The larynx, or voice box, is located in the lower part of the throat and is composed of cartilaginous tissue. It contains the vocal cords that vibrate to produce sound when we speak. Cancers that develop in this area are called laryngeal or larynx cancers.
What are the Symptoms of Laryngeal Cancer?
Symptoms of laryngeal cancer can include:
- Persistent cough
- Hoarseness or changes in the voice
- Difficulty swallowing
- Ear pain
- Non-healing sores
- Weight loss
- Pain in the larynx
What Causes Laryngeal Cancer?
Laryngeal cancer arises from mutations in the cells of the larynx. These genetic changes disrupt the normal structure of cells and lead to uncontrolled cell proliferation. These cells aggregate to form a tumor. The exact causes of these changes are not fully understood.
What are the Types of Laryngeal Cancer?
Laryngeal cancer can occur in various parts of the larynx:
- Hypopharyngeal Cancer: Starts in the hypopharynx (laryngopharynx), located below the larynx and above the trachea and esophagus.
- Glottic Cancer: Originates in the vocal cords.
- Supraglottic Cancer: Occurs in the upper part of the larynx and affects the epiglottis, the cartilage that prevents food from entering the trachea.
- Subglottic Cancer: Begins below the vocal cords in the larynx.
Risk Factors for Laryngeal Cancer
Several factors increase the risk of laryngeal cancer, although the exact causes are not known. Risk factors include:
- Smoking and tobacco use
- Excessive alcohol consumption
- Human papillomavirus (HPV), a sexually transmitted virus
- Poor nutrition
Early Detection of Laryngeal Cancer
Early detection is crucial for improving treatment efficacy.
Physical Examination and Laboratory Tests
A physical examination is performed if symptoms are present. Imaging techniques are used to confirm the diagnosis. Endoscopy allows for internal viewing, and a panendoscopy can be used to examine the larynx, trachea, and esophagus. Suspicious tissues can be biopsied during this procedure.
Imaging Tests
CT scans, MRI, and PET scans are commonly used imaging techniques. These methods help identify the location, spread, and relationship of the tumor to surrounding structures. PET scans use fluorodeoxyglucose contrast if kidney function tests are suitable.
Staging of Laryngeal Cancer
Staging is critical for determining treatment options and prognosis. The TNM staging system is used:
- T Stage: Describes the primary tumor’s location.
- N Stage: Indicates whether cancer has spread to lymph nodes.
- M Stage: Shows whether cancer has metastasized to other organs.
Stage I and II: Tumor is localized and can generally be treated with surgery and radiation therapy.
Stage III: Tumor size increases and may spread to lymph nodes.
Stage IV:
- IVa and IVb: Tumor grows larger and spreads to nearby organs and lymph nodes.
- IVc: Cancer cells have spread to distant organs such as the lungs or liver (metastasis).
Treatment Process
After diagnosis, imaging is used to determine the tumor’s location and spread. Treatment decisions are made by specialists based on the patient’s overall health. Early-stage cancers may be treated with surgery or radiation, while more advanced cancers may require combined treatments. In advanced stages, targeted therapies and chemotherapy may be considered.
Surgery for Laryngeal Cancer
Surgery is typically preferred for early-stage laryngeal cancer. Techniques vary based on tumor characteristics:
- Laser Surgery: Uses a laser to destroy cancerous cells.
- Cordectomy: Removal of all or part of the vocal cords, usually for small, glottic cancers.
- Laryngectomy: Removal of part or all of the larynx.
- Pharyngectomy: Removal of the pharynx.
Radiation Therapy for Laryngeal Cancer
Radiation therapy, or “organ-sparing treatment,” can be used alone in early stages. In advanced cases, it may be combined with chemotherapy. Radiation therapy preserves the vocal cords, often providing a better post-treatment quality of life compared to surgery. Palliative radiation may be used to relieve symptoms in advanced stages.
Intensity-Modulated Radiation Therapy (IMRT) and Arc Therapy
These technologies balance dose distribution and minimize damage to normal tissues.
Chemotherapy for Laryngeal Cancer
In advanced cases, chemotherapy is combined with radiation to enhance effectiveness and reduce metastasis risk. Chemotherapy is not typically used for early-stage tumors.
Immunotherapy for Laryngeal Cancer
Immunotherapy stimulates the immune system to fight cancer more effectively. It has shown promise in metastatic stages, improving survival and quality of life. Side effects can include fatigue, loss of appetite, and breathing difficulties.
Hyperthermia for Laryngeal Cancer
Also known as thermal therapy, it involves exposing body tissues to temperatures between 39-44°C. It is a complementary treatment used alongside radiation or chemotherapy.
Quality of Life Considerations
Head and neck cancers affect visible areas and essential functions like speech and swallowing. Rehabilitation for these functions should be part of the treatment plan, and a multidisciplinary approach is crucial. The experience of the treatment team is highly important.