A patient with T4a laryngeal cancer has cartilage penetration, a non-functioning aspirating larynx and repeated pneumonias. What is the most defensible curative strategy to discuss?
Anatomical preservation is not equivalent to functional preservation; major cartilage invasion and unsafe baseline function favour surgical discussion when resectable and the patient is fit.
A. Radiotherapy alone guarantees voice preservation: It may leave a non-functioning larynx and does not guarantee safe swallowing or control.
B. Endoscopic laser excision: This is inadequate for extensive transcartilaginous disease.
C. Primary total laryngectomy with appropriate neck treatment and rehabilitation: Anatomical preservation is not equivalent to functional preservation; major cartilage invasion and unsafe baseline function favour surgical discussion when resectable and the patient is fit.
D. Tracheostomy as definitive cancer treatment: It may secure an airway but does not treat the tumour.
E. No treatment because aspiration predicts poor outcome: Curative options and rehabilitation should still be assessed through the MDT.
If the tumour were T2 with preserved function, transoral surgery or radiotherapy could offer organ-preserving curative options.
Independent Clinora preparation material; not official JCIE content, an accredited programme or a substitute for local policy and specialist judgement.
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