Laryngeal Cancer (Voice Box Cancer): Symptoms, Diagnosis, and Treatment

What Is Laryngeal Cancer?

Laryngeal cancer occurs when cancerous cells grow uncontrollably in the larynx. In most cases, the malignancy develops in the squamous cells lining the larynx.

There are three primary parts in terms of larynx anatomy, and they are:

• Glottis (Makes Up About 60 Percent): Has the vocal cords, and it is the most common part where cancer develops.
• Supraglottis (Accounting for 35 Percent): It refers to the topmost portion of the larynx lying above the vocal cords.
• Subglottis (Comprising 5 Percent): Is located below the vocal cords and forms the link between the larynx and the trachea.

How Prevalent Is Laryngeal Cancer?

Laryngeal cancer is very prevalent in thousands of people around the world each year and is more likely to affect men than women. It mostly develops after age 55.

Statistics based on global cancer records show that:

• It occurs four or five times as often in men as in women.
• Most cases can be attributed to both tobacco and alcohol abuse.
• Countries where the consumption of smokeless tobacco is prevalent have high rates of incidence.

Who Is at Greatest Risk?

Smoking and Tobacco Abuse:

The risk of developing laryngeal cancer due to smoking is much higher than any other risk factor. Studies reveal that smokers are 10 to 15 times more at risk of developing the disease than non-smokers. Increased risks associated with:

• Cigarettes.

• Bidis.

• Cigars.

• Pipes.

• Smokeless tobacco.

Alcohol Abuse:

Drinking alcohol can increase your risk, particularly when paired with tobacco abuse.

Human Papilloma Virus (HPV):

HPV is associated with certain head and neck cancers, including laryngeal cancers.

Occupational Chemical Exposure:

May increase the risk of cancer.

Long-term exposure to:

• Asbestos.
• Wood dust.
• Paint fumes.
• Industrial chemicals.

Other Risk Factors

Some other risk factors are:

• Acid reflux disease.
• Malnutrition.
• Immunodeficiency.
• A family history of head and neck cancers.
• Sex and age.

Causative Agents of Laryngeal Cancer

In laryngeal cancer, certain genetic mutations disrupt the normal functioning of laryngeal cells, leading to uncontrolled growth. The continuous contact with various carcinogenic substances, such as smoke, alcohol, and certain chemicals, plays a critical role in the formation of cancer cells.

What Are the Symptoms and Signs of Laryngeal Cancer?

Symptoms vary depending on whether the cancer develops in the glottis, supraglottis, or subglottis.

Symptoms that are common:

• Hoarseness.
• Sore throat.
• Swallowing problems.
• Pain when swallowing.
• Persistent cough.
• Earache.
• Swelling.
• Foul breath.
• Unintentional weight loss.
• Tiredness.

Symptoms That Require Emergency Treatment

The following symptoms suggest more serious conditions, including difficulty breathing, stridor, hemoptysis, severe dysphagia, globus pharyngeus, or rapid neck swelling:

• Difficulty breathing.
• Stridor.
• Hemoptysis.
• Severe dysphagia.
• Globus pharynx.
• Neck swelling is progressing rapidly.
• Delay in seeking emergency treatment could be risky.

Laryngeal Cancer Diagnostic Techniques

• Physical Exam: The throat, neck, mouth, and lymph nodes are physically inspected.
• Laryngoscopy: An instrument attached to a camera and passed through the nasal or oral passage.
• Biopsy: A sample of the suspicious cells is analyzed to confirm the disease.
• Imaging Tests: They help assess the size and extent of the tumor's metastases.

Laryngeal Cancer Staging by the TNM System

The TNM staging method is widely used to determine the stage of cancer in patients:

• Tumor (T): Size and local spread of the tumor.
• Nodes (N): Lymph node metastases.
• Metastasis (M): Metastasis to distant organs.

Stages of Laryngeal Cancer

• Stage 0: Abnormal cells are restricted to the surface layer only.
• Stage I: Small tumor limited to the same region of the larynx.
• Stage II: Cancerous growth spreads locally within the larynx.
• Stage III: Local tumor spread into the neighboring tissues or lymph nodes.
• Stage IV: Metastatic disease involving adjacent structures and/or distant metastasis.

Treatment of Laryngeal Cancer

It depends on:

• Site of tumor.
• Stage of cancer.
• Involvement of the vocal cords.
• Health of the patient.

This treatment generally requires:

• ENT specialist.
• Surgeon for head and neck cancers.
• Radiation oncologist.
• Medical oncologist.
• Speech therapist.
• Nutritionist.
• Social worker.
• Rehabilitation specialist.

Early-Stage Treatment

• Radiation Therapy: High-energy beams are used to kill cancerous cells in this type of therapy, which is quite effective in treating early-stage tumors.

