Laryngeal Cancer
Learn about laryngeal cancer
Laryngeal Cancer (or larynx cancer) starts in the lower part of the throat.
Known as the ‘voice box’ because it contains our vocal chords, the larynx sits above the opening of our trachea (our windpipe) where it helps to keep food and fluids from entering our respiratory system.
Laryngeal cancer is approached differently according to the part of the larynx that is affected:
- The subglottis (the area below the vocal chords)
- The glottis (the area containing the vocal chords)
- Or the supraglottis (the area just above the vocal chords which manages the function of closing off the larynx to food and fluids).
The hypopharynx is a structure at the entrance to the oesophagus, close to the larynx. It helps to ensure food goes around the larynx and into the digestive system. When this particular organ gets cancer it is called hypopharyngeal cancer.
Almost all cancers in the larynx begin as a pre-cancerous condition called dysplasia. Most pre-cancers don’t cause symptoms, and will often disappear without any treatment, especially if the causal trigger (such as smoking) ceases. When they do go on to form invasive cancers, they are usually always squamous cell carcinomas, which start in the skin-like cells lining the larynx.
Symptoms for larynx cancer will differ depending on the area of the structure that is affected.
For example, if the glottis (vocal chords) are cancerous, the patient will experience hoarseness or a change in voice.
If this is where the cancer has started, these symptoms can lead to the cancer being detected at an early stage, with a greater chance of cure. Cancers that start in the other areas of the larynx usually do not cause changes to the voice, until the cancer spreads to the vocal chords. Symptoms of these cancers usually include:
- Soreness in the throat
- Pain or difficulty in swallowing
- Breathing difficulties and/or constant coughing
- Weight loss
- Ear pain
If the cancer spreads to the lymph nodes, a lump or mass in the neck might appear.
Since many of these symptoms are common to other health conditions, it is important to consult with your doctor for a thorough diagnosis.
As with other cancer types, treatment options for laryngeal cancer will depend on the size and spread of the cancer.
Diagnosing Laryngeal Cancer
If there is a possibility of laryngeal cancer, an ear, nose and throat (ENT) specialist will investigate.
An investigation of the larynx can either be:
- Direct (using a fibre-optic lighted tube inserted through the mouth or nose to directly locate and examine the larynx)
- Indirect (using small mirrors to view the larynx and surrounding areas).
Neighbouring areas of the head and neck will also be examined due to the close proximity of these regions and the chance that the cancer might have spread.
If deemed necessary, patients might be submitted for a full ‘panendoscopy’. This involves a thorough examination of the larynx, hypopharynx, oesophagus and trachea (windpipe).
Unlike the procedures above, which can be conducted with a simple local anaesthetic, the panendoscopy is conducted in an operating room, under a general anaesthetic. It is easiest to obtain a biopsy of the affected area while under general anaesthetic, due to the location of the regions, deep in the neck and throat.
Fine needle biopsies of the lymph nodes might also be conducted to help diagnose the spread of the cancer, and imaging tests such as x-rays or MRIs might also be used.
Laryngeal Cancer Treatment
Early stage laryngeal cancers are almost always glottic, detected through the symptomatic changes to the vocal chords. Curing patients at this stage of laryngeal cancer is very possible through vocal chord stripping, laser surgery or radiation therapy, provided any damaging behaviours like smoking are ceased.
A Stage I or II laryngeal cancer, whereby the cancer has spread will usually use radiation or a partial laryngectomy to eliminate the cancer. Supraglottic cancers are more likely to spread to the neck lymph nodes, so for these cancers, often the nodes will be removed or treated (through radiotherapy) as well.
If the cancer is found at a later stage (Stage III or IV) a combination of surgery, radiation and/or chemotherapy will be advised. Many specialists will prefer to tackle the cancer first with radiotherapy and chemo, due to the extreme nature of the surgical options. If surgery is required, either a partial or total laryngectomy will be used to remove the cancer from the area. A laryngectomy involves the removal of the larynx and the separation of the airway from the mouth, nose and oesophagus. An opening in the neck, or ‘stoma’ is created through which the patient will breathe.
Important risk factors for laryngeal cancer are:
- Tobacco use
- Excessive alcohol use
- Exposure to dangerous chemicals
The human papillomavirus has also been connected with laryngeal cancers.