Laryngeal Cancer

General and more comprehensive text about cancer diseases, their behavior, causes and treatment can be found here.

 

Laryngeal cancer (less accurately known as a throat cancer) involves, as the name suggests, the wall of the larynx. The larynx is anatomically the uppermost part of the respiratory tract located between the nasopharynx and trachea. From the nasopharynx, larynx is divided by a so-called laryngeal flap (epiglottis), which opens during speech and breathing and closes during swallowing to prevent the aspiration of fluids or food. The larynx contains two vocal cords - special ligaments vibrating with exhaled air. The vibration forms sound, which is the basis of our speech.

Causes

There are two important risk factors - smoking and drinking alcohol. Cigarette smoke irritates the lining of the larynx and this can in long-term cause formation of malignant tumor. Chronic alcoholism is also an important factor, especially when regularly drinking hard liquor. As the alcohol does not come to a close contact with laryngeal mucosa, its effects will be probably rather indirect.

Symptoms

The laryngeal tumors can occur in three places. Most (almost two thirds) tumors are located above the vocal cords, about a third can be found in the level of vocal cords and only minimal number of cases grows from mucosa under the vocal cords. Due to the close anatomical relationship to the vocal cords, the first symptom is usually chronic hoarseness (lasting for weeks). Other possible symptoms include breathing problems, difficulty in swallowing, pain during swallowing and sore throat. Locally spread tumors may cause painless enlargement of lymph nodes in the neck.

Prevention

The best way to decrease the risk of this tumor is to not smoke and avoid alcohol.

Diagnosis

The diagnosis can be done by otolaryngologic examination. When possible, the otolaryngologist can try to take sample of tumor tissue for histological examination. The size and local extent of the tumor may be evaluated by computed tomography.

Treatment

The treatment is similar to other forms of cancer. Early detection of the tumor is essential as it increases the chance of a successful surgical intervention. The surgeons may try to preserve the voice, but this is not always possible. Larger curative surgical interventions include removal of the tumor mass, vocal cords and surrounding anatomical structures including a part of windpipe an create a breathing hole in front of the neck (permanent tracheostomy). Chemotherapy and radiotherapy are rather means of supportive treatment. These methods can not cure the patient, but they may decrease the size of tumor, or destroy small local or distant metastases.

 

Even a surgical intervention with removal of vocal cords does not always mean a total loss of voice. With some practice, it is possible to create a voice without the vocal cords. Other option is an artificial larynx, which is a small cylindrical device helping to form vibrations by the exhaled air. The outcome is a “robot-like” voice, which is, however, quite well understood.

 

If we are concerned that the tumor growth is soon going to disrupt the patient's ability to eat, we can consider introduction of a special hose into the stomach through the abdominal wall. This feeding tube is also known as PEG (percutaneous endocopic gastrostomy) and it allows feeding the patient with nutrient-rich liquids.