Laryngeal Cancer Symptoms, Treatment and Prevention

Laryngeal cancer, also knows as throat cancer, is the malignancy of the mucous membrane lining the inside of the larynx. It can develop in the glottis, the segment which forms an opening of the larynx,  or in the sub-glottic region the part where the larynx and trachea join.

The larynx is a canal five centimetres long,  in the anterior neck after the junction of the pharynx and epiglottis. The epiglottis is a covering with cartilaginous muscle that protects the glottis during swallowing, preventing food and liquids from entering the larynx or lungs.

The larynx connects the pharynx to the trachea and the upper part of the larynx crossed by both vocal cords. When you speak, air flows between the vocal cords, which vibrates them. The vibration allows you to pronounce vowels and consonants or voiced sound. The larynx is an important organ of the vocal apparatus.

1. Statistics.

Larynx cancer accounts for less than 5% of male cancers and 25% of cancers of the upper aero-digestive tract. Cancer of the larynx affects approximate 12,000 Americans per year and causing 4,200 deaths.

The American Cancer Society estimated that they diagnosed 12,290 men and women ( with laryngeal cancer in 2009; 3,660 men and women died of it).

Laryngeal cancer incidence varies with age. From the year 2002 to 2006, the median age at diagnosis for cancer of the larynx was 65 years of age; thus, the percentages and ages of people diagnosed were approximate:

• 0.0% under age 20;
• 0.5% between 20 and 34;
• 3.4% between 35 and 44;
• 15.5% between 45 and 54;
• 28.7% between 55 and 64;
• 29.0% between 65 and 74;
• 18.1% between 75 and 84;
• 4.7% 85+ years of age.

2. Causes.

Most laryngeal cancers originate from epithelial cells, lining the inner wall of the glottis, the segment of the larynx below the vestibule and above the epiglottic cavity which includes both vocal cords.

Although less common, cancer of the larynx can develop in the part of the larynx above the vocal cords and under the epiglottis. This causes painful swallowing. Cancers that form under the vocal cords cause symptoms at an early stage, which leads to an early diagnosis.

The primary causative is smoking. The risk is even higher when associated with heavy and regular alcohol consumption, a known causative of laryngeal cancer. It estimated that heavy smokers have 20 times more chances to die from cancer of the larynx than non-smokers.

Tobacco has toxic substances such as tar and benzopyrene, which can alter the lining of the larynx by changing the morphology of the tissue and increase the air temperature inside the larynx to 42 ° C. Persistence in this practice will lead to microdamage (invisible to the naked eye)  which will turn into cancer.

3. Risk Factors.

Many risk factors are suspected in the development of laryngeal cancer, the most common include:

• Age – laryngeal cancer affects mainly people between 50 and 75 years;
• Sex – men are more often diagnosed with laryngeal cancer than women are;
• Chemicals – Exposure to fumes of sulfuric acid and asbestos; toxic vapours of organic substances/chemicals increases the risk of laryngeal cancer.
• Diet – Eating a diet low in fruits and vegetables and rich in salted and spicy foods  can cause laryngeal cancer;
• Race – laryngeal cancer is twice more common in people of African descent than among Caucasians;
• Gastroesophageal Reflux Disease (GERD) – Prolonged irritation associated with gastroesophageal reflux disease (GERD) may cause the occurrence of cancer of the oesophagus and larynx.
• Abuse of the vocal cords – Continuous abuse of the vocal cords (if you are a singer), can develop polyps that can turn into cancer if not removed.
• Heavy alcohol consumption – A moderate consumption of alcohol does not present any health risk. However, heavy consumption can double your risk of developing cancer of the larynx. When tobacco is involved, the risk is considerably increased.
• Human Papillomavirus – It is shown in many studies that a mother affected by HPV can transmit the virus to her child during birth. Without effective treatment, the virus will bind to the larynx and form tumours called laryngeal papillomas, which can develop into cancer.
• Weakened immune system – if your immune system is weakened, you are your likely to develop all types of cancer including laryngeal cancer. Factors that can weaken your immune system are numerous, the most common include:
• HIV / AIDS
• Stress.
• Unhealthy/poor diet.
• Malnutrition.
• Taking immunosuppressive drugs after an organ transplant.Cancer treatment: chemotherapy, radiation, etc..

 4. Symptoms. 

Depending on the location of a tumour, cancer of the larynx may remain completely asymptomatic for a long time. Signs and symptoms of laryngeal cancer tend to vary depending on the location of a tumour. In general, you will experience at least one of the following symptoms if you have cancer of the larynx:

• An earache.
• Persistent need to cough.
• Difficulty breathing
• A sore throat associated with difficulty swallowing
• Difficult or painful swallowing.
• Hoarseness for more than two weeks.
• Alteration of voice quality.
• The feeling of having a foreign body in your throat.

