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Overview
Laryngeal cancer is a condition in which the cells lining the inner wall of the larynx (voice box, located in the throat) multiply and grow uncontrollably to form a mass called tumour. The tumour can be benign (non-cancerous) or malignant (cancerous). It is the most common type of head and neck cancer. Men are affected four times more often than women.
Types of Laryngeal Cancer
Laryngeal cancer can be of the following types:
- Squamous cell cancer: This occurs in the flat, skin-like squamous cells which cover the surfaces of the parts of larynx such as epiglottis (flap in the throat which keeps food from entering the windpipe), vocal cords, etc.
- Adenocarcinomas: This type of laryngeal cancer is uncommon when compared with squamous cell laryngeal cancer. Adenocarcinomas start in the adenomatous cells, which are gland cells present around the larynx surface and produce mucus.
- Other types of laryngeal cancer: Sarcomas are a rare type of cancer affecting the supportive tissues of the larynx such as the cartilages, bone, muscle and nerves.
Causes
The causes of laryngeal cancer are not very clear. Although, it could be due to changes in some cells of the larynx. Most of the cancers begin due to alterations in the cell’s DNA.
DNA or genetic material provides necessary instructions which stimulate the functions of the body such as growth, reproduction, etc. A change in the genes can cause modifications in these instructions, which may cause the cells to grow continuously, thereby producing masses of a tumour and eventually cancer.
SYMPTOMS
Few of the general symptoms of laryngeal cancer are:
- Persistent cough or sore throat
- Change in voice such as hoarseness for two weeks or more
- Pain or difficulty while swallowing
- Pain in the ears
- Weight loss
- Shortness of breath
- High pitched or noisy breaths
- Presence of blood while coughing
- A lump in the neck
DIAGNOSIS
Laryngeal cancers are often suspected in the presence of specific signs and symptoms such as persistent hoarse voice and pain while swallowing.
Initially, medical history is recorded and the throat and neck are examined. Blood tests are done to assess the overall health of the individual. Some of the tests for the diagnosis of laryngeal cancer include:
- Nasendoscopy: This test is performed to get a clear view of the larynx. During the test, a small and flexible tube with a video camera and light at one end (called an endoscope) is passed through the nostrils down to the throat. The images captured by the endoscope are displayed on a monitor.
- Laryngoscopy: It is performed when nasendoscopy fails to provide a clear view of the larynx. In this test, an endoscope is inserted into the mouth to obtain detailed images of the larynx.
- Biopsy: A biopsy test involves extracting a small piece of tissue from the larynx to examine for any abnormalities or signs of cancer. This can be performed during laryngoscopy or nasendoscopy test. Also, in the presence of a lump in the neck, a needle or syringe can be used to extract a piece of tissue (fine needle aspiration).
- Imaging: CT scan, MRI scan, PET-CT scan and an ultrasound scan can be employed to obtain a clear view of the larynx and the surrounding tissues.
The stages of laryngeal cancer are as follows:
- Stage 0: This is a pre-cancerous stage with abnormal cells only in the lining of the larynx.
- Stage I: The tumor has grown deeper, affecting only one part (supraglottis) of the larynx, and vocal cords work normally.
- Stage II: Cancer has spread to more than one part of the larynx (supraglottis), and the vocal cords function normally.
- Stage III: Cancer is within the larynx or has spread to the surrounding tissues and has caused the vocal cord to stop moving. Cancer may have spread to a nearby lymph node, which is not more than 3cm in size.
- Stage IV: Cancer has grown beyond the larynx and reached the lymph nodes of head, neck or chest. In this advanced stage, it may have metastasized to distant parts of the body, such as the liver or lungs.
RISK FACTORS
Smoking tobacco or using other tobacco products significantly increases the risk of laryngeal cancer. Also, heavy alcohol consumption can elevate the chances of laryngeal cancer. Use of both tobacco and alcohol in combination can further increase the risk of laryngeal cancer.
Several factors can also increase the risk of laryngeal cancer:
- Age: Individuals aged >50 years are at increased risk of developing laryngeal cancer.
