Overview of Laryngeal Cancer

Laryngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the larynx--the part of the throat between the base of the tongue and the trachea. The larynx contains the vocal cords, which vibrate and make a sound when air is directed against them. The sound echoes through the pharynx, mouth, and nose to make a person’s voice.

There are three main parts of the larynx, which include:

  • Supraglottis - the upper part of the larynx above the vocal cords, including the epiglottis, which is the flap that covers the trachea when swallowing so that food does not enter the lungs.
  • Glottis - the middle part of the larynx where the vocal cords are located.
  • Subglottis - the lower part of the larynx between the vocal cords and the trachea (windpipe).

Laryngeal cancer is a type of head and neck cancer that forms in squamous cells, which are the thin, flat cells that line the inside of the larynx.

Risk Factors for Laryngeal Cancer

Anything that increases your risk of getting a disease is called a risk factor. Risk factors for laryngeal cancer may include:

  • Smoking and/or chewing tobacco
  • Moderate or heavy alcohol use (more than one drink a day)
  • Poor nutrition
  • Human papillomavirus (HPV) infection
  • Genetic syndromes (inherited gene mutations)
  • Workplace exposures to certain fumes and chemicals
  • Gender (more common in men than women)
  • Age (more common among patients age 65 and older)
  • Race (more common among African Americans and Caucasians)
  • Gastroesophageal reflux disease (GERD)

Keep in mind that having a risk factor, or even several of them, does not mean that you will get laryngeal cancer. Likewise, many people who get the disease may have few or no known risk factors.

Laryngeal Cancer Signs and Symptoms

There are several signs and symptoms that could be related to laryngeal cancer; however, it is important to remember that they can also be symptoms of other diseases. See your doctor if you have:

  • A change in your voice, such as unexplained hoarseness
  • A lump in the neck
  • A persistent sore throat
  • Ear pain not caused by an ear infection or other condition
  • Pain or difficulty when swallowing

Again, these could be symptomatic of something other than cancer. With that said, if any of these symptoms last for more than three weeks, it is a good idea to be checked by a doctor. If it is cancer, early detection can give you better treatment results.

Diagnosing Laryngeal Cancer

There are a variety of tests that examine the throat and neck in order to detect and diagnose laryngeal cancer. In many cases, you will start with an ear, nose, and throat specialist (ENT) who will perform the exams and request further testing if your doctor believes there may be a tumor in the larynx.

If the doctor suspects there could be cancer, a biopsy may be performed.  A biopsy requires a tissue sample be collected from the area of the body where cancer is suspected so that the cells can be tested to see if cancer is present. Some of the following tests or procedures may be run to make a determination.

  • Physical exam of the throat - An exam in which the doctor feels for swollen lymph nodes in the neck and looks down the throat with a small, long-handled mirror to check for abnormal areas.
  • Laryngoscopy - A procedure to look at the larynx (voice box) for abnormal areas. A mirror or a laryngoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the mouth to see the larynx. A special tool on the laryngoscope may be used to remove samples of tissue.
  • Endoscopy - A procedure used to look at areas in the throat that cannot be seen with a mirror during the physical exam of the throat. An endoscope (a thin, lighted tube) is inserted through the nose or mouth to check the throat for anything that seems unusual. Tissue samples may be taken for biopsy.
  • Panendoscopy - A procedure that combines laryngoscopy, esophagoscopy, and (at times) bronchoscopy. This lets the doctor thoroughly examine the entire area around the larynx and hypopharynx, including the esophagus (swallowing tube) and trachea (windpipe). While the patient is under general anesthesia, the doctor will thoroughly examine all of these areas to look for tumors and determine their size and if they’ve spread. A tissue sample can be collected for biopsy during this procedure as well.

