Carcinoma of the Larynx and Hypopharynx

Review by PJ Bradley
Nottingham, UK

This publication, combining laryngeal and hypopharyngeal cancer, is edited by three head and neck clinicians: two surgeons (SB and AT) from the All India Institute of Medical Science, and a radiation oncologist (BKM) from Manipal Hospital, New Delhi, India. The book chapters are supported by 10 colleagues from otolaryngology, surgical oncology, radiation oncology, radio-diagnosis and anaesthesiology, from other specialties and institutes based in Delhi.

The 17 chapters are subdivided into: 6 chapters on laryngeal cancer, 4 chapters on hypopharyngeal cancer, 2 chapters combined to cover anatomy and salvage surgery, and 1 chapter each on metastatic neck disease, surgical complications, anaesthetic complications, vocal rehabilitation and quality of life. In all, there are 226 pages, with figures, diagrams, tables, and radiological images, clinical, operative and pathological pictures – it is a pity that many of the clinical and operative pictures are of poor quality. The radiological images are exclusively computed tomography (CT) scans, and other modalities such as magnetic resonance imaging and positron emission tomography-CT are absent. In a number of places and across chapters, there are sections duplicated or information cited out of context to the chapter title – with more chapters and fewer subheadings this could have been resolved.

Chapter 1 ‘Surgical Anatomy and Tumour Spread in the Larynx and Hypopharynx’ starts with two very short paragraphs ( just 18 lines) on the epidemiology of laryngeal cancer in India, specifically supported by six references. The rest of the chapter (12 pages) discusses the surgical anatomy, barriers to cancer spread and specific subsites of laryngeal cancer (9 pages) and hypopharyngeal cancer (3 pages). There is no specific section on the epidemiology of hypopharyngeal cancer as experienced in India. The discussion on anatomy and tumour spread is not supported by any references, and frequently refers to the International Union Against Cancer (‘UICC’) manual published in 1997, which was the fifth edition – the current International Union Against Cancer manual, the eighth edition (2017), contains much the same information. This book, written as it has been in India, with a likely world distribution, seems to have missed an opportunity to inform the non-Asian readers (American and European) about the local epidemiology of laryngeal and hypopharyngeal cancer. In subsequent chapters, there is little detail about personal data on stage at presentation, modalities of treatment used, and their effectiveness on patients’ outcome and survival.

Chapter 2 ‘Imaging in Cancer of the Larynx’ has been well illustrated, but lacks an equivalent chapter on imaging in cancer of the hypopharynx, which instead is covered across a number of chapters (Chapters 9 and 10). There are three short paragraphs on ‘post-treatment imaging’ (of the larynx), which would be better included in a separate chapter of its own, also covering diagnosis of hypopharyngeal recurrence.

Chapter 4 ‘Metastatic Neck Disease’ is 20 pages long, and, while important, one questions whether so much information on classification of neck dissection and levels of the neck is required for a target readership of head and neck specialists! In Chapter 5 ‘Guidelines in the Management of Early Laryngeal Cancer’, the topic would have been improved by using the diagrams of the European Laryngological Society’s classification of glottic cancer, as well as supraglottic cancer, rather than as a summary table version (Chapters 5 and 7). A comment on Table 5.2: this is titled ‘Summary of recommended treatments…’ and should have been titled ‘Summary of reported options for treatment…’.

The supporting references in most chapters (excluding Chapter 1) are numerous, but many would be considered dated and of historical interest! The need for historical references is better addressed by the use of recent review articles rather than textbook chapters. The few references cited from the more recent period of 2013 to 2018 can be found in the four chapters (Chapters 8, 9, 12 and 17) authored by Dr Mohanti and colleagues.

This book is a brave attempt, by well-known and respected clinicians. The time and work involved in producing this volume, added to by the frustration of daily working, family life and publisher pressure, have produced a worthy product. Should this publication get to a second edition, the experience and lessons learned will allow for a more compact and informative work.

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