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Laryngeal Cancer

laryngeal cancer

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. When you breathe in, air passes into the larynx and down the trachea towards the lungs.

What is cancer of the larynx?

Cancer of the larynx is sometimes called laryngeal cancer. It is four times more common in men than in women.

There are different types of cancer of the larynx:

Squamous cell carcinoma. This type arises from cells which are on the inside lining of the larynx.

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. There are some other very rare types.

What causes cancer of the larynx?

It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiplies out of control.

 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, especially a 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. 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.

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 fibreoptic laryngoscope). This is passed into your nose and down the back of your throat.

To confirm the diagnosis

If anything suspicious is seen by the examination 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).

Grade of the cancer

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

Grade 1 (low grade). The cells look reasonably similar to normal cells in the larynx. 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 alone gives a good chance of a cure if the cancer is at an early stage. Radiotherapy is also sometimes used in addition to surgery or chemotherapy in certain situations

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 operations are all done under a general anaesthetic.

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 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. However, there are various techniques that you can be taught by a speech therapist which can enable you to make sounds and speak in a different way.

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.

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.

What is the prognosis?

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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