Laryngeal cancer (Cancer of the larynx)
The larynx is an organ located in the midline of the neck which functions in breathing, voice production and respiratory protection during swallowing. It consists of three anatomical parts: cords (glottis), the area above the cords (supraglottis) and area under the cords (subglottis).
What are the types of laryngeal cancer?
Malignant tumors (cancers) of the larynx are divided according to the type of cells from which they emanate. In most cases (95 % of cases) laryngeal cancer originate from squamous cells lining the throat which are called planocellular cancers. In the early stages of the disease, before beginning to spread over the surrounding tissue, these changes are called precancerous changes and carcinomas in situ.
Laryngeal cancer constitutes 1-2 % of all types of cancer. Incidence is 2-10 in 100.000. Men are 4 to 10 times more likely to be affected by this type of cancer than women. Usually it occurs after the age of 50.
Several factors may influence the occurrence of laryngeal cancer. Smoking is the most important risk factor for laryngeal cancer. Laryngeal cancer occurrence is 5-25 times more likely in smokers than in nonsmokers. Drinking alcoholic beverages, especially if combined with smoking, increases the likelihood of developing the disease by up to 40 times. Gastroesophageal reflux, chemical irritant and asbestos are also risk factors.
What are the symptoms?
The tumor is usually located on the chords and the first symptoms include voice changes and hoarseness. If hoarseness lasts for more than 2 weeks, it is advised to immediately consult an otorhinolaryngologist. Other symptoms of laryngeal cancer are : sore throat and earache, and in more advanced cases - stridor (high-pitched wheezing sound). Pain at swallowing, and bloody sputum can be reported. If the cancer has spread to the lymph nodes, neck swelling occurs.
The diagnosis of laryngeal cancer is set by an otorhinolaryngologist, on the basis on multiple diagnostic procedures. Primarily, during the discussion with the patient, when inquiring the symptoms and the time of their occurrence, the physician gathers important information on the patient's medical history. The clinical examination involves a series of diagnostic procedures such as throat examination (oropharyngoscopy), larynx and vocal cords examination using rigid or flexible endoscope (laryngoscope), palpation of the neck and neck radiological examination (ultrasound, computerized tomography - CT scan and magnetic resonance imaging - MRI). In the case of laryngeal cancer being suspected, the patient is advised to undergo direct laryngoscopy by using video laryngoscope or operating microscope (during short anesthesia), and biopsy determining changes in the histopathological diagnosis. Depending on the results of the histological analysis, the patient is advised on further treatment.
What are the treatment options?
In the treatment of laryngeal cancer there are two therapeutic approaches: surgery and radiotherapy. Chemotherapy is often used as a supplement to the surgery and radiotherapy treatment. The type and the extent of the surgery depends on the position and the size of the cancer, as well as its progression, i.e. the presence of regional and distant metastases. Surgery may be useful only in cases when the tumor is removed along with a part, or the whole voice chord (cordectomy). There are laryngectomies by which the tumor and part of the larynx is removed (partial horizontal and vertical laryngectomy). If the tumor is large and is detected post hoc, it is necessary to remove the entire larynx (total laryngectomy). It should be noted that in most surgical interventions in order to provide breathing path for the patient, it is necessary to create a temporary or permanent tracheostomy, an incision in the neck and throat through which the patient can breathe postoperatively. If metastases in the lymph nodes of the neck exist, radical or selective neck dissection to remove lymph nodes on one or both sides of the neck are performed. After surgery, oncology review and assessment for further treatment is conducted (radiotherapy, chemotherapy). In some cases the tumor may be so large that surgical treatment is not an option, and in those cases a sole suggested treatment is radiotherapy and chemotherapy.