5. Complications.  Some complications include:

• Metastasis – cancer can spread to other parts of the body,  such as the cervical lymph nodes to form new cancer. In severe cases, cancer can spread into the lungs through the bloodstream.
• Airway obstruction – a tumour can block the airways and make breathing difficult. Besides cancer, the treatment itself can cause respiratory problems. If you had a total removal of the larynx, you will need a tracheostomy to maintain respiration.
• Deformation of the throat and neck – certain surgical intervention in the neck to remove a tumour and surrounding tissue can lead to some distortion of the throat and neck. The operation can make the movement of your neck difficult. In addition, a tracheostomy may leave a permanent opening (stoma) in your neck.
• Difficulty eating – in most cases, after surgery, you will have difficulty swallowing foods of a certain consistency. In addition, if you have radiotherapy treatment, you may experience difficulty swallowing or even chewing.
• Loss of voice – the removal of the larynx can affect your vocal chords and prevent you from speaking normally. Fortunately, there are methods that are used to help patients facing these problems:

• Oesophagal speech (or voice) – this alternate method allows you to vocalize without the oscillation in your vocal cords; it involves swallowing air and expelling it to produce sounds. Oesophagal speech is the basic method to replace the normal voice; however, you will need a speech therapist at the beginning to help you become familiar with the technique.
• Tracheoesophageal (TE) voice prosthesis – this technique involves placing a small valve between the trachea and oesophagus. It allows you to produce TE speech by shunting air from the lungs into the oesophagus, which vibrate the oesophagal tissue. This medical device is usually recommended by a speech-language pathologist for voice rehabilitation following a total laryngectomy.
• Electrolarynx – this is an electronic device used to produce clearer speech by those who have lost their original voice-box due to cancer of the larynx. Held near the skin of the throat or the corner of the mouth, the device produces a mechanical voice that helps the wearer communicate in a comfortable and familiar way.

6. Diagnosis. 

Before confirming the diagnosis of laryngeal cancer, your physician will ask you questions related to your medical history, your lifestyle (smoking and alcohol consumption), your general health and the symptoms that you experience: an earache, persistent cough, difficulty breathing, etc.

These symptoms do not automatically mean that you have laryngeal cancer; they are simply indicators. Therefore, to confirm the diagnosis, your doctor will perform other medical procedures:

• Laryngoscopy – the purpose of this test is to examine your throat to look for signs of a tumour. During the procedure, the doctor passes a flexible, lighted tube with a lens (laryngoscope) through your nose or your mouth into the upper airway to be able to visualize the upper part of your larynx. To prevent discomfort, the laryngoscopy can be performed under anaesthesia.
• Chest X-ray – an x-ray is necessary to ascertain whether a tumour has spread to the lungs or not. In fact, if you have shortness of breath, persistent cough, pain in the chest or chest trauma, a chest x-ray may be the first imaging technique recommended by your doctor.
• CT scan – this is an imaging technique often performed in the diagnosis of laryngeal cancer to detect abnormalities in the throat.  This technique is very important in the diagnosis of laryngeal cancer; it produces precise images that help your physician to determine if the cancer is metastatic or not. However, as for x-ray, repeated exposure to CT scan can lead to a major health problem.
• Magnetic resonance imaging (MRI) – MRI is another imaging technique often used in the diagnosis of laryngeal cancer. It allows your doctor to visualize the tissues of your neck and detect abnormalities in your throat.
• Biopsy – a biopsy is a key procedure to confirm the presence of cancer in your larynx. It involves taking a sample of a tumour tissue for laboratory analysis. The removal of the sample is done through endoscopy under general anaesthesia, or through a thin needle that is inserted into your neck.

7. Stages.

Once the diagnosis is confirmed, your doctor will determine the stage of cancer. In general, your physician will stage a tumour based on its size and degree of the cancer cells within your body. Staging is very important because it helps to determine an appropriate and effective treatment to fight cancer.
The stage of laryngeal cancer is often identified by Roman numerals: I, II, III and IV; the higher the stage, the lower your chances of survival.

• Carcinoma in situ stage – the genesis of cancer in the cells lining the inside of the larynx. Surgery may remove a tumour without causing physiological damage.
• Stage I – the tumour has invaded the tissue of the larynx, but it has not spread to other tissue.
• Stage II – Cancer has spread to the surrounding tissue of the larynx.
• Stage III – cancer, has spread beyond the surrounding tissues of the larynx to nearby lymph nodes.
• Stage IV –  A tumour has not only invaded the nearby lymph nodes, but also distant sites in the body such as the lungs.

