Laryngeal Cancer The Smoker's Curse

From Dick Aronson

Laryngeal cancer is cancer of the larynx, a tube in the front of the neck between the esophagus and  the trachea (the voice box). The larynx assists in breathing, speaking, and even swallowing.

The most common form of Laryngeal cancer is squamous cell cancer, rare form which comprise 5%  include; adenocarcinoma and sarcoma.

Laryngeal cancer most commonly starts in the vocal cords, it is most common in males with a ratio of 10:1 over females, African Americans and people over 65.

Risk factors for Laryngeal Cancer:

The development of laryngeal cancer is strongly linked to smoking and heavy use of alcohol.  The more a person smokes, the greater the risk of developing laryngeal cancer. It is unusual for  someone who does not smoke or drink to develop cancer of the larynx. Occasionally, however people  who inhale such things as asbestos particles, wood dust, paint or industrial chemical fumes over a  long period of time develop the disease.

Other risk factors for laryngeal cancer include certain viruses, such as the human papilloma virus (HPV), and possibly, acid reflux.


Symptoms of Throat Cancer:

Symptoms of laryngeal cancer include abnormal breathing sounds, a persistent cough, difficulty  swallowing, swelling or lumps in the neck, coughing up blood, a persistent sore throat, and hoarseness of voice that does not subside in one to two weeks. Unexpected weight loss or a prolonged earache  may also be signs of the disease. 

Diagnosis:

An individual who is exhibiting these symptoms will most likely be advised to undergo an laryngoscopy, which is a procedure in which a throat doctor, or laryngologist, will view the inside of the throat with a  special piece of equipment called an endoscope.

In some cases, the laryngologist may also cut out a small piece of tissue during the laryngoscopy to  later be tested in a lab. This is called a biopsy.If laryngeal cancer is suspected, the throat with be  examined with a small long-handled mirror or a fibre-optic light called a laryngoscope. If abnormal  areas are seen, a biopsy will be taken under local or general anaesthetic. This is the only way of  accurately diagnosing laryngeal cancer.

Once laryngeal cancer is found, staging tests are performed to find out if the cancer has spread and,  if so, to what extent.

Laryngeal cancer staging is defined not by primary tumor size but by extent of laryngeal involvement. Each of the three divisions of the larynx, the supraglottis, the glottis, and the subglottis, define advanced lesions as those that compromise vocal cord motion.This functional deficit often implies deep muscular involvement and portends eventual tumor spread outside the confines of the larynx.

Squamous cell carcinoma tends to metastasize by lymphatic spread in a relatively predictable pattern  within the cervical lymph node chains.

While early lesions show a 10-30% rate of metastasis at diagnosis, advanced lesion show rates  greater than 50%. Of those with metastatic lymph node involvement, 40% will show no clinical  evidence of lymphadenopathy.

Development:

When the cells that make up the tissue of the larynx begin to multiply and divide at an unusual rate it is called laryngeal cancer. The cells also grow abnormally large, usually forming a mass called a tumor. The tumor can displace and interfere with other organs surrounding the larynx and spread to other parts of the body.

Laryngeal cancer may spread, either by direct extension to adjacent structures, by   metastasis to regional cervical lymph nodes or more distantly, through the blood stream.  Distant metastates to the lung are most common.

Treatment for Laryngeal Cancer:

Treating laryngeal cancer may involve multiple medical experts including otlaryngologists , surgeons,  oncologists, and radiation oncologists.The exact method of treatment will depend on your particular  situation but often will involve surgery to remove as much of the cancer as possible.

Local radiation of  the cancer cells may be performed before surgery in an effort to reduce the size of the tumor or after surgery to eradicate as many cancer cells as possible.Chemotherapy is used in some cases of  laryngeal cancer

Treatment depends on the stage of the cancer.

The exact method of treatment will depend on your particular situation but often will involve surgery to remove as much of the cancer as possible. Local radiation of the cancer cells may be performed before surgery in an effort to reduce the size of the tumor or after surgery to eradicate as many cancer cells as possible.

Chemotherapy is used in some cases of laryngeal cancer.

Vitamin A and beta-carotene may play a protective role.

For early stage laryngeal cancer, either surgery or radiation alone is the most common and appropriate therapies offered. For more advanced disease, either radiation (with chemotherapy) or surgery followed by radiation is  the most common treatment given.

In stage 0, abnormal cells are found in the lining of the larynx. These abnormal cells may become  cancer and spread into nearby normal tissue.

Stage 0 is also called carcinoma in situ.

In stage I, cancer has formed.

Stage II laryngeal cancer depends on where cancer is found in the larynx:

Supraglottis: Cancer is in one area of the supraglottis only and the vocal cords can move normally.

Glottis: Cancer is in one or both vocal cords and the vocal cords can move normally.

Subglottis: Cancer is in the subglottis only.

Stage III and stage IV cancers are usually treated with total laryngectomy . This is an operation to  remove the entire larynx. Sometimes other tissues around the larynx are also removed.

In stage IVA: cancer has spread through the thyroidcartilage and/or has spread to tissues beyond the larynx such as the neck, trachea, thyroid, or esophagus, and may have spread to one lymph node  on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters; or cancer has spread to one or more lymph nodes anywhere in the neck and the lymph nodes are  smaller than 6 centimeters; cancer may have spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus.
Vocal cords may not move normally.

Surgeries for laryngeal cancer include:

Total laryngectomy which involves the removal of the larynx,including the vocal cords.   Partial laryngectomy where the surgeon removes the cancerous tissue while leaving as much of the  vocal cords as possible.

Tracheotomy where to help with breathing, a hole is made in the neck below the larynx.  This may be temporarily necessary after surgery, or permanently placed in the case of laryngeal tumors that are too large to be removed.

Neck dissection which involves the removal of the lymph nodes and part of the neck muscles to  determine the spread of cancer.


Prognosis:

A diagnosis of laryngeal cancer does not always mean surgical removal of the entire larynx . Depending on the size, location, and time of cancer detection, one or more of the following approaches may be used: radiation therapy , chemotherapy , partial laryngectomy.
In these cases, voice may  be preserved although its quality may not be normal.

If speech preservation is impossible, speech rehabilitation may include esophageal speech or  prosthetic devices; surgical techniques to construct a new voice box are still experimental.

Cancers found in stage 0 and stage 1 have a 75% to 95% cure rate depending on the site.

Late stage cancers that have metastasized have a very poor survival rate, with intermediate stages  falling somewhere in between. People who have had laryngeal cancer are at greatest risk for recurrence, especially in the head and neck, during the first two to three years after treatment.

Check-ups during the first year are needed every other month, and four times a year during the second year.  It is rare for laryngeal cancer to recur after five years of being cancer-free.