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Laryngeal (Throat) Cancer

cancer larynx


The larynx is the top part of the trachea (windpipe). It is about 5 cm long and is sometimes called the voice box. The larynx contains the vocal cords. These are V-shaped ridges of muscle tissue on the inside lining of the larynx. They vibrate when air passes between them to produce speech.

When you breathe in, air passes into the larynx and down the trachea towards the lungs. When you swallow, the larynx moves upwards slightly and a flap of cartilage tissue at the back of the tongue, called the epiglottis, closes over the entrance to the larynx. This ensures that food or drink go down the oesophagus (gullet) and not down the trachea.

What is cancer of the larynx?

Cancer of the larynx is just one type of cancer that can occur in the throat. It is four times more common in men than in women. It is rare in people aged less than 40 years and is most common in people aged over 60 years.
Squamous cell carcinoma of the larynx occurs in more than 9 in 10 cases. This type arises from cells which are on the inside lining of the larynx.

Other types.

There are some rare types of cancer which arise from other types of cells within the larynx. For example, adenocarcinoma of the larynx arises from cells in the tiny glands in the wall of the larynx that make mucus.

What causes cancer of the larynx?
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiplies out of control.
However, certain risk factors increase the chance that cancer of the larynx may develop. These include:

  • Ageing.
  • Smoking.
  • Drinking a lot of alcohol, especially spirits.
  • A poor diet lacking certain vitamins and minerals.
  • Long-term exposure to certain chemicals, fumes or pollutants.
  • Human papillomavirus (HPV).

What are the symptoms of cancer of the larynx?

A hoarse voice is often the first symptom because most cancers of the larynx first start on, or close by, a vocal cord.
Other symptoms that may occur as the tumour grows in the larynx include: a lump in the throat, pain in the throat when swallowing, difficulty with breathing. If the cancer spreads to local lymph nodes (lymph glands) then the nearby glands in the neck will swell.If the cancer spreads to other parts of the body, various symptoms can develop.

How is cancer of the larynx diagnosed and assessed?

Initial assessment

If a doctor suspects that you may have cancer of the larynx, he or she will refer you to an ear, nose and throat (ENT) specialist. The specialist will examine the inside of your throat by using a small mirror and light. He or she may also use a thin, flexible, telescope (a nasoendoscope).

To confirm the diagnosis

If anything suspicious is seen by the examination or with the nasoendoscope, you will usually need a biopsy. A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then looked at under the microscope to look for abnormal cells.

Assessing the extent and spread (staging)

Other tests may be arranged to see if the cancer has spread to other parts of the body. For example, a CT scan, an MRI scan, or other tests.
This assessment is called staging of the cancer. The aim of staging is to find out:

  • How much the tumour in the larynx has grown.
  • Whether the cancer has spread to local lymph nodes.
  • Whether the cancer has spread to other areas of the body (metastasised).

The common grading system used for cancer of the larynx is:

  • Grade 1 (low grade).  The cancer cells are said to be well differentiated. The cancer cells tend to grow and multiply quite slowly and are not so aggressive.
  • Grade 2 (intermediate grade).
  • Grade 3 (high grade). The cells look very abnormal and are said to be poorly differentiated. The cancer cells tend to grow and multiply quite quickly and are more aggressive.

What are the treatment options for cancer of the larynx?

Treatment options which may be considered include radiotherapy, surgery, and chemotherapy. The treatment advised for each case depends on various factors such as the exact site of the primary tumour in the larynx, the stage of the cancer (how large the cancer is and whether it has spread), the grade of the cancerous cells, and your general health.

Radiotherapy

This is the common treatment if the cancer is small and has not spread from the larynx (early stage). Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying.

Radiotherapy is also sometimes used in addition to surgery or chemotherapy in certain situations. For example, radiotherapy may be used to shrink a large tumour prior to surgery.

Surgery

Tumours which are larger tend to require surgery. Sometimes surgery is aimed at curing the cancer by removing it all. Sometimes surgery is used to relieve symptoms if the cancer is at an advanced stage (palliative surgery). The type of operation done depends on the size of the tumour, the exact site of the tumour in the larynx, and whether the cancer has spread to nearby structures or lymph glands. For example:

  • Endoscopic resection. This is a technique which can remove a small tumour in the larynx. Instruments are passed down the inside of the larynx which cut out a tumour. Sometimes a laser is used to burn out the tumour. This technique does not involve a cut from the outside. It is only suitable for tumours that are small and still confined to the inner lining of the larynx.
  • Partial laryngectomy. This is an operation where the affected part of the larynx is cut out. A cut is made in the front of the neck to get at the larynx. If only part of the larynx is removed you should not need a permanent stoma (hole in the neck) to breathe, and speech may be preserved. A temporary stoma may be required whilst the wound is healing.
  • A total laryngectomy. This is an operation where the entire larynx is removed. To be able to breathe after the operation, the top part of the trachea is attached to the front of the neck. You will then have a permanent hole (stoma) in the front of the neck. The vocal cords will have been removed so you will not be able to speak normally again.

Chemotherapy

Chemotherapy is a treatment which uses anti-cancer drugs to kill cancer cells, or to stop them from multiplying. Chemotherapy used in conjunction with radiotherapy is sometimes used as an alternative to surgery. It aims to preserve the larynx and normal speech. Your specialist will advise when this may be an option. Chemotherapy may also be advised if the cancer has spread to other areas of the body.

Other treatments

Cetuximab is a fairly new treatment for laryngeal cancer. It is a type of monoclonal antibody which means that it can recognise and bind to specific proteins (receptors) that are found in the cancer cells. These proteins are epidermal growth factor receptors (EGFRs) which stimulate the cancer cell to grow and divide.

What is the prognosis (outlook)?
If a cancer of the larynx is diagnosed and treated at an early stage then there is a good chance of a cure. A cure is less likely if the cancer has spread.


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