Cancer of the larynx

The larynx is the top part of the throat which contains the vocal cords, muscles, tissues and cartilage. It is located at the top of the trachea and enables us to produce sounds, sing and speak.

But like any part of the body it can develop cancer although some people are at a greater risk than others.

What is the main reason for this? In a word: their lifestyles.

Causes of cancer of the larynx

Cancer can develop for any number of reasons which makes it difficult to pinpoint an exact cause. There are so many factors involved as well as some factors which we might not be aware of.

What has been proved is that smoking and drinking alcohol are most likely to cause cancer of the larynx. You are at increased risk if you smoke or if you consume excess amounts of alcohol but this risk is doubled if you do both.

So if you enjoy a cigarette with your drink then be aware that this is increasing your risk of developing this cancer.

This type of cancer affects middle aged and older people and men more than women. But people who started smoking at a young age, for example their teens are also at an increased risk of developing cancer of the larynx.

Other causes include:

• Contact with certain chemicals such as paint fumes or coal dust.
• Acid reflux
• Poor/unhealthy diet
• Human papilloma virus (HPV): this can cause an infection of the larynx which may increase the risk of cancer.
• Family history
• Compromised immune system, e.g. HIV

Symptoms of cancer of the larynx

These will depend upon the site of the tumour (or tumours). If the tumour has grown on or around the vocal cords then the first sign of anything wrong is a change in the tone of the voice. One example of this is hoarseness.

Other symptoms include:

• Feeling of a lump in the throat
• Noticeable sign of a lump in the throat (this can be seen)
• Pain in the ears or neck
• Difficulty in swallowing
• Bad breath
• Weight loss
• Persistent cough or a shortness of breath

An earache is another sign although this is very rare.

In most cases the tumour develops on the vocal cords. They are not usually painful but they can change the quality of the voice. Breathing sounds noisy and laboured.

If you notice any of these symptoms then consult your GP as soon as possible. They may not be the sign of laryngeal cancer but it is important that they are investigated in order to rule this out.

Diagnosing cancer of the larynx

Your GP will examine your throat (and larynx) as well as asking you about your medical history. He or she will then refer you to a specialist for further investigation.

This will involve a series of tests and X-rays/CT/MRI scans. These tests may include any of the following:

• Endoscopy
• Nasendoscopy
• Transnasal oesophagoscopy
• Fine needle aspiration

(Source: Cancer Research UK: laryngeal cancer)

Endoscopy

Endoscopy involves the insertion of a tube with a camera and light at one end and an eyepiece at the other into the throat. This is designed so that the specialist is able to have a closer look at your larynx. The specialist may also perform a biopsy (small section of tissue).

Nasendoscopy

Nasendoscopy is very similar to endoscopy in that you have a slim tube passed up your nose and down into your throat to enable a close examination of your larynx.

Transnasal oesophagoscopy

Transnasal oesophagoscopy is a relatively new test which may be performed instead of an endoscopy. It also involves the insertion of a tube although this one has a digital video camera as well as a light at one end. This results in clear, detailed images of the larynx and opening to the oesophagus.

Fine needle aspiration

Fine needle aspiration is performed if you have a noticeable lump in your neck. The specialist will insert a fine needle into this lump to draw off cells and liquid. This sample of cells is then sent to a laboratory for analysis.

You may undergo additional tests such as an ultrasound scan or a PET-CT scan.

What happens after these tests?

Once you have undergone these you will then have to wait for the results. This can take a week or so but waiting does not mean that you have a negative result –as in a diagnosis of cancer. The period of waiting is the same for positive and negative results.

You will be asked to return to the hospital when these results are available and to discuss your treatment options. This may require you to attend a clinic where you will meet with cancer specialists and surgeons to discuss your treatment.

If a cancer diagnosis has been confirmed then a treatment plan will be formulated and discussed with you. This is understandably, a stressful and upsetting time so you may wish to talk to a friend, family member or a counsellor.

Some people find it helpful to contact a cancer support group where they can meet and talk to others who have been through this and understand what it feels like. This type of group can offer advice and support.

Your specialist will also discuss your outlook or prognosis: this means your chances of recovery now and in the long term. This will depend upon the stage of your cancer or in other words, how advanced it is.

Early stage cancers of the larynx have a better prognosis than those diagnosed at a later stage.

Treatment for cancer of the larynx

Your treatment options will be explained to you by a multidisciplinary team. They will discuss the advantages and disadvantages of all options with you.

There are three types of treatment for cancer of the larynx which are:

• Surgery
• Radiotherapy
• Chemotherapy

Surgery

This is performed on larger tumours which would not be suitable for radiotherapy. The size of your tumour or tumours will determine the extent of the surgery.

This can include using a laser to kill small tumours or stop the spread of a tumour: or the partial removal or the full removal of the growth. You will also have some of your lymph nodes in that area excised as well.

Your voice will be affected if the whole of your larynx is removed. This may not return to normal although your medical team will suggest ways of dealing with this.

Radiotherapy

This is used when the tumours are small, especially those on the very early stages. This is the most common form of treatment for cancer of the larynx and uses high powered x-rays t do so.

In some cases this is combined with chemotherapy.

Chemotherapy

Chemotherapy is based upon a cocktail of drugs which is designed to destroy cancer cells. This is often performed after surgery or in combination with radiotherapy.

If it is used with radiotherapy then the format is as follows:

• Chemotherapy is undertaken before surgery to help shrink the tumours.
• Chemotherapy is combined with radiotherapy

Another option is biological therapy in which you are given a substance, e.g. a type of antibody which can block those areas on the surface of cancer cells which encourage further growth.

Basically, this biological therapy tells the cancer to stop growing.