You Asked, We Answered: Speaking Out on Vocal Cord Cancer

May 1, 2008— -- You submitted your questions to Dr. Steven Zeitels who has saved the voices of Steven Tyler of Aerosmith, Julie Andrews and Cher. Below are his answers.

Dr. Zeitels is the Eugene B. Casey Professor of Laryngeal Surgery at Harvard Medical School and the director of the Center for Laryngeal Surgery and Voice Rehabilitation at Massachusetts General Hospital. Dr. Zeitels serves as laryngologist to various voice departments in Boston, as well as to the American Repertory Theater at Harvard University, the Boston Lyric Opera and the Boston University Huntington Theater.

Do you need help or advice on vocal cord cancer? Contact the Massachusetts General Hospital Voice Center.

Esther from Lakewood Ranch, Fla., asked: "Could your treatment method -- blocking the blood from getting to the tumor -- work for other kinds of cancer?"

Dr. Zeitels answered: Since a substantial number of cancers create abnormal and increased blood vessels (angiogenesis), there will likely be other cancers for which this, the angiolytic KTP laser, will be useful.

Joe from Sterling, Neb., asked: "Dr. Zeitels, What is the most common and not-so-common symtoms of the cancer of the vocal cords?"

Dr. Zeitels answered: Hoarseness/voice change is the first and most common symptom. If an individual has a rough or harsh voice quality, then he or she should have a skilled laryngologist perform an examination. This is especially so if he or she has been a smoker at any time in their life. Frequently, people with vocal cord cancer have had people that know them or new aquaintances ask them if they are sick from a cold, confusing the long-term voice deterioration with an acute illness. In fact, most individuals with early vocal cord cancer have had a precancerous lesion (abnormality) for years prior to degenerating to invasive cancer. Larger vocal cord cancers can cause breathing problems, throat pain and/or difficulty swallowing.

Most vocal cord cancers can be controlled and cured, until they get large, which we call a T4 cancer. The great advantage of finding the cancer when it is smaller is the voice quality can typically be restored.

Ken from Leesburg, Va., asked: "I am an equine surgeon and do a great deal of endoscopic laser surgery in the upper airway. What tumor type are you treating, SCC? Can you please tell me which laser/wavelength you are using? Are more specifics of your procedure published or available?

Dr. Zeitels answered: I'm treating squamous cell carcinoma: 532nm KTP laser (green light) in a pulsed mode (15/1000 sec) to allow for tissue cooling. The manuscript is in press and will be published as a supplement to the Annals of Otolgy, Rhinolgy & Laryngology in July.

Richard from Leesburg, Fla., asked: "I wish I heard about you two months ago. Just had a partial larynjectomy, my cancer wasn't anywhere near as bad as the guy from Israel. Now I can't swallow, I have a feeding tube in my stomach, I can only whisper and have to wait another month for another swallow test, that will be three months since the surgery, it is very dissapointing, is there anything I can do now?"

Dr. Zeitels answered: In many circumstnaces, there are things that can be done to improve a patient's condition such as yours, however, this can only be determined through a careful examination. We would be pleased to try and help if you would like. Our number at the Massachusetts General Hospital is 617-726-0218.

Michele from Plymouth, N.H., asked: "I have a 15 yr old son who was diagnosed with leukemia when he was three, his voice sounds like Froggy from the little rascals, would like to know if this was caused by chemo drs cant be sure and if something should be done like your surgery that was just on news, basically if u could guide me if possible thanx"

Dr. Zeitels answered: It is unlikely that the source of your son's voice abnormality can be traced this many years later. However, he should have an examination by a highly skilled laryngeal surgeon since there are many new, effective and promising procedures to repair voices that were not available even 10 years ago.

Juanita from Baton Rouge, La., asked: "My dad is scheduled for vocal cord removal on 0507. He was diagnosed with vocal cord cancer in 2006. He had radiation and we were under the impression the cancer was gone. He is a smoker and is 83 years old in good health, taking no medication. When the cancer came back about a month ago we were hoping it could be removed again. Is there any hope?"

Dr. Zeitels answered: In some cases the cancer can be treated by an endoscopic (through the mouth) procedure, however if the tumor is large, he will require an open surgical removal of the cancer through his neck. My suggestion is that a highly specialized laryngeal cancer surgeon evaluate him.

Eileen from Ontario, Canada, asked: "As a speech-language pathologist, I was fascinated by the story on ABC news. Do you find there is still a need for voice therapy in some of your patients after your treatments? I work very closely with 4 speech-language pathologists. Many of our cancer patients do have a number of voice therapy sessions relearning optimal strategies for voice use. It is somewhat variable how many sessions patients require."

Joan from unknown location, asked: "What stages of cancer have been treated with this means?????"

Dr. Zeitels answered: This new pulsed-KTP laser technique has been used primarily on T1 and T2 lesions. The patient on the show did have a larger lesion due to mucosal extension to the proximal trachea.