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Tagline Voice Center : Massachusetts General Hospital
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Department of Surgery

 
PRE-CANCEROUS DYSPLASIA
General Information

The MGH Center for Laryngeal Surgery and Voice Rehabilitation team is setting the standard-of-care for the treatment of vocal cord dysplasia.  For the past 15 years, MGH team has published extensively on vocal cord dysplasia and have been invited to share and teach these innovative techniques throughout the United States and around the world.  Based on this body of work the MGH group is recognized nationally and internationally for their highly-successful pioneering surgical techniques to restore and preserve the voice of patients with vocal cord precancerous dysplasia.

The mucosa (membranes) of the vocal folds can develop precancerous dysplasia.  These membranes are not yet cancer but on the way to become cancer.  These mucosal changes (lesions) can be referred to in a number of ways such as premalignant (precancerous), keratosis (skin-like surface), leukoplakia (white patch), erythroplakia/erythroplasia (red patch), and atypia.  When patients develop precancerous dysplasia of the vocal folds, there is a window of opportunity to treat the disease before it deteriorates to cancer. 

The goal of treatment is to treat the disease while preserving or restoring their voice.  It is commonplace for vocal cord membranes to redevelop dysplasia after they have been successfully treated similar to someone who has sun-damaged skin.  The majority of patients with precancerous dysplasia have smoked at some time in their life although it may be years prior to the development of vocal cord dysplasia.

Symptoms

By far, the most common symptoms associated with vocal cord dysplasia are voice changes (dysphonia) or hoarseness since the dysplastic lesions disturb normal vocal cord vibration.  The voice changes can be quite gradual and even take place over a period of years while being thought to be normal voice changes associated with voice overuse or smoking. 

Diagnosis

Precise office examination with both a rigid telescope through the mouth and a specialized distal-chip flexible laryngoscope passed through the nose will provide key information about the size, location, and extent of the cancer.  These larynx examinations should be done with stroboscopy to identify which areas of the vocal cords are still vibrating.

If laryngeal stroboscopy is not done with the rigid telescope or flexible laryngoscope, the examiner is unlikely to be a skilled voice expert.  If a precancerous/premalignant dysplastic vocal cord lesion is seen, the patient is scheduled to go to the operating room to examine the larynx with a surgical microscope (microlaryngoscopy) with the patient asleep under general anesthesia. 

During that diagnostic procedure, the lesion is typically biopsied to ensure that invasive cancer is not present and mucosal dysplasia is treated. 

Treatement

Members of the MGH team have likely created more developments for optimally treating precancerous / premalignant vocal cord dysplasia/atypia than any other group. [1-16]  For this reason, patients from though out the USA and abroad seek care at the MGH Voice Center for their unique expert care.  Furthermore doctors from throughout the world have sent their patients and personally traveled to the MGH Voice Center to learn the new techniques. 

Recently, the MGH Voice Center team created the latest state-of-the art treatment for vocal cord dysplasia which is pulsed KTP laser, which most of the time can be done in the office or clinic in approximately 20 minutes as an office-based clinic procedure.  In fact office-based laser surgery to treat vocal cord dysplasia and respiratory papillomatosis was created by the MGH Voice Center team.  

Pulsed-KTP laser treatment of vocal cord dysplasia successfully is successful in removing the disease while preserving and restoring patients’ voice. The MGH team had previously introduced the pulsed-dye laser (PDL) to treat vocal cord dysplasia, which has been abandoned due to the substantially better performance of the pulsed KTP laser. [11-16]  Remarkably, many patients with vocal cord dysplasia are managed by watching (watchful waiting) the dysplasia and it s growth waiting for cancer to develop.  Many are biopsied to confirm the presence of dyplasia and not actually treated at all because of the inaccessibility of the pulsed KTP laser and because clinicians concern that removal of the vocal cord dysplasia will cause further voice loss with worsening hoarseness.  Radiation and chemotherapy are rarely used for dysplasia, which is why surgery is sole treatment option.