December 2009

This information should not be used to self-diagnose, or be used in place of a qualified physician’s care.

Larynx Cancer

• Larynx cancers are treated by members of the BC Cancer Agency’s Head & Neck Tumour Group.
• Larynx cancer may also be called laryngeal cancer or tumour, throat cancer, cancer of the voice box or of the vocal cords, cancer of the glottis or subglottis, glottic cancer or tumour, supraglottic cancer or tumour.
• The larynx, or voice box, is located just above the trachea. Most of it lies just behind the Adam's apple.
• The larynx consists of three distinct parts:
• The Glottis consists of the two "true" vocal cords, the narrow fibrous bands that vibrate to produce sounds, which are turned into speech by the muscles of the tongue, mouth and lips.
• The Supraglottis is a larger area above the vocal cords which extends up to the base of the tongue. The epiglottis (a flap that helps prevent food from going into the lungs when swallowing) and other structures - the false cords, ventricles, aryepiglottic folds, and the arytenoids - separate the air and food passages.
• The Subglottis is the area between the vocal cords and the top of the windpipe or trachea.

What causes it and who gets it?
Listed below are some of the known risk factors for this cancer.  Not all of the risk factors below may cause this cancer, but they may be contributing factors.

• These cancers take a long time to develop so most people diagnosed with laryngeal cancer are over 60.
• Heavy drinking greatly increases the risk for laryngeal cancer.
• Tobacco use in any form increases the risk of developing laryngeal cancer. The longer tobacco has been used, the greater the risk.
• Drinking alcohol in combination with tobacco use greatly increases the risk of laryngeal cancer.
• Passive smoking (spending time in a smoking environment, or living with a smoker) increases risk.
• Human papilloma virus (HPV) infection is a risk factor.
• Acid reflux (heartburn or gastroesophageal reflux disease) may increase the risk of laryngeal cancer.
• Larynx cancers are rare in Canada.
• Statistics
• BC
• Canada 
  

Can I help to prevent it?

• Most laryngeal cancers can be prevented. Tobacco use and excessive alcohol use are the major risk factors for developing this cancer.
• If you drink alcohol, stop, or limit your intake.
• Don’t start smoking or chewing tobacco products. If you smoke, quit. If you chew tobacco, stop. This will reduce your risk, even after years of use.
• Patients who are cured of laryngeal cancer are more likely to develop a second cancer, especially if they continue to use tobacco and alcohol. By quitting tobacco and alcohol use you can reduce the possibility of the cancer happening again. 
• Eat a healthy diet.  A diet high in fresh fruit and vegetables is associated with reduced risk of laryngeal cancer. The Canada Food Guide recommends eating 7-10 servings each day.
• If you suffer from regular heartburn or acid reflux, seek medical treatment to control it.

Screening for this cancer

• No general screening program is effective for laryngeal cancer.
• If symptoms occur, physical examination by a doctor is effective for detecting this cancer.

Signs and Symptoms

• If caught early, cancer of the larynx is highly curable. This type of cancer does not develop quickly.
• Persistent hoarseness or a change in voice quality is the most common symptom.
• Other common symptoms of laryngeal cancers are also symptoms of non-cancerous conditions. Any of the following symptoms lasting for more than a few weeks should be evaluated by a physician:
• A lump or swelling in the throat
• Pain on swallowing or trouble swallowing
• Persistent earache
• Persistent cough
• Trouble breathing

Diagnosis
This is a list of some or all of the tests used to diagnose this type of cancer.  More information on other diagnostic tests is available.

• Physical examination
• In-depth examination by a head and neck specialist (an otolaryngologist) using a mirror (indirect laryngoscopy) or an endoscope.
• Biopsy (usually done under general anaesthetic)
• Imaging of the tumour site by one or more of the following methods:
•  X-rays
• Computed tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Positron Emission Tomography (PET)
• Ultrasound

Types & Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world.  In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

• T describes the site and size of the main tumour (primary);
• N describes involvement of lymph nodes;
• M relates to whether the cancer has spread (presence or absence of distant metastases).

