A glimmer of hope for larynx cancer patients

The recent debate on the ill-effects of tobacco created quite a stir across the political spectrum. All the sides were pretty vociferous in their attack on each other. The pitch of debate was so shrill that no less than Prime Minister Narendra Modi had to intervene and cool down the tempers. Though not much seems to have come out of the  debate for now, the pro-tobacco lobby must realise that there remains a sizeable number of people across this country who have simply lost their voice due to consumption of tobacco.

For Shaktisinh Rajput, a senior functionary of the Bharatiya Janata Party in Ahmedabad and retired principal of a school, his voice was basis of his survival. Be it as a teacher or as a political person, it was mandatory for him that his oratory skills are on full display before his audience. It was mandatory for him to communicate with his target group through effective modulation of his vocal chords. And he did so with relative ease for a pretty long time.

But one day, it was time for him to get a reality check. A consumer of tobacco,
Rajput was diagnosed with larynx cancer. Other than tobacco use, Rajput feels that what further aggravated his situation was daily eatables, which generally are grown by indiscriminate and constant use of pesticides and insecticides by farmers.

“I was told that I will have to sacrifice my voice box if I seek to live longer. I was in a shock and was numb,” Rajput scribbled on a piece of paper in Gujarati when asked of his first reaction on hearing that he had contracted cancer.

Voice box cancer is more due to smoking than chewing tobacco and today cuts across economic strata. Earlier, it was common in people over 50 years old but in the last decade patients in the age group of 25 years and above is on the rise. This is primarily due to the fact that people begin consumption of tobacco early, sometimes even in school.

When you have a voice box, the air you throw out of lungs, passes through the voice box and your pallete, tongue, teeth all vibrate to produce a voice. Once surgeons remove the voice box, it leaves relatively a decent sized hole in the neck. There is no skin covering the hole and thus when lungs breathe out air to speak, the air escapes through this hole and so there is no speech. The patients also face another acute problem of inability to smell due loss of natural breathing passage from nose to windpipe through voice box.

“Cancer of certain stage cannot be cured without removal of voice box. And once you remove the voice box, the voice is lost permanently. For a person who has spoken for his entire life and suddenly is devoid of the speech is unnerving,” Dr Kaustubh Patel, Director & Senior oncologist at HCG Hospitals, said.

But not all hope is lost for people who have to lose their larynx. For years
together, surgeons give a voice machine that helped cancer patients communicate. However, its use was pretty painful and it generated more like a monotonous electronic voice that sounded more like aliens in sci-fi movies. That was best medicine could offer.
“Some smart patients also developed esophageal speech, wherein they swallowed lot of air and tried to burp the air. So when air came out, the pallete, teeth and tongue vibrated. This created a sound. But this too was not a good quality sound,” Patel said.
Over the years, many cancer patients today are living longer due to better treatment. The focus for most of the scientists and oncologists has thus shifted to improving the lifestyle of the cancer patient. There is also demand from  patients for treatment that helps them not just protect their life but even their lifestyle, Patel said.

Hence, scientists started to search for options. They came up with an idea of a Tracheo Esophaegal puncture. It is a puncture between trachea and esophagus. The surgeons instal a valve in this puncture. When a patient blocks the puncture with a thumb or estoma cap, the air which he breathes out would pass through this valve into pharynx and esophagus before coming out. This helps create vibration and the patient is able to speak.

The surgeons globally have not been able to reconstruct voice box till date due to complexity of nervous system and natural tissues. Even animal transplants have not been successful till date and the only solution available is installation of this valve.
“These earlier valves had a problem. When you eat or drink something, it might leak through this valve and go into the lungs. This increased the risk of pneumonia in the patients using these valves. They remain a health risk,” Patel said. “Thankfully, the technology today has seen a private medical firm develop a valve-- Provox Vega. It has one-way mechanism that removes the anomaly in other valves. It is made of titanium and is coated with drug to cut chances of any infection.” 

Moreover, the life of valve, according to the company, is just for a little over a year but in India patients generally can take good care and increase its life to two-and-a-half to three years. The other reason is that in Western world cost of the valve is borne by an insurance firms but in India pati­ents need to bear the cost individually.

Once one gets this valve placed through a small surgical procedure, the patient is able to speak almost naturally without the voice box. There are also no precautions required post surgery of this valve and the patients can speak as long as they want. The only thing the patients need to do is to clean the valve properly with special brushes during the day.

Costing Rs 30,000-35,000 per valve, the doctors at HCG hospital in Ahmedabad now plan to instal valves in about a 10 patients suffering from larynx cancer, half of them for free and remaining at half the cost this week. The team led by Patel is also seeking to extend this knowledge of surgery procedure for the doctors from across the state. They have invited over 50 cancer and ENT surgeons from across the state to learn the procedure.
“Over 200 surgeons from the state can develop the expertise of installing such valves and we want to train them over a period of time so that the patients from nook and corner of the state need not visit our centre in Ahmedabad for treatment,” Patel said.

While such workshops have been done on institutional level in Gujarat, that  incidentally is believed to have highest number of cancer patients, nobody has done such a thing on a state level.