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by Alan R

Laryngeal Cancer

(Cancer of the Larynx; Cancer of the Voicebox )

Definition

Laryngeal cancer is a disease in which cancer cells grow in the larynx. The larynx is a tube-shaped organ inside the neck that lies between the throat and the windpipe. Its main function is to produce sound for speaking.
The Larynx
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Causes

Cancer occurs when cells in the body divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues. Cancer that has invaded nearby tissues can then spread to other parts of the body.
It is not clear exactly what causes these problems in the cells, but it is probably a combination of genetics and environment.

Risk Factors

Laryngeal cancer is more common in men, and in people over 55 years old. It is also more common in African Americans. Other factors that increase your chance of getting laryngeal cancer include:
  • Smoking—the most common high-risk behavior
  • Excessive use of alcohol
  • Occupational exposure to certain air pollutants such as wood dust, chemicals, and asbestos
  • Gastroesophageal reflux (GERD)—chronic condition marked by stomach acid that backs up into the esophagus and throat where it may come in contact with the larynx
  • Weakened immune system
  • Laryngeal dysplasia—a precancerous condition

Symptoms

Laryngeal cancer may cause:
  • Persistent cough, hoarseness, or sore throat
  • Abnormal lump in the throat or neck
  • Difficulty swallowing
  • Pain when swallowing
  • Frequent choking on food
  • Difficulty breathing
  • Noisy breathing
  • Persistent ear pain or an unusual ear fullness or sensation in and around the skin of the ear
  • Unplanned, significant weight loss
  • Persistent bad breath
  • Coughing blood

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.
Your bodily tissue may need to be tested. This can be done with biopsy.
Imaging tests evaluate the larynx and other structures. These may include:

Treatment

When laryngeal cancer is found, staging tests are performed to find out if the cancer has spread and, if so, to what extent. Treatment depends on the stage of the cancer. For early stage laryngeal cancer, either surgery or radiation therapy alone are the most common and appropriate therapies offered. For more advanced disease, either radiation therapy with chemotherapy, or surgery followed by radiation therapy are most the common.
Treatment includes:

Surgery

Surgery requires removal of a cancerous tumor and nearby tissue, and possibly nearby lymph nodes. Surgeries for laryngeal cancer include:
  • Total laryngectomy—This involves the removal of the larynx, including the vocal cords.
  • Partial laryngectomy—In this procedure, the surgeon removes the cancerous tissue while leaving as much of the vocal cords as possible.
  • Tracheotomy—To help with breathing, a hole is made in the neck below the larynx. This may be temporarily necessary after surgery, or permanently placed in the case of laryngeal tumors that are too large to be removed.
  • Neck dissection—This involves the removal of the lymph nodes and part of the neck muscles to determine the spread of cancer.

Radiation Therapy

Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. This may be external radiation therapy, where the beam is directed at the tumor from a source outside the body.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. This form of treatment may be given in many forms including pill, injection, and catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells. Chemotherapy may be used to reduce the size of a particularly large cancer.

Prevention

Since laryngeal cancer is extremely rare in nonsmokers, the best way to prevent this type of cancer is by not smoking. Other measures you can take to reduce your risk of laryngeal cancer include:
  • Avoiding excessive alcohol use
  • Protecting yourself from toxic exposures that have been linked to laryngeal cancer
  • Get or maintain GERD treatment

RESOURCES

American Cancer Society http://www.cancer.org

National Cancer Institute http://www.cancer.gov

CANADIAN RESOURCES

BC Cancer Agency http://www.bccancer.bc.ca

Canadian Cancer Society http://www.cancer.ca

References

Laryngeal and hypopharyngeal cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003108-pdf.pdf. Accessed August 14, 2014.

Berkow R. The Merck Manual of Medical Information. New York, NY: Pocket; 2000.

General information about laryngeal cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/laryngeal/healthprofessional. Updated July 31, 2014. Accessed August 14, 2014.

Head and neck cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 13, 2014. Accessed August 14, 2014.

2/3/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Weller MD, Nankivell PC, McConkey C, Paleri V, Mehanna HM. The risk and interval to malignancy of patients with laryngeal dysplasia; a systematic review of case series and meta-analysis. Clin Otolaryngol. 2010;35(5):364-372.

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