Laryngeal cancer, or voice box cancer, occurs when cancer cells procedure in the larynx. The voice box, the larynx, is the part of the gullet that controls the vocal cords. Cancer can develop in one of three main parts of the larynx:
Glottis: The middle part containing the vocal cords
Supraglottis: The area overhead the vocal cords
Subglottis: The area under the vocal cords and above the windpipe
We spoke with the head and then neck surgeon Eduardo Diaz Jr., M.D., to study additional about laryngeal cancer.
How common is laryngeal cancer?
It’s much less mutual than it used to be since fewer Americans smoke, which is a risk factor for this type of cancer. That said, laryngeal cancers account for about one-fifth of head and neck cancers.
The most common type of laryngeal cancer is squamous cell carcinoma. Other less common types include:
- warty cancer
- adenocarcinoma
- undifferentiated lymph node carcinoma
What are the symptoms of laryngeal cancer?
Hoarseness is the most common symptom of laryngeal cancer. Other symptoms include:
- difficulty swallowing
- shortness of breath
- bloody mucus
“It’s very common to have a hoarse voice when you have a cold or an allergy attack,” Díaz says. “You don’t have to run to the doctor every time it happens.” However, your symptoms should improve after about a week.
If you experience persistent hoarseness and/or voice changes for more than a week or have hoarseness associated with other symptoms, you should see an ear, nose and throat (ENT) specialist.
How is laryngeal cancer typically diagnosed?
You’ll have a complete head and neck exam when you see an ENT doctor.
Your doctor may also perform a fiberoptic laryngoscopy, in which a small endoscope is placed at the back of your nose so the doctor can get a clear view of your larynx.
“This is a painless procedure done in the clinic and gives us a great view of your larynx and vocal cords,” Diaz says. “Sometimes, we can even take biopsies using one of these endoscopes in the clinic.”
If you have a biopsy, a pathologist will examine your tissue cells and then determine if you have cancer.
“In some cases, if we suspect that the cancer has spread to a lymph node in your neck, we may do a fine-needle aspiration of the lymph node to confirm our suspicions,” Diaz says.
What are the risk factors for laryngeal cancer?
The most critical risk factors for developing laryngeal cancer are smoking and tobacco use.
Some less common risk factors associated with laryngeal cancer include:
- silent reflux or heartburn
- drinking alcohol
- human papillomavirus (HPV)
“Silent reflux occurs when stomach acid backs up into the oesophagus and spills over into the larynx,” says Díaz. “The acid is an irritant that removes mucus, which is a protector. For example, if you smoke, the mucus prevents carcinogens from reaching the mucosa, but if reflux removes it, your risk of developing cancer increases.
Alcohol is a solvent that also removes mucus.
“We see a lot of tumours in the larynx that seem to be associated with HPV, so it’s important to get the HPV vaccine if you’re eligible,” says Díaz.
The HPV vaccine prevents six types of cancer, including throat cancers such as laryngeal cancer. It is recommended that everyone between the ages of 9 and 26 get vaccinated, and the vaccine is most effective when given between the ages of 11 and 12. Adults between the ages of 27 and 45 should talk to their doctor about the benefits of vaccination.
How is laryngeal cancer usually treated?
Laryngeal cancer is usually treated with radiation therapy and/or surgery. For injuries detected very early, surgery is the best option.
“Once the biopsy confirms that it is cancer, we can use a laser to burn the cancer,” Diaz explains. “It is a very effective option with a high cure rate.”
Radiotherapy is preferred for intermediate-stage cancers.
“It is excellent for treating laryngeal cancer, but we do not use it for all stages because radiation therapy is something that can only be used once,” Diaz explains. “We do not want to use it for a small tumour and then have the patient develop another type of cancer in the future. Also, we cannot use radiation therapy because it has already been used. »
Most advanced laryngeal cancers, T3 and some T4, will be treated with chemotherapy and radiation. Advanced T4 is usually treated first with surgery. In T3 laryngeal cancer, the tumour is limited to the larynx, while in T4 laryngeal cancer, the tumour has spread beyond the larynx.
“For patients with advanced laryngeal cancer, killing the cancer is wonderful, but the larynx can’t go back to normal because the tissue around it is also affected,” Díaz says. “So if a patient has a huge tumour and their larynx isn’t functioning well, radiation may not be very beneficial for the patient in terms of function. “That’s why we usually opt for surgery first and then radiation.”
What lifestyle changes can laryngeal cancer patients expect?
At MD Anderson, we focus on preserving function when treating laryngeal cancer.
“How can we cure cancer first and then preserve function so patients can have a good voice, tolerate a normal diet, and avoid having a permanent stoma or hole in the neck?” Diaz asks.
Some patients aren’t thrilled with the idea of a total laryngectomy, a procedure to remove the entire larynx through the neck. Still, Diaz says it’s a tremendous curative option for some extensive cases.
“A total laryngectomy leaves a permanent hole in the neck that you can breathe through, but we can rehabilitate patients so they can speak hands-free and communicate openly in public,” Diaz says. “We try to introduce them to other laryngeal cancer patients who communicate well and live wonderful lives.”
Diaz acknowledges that total laryngectomies can be scary for some patients, so he does his best to avoid such surgeries when possible.
“That’s why we try to diagnose laryngeal cancer early and do simple surgeries,” he says. “Sometimes we can do treatments that don’t involve surgery, like radiation and chemotherapy.”
Diaz also performs laryngeal-sparing surgery, which often only requires a laser to remove the cancer while preserving the functionality of the larynx so the patient can continue to speak and swallow without a permanent stoma.
What are the latest advances in treating laryngeal cancer?
We recently presented research at the annual American Society of Clinical Oncology meeting. Which showed the success of treating some patients with immunochemotherapy alone.
“We found that we could control the disease with just immunotherapy and chemotherapy in a good portion of patients,” Díaz says. “They never get radiation or surgery. We’re trying to expand this study nationally so that it’s available to more patients.”