If cancer has been found in the biopsy, it’s common to add other tests including imaging to see if the cancer has spread, and if so, how far. Your doctor may request one or more of the following imaging studies:

  • CT scan (CAT scan) - A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an X-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • PET scan (positron emission tomography scan) - A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. In some cases the PET scan and CT scan may be used together. This is called a PET-CT.
  • MRI (magnetic resonance imaging) - A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Bone scan - A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.
  • Barium esophagogram - An x-ray of the esophagus that is taken after the patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and makes it easier for the doctor to see problems in the throat.

Staging Laryngeal Cancer

Many of the test results (as described in the Diagnosis section) are used to determine the extent, or stage, of the cancer. The stage of cancer describes how much cancer is in the body. It helps your doctor understand the seriousness of the cancer, how best to treat it, and what the chance of survival is.

For laryngeal cancer, doctors mostly depend on the TNM system created by the American Joint Committee on Cancer (AJCC). The TNM system is based on three key pieces of information:

  • How big the main tumor (T) is
  • If the cancer has spread to nearby lymph nodes (N)
  • The spread (metastasis) to distant parts of the body (M)

Numbers or letters after T, N, and M provide more details about each of these factors. Lower numbers mean that the cancer is in an early stage. Higher numbers mean the cancer is more advanced.

The standardized stages of laryngeal cancer are:

  • Stage 0 - abnormal cells in the top layer of cells lining of the larynx that may become cancer.
  • Stage 1 - cancer has grown deeper but is only in one part of the supraglottis, and the vocal cords move normally.
  • Stage 2 - cancer has grown deeper and spread into more than one part of the supraglottis (or glottis), and the vocal cords move normally; it has not spread to nearby lymph nodes or to distant parts of the body.
  • Stage 3 - tumor is only in the larynx but has caused a vocal cord to stop moving, or the tumor is growing into nearby areas such as the postcricoid, paraglottic space, pre-epiglottic (in front of the epiglottis) tissues, or the inner part of the thyroid cartilage (firm tissue that separates the thyroid gland from the front of the larynx); the cancer has spread to a single lymph node on the same side of the neck and is no larger than three centimeters.
  • Stage 4A - cancer has spread to the cartilage around the thyroid or trachea, bone under the tongue, the thyroid, or nearby soft tissue (this is also known as a moderately advanced local disease); it may or may not have spread to a single lymph node on the same side of the neck.
  • Stage 4B – cancer has spread to the muscles in the upper spinal column, carotid artery, chest cavity lining, and/or lymph nodes (this is also known as a very advanced local disease).
  • Stage 4C - any size tumor has spread to other parts of the body.

Laryngeal Cancer Treatment Options

People with early laryngeal cancer may be treated with surgery and/or radiation therapy. If the cancer is more advanced, patients may have a combination of treatments. Even if surgery removes all of the tumor, there is a chance that some cancer cells remain and chemotherapy may be recommended.

Your oncologist will recommend a treatment plan based on your stage, your general health, and whether the cancer has recurred. The recommended treatments may also change based on where the cancer is located to give the patient the best chance at keeping their ability to talk, eat, and breathe as normal as possible.

  • Surgery - removal of the tumor in the throat and/or lymph nodes or other tissue in the neck. The American Cancer Society lists several types of surgery options for treating laryngeal cancer.
  • Chemotherapy - the use of anticancer drugs to shrink or kill cancerous cells and/or to reduce the spread of cancer to other parts of the body. The specific combination of medicines will depend on the location and stage of the disease as well as what works well for the patient.
  • Radiation therapy - the use of high-energy radiation to kill or shrink cancer cells. Hyperfractionated radiation therapy may be used to treat laryngeal cancer. The radiation therapy is delivered in smaller doses, at a more frequent pace. Instead of one time per day, hyperfractionated radiation therapy may deliver the radiation in two doses per day.
  • Targeted therapy - a special type of chemotherapy is under clinical research for laryngeal cancer that takes advantage of differences between normal cells and cancer cells. The targeted therapy only attacks the cancerous cells, while leaving the healthy ones alone.

Other new types of treatment are also being tested in clinical trials. Patients who may want to participate in a clinical trial should talk with their Maryland Oncology cancer care team to see if one is available or view our current clinical trials available online

 

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