Laryngeal Cancer

The larynx (voice box) is an organ at the front of the neck, between the base of the tongue and the windpipe, which is responsible for breathing, producing the voice and protecting the airway during swallowing. Laryngeal cancer arises when the cells lining this organ multiply uncontrollably. Because a change in the voice usually reveals it early, the treatment options are wider when it is caught in time.

What is laryngeal cancer?

The inner surface of the larynx, like that of the mouth and throat, is covered by a lining of flat cells. The great majority of laryngeal cancers arise from these cells and are called “squamous cell carcinoma”. The tumour is classified according to the part of the larynx in which it starts:

• The vocal cord region (glottis): the middle part, where the vocal cords lie; it is the most common site and causes hoarseness early on.
• Above the vocal cords (supraglottis): the upper part, including the epiglottis and its surroundings; symptoms may appear later.
• Below the vocal cords (subglottis): the transition to the windpipe; the rarest site.

Risk factors

Laryngeal cancer cannot be traced to a single cause, but certain habits and conditions clearly increase the risk:

• Cigarettes and other tobacco products are the most important and best-known risk factor.
• Regular, heavy alcohol consumption; combined with tobacco, the risk rises further.
• Long-term exposure to dust, fumes and chemical vapours in certain occupations.
• Long-standing, untreated acid reflux and constant straining of the voice.
• A diet low in vegetables and fruit.

Symptoms

The most common symptom is hoarseness that has not gone away for a few weeks. Other possible symptoms are a feeling of something stuck in the throat or of a foreign body, pain on swallowing, pain radiating to the ear, a persistent cough, noisy breathing and a swelling in the neck. None of these symptoms means cancer on its own, but when they persist, the cause needs to be clarified by an examination.

How is it diagnosed?

The first step in diagnosis is a direct inspection of the larynx by an ear, nose and throat doctor, using a mirror or a thin camera (endoscope). When a suspicious area is seen, a small tissue sample (biopsy) is taken, usually in a procedure performed under general anaesthesia, and the diagnosis is confirmed in this way. The depth of the tumour and the state of the lymph nodes in the neck are assessed with imaging methods such as computed tomography or magnetic resonance imaging.

Treatment options

Treatment is planned according to the site and stage of the tumour and your general state of health. In early-stage tumours, limited surgery that preserves the vocal cords or radiation treatment (radiotherapy) alone may be sufficient. In advanced stages, surgery, radiotherapy and drug treatment (chemotherapy) are used together. The aim of treatment is not only to remove the disease, but also to preserve breathing, swallowing and speech as far as possible.

When to see a doctor

If you have hoarseness lasting longer than a few weeks, a sore throat that does not go away, difficulty swallowing or a lump you can feel in the neck, and especially if you smoke, do not put off an ear, nose and throat examination. Early diagnosis both widens the treatment options and increases the likelihood of preserving the voice.