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.