• Nearly all laryngeal cancers are carcinomas arising from cells that line the larynx (squamous cells), but they differ widely in their behavior depending on their site of origin.
• Cancers of the vocal cords (glottis) are the most common type of laryngeal cancer. They tend to grow slowly; early spread to other sites (metastasis) is uncommon.
• Hyperkeratosis (thickened lesions) on the vocal cords can progress to cancer and should be monitored carefully.
• Cancers of the subglottis are rare (only 1-8% of all laryngeal cancers), and are more likely to spread to other sites early.
• Supraglottic carcinomas are also rare, and also likely to metastasize, especially to lymph nodes of the neck.

Treatment 
Cancer therapies can be highly individualized – your treatment may differ from what is described below.

• Selection of the treatment plan for each patient is based on factors such as the tumour type, the size and stage of the cancer, and patient-specific factors such as age, presence of other medical conditions (co-morbidities), previous therapies.
• Patients should be referred to one of the BCCA regional cancer centres for assessment.
• Radiation therapy is the preferred treatment for early stage laryngeal cancer. Types of RT used include:
• External beam radiotherapy
• Brachytherapy
• 3-D conformal and stereotactic radiotherapy
• Intensity modulated radiotherapy (IMRT)
• Before beginning radiation therapy, patients should have a thorough dental evaluation. A detailed dental evaluation and treatment plan is found at  http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/HeadnNeck/Dentistry/RadiationTherapyEvaluationandTreatmentPlan+.htm
• Treatment planning for radiation therapy is complex and requires construction of a custom made mask to keep the head and neck from moving during therapy. The treatment planning phase may take 7 to 10 days before treatment can start.
• Radiation therapy in the head and neck region is likely to cause some of the following side effects:
  • Dry mouth
  • Dental problems
  • Mouth sores
  • Difficulty swallowing
  • Hearing loss
• Chemotherapy alone does not offer a cure for larynx cancers, but it may be used with radiation therapy to increase control of the disease.
• Treatment of advanced cancers (stages T3 orT4) usually involves a combination of available therapies. Many patients may be cured by either radiation or surgery alone.
• Metastasis to the lymph nodes is common in cancers of the larynx, except those confined to the glottis. A small single node may be cured by radiation alone, but larger or multiple nodes will require surgery.
• Persistent or recurrent laryngeal tumours usually require total surgical removal of the larynx (total laryngectomy). This results in loss of speech.

Follow-up after Treatment

• Guidelines for follow-up after treatment has ended have been developed by the BC Cancer Agency and are listed on our website:  http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/HeadnNeck/FollowUp/default.htm

• It is essential that patients be followed carefully for at least two years after initial treatment, by a cancer specialists and/or otolaryngologist.  A large majority of recurrences are found in the first two years after treatment, very few recurrences are found after three years.
• Following the active treatment phase many patients also require the services of speech therapists, as the cancer may cause loss of speech.
• Excellent oral hygiene must be maintained. Detailed information about the effects of radiation to teeth are found at : http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/HeadnNeck/Dentistry/HowWillRadiationAffectMyTeeth.htm

Coping with Cancer

• BC Cancer Agency staff can help with quality of life issues for those living with or affected by cancer. This includes the physical, emotional, psychological and practical aspects of care. Each cancer experience is different, but in one way or another, many cancer patients share the same needs.
• The effects of cancer and its treatment can present unique challenges: from practical concerns like money and housing, to emotional concerns like anxiety and grief. If you need support with the practical and emotional impacts of cancer, or in managing symptoms and side effects you can use the information in Coping with Cancer to connect to these resources.

Search our library catalogue

• Automatically get a bibliography of books, videos and other items available through our library.

Recommended websites 
The following websites have been selected and evaluated by the BC Cancer Agency.

1. NCI  http://www.cancer.gov/
2. CCS http://www.cancer.ca/ 
3. ASCO http://www.cancer.net/
4. BC Cancer Agency Recommended Websites http://www.bccancer.bc.ca/PPI/RecommendedLinks/typesofcancer/larynx.htm

Can I help with research at BCCA?
BCCA cancer patients are very helpful when it comes to the fight against cancer.  Here are a few ways that you can help.

• Clinical Trials – join our treatment-based research.  Ask your oncologist if you qualify for a clinical trial.
• What are the pros and cons of joining a clinical trial?
• Tumour Tissue Bank - support our research by donatingsome of your cancer tissue
• BC Cancer Foundation - support our research with a donation of money.