New Surgical Procedure to Treat Laryngeal Chondrosarcoma
Laryngeal chondrosarcoma is a rare type of cancer that grows in the cartilage tissue that makes up the larynx, also known as the voice box. Traditionally, treatment options have been both limited and bleak. The current standard of care is a life-changing surgery that removes the larynx entirely—forever changing the way a patient speaks, breathes, and swallows.
Experts at the Grabscheid Voice and Swallowing Center of Mount Sinai and Head and Neck Institute are leading the way in advancing medicine for this difficult to treat cancer. Over the last decade, our surgeons have pioneered a new method that removes only the affected cartilage in the larynx. Home to the nation’s first fellowship-trained laryngologists, the Grabscheid Voice and Swallowing Center is the only facility in the country offering this cutting-edge technique, which preserves the patient’s natural anatomy and ultimately allows them to lead more normal lives.
Symptoms of Laryngeal Chondrosarcoma
The larynx is an organ in the neck that helps us breath, produce sounds, and protect our lower airway from obstructions. This delicate structure is made up of nine different types of cartilage. When laryngeal chondrosarcoma develops in these cartilages, the tissue slowly begins to expand and compromise the laryngeal skeleton it is supposed to hold together. Over time, this affects a patient's ability to speak, eat, or breathe.
Since the symptoms of laryngeal chondrosarcoma develop slowly over a long period of time they are often dismissed. Make an appointment with your physician if you experience any of the following:
- Change in the voice, such as prolonged hoarseness
- Difficulty swallowing
- Trouble breathing
- A feeling like there is a lump in your throat
- Coughing up blood
Diagnosing Laryngeal Chondrosarcoma
Patients who present with symptoms of head and neck cancers are given a thorough examination. Video laryngeal stroboscopy is a minimally invasive procedure that inserts a scope with a camera into the throat to visualize the larynx, vocal cords, and related structures. This diagnostic tool is used to observe changes that could indicate cancer such as a bulge from the expansion of the cartilage or a change in the way the vocal cords vibrate. The larynx is often difficult to biopsy. When changes are found on stroboscopy, high-resonance imaging including CT and MRI scans are typically used to make a definitive diagnosis.
Partial Laryngectomy Surgery Offered Exclusively at Mount Sinai
Laryngeal chondrosarcomas need to be surgically removed. Research has found that therapies used to treat other types of cancer, such as radiation, are generally ineffective.
Before surgeons at Mount Sinai developed an alternative, the traditional surgery for laryngeal chondrosarcomas was a total laryngectomy—a procedure that removes the larynx entirety. However, this life-altering surgery drastically changes the anatomy. Patients need to learn to speak and breathe through a new opening in their neck called a stoma. The procedure used to create this hole that is connected to a tube and attached to the windpipe is called a tracheostomy.
Our surgeons have extensive experience using partial laryngectomy to treat other head and neck cancers. As part of a decade-long study being conducted in conjunction with University of California San Francisco, experts at the Grabscheid Voice and Swallowing Center and Head and Neck Institute have had promising outcomes treating laryngeal chondrosarcomas with partial laryngectomy.
Instead of removing the entire larynx only the affected cartilage is removed, and the diseased portion is rebuilt. The laryngeal framework is a delicate structure—when part of it is taken out, the cartilage has to be replaced or it will collapse entirely. To reconstruct the cartilage, surgeons at Mount Sinai typically take bone from the patient’s fifth rib. The bone is shaped to match the removed cartilage, wrapped with tissue harvested from the thigh, and set into place.
Outcomes of Partial Laryngectomy
Experts are currently following nine patients with laryngeal chondrosarcomas from all over the U.S. who came to Mount Sinai to receive care. Most were told by other institutions that laryngectomy was their only option.
Patients who have partial laryngectomy will have a temporary tracheostomy while the airway heals and stabilizes. However, within a year or two, every participant in the study was able to have their stoma removed. So far, all of the surgeries have been successful with none of the patients requiring a follow-up total laryngectomy procedure. Researchers are continuing to monitor their ability to breathe, swallow, and speak — both before and after the procedure — as well as disease recurrence.