Laryngeal (larynx) cancer is a type of cancer affecting the vocal cords that is especially common in men. The most important cause is tobacco and alcohol use. Poor nutrition, vitamin deficiency and genetic predisposition are the other risk factors. It is possible to prevent laryngeal cancer by exercising a healthy life-style and balanced diet. It is common in men over 50 years old; and its prevalence increased even more with the increasing tobacco use. Main symptoms of laryngeal cancer include hoarseness and voice change. Main treatment methods include surgery, radiotherapy and chemotherapy; the treatment method is based on the cancer site and stage. It can be successfully treated with early diagnosis, but there is always a risk of cancer recurrence or new cancer development in the head-neck region. The patients should be closely followed up even after the treatment.
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Laryngeal (larynx) cancer is type of cancer especially common in men. Larynx is a part of the throat and located at the entrance of the trachea. It contains vocal cords and helps breathing and speaking. A change in the DNA of a laryngeal cell leads to uncontrolled proliferation and division of the abnormal cells resulting in formation of a cancerous tumor.
Laryngeal cancer is a sub-type of head-neck cancers. Cancerous tumors growing in the throat and oral area are termed based on the involved site. Almost all cancers in larynx or throat develop from the thin and flat squamous cells in the innermost layer.
The exact cause of laryngeal cancer remains to be unknown; however, certain factors may increase the risk:
As larynx and hypopharynx are placed next to each other, the cancers of this region present with similar symptoms. Many laryngeal cancers can be detected early, if the symptoms last more than 3 weeks, you must seek medical help.
Larynx has 3 sub-divisions; the site of cancer onset determines the type of the tumor and the treatment method:
Physical examination includes, information about the symptoms, risk factors, familial history and personal medical history. The inner and outer parts of the throat are examined for lumps, abnormal regions and swollen lymph nodes.
Blood tests are performed to see the functioning of liver and kidneys, and assess general health condition before treatments such as surgery or chemotherapy.
Imaging tests are not used for diagnosing the laryngeal cancers, they are performed to determine the exact margins of spread after biopsy results confirm the cancer.
Metastasis is called spreading of cancer from the onset site to other body regions via tissue, lymphatic system and blood. Being mostly fatal, metastatic tumor is of the same type of cancer with the original tumor which is called the primary tumor. Laryngeal cancer may spread to adjacent tissues such as neck, windpipe, thyroid, esophagus, or distant regions such as lungs, liver and bones.
Main treatment options for laryngeal cancer include radiotherapy, operation and chemotherapy. The treatment plan is based on the stage and onset site of the cancer. After the operation, reconstructive surgery might be necessary to reconstruct the changed regions. Additional therapy might be necessary as you may not be able to speak and breath normally. Treatment team consists of different types of physicians such as ear-nose-throat specialist, radiation oncologist, medical oncologist, and speaking and language therapist.
The treatment success of laryngeal cancer is based on the cancer stage. It can mostly be detected at early stages and the success rate is very high.
In chemotherapy, potent medications are used to damage the DNAs of the cancerous cells or kill these cells. It can be administered before the surgery and radiotherapy, or together with radiotherapy; it can alleviate the symptoms when used for the treatment of advanced and recurrent cancer, it may slow down the tumor growth. Medications are usually administered via intravenous route every 3-4 weeks for 6 months at most.
A few days of hospitalization might be necessary for each treatment session. As medications may damage the healthy tissues as much as they damage the cancerous tissue, there may be some side effects. These include:
Targeted therapy acts by using certain defects that accelerate tumor growth. Cetuximab is one of targeted therapy medications approved for treatment of laryngeal cancer. For treatment of advanced laryngeal cancer in cases where chemotherapy is not possible, it can be used together with radiotherapy (chemotherapy cannot be used in patients with heart or kidney disease). Mild side effects such as skin rash, diarrhea and allergic reactions may occur.
When the cancer is at an early stage, a magnified image of the larynx is taken by a special microscope and the cancer is removed using laser or surgical instruments under general anesthesia. After the operation, persistent voice changes or sore throat lasting for a few weeks may be seen.
In small tumors, the cancerous part of the larynx is removed and some of the vocal cords are preserved. This procedure spares the speaking ability but the voice level might be very low. A temporary tube is inserted through the neck to facilitate (temporary tracheostomy). The tube is removed when the larynx is healed, and then the hole is healed.
In large, advanced cancer, all larynx, vocal cords and adjacent lymph nodes are removed. After the operation, a permanent hole (stoma) will be opened on the neck to provide breathing (tracheotomy). The patient needs to work with a speech pathologist to learn speaking without vocal cords.
If the cancer spreads to your neck, your physician may recommend operation to remove a part or all of the lymph nodes.
All or a part of the vocal cords is removed. Cordectomy can be used for very small cancers or cancers on the glottic surface, and its effect on speech is based on the number of the vocal cords removed.
After the operations performed to remove the cancer, muscle and skin is transplanted from a region close to the throat to improve the structure or functioning of the affected areas.
Laryngeal cancer treatment usually causes complications which require working with specialist to regain the abilities of swallowing, eating, smelling and speaking. If the larynx is removed completely, a throat implant or using an electric device (electrolarynx) might be necessary to regain the voice.
In radiotherapy, high-energy radiation doses are used to destroy the cancerous cells. It can be used as main therapy in early-stage laryngeal cancers or added to chemotherapy after the operation in recurrent cancer. A special plastic mask is produced by taking a mold of the face before the treatment to provide correct head positioning and sending the rays directly to the larynx during the procedure.
The type of radiation delivery is based on the type and stage of the cancer; external radiotherapy which sends rays from an external machine or internal radiotherapy in which a sealed radioactive substance is placed into tumor or surrounding area inside a needle, seed, wire or catheter.
The treatment usually lasts for 3 to 7 weeks; it is given in short sessions for 5 days a week, and the patient rests on the remaining 2 days. Side effects include skin reactions similar to sunburn, mouth ulcers, fatigue, and loss of taste and appetite.
The condition is based on the size, stage and treatment response of the cancer; in general, early-stage cancers have higher survival rates. However, many other factors including the patient’s age and general health status may affect the prognosis.
Survival rates for laryngeal cancers are based on the onset site and stage of the laryngeal cancer. If early diagnosis is possible, 5-year survival rate after the treatment is around 80-90%. In general, 60% of the patients have a chance of surviving 5 years or longer.
Moreover, sage, chamomile, juniper seed, basil, mustard, dead nettle, black mulberry, blackberry, black pepper, thyme, rose hip and pomegranate minimize the negative effects of the laryngeal cancer and alleviate the throat.
Some herbs may interact with the medications. You must inform you physician before using them.
A balanced diet is an important part of being healthy. Consuming various food at accurate rations means keeping the healthy weight. Eating plenty of fruits and vegetables that are sources of vitamin and minerals, and consuming plenty of cheese, yoghurt, milk and soy drinks, and water may reduce the risk of cancer.
Legumes, fish, eggs and meat are the necessary protein sources to allow body to repair itself. Food and beverages which contain high fat, salt and sugar should be avoided.
References: 1- What is throat cancer?, 2- Throat Cancer, 3- Laryngeal (larynx) cancer