Laryngeal cancer is a rare form of cancer, and accounts for less than 5% of all male cancers and nearly 25% of cancers of the upper aero-digestive tract. Cancer of the larynx affects approximately 12,000 Americans per year, causing about 4,200 deaths.
According to the American Cancer Society, it is estimated that 12,290 men and women (9,920 men and 2,370 women) were diagnosed with laryngeal cancer in 2009 with 3,660 men and women dying of it.
Laryngeal cancer, also called throat cancer, is the formation of a malignancy on the mucous membrane lining the inside of the larynx. The cancer can develop in the glottis (segment which forms the opening of the larynx, including both vocal cords), in the supraglottic region (segment above the vocal cords, which includes the epiglottis), or in the subglottic region (part where the larynx and trachea join together).
The larynx is a canal about five centimeters long, located in the anterior neck after the junction of the pharynx and epiglottis. The epiglottis is a covering and cartilaginous muscle that protects the glottis during swallowing and prevents food and liquid from entering the larynx or lungs. Connecting the pharynx to the trachea, the upper part of the larynx is crossed by both vocal cords. When you speak, air flows between the vocal cords and vibrates them. The vibration allows you to pronounce vowels and consonants or voiced sounds. The larynx is an important organ of the vocal apparatus.
Laryngeal cancer incidence varies with age. From 2002-2006, the median age at diagnosis for cancer of the larynx was sixty-five years of age. The percentages and ages of people diagnosed were approximately:
- 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
Laryngeal Cancer Causes
Most laryngeal cancers originate from epithelial cells lining the inner wall of the glottis, which is the segment of the larynx located below the vestibule and above the epiglottic cavity. It includes both vocal cords.
Although less common, the cancer can develop in the part of the larynx located above the vocal cords and under the epiglottis. When that happens, the cancer tends to cause difficult, painful swallowing. Cancers that form under the vocal cords cause symptoms at an early stage, which leads to an early diagnosis.
Although all causes of laryngeal cancer are not known, its primary causative factor is smoking. The risk is even higher when smoking is associated with heavy and regular alcohol consumption, another causative factor of laryngeal cancer. It is estimated that heavy smokers have about 20 times more chance to die from cancer of the larynx than non-smokers do.
Tobacco contains toxic substances such as tar and benzopyrene. Once in the aerodigestive tract, tobacco smoke and other harmful substances directly 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) to the mucous membrane of the larynx, which will, sooner or later, turn into cancer.
Laryngeal Cancer Risk Factors
Many risk factors are suspected in the development of laryngeal cancer, the most common include:
- Age – Laryngeal cancer affects mainly people between 50-75 years.
- Sex – Men are more often diagnosed with laryngeal cancer than women are.
- Chemicals – Exposure to fumes of sulfuric acid and of asbestos or toxic vapors 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 cancers of the esophagus and larynx.
- Abuse of the vocal cords – If you continuously abuse your vocal cords (if you’re a singer for example), you can develop polyps that can turn into cancer if not removed.
- Heavy alcohol consumption –Moderate consumption of alcohol does not representany health risk, but heavy consumption may 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 later cause the formation of 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, and the most common include:
- a) HIV / AIDS
- b) stress
- c) unhealthy / poor diet
- d) malnutrition
- e) taking immunosuppressive drugs after an organ transplant
- f) cancer treatment: chemotherapy, radiation
Laryngeal Cancer Symptoms
Depending on the location of the tumor, cancer of the larynx may remain completely asymptomatic for a long period of time.
When it finally occurs, signs and symptoms of laryngeal cancer tend to vary depending on the location of the tumor. In general, you will experience at least one of the following symptoms if you have cancer of the larynx:
- persistent need to cough
- difficulty breathing
- sore throat associated with difficulty swallowing
- difficult or painful swallowing
- hoarseness for more than two weeks
- alteration of voice quality
- feeling of having a foreign body in your throat
Laryngeal Cancer Complications
Cancer of the larynx is not free of complications; complications can be due either to the cancer itself or its treatment. Some laryngeal cancer complications include:
Metastasis – The cancer can spread to other parts of your body such as the cervical lymph nodes to form new cancer. In severe cases, the cancer can spread into the lungs through the blood stream.
