Laryngeal Cancer
Cancer of the larynx or "voice box" is now less common due to declining number of smokers and earlier diagnosis.
The larynx is the area of the throat which includes the vocal cords. It consists of three parts:
- Glottis:the middle portion of the larynx that contains the vocal cords
- Supraglottis:the area above the vocal cords
- Subglottis:the area between the vocal cords and the trachea (windpipe)
Risk factors
- Smoking and alcohol consumption are the most common
- Gender; men are 5 times more likely
- Age- usually over 60 years old but younger patients are increasing
- Occupational or environmental exposure to certain chemicals, including nickel, asbestos and sulphuric acid fumes
Symptoms of Laryngeal Cancer
If any of the following conditions persist more than two weeks, consult a doctor:
- Hoarseness or other change in the voice
- Difficulty swallowing or breathing
- Persistent sore throat
- Ear pain
- Lump in the neck
Treating Laryngeal Cancer
For early stage laryngeal cancers (stages I–II), patients respond equally well to surgery or radiation treatment. For intermediate stage cancers(stages II–III), a combination of radiation and chemotherapy or radiation and surgery provide the best opportunity to preserve the larynx. Depending on the location and size of the tumor, some patients may undergo radiation or surgery alone.
Surgery may involve partial or total removal of the larynx ( laryngectomy), portions of the subglottis or supraglottis, or removal of just the vocal cords (cordectomy). In some patients, the thyroid gland may also be removed. Partial laryngectomy allows surgeons to preserve speech. Dr Pham utilises two procedures to preserve normal function:
- Transoral laser microsurgery: a laser is used to resect small tumour through the oral cavity without an external incision
- Supracricoid partial laryngectomy: the supraglottis, vocal cords and thyroid cartilage are removed, while sparing other structures needed to swallow and produce speech
Chemotherapy drugs can be used to shrink the tumor before surgery or to kill lingering cancer cells after surgery and/or radiation treatment. A combination of chemotherapy and radiation may be used as a primary treatment for patients with larger tumors or those who cannot tolerate surgery.
Dr Pham recommends organ preservation(combination radiotherapy and chemotherapy) as the first choice and reserve radical surgery for salvage.
While advanced techniques are helping preserve normal function, patients who have had their entire larynx or vocal cords removed will lose the ability to speak or breathe normally. There are several options to restore speech: - A special valve (Blom-Singer) implanted between the trachea and oesophagus (food pipe), which eliminates the need for an electrolarynx- tracheo-oesophageal speech.
- Using a handheld vibrating device(electrolarynx) to produce sounds and words
- Intensive speech therapy to learn how to use the oesophagus for speaking
Prognosis
Laryngeal cancer patients are strongly urged not to smoke or drink alcohol both during and after cancer treatment. Drinking and smoking can make treatments less successful, as well as greatly increasing the chances for recurrence.
Follow up Care
You will have follow-up visits, routine exams and blood tests to:
- Check for any recurrence
- Chest X–ray, CT scan for recurrence – if required
- Blood count and liver function
Regular follow-up and screening is vital due to the high risk of cancer returning to the larynx or other areas in the head and neck region. Patients with laryngeal cancer will need regular follow-up for 5 years; every 3 months for the first 2 years and then every 6 months for remaining 3 years. 80-90% of new cancer´s occur within the first three years.
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