Laryngeal Cancer

Laryngeal Cancer Overview

Laryngeal cancer is a type of head and neck cancer that starts in the larynx, which you might know as the voice box. This small but vital part of your throat does a lot for you—it helps you talk, breathe, and swallow. Cancer of the larynx means that some cells have started to grow uncontrollably and, if left untreated, can cause problems with talking, breathing, and swallowing. This cancer can also spread to other parts of the body in a process known as metastasis, causing issues in other organ systems.

While we don’t always know precisely why a person develops laryngeal cancer, some factors can increase your risk:

• Smoking and tobacco use: Smoking or using tobacco, in any form, can significantly increase the chance of developing laryngeal cancer.
• Heavy drinking: Significant consumption of alcohol also plays a role, especially when combined with smoking.
• Chemical and substance exposure: Contact with materials like asbestos over time can increase risk.
• Human papillomavirus (HPV): Infection with HPV may increase your risk of developing laryngeal cancer.

Laryngeal cancer symptoms can vary but often include changes in your voice (like hoarseness), a persistent cough, trouble swallowing, or a lump in the front of your neck. You should consider seeing a doctor if you notice any of these, especially if they’ve lasted over a few weeks.

Your doctor may want to conduct a laryngoscopy for suspected laryngeal cancer. Laryngoscopy is a procedure that allows healthcare professionals to get a closer, more detailed look at the tissue in your voice box. If this tissue looks concerning, your doctor may want to perform a biopsy. This involves taking a small sample of the tissue in question and looking at it under a microscope to check for cancerous cells. Imaging tests, like MRI, CT scans, or PET Scans, may be used to see if the cancer has invaded the surrounding tissue or spread to other sites.

Treatment depends on the cancer’s stage, your overall health, and what you feel comfortable with. These options can include surgery to remove the tumor, radiation therapy to destroy or shrink it, and chemotherapy to kill the cancerous cells using specialized medicines.

Treating laryngeal cancer can affect your voice and sometimes your ability to speak or swallow. Rehabilitation, like speech therapy, is a vital part of recovery. It’s also essential to have support—whether it’s your healthcare team, support groups, or family and friends.

Anatomy of the Throat

The throat is a tube wrapped in muscle that starts behind your nose and mouth and extends down the neck to the larynx (or voice box). You use it to bring air into your lungs and food into your stomach.

It includes the orpharynx:

• The back of your nose and mouth
• Soft part of the palate/roof of your mouth
• Tonsils
• The back third of the tongue

And also:

• Epiglottis (the flap that prevents solids and liquids from entering your windpipe)
• Voice box (larynx)
• Windpipe (trachea)
• Esophagus

Symptoms of laryngeal cancer include:

• Hoarseness or changes in your voice that persist for more than two weeks. This is often one of the first signs people notice.
• A lump or swelling in your neck. This can be a sign that cancer is present or that it has spread to lymph nodes.
• Difficulty swallowing or a feeling that something is stuck in your throat. You might feel discomfort or pain when swallowing food or liquids.
• A persistent sore throat or cough that doesn’t go away. These symptoms may be accompanied by pain.
• Breathing difficulties. This might include feeling short of breath or experiencing noisy breathing (stridor).
• Ear pain. This symptom might not be directly related to the ear but could indicate cancer spreading in areas around the larynx.
• Unintended weight loss. Losing weight without intent can be a sign of various cancers, including laryngeal cancer.

Conditions that are not cancer can also cause these symptoms. For example, a persistent cough or changes in your voice could be due to a viral infection or laryngitis. If you’re experiencing any of these symptoms–especially if they’ve lasted for more than two weeks–it’s essential to see a doctor. They can help determine the cause and, if necessary, start the appropriate treatment.