- Personal history of head and neck cancer: About one in four individuals with a previous diagnosis of head and neck cancer are at an increased risk of laryngeal cancer.
- Family history: Individuals with a first-degree relative diagnosed with head and neck cancer are twice as likely of developing laryngeal cancer.
- Diet: Consumption of high quantities of red meat, processed meat and fried food can increase the risk of laryngeal cancer.
- Human Papillomavirus (HPV): These are a group of viruses which affect the skin and moist regions of the body such as the cervix, anus, throat and mouth. Typically, HPV spreads through sexual intercourse, but it can spread to the larynx during oral sex and cause laryngeal cancer.
- Occupational exposure: Individuals exposed to wood dust, asbestos, nickel, paint, diesel fumes, sulfuric acid mist, or who are involved in the production of mustard gas or cosmetics are at a higher risk of laryngeal cancer.
POST-OPERATIVE CARE
The measures below must be followed after a total laryngectomy surgery:
- Keep the stoma clean and dry
- Clean the stoma at least once a day
- Cover the stoma with a cloth or tissue while coughing or sneezing
- Communicate with the help of pen and paper, or electronic gadgets
- Perform breathing and swallowing exercises regularly
- Stop tobacco smoking
- Refrain from drinking alcohol
- The complications of surgery are:
- Infections
- Blood clots
- Stenosis (narrowing) of the larynx or throat
- Swallowing difficulties
- Loss of speech
- Fistula growth
- Rupture of the carotid artery
The complications of surgery are:
- Infections
- Blood clots
- Stenosis (narrowing) of the larynx or throat
- Swallowing difficulties
- Loss of speech
- Fistula growth
- Rupture of the carotid artery
TREATMENT
Laryngeal cancer treatment consists of radiation therapy, chemotherapy or surgery.
- Radiation therapy: In this treatment, controlled doses of high-energy X-rays are used to destroy cancer cells. These radiations should be precisely targeted onto the larynx to prevent any damage to the surrounding tissues. Radiotherapy is used in early stages of cancer or after surgery to prevent its recurrence.
- Chemotherapy: In this therapy, medicines are used to kill or slow the multiplication of cancer cells. It can also be used to shrink tumours before surgery or radiotherapy. They are usually given through injections and have significant side effects.
- Surgery: Surgery is performed to remove the cancer tissues without affecting the functions of the larynx. Some of the surgical procedures include:
- Endoscopic resection: It is recommended for early stages of cancer. A special microscope is used to get a magnified visual of the larynx, which aids for the removal of cancer tissues with either a laser or small instruments. It is carried out under general anesthesia.
- Partial laryngectomy: The surgery involves removal of the affected part of the larynx. A few vocal cords will be left in place to allow the individual to speak (but with a hoarse or weak voice). A temporary hole may have to be created and attached to a tube to help in breathing.
- Total laryngectomy: It is used to treat the advanced stages of laryngeal cancer and involves the complete removal of the larynx. The surrounding infected lymph nodes may also be removed. A permanent hole will be created in the neck (stoma) to allow in breathing after the surgery. As all the vocal cords are removed, speaking may become difficult.
FAQ
The appearance of warning signs depends on the location of cancer in the larynx. In a few cases, there are no apparent warning signs. Any of the following signs or symptoms which last for two weeks or more may require medical intervention:
- Swelling of the jaws
- Pain while swallowing or chewing
- Slurring speech
- Changes in the voice
- Sore throat
- Feeling of a lump in the throat
The following are the most common side effects seen with laryngeal cancer treatment:
- Hoarse and weak voice
- Excessive fatigue
- Decreased appetite
- Hair fall
- Nausea and vomiting
- Dry mouth
- Bitter taste
- Increased sensitivity of the tongue
- Tender sores in the mouth
Laryngeal cancer can be prevented by stopping the use of tobacco products like cigarettes, pipes, chewing tobacco and cigars. It can also be prevented by reducing or stopping alcohol consumption.
The individual may have to stay for at least 2 to 3 days after surgery.
