Carcinoma in Situ

A special issue relates to the treatment of carcinoma in situ of the vocal cords. This disease often can be managed with vocal cord stripping, but if enough serial sections are examined, foci of invasive carcinoma are often found. Pane and Fletcher reported on a series of 79 patients with carcinoma in situ and 7 patients with leukoplakia/atypical hyperplasia who were treated with radiotherapy. Patients were staged as either T1 or T2, using the same criteria as for invasive tumors. Local control rates were the same as for invasive lesions - 89% for T1 and 74% for T2.

However, only 2 of 12 failures were on the initially involved cord, suggesting that most were not true recurrences but rather new disease developing in dysplastic epithelium. Furthermore, it took about 5 years for 80% of the failures to develop, which further suggests a second process. Most of the failures after primary radiotherapy tend to be invasive whereas failures after vocal cord stripping tend to be equally divided between carcinoma in situ and invasive disease.

Very superficial cancers limited to the free edge of the vocal cord or carcinoma in situ can be effectively treated by limited excision by conventional means or with laser excision, with excellent voice preservation. More extensive disease requires cordectomy or vertical hemilaryngectomy. Numerous methods have been devised for reconstructing the vocal cords after conservation surgery although, in fact, they are probably not necessary if proper patient selection is pursued.

In general, voice results are inferior to those achieved with radiation therapy alone for early lesions. The patient with carcinoma in situ, however, by inference has diffuse premalignant mucosal findings and certainly should be targeted for novel prevention strategies due to the likelihood of later developing invasive disease.

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