The larynx, also called the voice box or Adam’s apple, is the part of the body that allows humans to produce sounds and speech. The larynx contains the vocal cords (glottis), which vibrate when air passes through. The epiglottis is a small flap of cartilage found at the top of the larynx. The epiglottis protects the airways by keeping food and saliva from going down the trachea (the “windpipe” tube that leads to the lungs).
Cancer of the larynx can occur on the glottis (most laryngeal cancers are there), the supraglottis (the area above the vocal cords that includes the epiglottis), or the subglottis (the area that connects the larynx to the trachea).
Cancer of the larynx affects more men then women, although more women are developing it today due to an increase in smoking in the female population.
Although the exact cause of cancer is unknown, some known risk factors for cancer of the larynx include:
The symptoms of laryngeal cancer depend on where in the larynx the tumour is located. Cancer on the vocal cords can often be detected early because the main symptom is hoarseness. Most people go hoarse from time to time, but if the hoarseness doesn’t go away in two weeks, it should be checked.
Symptoms that the cancer has spread or is occurring in another part of the larynx include:
There are a few complications that can result from laryngeal cancer.
Airway obstruction: Any tumour or swelling in the airway can cause a blockage, making breathing difficult. If treatment involves total removal of the larynx, a tracheostomy (surgery to create an artificial airway in the trachea) is then performed to improve breathing.
Disfigurement: Removing the tumour and surrounding tissue could leave some disfigurement of the throat and neck. Muscles might be removed as well, making neck movement more difficult. If a tracheostomy was performed, the stoma (opening in the throat) is sometimes permanent.
Difficulty eating: After surgery, it may become difficult to swallow certain consistencies of food. Those undergoing radiotherapy may have trouble swallowing or even chewing. Chemotherapy can cause nausea and vomiting. A good, healthy diet is vital when recuperating from cancer, so it’s important that adequate nutrition be maintained throughout the treatment.
Cancer spread: It’s possible that the cancer may spread to other areas of the body.
Voice loss: Treatment that involves removing the entire larynx makes normal speech impossible. In this case, alternate methods of speaking need to be learned. These are:
While these new methods of speech are being learned, other ways of communicating will be needed. This might mean keeping a “magic slate” or pad and pencils easily available. It’s important to plan ahead to help avoid frustration after surgery.
If cancer is suspected, your doctor will first take a medical history, including information about smoking and alcohol use. It’s important to mention past use or exposure even if there’s none at the present. After a physical exam, the following tests may be performed:
Diagnosis also includes determining the stage of the cancer in order to identify how advanced it is.
Like most cancers, treatment for laryngeal cancer involves surgery, radiotherapy, chemotherapy, or a combination of treatments. The decision about what type of therapy to use is made according to how advanced the cancer is (i.e., the stage) and exactly where it is located.
Early-stage cancer of the larynx can often be treated with radiation alone. Radiotherapy is the preferred method whenever possible, because it usually doesn’t affect the quality of the voice and side effects are most often temporary. The side effects to radiation can include:
Surgery can involve removing the whole larynx and surrounding tissues or just part of the larynx, depending on how far the cancer has spread.
With partial removal (laryngectomy), you will often be able to eat and breathe as you did before the surgery, after healing is complete. You will probably have a temporary tracheostomy while the throat repairs, but the stoma will be allowed to close up and breathing will return to normal. Your voice quality may change but you will be able to speak.
If you need to undergo a total laryngectomy where the voice box is completely removed, you will be left with a tracheostomy in order to breathe. This tracheostomy is permanent.
Finally, chemotherapy may be needed if the cancer has spread. Chemotherapy is also used to “sensitize” the area for radiation in cases of advanced tumours that are still thought to be treatable. Because chemotherapy circulates throughout the body, more of the body systems are affected by the treatment.
Side effects from chemotherapy include:
The five-year survival rate for laryngeal cancer that’s detected early is 59% to 90%. Most recurrences of cancer happen within the first 2 or 3 years of treatment. Follow-up procedures usually involve monthly checkups for the first year and then every few months thereafter. Unfortunately, because the very same risk factors that might have caused the first tumour may also have caused other damage, the chances of a second tumour developing (often in the head, neck, or lung) can be as high as 25%.
Many risk factors for cancer of the larynx are known, the most common of these being smoking and heavy alcohol use. Many cases of cancer could be prevented by avoiding these known causes.
Other ways to reduce risk include:
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