Among all cancers, cancer of the larynx and the head and neck account for 500,000 cases yearly, worldwide. That figure could make up for quite a large fraction of the 1,685,210 cancer cases expected to be diagnosed in 2016. Further, in addition to the difficulty in treating these cancers because of the complexity of the anatomy of the neck, the wide chain of lymph nodes, located in the neck, allow cancers in this region to spread quickly.
But if those aren't reasons enough to listen up, maybe this next statement is. There is now new hope with a novel treatment, currently being carried out by a group of researchers, led byDr. David Lott at the Mayo Clinics in Scottsdale, Arizona. The new treatment consists of rebuilding and replacing the larynx invaded by a cancerous tumor, in a process known at Regenerative Medicine.
Treating issues of 'the voice box'
Life is clearly not easy without a larynx. Without this structure, the patient loses their voice since the vocal cords are also removed. There is also a loss of a connection between the lungs, the mouth and the nose, so individuals lose their sense of smell and eventually, their ability to taste food.
The standard treatment for treating cancer of the larynx has been removal of the entire larynx or 'voice box.' Since it plays such an important role in breathing, swallowing and separation of these two life functions, the surgical approach is to redirect the trachea to a surgically created hole in the front of the neck, called a laryngeal stoma. An additional risk with this procedure is that the hole in the neck is permanent and cannot be closed like one can close their mouth, so the person is always vulnerable to choking if water enters the laryngeal stoma. A diagnosis of laryngeal cancer and this treatment approach can be devastating for the patient.
Given the tremendous consequences involved in surviving laryngeal cancer, it is not uncommon for patients to choose to live out whatever time they have left with the disease, rather than undergo this treatment that can leave them unable to talk, taste, ability to smell.
What is regenerative medicine?
This is a new technology that involves using scaffolds, cells and biological molecules to recreate functional tissues. This technology has many similarities to the manufacturing process of basic consumer products. But in this case, it involves tissue engineering.
This novel approach offers significant advantage over receiving a transplanted donor organ, in that the organ is generated from one’s own donated cells. This allows greater chance for the patient to avoid the usual risks and consequences of possible donor organ rejection. Rejection is always a risk when a patient receives a donated organ or body part, despite the use of immunosuppressive drugs to limit the rejection.
What are the challenges of rebuilding the larynx?
The larynx has different types of cartilage, muscle and specialized tissue that make up the vocal cords. The vocal cords alone have many different types of highly specialized cells that allow it to constantly be pulled and vibrate, in order to provide all the different pitches and nuances of one’s voice.
With the current regenerative medicine capabilities, it’s still not possible to reproduce the entire organ, but fortunately most laryngeal tumors tend to present in a way that allows resection of one half of the larynx. The team at the Mayo Clinic can then grow and reproduce the section of the larynx that was removed.
Details of the procedure
In this procedure, the doctors first take a CT scan of the entire larynx, creating a framework of the native larynx with all of its individual details. Then, a 3D printer takes that framework and builds what will become the scaffold for the new organ
Stem cells are later collected from fat tissue of the individual. These stem cells are harvested in a carefully selected environment that also includes exposure to air, since the new section of the larynx will be expected to function in all aspects. These stem cells are embedded into the scaffold where they will differentiate into a tissue that will be ultimately work to replace the portion of the organ that removed due to the presence of the cancerous tumor.
Thanks to regenerative medicine this artificially created 'natural' organ can be used to replace the section of the missing larynx.
The following video fully details the wonders of this process:
Credit: Youtube, MayoClinic
When will this treatment be fully available?
Regenerative medicine is still considered experimental since it uses stem cells. Currently, every individual case that requires this new approach needs to be presented to the FDA for approval.
As the medical community continues to encounter the problems and challenges associated with organ transplants from other donors, this exciting technique that allows one owns cells to be used to crucial tissue and organs holds incredible promise in the treatment of cancers and many other devastating illnesses and trauma.
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Eli Hendel, M.D. is a board-certified Internist and pulmonary specialist with board certification in Sleep Medicine. He is an Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, Qualified Medical Examiner for the State of California Department of Industrial Relations, and Director of Intensive Care Services at Glendale Memorial Hospital. His areas of expertise in private practice include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases.
Published On: June 20, 2016