Cancer of the Larynx
Like all cancers, laryngeal cancer is the result of uncontrolled division by the body's cells. As these cells divide and accumulate, a mass develops. Unlike benign growths, however, cancer can invade healthy tissue and spread to other parts of the body. This process is called metastasis, and it is the reason why it is important to identify cancers early.
The images below show views through a laryngoscope of laryngeal tumors (yellow arrows). The image on the left is of a large tumor above the voicebox. The epiglottis is completely obscured, and the vocal folds are barely visible below the mass. The image on the right is of a laryngeal tumor of the left vocal fold.
Symptoms: The symptoms of laryngeal cancer depend largely on the size and location of the tumor. Hoarseness or other changes in vocal quality are oftentimes the first symptoms. Large tumors may interfere with the airway and cause difficulty breathing or noisy breathing. Tumors can also cause difficulty swallowing. Other symptoms may include throat or ear pain, lumps in the neck or throat, blood in the sputum or a persistent cough.
Causes: The exact cause of these cancers is unknown, but the risk factors are well established. Cancer of the larynx usually occurs in patients older than 55 and is four times more likely to occur in men than in women. It is also more prevalent among African-American populations than among white populations. Smoking, especially in combination with heavy alcohol consumption, also increases the risk of cancer. Exposure to carcinogens in one's environment (such as asbestos) is also associated with laryngeal cancer.
Treatment: The treatment for cancer of the larynx depends on the size and stage of the tumor, as well as the age, health and opinions of the patient. Treatment usually involves radiation therapy, surgery or a combination of the two. In advanced lesions, chemotherapy is often added to the treatment regimen.
In radiation therapy, high-energy rays are directed at a tumor and the surrounding tissue to stop the cancer and prevent its spread. Radiation therapy usually lasts five days a week for five to six weeks. At the end of this period, the tumor bed often receives an additional "boost" of radiation.
Surgery is indicated for larger tumors if radiation therapy has failed, and it is sometimes indicated as the primary treatment for small tumors. A partial laryngectomy may be performed, in which only a portion of the larynx is removed. This is used in smaller tumors because it often preserves the voice. If a tumor is widely invasive, however, a total laryngectomy may need to be performed in which the entire larynx is removed. To allow one to breathe, a tracheostoma is also created, which brings the upper end of the trachea to open onto the surface of the neck. Because a total laryngectomy includes removal of the vocal folds, normal voice is precluded. However, alternative speech techniques are possible and should be discussed before surgery. If a surgeon suspects that cancer may have spread to nearby tissue, a radical neck dissection may also be performed to remove the lymph nodes and surrounding tissues in the neck.
For a patient with a total laryngectomy, several options are available to restore speech function.
- Electrolarynx: A battery-operated device is placed on the neck when one wishes to speak. It produces high-frequency vibrations that are manipulated by the mouth and tongue to produce speech. The technique is usually easy to learn, but speech is mechanical and monotone.
- Esophageal speech: This is a technique that involves injecting air into the esophagus by the tongue. As the air is regurgitated and passed back through the mouth, it is manipulated to form speech. Although this technique produces more natural-sounding speech, it may be more difficult to learn.
- Tracheoesophageal puncture: A puncture is made (during the laryngectomy or shortly thereafter) between the esophagus and the trachea, and a small silicone prosthesis is inserted. When the patient wishes to speak, he or she places a finger over the opening to the tracheostoma to divert air through the prosthesis into the esophagus and out the mouth. As in esophageal speech, the exiting air is manipulated by the mouth and tongue to produce speech. This procedure is usually very successful and produces relatively natural-sounding speech. The major disadvantage of this method is that it requires one hand.