Airway obstruction – The tumor can block the airways and make your breathing difficult. Besides the 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 the tumor 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 – 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:
- Esophageal 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. Esophageal 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 esophagus. It allows you to produce TE speech by shunting air from the lungs into the esophagus, which vibrate the esophageal tissue. A laryngologist or a speech-language pathologist for voice rehabilitation following a total laryngectomy usually recommends this medical device.
- Electrolarynx – This is an electronic device used to produce clearer speech by those who have lost their original voice box. 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.
Laryngeal Cancer Diagnosis
Before confirming the diagnosis of a 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 such as earache, persistent cough, or difficulty breathing. These symptoms do no 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 tumor. 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 anesthesia.
Chest X-ray – An x-ray is necessary to ascertain whether the tumor 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.
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 the key procedure to confirming the presence of a cancer in your larynx. It involves taking a sample of tumor tissue for laboratory analysis in search of cancer cells. The removal of the sample is done through endoscopy under general anesthesia, or through a thin needle that is inserted into your neck.
Laryngeal Cancer Stages
Once the diagnosis is confirmed, your doctor will determine the stage of the cancer. In general, your physician will stage the tumor based on its size and degree of the cancer cells that have spread within your body. Staging is very important because it helps determine an appropriate and effective treatment to fight the 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 to survive.
- Carcinoma in situ stage – This is the genesis of the cancer in the cells lining the inside of the larynx. Your surgeon may remove the tumor without causing physiological damage.
- Stage I – The tumor has invaded the tissue of the larynx, but it has not spread to other tissue.
- Stage II – At stage 2, laryngeal cancer has spread to surrounding tissue of the larynx.
- Stage III – The cancer has spread beyond the surrounding tissues of the larynx to nearby lymph nodes.
- Stage IV – In this final stage, the tumor has not only invaded the nearby lymph nodes but also distant sites in the body such as the lungs.
Laryngeal Cancer Treatment
Before deciding what treatment you should follow, your doctor will consider many factors like your age, health in general, and the stage of the tumor. In general, cancer of the larynx is treated by radiotherapy, chemotherapy, or surgery. In most cases, your physician will choose a combination of these therapies.
Radiation therapy (Radiotherapy)
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 radiation therapy provides physiological advantages; it does not damage the vocal cords.
Although temporary, radiotherapy can cause side effects:
- sore throat
- voice changes
- mouth sores
- sensitivity of the mouth and gums
- dry mouth or lower production of saliva
- redness, dry skin
- loss of taste or smell
Chemotherapy involves using powerful drugs to kill or slow down the proliferation of cancer cells. Chemotherapy is not always practiced in the treatment of laryngeal cancer; it is used if the cancer has spread into other tissue, or in case of aggressive tumor that grow quickly. Unlike radiotherapy, chemotherapy drugs circulate throughout your organism, and affect all organs in your body.
Chemotherapy always causes side effects, which may include:
- hair loss
- nausea and vomiting
- mouth sores
If you doctor thinks surgery can be helpful, your surgeon will perform either a total or partial laryngectomy. 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, but there are several solutions that can help you learn to speak. In fact, the majority of laryngeal cancer victims who undergo a laryngectomy successfully communicate with others.
Laryngeal Cancer Survival Rates
Laryngeal cancer prognosis depends on the stage of the tumor at diagnosis and your lifestyle (including diet) during and after the treatment. If the cancer is diagnosed early, the more chance you have to survive. The diagnosis of a 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%.
Survival Rates by Age
The overall five-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
Laryngeal Cancer Prevention
While it is not always easy to prevent cancer, you can reduce your risk of laryngeal cancer. To prevent the occurrence of any cancer including cancer of the larynx, it is important to live a healthy lifestyle and live in a healthy environment. Your lifestyle and even your environment (including workplace) may be open doors to many cancers, including laryngeal cancer.
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 significantly reduces your risk of becoming a laryngeal cancer victim.
Risk factors such as age, sex, and genetics 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 smoke, 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 5-10 servings of fruits and vegetables a day may help prevent 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.
- Tell your doctor or dentist of any change that indicates the presence of cancer.