• IMRT (Intensity-Modulated Radiotherapy): It is an advanced form of radiation therapy that focuses on delivering a precise dose to tumors while sparing nearby healthy tissues.

• Laser Surgery: This treatment uses lasers to remove a tumor without affecting the individual’s speech capabilities.

• Cordectomy: In this procedure, a section of the entire vocal cord is removed.

Surgical Treatments for Laryngeal Cancer

• Supraglottic Laryngectomy: Involves the removal of structures above the vocal folds while maintaining the ability to speak in select cases.

• Hemilaryngectomy: Removal of one half of the larynx while retaining some degree of voice production.

• Partial Laryngectomy: Only a portion of the larynx is removed while retaining speaking and swallowing abilities wherever possible.

• Total Laryngectomy: Complete removal of the larynx, with breathing achieved via a permanent opening in the neck referred to as a "stoma."

• Thyroidectomy: Either partial or complete removal of the thyroid gland if cancer has invaded this area.

• Neck Dissection: Surgical removal of lymph nodes if there has been a spread of cancer to the neck region.

Chemotherapy, Targeted Therapy, and Immunotherapy

Chemotherapy:

Chemotherapy can be used in combination with radiation therapy for advanced cases.

Targeted Therapy:

Targeted therapies target particular cancer-causing pathways with minimal harm to surrounding normal cells.

Immunotherapy:

Current immunotherapy agents enable the immune system to recognize and eliminate cancer cells. It is currently more applicable to recurrent or metastasized cancer.

Rehabilitation and Recovery Assistance:

Treatment recovery should also form an integral part of cancer care and rehabilitation.

Speech Rehabilitation:

Patients may require the following:

• Speech therapy.

• Voice prosthetic surgery involving tracheoesophageal puncture (TEP).

• Use of the electrolarynx device.

Dysphagia Therapy:

Dysphagia therapists assist individuals with safe swallowing.

Nutritional Management:

Nutritive assistance involves the guidance of dieticians to achieve nutritional maintenance.

Psychological and Emotional Support:

Counseling and support groups assist with emotional adjustment to new physical appearances and speech difficulties.

Stoma Care After Total Laryngectomy:

In a total laryngectomy, breathing occurs through a stoma in the neck. Stoma care becomes imperative after the procedure.

Daily Stoma Hygiene Guidelines

• Avoid accumulation of mucus and discharges.

• Check for any redness, inflammation, or symptoms of infections.

• Install humidifiers to maintain sufficient humidity levels in the stoma.

• Prevent exposure to cigarette smoke and other irritants.

• Avoid water entering the stoma when bathing and swimming.

• Go to your physician right away if you experience any bleeding, shortness of breath, or abnormal discharge from the stoma.

Follow-Up Procedures

• It is important to have regular follow-ups for:

• Detecting any recurrences.

• Checking the progress in speaking and swallowing.

• Dealing with adverse reactions to treatments.

• Cessation of smoking and drinking alcohol.

When Should I Visit a Doctor?

Visit your doctor if you have:

• Hoarseness for over two weeks.

• Sore throat persists.

• Swallowing problems.

• Enlargement of the neck.

• Persistent cough.

• Ear pain without an infection.

• Breathing problems.

• Coughing up blood needs immediate medical attention.

Early treatment greatly increases the chances of a cure and helps save your voice.

Prevention Strategies

Your chances of developing laryngeal cancer can be lowered by:

• Not smoking.

• Staying away from tobacco.

• No use of gutka or pan masala.

• Limited alcohol consumption.

• Healthy nutrition: fruits and veggies.

• Controlling gastroesophageal reflux.

• Wearing protective gear near chemicals.

• HPV vaccine in case you need one.

Conclusion

This condition is considered very serious, yet potentially treatable if diagnosed early. Hoarseness is one of the most common warning signs, which should not be neglected. There are advanced treatment methods for laryngeal cancer, such as laser surgery, IMRT, chemotherapy, targeted therapy, and immunotherapy, that have led to increased life expectancy and improved quality of patients' lives.

Rehabilitation measures, such as speech therapy, TEP voice prosthesis, swallowing therapy, and psychotherapy, are also important to recover fully from the procedure. In case you suspect any problems with your throat or voice, visit a physician. Early diagnosis can be crucial for saving both your life and your voice.

Key Takeaways

• Persistence of hoarseness for more than two weeks is a critical symptom of laryngeal cancer.
• The chances of getting laryngeal cancer are about 10 to 15 times greater among smokers.
• In the Indian subcontinent, gutka, pan masala, tobacco chewing, and alcohol consumption increase the risk.
• Present-day treatments include IMRT, laser surgery, chemotherapy, immunotherapy, and targeted therapy.
• For total laryngectomy, permanent stoma care and voice therapy are needed.
• Consultation with an ENT physician is essential at an early stage of diagnosis.