Laryngeal cancer 2011

What is laryngeal cancer?

The larynx is located in the neck at the top of the windpipe (trachea) and is used when we talk, swallow and breathe. It's also called the voice box and is made up of cartilage - the large cartilage in the front is often called the Adam's apple. Inside the larynx are the vocal cords.

The larynx is made up of three main parts:

• The supraglottis - the tissue at the top of the larynx.
• The glottis - the middle part of the larynx where the vocal cords are located.
• The subglottis - the tissue at the bottom of the larynx that connects the larynx to the windpipe.

Cancer of the larynx, or laryngeal cancer, can develop in any of these parts, but most commonly develops on the vocal cords.

Causes and risk factors

The precise causes of laryngeal cancer aren't known. However, it's more common:

• On the vocal cords.
• In men.
• Between the ages of 55 and 65.
• In smokers.
• In those who drink alcohol heavily.

Symptoms

Symptoms of laryngeal cancer depend on where the cancer develops. Since it most often develops on the vocal cords, hoarseness or other changes in the voice are common.

Other symptoms that may occur when cancer develops above or below the vocal cords, or if it spreads from the vocal cords, include:

• A persistent sore throat.
• Ear pain.
• Noisy breathing.
• Difficulty swallowing.
• Difficulty breathing.
• A lump in the neck.
• Painful swallowing.
• A feeling of a lump in the throat.
• A persistent cough.

If the cancer spreads outside the larynx, the lymph glands in the neck may become enlarged.

If laryngeal cancer is suspected, the throat with be examined with a small, long-handled mirror or a fibre-optic light called a laryngoscope. If abnormal areas are seen, an examination under general anaesthetic (EUA) is carried out. This helps to map out the local spread of cancer to guide treatment. A biopsy is taken from suspected areas at this procedure. This is the only way of accurately diagnosing laryngeal cancer.

If cancer is detected, x-rays, a CT scan (or CAT scan) or magnetic resonance scan (MRI) may be used to establish the size of the tumour and whether the cancer has spread.

Treatment and recovery

Treatment of laryngeal cancer may involve:

• Radiotherapy - when high-energy x-rays are used to kill cancer cells.
• Surgery - this may involve the removal of a vocal cord (cordectomy), part of the larynx (partial laryngectomy) or the entire larynx (total laryngectomy) and lymph glands may also be removed (neck dissection). For early laryngeal cancers, laser therapy may be used.
• Chemotherapy - when drugs are used to kill cancer cells.

A team of experts is involved in caring for a person with laryngeal cancer. This team may include an ear, nose and throat (ENT) surgeon, a clinical oncologist, a medical oncologist, a specialist cancer nurse, a dietician, a dentist and a speech therapist. Following treatment, a person may need specialist help and advice with talking and breathing, especially if the whole larynx has been removed. Helping someone speak involves using a speaking valve inserted at time of surgery, using a special electronic device that generates sound or using the oesophagus (gullet) to speak.

Emotional help and support is also often needed following diagnosis and treatment.