can still be some functional changes following laser treatment.

Operator expertise: laser treatment for larynx cancer requires a highly skilled and experienced surgical team. The success of the procedure greatly depends on the surgeon’s expertise in using the laser and their ability to accurately remove the tumor while preserving surrounding healthy tissues.

It is important to consult with a medical professional who specializes in laryngeal cancer to determine the most suitable treatment approach based on individual factors and tumor characteristics. They can provide detailed information on the benefits and limitations of laser treatment and help guide treatment decisions.

After undergoing laser treatment for larynx cancer, a patient may require additional treatments such as radiation therapy and chemotherapy. These treatments are often recommended to target any remaining cancer cells, reduce the risk of recurrence, and improve the chances of long-term survival.

Radiation therapy: radiation therapy uses high-energy beams, such as X-rays or protons, to target and kill cancer cells. It can be delivered externally (external beam radiation) or internally (brachytherapy). In the case of larynx cancer, external beam radiation therapy is commonly used. The radiation is carefully aimed at the larynx area to destroy any remaining cancer cells. Radiation therapy may be administered over several weeks, with daily treatments scheduled from Monday to Friday. Side effects of radiation therapy may include fatigue, skin changes in the treated area, difficulty swallowing, and hoarseness.

Chemotherapy: chemotherapy involves the use of drugs to destroy cancer cells throughout the body. It is often administered through a vein (intravenously) or taken orally. Chemotherapy is commonly used in conjunction with radiation therapy and is known as chemoradiation. The drugs circulate in the bloodstream and target cancer cells not only in the larynx but also in other areas of the body. The specific chemotherapy regimen depends on the individual case, but commonly used drugs for larynx cancer include cisplatin and fluorouracil. Side effects of chemotherapy may include nausea, vomiting, hair loss, fatigue, and increased susceptibility to infections.

It’s important to note that the specific treatment plan for larynx cancer, including the use of radiation therapy and chemotherapy, will depend on various factors such as the stage of cancer, the location and size of the tumor, and the overall health of the patient. The oncology team, including radiation oncologists and medical oncologists, will evaluate the individual case and develop a personalized treatment approach. They will also discuss the potential risks, benefits, and side effects of each treatment option with the patient.

While laser treatment for larynx cancer is generally considered safe and effective, like any medical procedure, it does carry some potential risks. Here are some of the potential risks associated with laser treatment for larynx cancer:

Bleeding: the use of a laser to remove cancerous tissue in the larynx can cause bleeding. Although the laser can cauterize blood vessels as it cuts, there is still a risk of post-operative bleeding. This risk is typically managed by the surgical team during the procedure.

Infection: any surgical procedure carries a risk of infection. Laser treatment for larynx cancer is no exception. The surgical site can become infected, leading to pain, swelling, and other signs of infection. Precautions are taken to minimize the risk of infection, such as the use of sterile techniques and antibiotics.

Voice changes: the laser treatment may cause changes to the voice quality. This can include hoarseness, changes in pitch, or a weak voice. These changes can be temporary or permanent, depending on the extent of the treatment and the individual patient.

Scarring: laser treatment can result in scarring of the tissues in the larynx. Excessive scarring can lead to difficulty with voice production or swallowing. The severity of scarring varies among individuals and depends on various factors, including the extent of the treatment and the healing process.

Breathing difficulties: in some cases, laser treatment for larynx cancer may cause swelling or narrowing of the airway, leading to breathing difficulties. This risk is more significant when larger tumors are treated or when multiple treatments are required. Close monitoring during and after the procedure helps to detect and manage any breathing complications.

Damage to nearby structures: the laser energy used during the procedure may inadvertently damage surrounding tissues or structures, such as the vocal cords, esophagus, or nerves. Surgeons take great care to minimize the risk of damage to these structures, but it remains a potential risk.

It’s important to note that these risks are generally rare, and skilled surgeons take precautions to minimize them. The specific risks and potential complications will be discussed with the patient by the medical team before the procedure, and appropriate measures will be taken to address and manage these risks during and after the treatment.

There are several strategies that can be used to decrease the risk of complications associated with laser treatment for larynx cancer:

Precise laser technology: using the most advanced and precise laser technology available can help to minimize the risk of damage to healthy tissue and reduce the risk of complications. This can be achieved by using high-precision laser systems that are specifically designed for use in the treatment of larynx cancer.