8. Treatment.

Before deciding what treatment you should follow, your doctor will consider many factors: your age, health in general, and the stage of a tumour. After all, you’ll be invited to participate in the final choice of the treatment.
In general, a cancer of the larynx is treated by radiotherapy, chemotherapy or surgery. In most cases, your physician will choose a combination of these therapies.

I. Radiation therapy (Radiotherapy) 

A radiotherapy is a form of cancer treatment using ionizing radiation to kill cancer cells. If you have an early stage laryngeal cancer (stages 1 or 2), radiation therapy may be the ideal choice; In fact, many of laryngeal cancer diagnosed early are treated solely by radiotherapy. In addition, unlike surgery, radiation therapy provides physiological advantages; it does not damage the vocal cords.
Although temporary, radiotherapy can cause side effects such as:

•  A sore throat
• Voice changes
• Mouth sores
• The sensitivity of the mouth and gums
• Dry mouth or lower production of saliva
• Redness, dry skin
• Loss of taste or smell.
  

II. Chemotherapy.
Chemotherapy involves using powerful drugs to kill or slow down the proliferation of cancer cells. Chemotherapy is not always practised in the treatment of laryngeal cancer; it is used if cancer has spread into other tissue or in case of an aggressive tumour that grows quickly. Unlike radiotherapy, chemotherapy drugs circulate throughout your organism and affect all organs in the body.
Chemotherapy always causes side effects, which may include:

• Fatigue.
• Diarrhoea.
• Chills.
• Shortness.
• Hair loss.
• Nausea and vomiting.
• Mouth sores.
• Surgical Treatment.

If your doctor thinks surgery can be helpful, your surgeon will perform a laryngectomy; which can be total or partial. During surgery, the surgeon will remove a part, or the entire larynx,] and make a sort of opening (stoma) in your neck so you can breathe.

This will damage your vocal cords, There are several solutions that can help you learn to speak. In fact, the majority of laryngeal cancer victims undergo a laryngectomy successfully to communicate with others as before the surgery.

9. Survival Rates. 

Laryngeal cancer prognosis depends on the stage of a tumour at diagnosis and your lifestyle (including diet) during and after the treatment. If cancer is diagnosed early, the more chances of survival.

The diagnosis of laryngeal cancer limited to the vocal cords is always excellent. In fact, five-year survival is observed in nearly 80% of cases. The five-year survival rate of laryngeal cancer after total laryngectomy is often less than 60%.

I. Survival Rates by Age  

The overall 5-year relative survival rate for 1999-2005 was 61.6%. Five-year relative survival rates by race and sex were:

• 64.0% for white men;
• 59.6% for white women;
• 51.6% for black men;
• 46.1% for black women
• Death rates by races

The age-adjusted death rate was 1.3 per 100,000 men and women per year. These rates are based on patients who died in 2002-2006 in the US. In general, death rates by race include:

• All Races: 2.3 per 100,000 men – 0.5 per 100,000 women
• White: 2.1 per 100,000 men  – 0.5 per 100,000 women
• Black: 4.7 per 100,000 men  – 0.7 per 100,000 women
• Asian/Pacific Islander: 0.7 per 100,000 men – 0.1 per 100,000 women
• American Indian/Alaska Native: 1.9 per 100,000 men
• Hispanic: 1.9 per 100,000 men  – 0.2 per 100,000 women

10. Preventions.

While it is not always easy to prevent cancer, you can reduce your risk of laryngeal cancer. To prevent the occurrence of cancer of the larynx, it is important to live a healthy lifestyle and live in a healthy environment. Your lifestyle and even your environment may be open doors to many carcinogens.
Several factors can cause the formation of cancerous cells in your body. In the case of laryngeal cancer, tobacco is the main cause. Eliminating smoking is significantly reduce your risk of becoming a laryngeal cancer victim.

Some risk factors such as age, sex and genetic are impossible to change; some factors, however, can be prevented. If you want to prevent cancer of the larynx and many other cancers, you need to:

• Avoid tobacco, including second-hand smoke.
• Do not expose yourself to harmful chemicals
• Treat gastroesophageal reflux disease (GERD) completely
• Do not abuse of the vocal cords.
• Adopt a healthy diet: a diet containing 5 to 10 servings of fruits and vegetables a day may help prevent an occurrence of laryngeal cancer.
• Maintain a healthy weight;
• Limit your alcohol intake
• Reduce your exposure to toxic chemicals
• Reduce your exposure to ultraviolet (UV) radiation
• Exercise regularly
• Practice safe sex
• Inform your doctor or dentist of any change that indicates the presence of cancer.