Regenerative Medicine for Laryngeal Cancer Treatment
Can people with hard-to-treat laryngeal cancer get a healthy new voice box built from their own stem cells?
In 2018, 13,150 new cases of cancer of the larynx (also called the voice box) will be diagnosed in the United States, according to estimates from the American Cancer Society. Not only are these cancers often difficult to treat due to the complex anatomy of the neck, but the wide chain of lymph nodes located in the neck allow these cancers to spread quickly as well.
But if those aren't reasons enough to listen up, maybe this next statement is: There is new hope with a novel treatment, currently being carried out by a group of researchers led by David Lott, M.D., at the Mayo Clinic in Scottsdale, Arizona. The new treatment consists of rebuilding and replacing the larynx invaded by a cancerous tumor in a process known as regenerative medicine.
Standard treatment options for cancer of the voice box: Total laryngectomy
Life is clearly not easy without a larynx. Without this structure, a person loses their voice because 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 later-stage cancer of the larynx has been removal of the entire larynx, according to the American Cancer Society. Because the larynx 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. The hole in the neck is permanent and cannot be closed like one can close their mouth, so an additional risk is that 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 complications involved in surviving laryngeal cancer, it is not uncommon for people to choose to live out whatever time they have left with the disease, rather than undergo this treatment that may leave them unable to talk, taste, and smell.
What is regenerative medicine?
Regenerative medicine 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 advantages 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 someone receives a donated organ or body part, despite the use of immunosuppressive drugs to limit that risk.
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, which allows them to provide all the different pitches and nuances of a person’s voice.
With the current capabilities of regenerative medicine, 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 (meaning only one half is removed). The team at the Mayo Clinic can then grow and reproduce the section of the larynx that was removed.
How is a larynx regenerated?
In this procedure being developed by Dr. Lott and his team, according to a video from the Mayo Clinic, the doctors first take a CT scan of the entire larynx, creating a framework of it with all 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 patient. These stem cells are harvested in a carefully selected environment that also includes exposure to air because 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 ultimately work to replace the portion of the organ that was removed.
Thanks to regenerative medicine, this artificially created "natural" organ can be used to replace the section of the missing larynx.
The following video from the Mayo Clinic fully details the process:
When will this treatment be fully available?
Because of its use of stem cells, regenerative medicine is still considered experimental. To be considered for this type of treatment, patients may need referrals to participate in research studies and clinical trials.
As the medical community continues to encounter the problems and challenges associated with organ transplants from other donors, this exciting technique that allows a person's own cells to be used to create crucial tissue and organs holds incredible promise in the treatment of head and neck cancers, like cancer of the larynx, and many other devastating illnesses and trauma.