Laryngeal Cancer

Squamous cell carcinoma constitutes about 95% of laryngeal cancers. Rare laryngeal cancer forms - adenocarcinoma and sarcoma - account for the rest. The disease affects men about nine times more often than women, and most victims are between ages 50 and 65.

An intrinsic tumor is on the true vocal cords and tends not to spread because underlying connective tissues lack lymph nodes. An extrinsic tumor is on some other part of the larynx and tends to spread easily. Laryngeal cancer is classified by its location:

• supraglottis (false vocal cords)
• glottis (true vocal cords)
• subglottis (rare downward extension from vocal cords).

Causes

People who smoke or otherwise use tobacco are at risk of developing throat cancer. Excessive alcohol use also increases risk. Smoking and drinking alcohol combined lead to an extreme risk for the development of throat cancers.

Signs and Symptoms

The signs and symptoms of laryngeal cancer depend on the location of the tumour in the larynx. Having the following signs and symptoms does not necessarily mean you have laryngeal cancer. They could be caused by other problems, so see your doctor to be sure.

• hoarseness, especially if there is no infection
• trouble swallowing
• ear ache in one ear
• the feeling of a lump in the throat
• persistent sore throat or soreness on one side of the throat
• spitting up blood
• unplanned weight loss
• a lump in the neck
• bad breath
• persistent cough (usually a late symptom)

Diagnostic tests 

The usual work up includes laryngoscopy, xeroradiography, biopsy, laryngeal tomography and computed tomography scans, and laryngography to visualize and define the tumor and its borders. Chest X-ray findings can help detect metastases.

Treatment

Early lesions may respond to laser surgery or radiation therapy; advanced lesions to laser surgery, radiation therapy, and chemotherapy. Treatment aims to eliminate cancer and preserve speech. If speech preservation isn't possible, speech rehabilitation may include esophageal speech or prosthetic devices. Surgical techniques to construct a new voice box are experimental.

In early disease, laser surgery destroys precancerous lesions; in advanced disease, it can help clear obstructions. Other surgical procedures vary with tumor size and include cordectomy, partial or total laryngectomy, supraglottic laryngectomy, and total laryngectomy with laryngoplasty.

Radiation therapy alone or combined with surgery can create complications, including airway obstruction, pain, and loss of taste (xerostomia).

Chemotherapeutic agents may include methotrexate, cisplatin, bleomycin, fluorouracil, and lomustine.

Prevention

Minimize or avoid smoking and excess alcohol use.