Proper patient selection: proper patient selection is crucial for reducing the risk of complications. Patients who have a history of previous laryngeal surgery, radiation therapy, or other medical conditions may not be good candidates for laser treatment and should be carefully evaluated by a qualified medical professional before undergoing the procedure.

Experienced surgeon: choosing a surgeon with extensive experience in performing laser treatment for larynx cancer can also help to reduce the risk of complications. This is because an experienced surgeon will have a deep understanding of the anatomy of the larynx and will be able to more effectively plan and execute the procedure to minimize the risk of complications.

Multidisciplinary approach: a multidisciplinary approach to the treatment of larynx cancer can also help to reduce the risk of complications. This involves collaboration between a team of medical professionals, including a laryngologist, an oncologist, and a radiation oncologist, to create a comprehensive and personalized treatment plan that is tailored to the specific needs of each patient.

Post-operative care: proper post-operative care is essential for reducing the risk of complications. This includes close monitoring of the patient, prompt recognition and treatment of any post-operative complications, and regular follow-up visits with a medical professional to ensure that the patient is healing properly and that any potential complications are detected and treated early.

By implementing these strategies, it is possible to decrease the risk of complications associated with laser treatment for larynx cancer and improve the outcomes for patients undergoing this procedure (Fig. 3).

Figure 3. (A) Insertion of laryngeal endoscope through the oral cavity to visualize the laryngeal structures. (B) Classical view through the laryngoscope, where the vocal cords are seen. Reused from the article of Rubinstein and Armstrong (Lasers Med Sci 2011;26:113-24) [5] with original copyright holder’s permission.

The success of laser treatment for larynx cancer is influenced by several factors, including:

The stage of the cancer: early-stage larynx cancer is more likely to be successfully treated with laser treatment compared to advanced-stage cancer.

The size and location of the tumor: Larger or deeper tumors may be more difficult to remove with laser treatment, and tumors located near critical structures such as the airway or the vocal cords may also pose a higher risk.

The patient’s overall health: patients who are in good overall health are more likely to have a successful outcome from laser treatment compared to patients with underlying health conditions.

The expertise of the surgeon: the success of laser treatment for larynx cancer is largely dependent on the skill and experience of the surgeon, so it is important to choose a surgeon who is highly experienced in this type of procedure.

As medical technology continues to advance, it is likely that new and improved techniques for the treatment of larynx cancer will be developed. In particular, the field of laser treatment is likely to see continued growth and development. One area of focus for the future of laser treatment for larynx cancer is the development of more precise and sophisticated laser technology. This could allow for even more accurate removal of cancerous tissue while minimizing the risk of complications [5].

In addition, there is growing interest in the use of minimally invasive techniques for the treatment of larynx cancer. This includes the use of endoscopic laser surgery, which uses a small scope to perform the procedure through a tiny incision in the neck. This approach offers many of the benefits of traditional laser treatment, but with even less invasive and with reduced risk of morbidity [9].

Another area of focus for the future of laser treatment for larynx cancer is the use of laser-assisted reconstructive techniques. This involves the use of laser energy to help with the reconstruction of the larynx after cancer surgery. This approach can help to improve the patient’s speech and swallowing ability, and may also reduce the risk of complications [10].

The future of laser treatment for larynx cancer is bright, with many exciting advances in the pipeline. Whether through the development of more precise and sophisticated laser technology, the use of minimally invasive techniques, or the use of laser-assisted reconstruction, it is likely that patients will continue to benefit from the many advantages of laser treatment for larynx cancer.

Laser treatment for larynx cancer is a promising alternative to traditional treatments such as surgery, radiation therapy, and chemotherapy. It offers a number of advantages, including precise removal of cancerous tissue, preservation of healthy tissue, and reduced risk of complications. However, like all treatments, laser treatment for larynx cancer is not without risks, and patients should carefully consider all of their options before making decision. If you have been diagnosed with larynx cancer, it is important to work closely with your doctor to determine the best course of treatment for your individual needs. With proper treatment and close monitoring, it is possible to effectively treat larynx cancer and achieve a good outcome.

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All work was done by SHW.

Seung Hoon Woo is the Editor-in-Chief of the journal, but was not involved in the review process of this manuscript. Otherwise, there is no conflict of interest to declare.

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