OMS Doctor performing a Laryngeal cancer exam

The Centers for Disease Control and Prevention (CDC) reports that cancer is the second leading cause of death in the United States, taking nearly 600,000 lives annually. It’s essential to understand that it is a collection of over 100 related conditions and not just one disease. Laryngeal cancer accounts for 1.8 percent of all deaths collectively with other pharynx and oral cavity cancers.

What Is Laryngeal Cancer?

First, let’s begin with where it occurs in the body. You can think of it as larynx cancer since that is where it starts. The larynx or voice box is located below your throat on top of your windpipe. It consists of three primary divisions, including:

  • Supraglottis
  • Glottis or vocal cords
  • Subglottis

This organ plays a vital role in breathing, swallowing, and speech. About 60 percent of laryngeal cancer cases occur in the glottis. However, the majority of occurrences are detected in the earliest stages when the disease has a 90 percent survival rate. Likely, its function in speech makes the initial symptoms more noticeable.

Other laryngeal cancer types include supraglottic cancer which occurs in the region above your vocal cords and subglottic cancer, which starts below this structure.

The latter is the rarest form.

Symptoms of Laryngeal Cancer

Early signs of this type of throat cancer include a persistent cough. On its own, it’s not diagnostic of the disease. It typically occurs with other noticeable laryngeal cancer symptoms such as voice changes, ear discomfort, and a sore throat that doesn’t go away. They make it more apparent that something else is wrong.

As cancer progresses, the individual may develop difficulty swallowing and weight loss. These signs may indicate that it has begun to spread to nearby tissues or other organs.

Risk Factors for Laryngeal Cancer

Several things can affect your chances of getting laryngeal or any other type of cancer. Genetics may heighten your risk. Exposure to carcinogens can cause cell mutations. You may have a predisposition to trigger the disease sporadically due to environmental factors.

There were over 13,000 new cases of laryngeal cancer in 2018 with about 3,700 deaths. Almost 80 percent occurred in men.

Excessive alcohol consumption and tobacco use in any form are the primary risk factors not only for laryngeal cancer by all types affecting the head and neck regions. Nearly all cases of the disease involve smokers.

Researchers have found several other possible influences. Some are things you can’t control. White and black individuals, for example, are more likely to develop this condition than those of other races. Age also increases your risk.

There are also things you can change. You can include plenty of fruits and vegetables in your diet to ensure that you get adequate amounts of vitamins A and E. You can limit your exposure to known cancer-causing agents like tobacco smoke and asbestos. You can also practice proper oral hygiene to lower your risk.

Specific laryngeal cancer causes are not clear. However, researchers have determined an association with these factors.

Laryngeal Cancer Diagnosis

Diagnosis usually begins with a physical examination of the patient’s mouth and throat. Another telltale symptom of the disease is a sore or lump that doesn’t heal normally. If the doctor detects something, the next step is a biopsy.

Collection of the sample is possible with an endoscopy or laryngoscopy. The former examines the trachea and esophagus as well to determine if there are any other areas of concern. The latter focuses on the larynx with the use of a scope. Either way, the procedure will help identify abnormal cells, which are the hallmark of cancer.

The physician follows up these initial tests with other imaging. An x-ray can’t detect changes in soft tissue, making other diagnostics necessary. They may include computed tomography or a CT scan. She may also order magnetic resonance imaging or MRI. Both provide more details and a clearer picture of the affected organ and surrounding area for the next step, staging.

Laryngeal Cancer Staging

This part of the diagnosis is crucial for determining the course of treatment and prognosis. They are dependent on four primary factors, including:

  • Progression of the disease
  • Tumor location and size
  • Tumor’s grade
  • State of the patient’s overall health

Your medical team will use a system called TNM for coming to a final analysis of the diagnosis. The acronym stands for:

  • T for tumor
  • N for node, referring to lymph nodes
  • M for metastasis

Tumor

This part of the system grades the tumor with a number and sometimes a letter, depending on the location or spread. It varies with the specific structure of the larynx.

Node

One way that cancer of any type can spread is through the lymph system, referred to as an extranodal extension (ENE). Its assessment, therefore, is an essential part of the process. It also uses a number-letter system based on clinical findings or those observed during laryngeal cancer surgery.

Metastasis

This final part indicates whether cancer exists in other parts of the patient’s body. It is simply a zero for no and number 1 for yes. Then, the team can stage the disease from 0 to 4, with subgroups under the non-zero numbers.

Laryngeal Cancer Surgery and Treatment

Head and neck surgery is often a part of the treatment to remove the cancerous growth physically for larger tumors. The procedure depends on the structure affected and can include part or all of the larynx.

A surgical team can use endoscopy to treat early-stage cancer that is superficial. The doctor may opt to perform a laryngectomy which may or may not retain the patient’s ability to speak. A tracheotomy follows the removal of the entire larynx to restore breathing.

Adjuvant therapy will follow to prevent a recurrence. Depending on the stage and spread, the medical team may elect to use either external radiation or chemotherapy.

External Radiation

This process involves the use of a focused beam of high-energy radiation at the site of the tumor. If it has spread, the team may also opt for brachytherapy or internal radiation to place radioactive substances at the source. It is often the treatment of choice if your doctor caught laryngeal cancer early.

Chemotherapy

Chemotherapy is administered orally, through an IV, or by injection directly into the site to kill cancer cells. The medical team may use it alone or with radiation to increase its effectiveness. However, the combination of the two may increase the patient’s risk of side effects.

Rehabilitation

Patients can expect some challenges after treatment.  Rehabilitation will focus on regaining any abilities compromised by the procedures, relieving pain, and preventing other complications. Regular follow-up care is imperative. It may include periodic testing and imaging. Your doctor may also order blood tests to monitor the functionality of any other affected organs.

It will invariably include lifestyle changes such as cessation of smoking and drinking alcohol. Doing so will help prevent a recurrence of laryngeal cancer.

Laryngeal Cancer Survival Rate

The five-year survival rate of this disease is encouraging at 65.3 percent. Location and the stage are critical factors. The percentages for advanced subglottic and supraglottic are 32 and 34 percent, respectively.

Fortunately, research is underway to develop targeted drugs to improve the figures and the patients’ quality of life. And efforts to reduce tobacco use will undoubtedly have a positive impact on reducing new cases in the future.

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