An Overview of Laryngeal Cancer

Laryngeal cancer is a type of cancer that affects the larynx, the organ we commonly know as the voice box. Around 12,500 Americans are diagnosed with laryngeal cancer each year, of which an estimated 3,500 will die of the disease. 

Anatomy

The larynx contains the vocal cords and is divided into three parts:

1. the glottis, the true vocal folds, around which 60 percent of cancers develop
2. the supraglottis, situated above the glottis, where 35 percent of cancers occur
3. the subglottis, situated just below the glottis

The location of a tumor can produce different symptoms and require different treatment approaches.

Symptoms

One of the most common symptoms of laryngeal cancer is a persistent hoarseness of the voice. A hoarseness that does not go away after two weeks should be reported to your healthcare provider. While the condition can be caused by anything from seasonal allergies to laryngitis, the persistence of hoarseness should always be of concern whatever the cause.

Other symptoms can include:

• difficulty swallowing (dysphagia)
• pain or burning when swallowing
• the sensation of food being stuck in your throat
• a persistent cough unrelated to a cold or allergy and lasting for more than eight weeks
• a lump on the neck around the voice box
• sore throat
• earaches
• choking on food
• persistent bad breath (halitosis)
• unintentional weight loss of more than five percent within a 12-month period

Tumor size and location are the greatest factors in determining which symptoms a person may experience. If a tumor develops in the vocal cords, a change in voice and hoarseness is common. When tumors develop above or below the vocal cords, different symptoms such as an earache or breathing difficulties may occur.

Risk Factors

While we don't know the exact cause of laryngeal cancer, we do know what the most common risk factors are. Laryngeal cancer is one of the many types of cancer related to smoking.

While it can occur in non-smokers, the evidence has strongly placed cigarettes as the single, highest risk factor for the disease. Smoking and heavy alcohol consumption together increase the risk even further.

Among the other key factors:

• older age (45 and above)
• male gender (due in part to higher rates of smoking in men)
• a history of head and neck cancer (including exposure to head or neck radiation)
• heavy alcohol use
• occupational exposure to asbestos, coal, or formaldehyde
• diets high in meat and/or processed meat
• genetics and family history
• immune suppression, including organ recipients and people with HIV
• race (with more African Americans getting laryngeal cancer than whites)

GERD, HPV, and Laryngeal Cancer Risk

Some studies have linked laryngeal cancer to gastrointestinal reflux disease (GERD). While the association is still considered controversial, even the American Cancer Society has eluded to the impact of persistent acid reflux on laryngeal cancer.

Similarly, the human papillomavirus (HPV), a virus linked to over 95 percent of cervical cancer cases, may also increase the risk of laryngeal cancer. While some groups consider the risk low, other studies have shown that 25 percent of laryngeal carcinomas harbor HPV infection (including high-risk HPV types 16 and 18).

Diagnosis

Laryngeal cancer is diagnosed by first performing a physical exam to feel for any lumps in the neck. To get a better look inside, the healthcare provider may recommend either an indirect or a direct laryngoscopy:

• An indirect laryngoscopy involves a long-handled instrument with a mirror that is inserted into your mouth to get an indirect look at your larynx.
• In a direct laryngoscopy, a tissue sample (biopsy) may be taken if anything suspicious is found. This procedure is done under general anesthesia so that the entire area can be well inspected.

Other investigative techniques include magnetic resonance imaging (MRI), computerize tomography (CT scan), an X-ray barium swallow, or positron emission tomography (PET scan).

Staging

If cancer is found, your healthcare provider will aim to identify the size and extent of the cancer. This is a process called staging. The stage of laryngeal cancer will help determine the treatment approach most appropriate for you as an individual.

Healthcare providers do this by first using the TNM system. In this system:

• T stands for tumor and represents the size of your tumor ranging from T1 (affecting a smaller portion of the larynx) to T4 (spreading beyond the larynx).
• N stands for lymph node and represents how much cancer is present in your lymph nodes ranging from N0 (no cancer) to N3 (spreading beyond the lymph nodes). 
• M stands for metastasis and represents how far the cancer has spread (metastasized) to distant organs ranging from M0 (no metastasis) to M1 (metastasis).

Based on this evaluation, your cancer would then be given a stage:

• Stage 0 (or carcinoma in situ) are cancers considered non-invasive.
• Stage I are cancers located on one part of the body.
• Stage 2 are cancers that are localized but advanced.
• Stage 3 are cancers that are also localized and advanced but considered more serious.
• Stage 4 are cancers that have metastasized. 

Treatment

Surgery and radiation therapy are the standard methods of treatment for laryngeal cancer. These can include the following surgical procedures:

• total laryngectomy, the surgical removal of the entire larynx (which may leave the person unable to speak without a mechanical device)
• partial laryngectomy involving the surgical removal of the affected area of the larynx
• supraglottic laryngectomy involving the surgical removal of the larynx above the vocal cords
• cordectomy involving the surgical removal of one or both of the vocal cords

Other procedures include:

• radiation therapy is given either as a primary treatment or used after surgery to eliminate any remaining cancer cells 
• lymph node dissection involving the surgical removal lymph nodes near the site of the malignancy
• chemotherapy typically used as either a neoadjuvant therapy (to shrink a tumor before surgery) or adjuvant therapy (to clear up any remaining cancer cells after surgery)

Outcomes can vary from person to person. The general rule of thumb is that the earlier you are diagnosed and treated, the greater chance you will have of being cured. Early-stage disease includes stage 1, 2, and 3 cancers.

Coping

Being diagnosed with cancer can turn your life upside down even in earliest stages of the disease. Ask for help, and allow people to help you. Reach out to others. Consider joining a cancer support group whether at a community center or online.

Medicine is rapidly changing and becoming your own advocate not only helps you feel more in control, it can help you make better decisions about your health. This includes the types of treatment you choose.

Deciding whether to have surgery—or even the extent of your surgery—is a very personal choice. The quality of life can be affected, so it's important to spend as much time learning about your disease and what it takes to cure it. The most important thing is to make an informed choice based on your best understanding of your options.