Diagnosis

Diagnosing laryngeal cancer involves several steps to accurately understand what’s happening in your larynx or voice box. We aim to make this process as smooth and straightforward as possible. Laryngeal cancer is typically diagnosed using the following:

1. Medical History and Physical Examination: Your doctor will begin by discussing your medical history and symptoms. This conversation helps to understand your risk factors and the symptoms you’re experiencing. Then, your doctor will perform a physical exam, which includes looking at your throat and feeling your neck for any lumps or swelling.
2. Laryngoscopy: Laryngoscopy allows us to look directly at your larynx. There are different types of laryngoscopy procedures:
   
   Indirect laryngoscopy uses a small mirror positioned at the back of your throat. Your doctor will shine a light in your mouth to see the mirror’s reflection of your larynx.
   
   Flexible laryngoscopy is usually done in the office if you are not a good candidate for indirect laryngoscopy.  Your doctor will use a small flexible fiber optic scope that is passed through your nose to see your larynx.
   
   Direct laryngoscopy is usually done under general anesthesia. Your medical team will use a laryngoscope, a thin, flexible tube with a light and camera, to see your larynx more clearly. This method allows your doctor to examine areas that are harder to see and take small tissue samples if needed.  Sometimes this can be paired with a microscope and a laser to remove tumors or cancers.
   
3. Biopsy: If any unusual areas are seen during the laryngoscopy, a biopsy may be taken, which means removing a small piece of tissue from your larynx. This sample is then examined microscopically to check for cancer cells. A biopsy is the only certain way to diagnose cancer.
4. Imaging Tests: Depending on the biopsy results and the extent of the cancer suspected, your doctor might recommend imaging tests like CT scans, MRIs, or PET scans. These tests help us see if the cancer has spread beyond the larynx and plan the best treatment approach.

After these diagnostic steps, if laryngeal cancer is confirmed, your doctor will discuss your best treatment options. The treatment plan will consider the stage of the cancer, your overall health, and your preferences.

Treatments for Laryngeal Cancer

If you have diagnosed with laryngeal cancer, the next step is to talk about your treatment options. The best approach for you will depend on several factors, including the stage and location of the cancer, your overall health, and your preferences.

Transoral Surgery: For smaller tumors, we aim to remove cancer while keeping as much of the voice box intact as possible. This is often done through the mouth with either a microscope and a laser (transoral laser microsurgery, or TLM) or a robot (transoral robotic surgery, TORS).

Partial laryngectomy: This is an open operation that involves removing part of the larynx. You might still be able to speak after this surgery, but your voice might sound different.

Total laryngectomy: Removing the entire larynx might be necessary for larger or more aggressive cancers, or those cancers that did not respond to non-surgical treatment. This involves removal of the entire larynx (voice box) and often may require reconstructive surgery to be done at the same time.  Total laryngectomy will change the way you breathe and speak, and your care team will work with you on rehabilitation and adapting to these changes.

Radiation Therapy

Radiation therapy uses high-energy rays to target and kill cancer cells. It can be used as a primary treatment for early-stage laryngeal cancer. It can also be used after surgery to kill any remaining cancer cells or to reduce symptoms and improve quality of life if your laryngeal cancer is advanced.

Chemotherapy

Chemotherapy involves using drugs to kill cancer cells. It’s often used in combination with radiation therapy, especially for cancers that can’t be entirely removed by surgery or to shrink the tumor before surgery.

Targeted Therapy

Targeted therapy drugs target specific abnormalities in cancer cells. For laryngeal cancer, this type of treatment might be combined with chemotherapy and radiation therapy, especially if the cancer is advanced.

Immunotherapy

Immunotherapy is a type of cancer treatment that works by boosting the immune system’s ability to fight cancer cells. It helps your body to recognize and attack cancer cells more effectively. It might be an option for you if laryngeal cancer has advanced or returned after other treatments.

Rehabilitation

Depending on the treatment, you might need help with speaking and swallowing afterward. Our team includes speech and language therapy specialists, nutritionists, respiratory therapists, and other support services to help you adjust and maintain your quality of life.

Making a Decision

Choosing the right treatment plan is a potentially life-changing decision that you’ll make together with your care team and your loved ones, considering the benefits and potential side effects of each option. The aim is to treat your cancer effectively while preserving as much of your normal function and quality of life as possible.