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Larynx

This information should not be used for self-diagnosis or in place of a qualified physician's care.

Reviewed Feb 2017

The basics
  • Guidelines for treating these cancers have been developed by the Head & Neck Tumour Group.
  • For health professional information on treating this cancer, please see our Cancer Management Guidelines.
  • 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 parts:
    • The glottis consists of the two "true" vocal cords, the narrow 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 larynx cancer.
  • Larynx cancers are rare in Canada.
  • Statistics

Can I help to prevent it?

  • Most larynx 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 larynx 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. Canada's 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 effective screening program exists for this cancer yet.

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.
  • Hoarseness that doesn't go away or a change in voice quality is the most common symptom.
  • Other common symptoms of larynx cancers are also symptoms of non-cancerous conditions. Any of the following symptoms lasting for more than a few weeks should be checked by a doctor:
    • A lump or swelling in the throat
    • Pain on swallowing or trouble swallowing
    • Persistent earache
    • Persistent cough
    • Trouble breathing
Diagnosis & staging

Diagnosis

These are tests that may be used to diagnose this type of cancer.

  • 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

For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section. 

Types and Stages

Types

  • Nearly all larynx 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 larynx cancer. They usually 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 larynx cancers), and are more likely to spread to other sites early.
  • Supraglottic carcinomas are also rare, and also likely to spread, especially to lymph nodes of the neck.

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)

describes involvement of lymph nodes

M relates to whether the cancer has spread (presence or absence of distant metastases)

  • T1 
    The tumour is limited to just one part of the larynx; all the parts have normal mobility. 
  • T2
    The tumour extends to more than one part of the larynx and the mobility of the vocal cords may be impaired.
  • T3
    The tumour is limited to the larynx but vocal cords have lost mobility; supraglottic tumours may have invaded adjacent structures like the postcricoid area.
  • T4
    The tumour has spread into the soft tissues of the neck, thyroid, pharynx, or esophagus.
    • T4a
      Surgical removal is possible
    • T4b
      Surgical removal is not possible
Treatment

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) and previous therapies.

Patients should be referred to one of the BCCA regional cancer centres for assessment.

Radiation therapy

  • Radiation therapy is the preferred treatment for early stage larynx cancer. Types of radiation therapy 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 will be done.
  • 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.
  • The BC Cancer Agency provides information to help reduce mouth problems during and following radiation therapy. 
  • 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

  • Chemotherapy alone does not offer a cure for larynx cancers, but it may be used with radiation therapy to increase control of the disease.

Surgery

  • Treatment of advanced cancers (stages T3 or T4) usually involves a combination of available therapies. Many patients may be cured by either radiation or surgery alone.
  • Metastasis (spread) 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 active treatment are covered on our website.
  • It is essential that patients be followed carefully for at least two years after initial treatment, by a cancer specialist and/or otolaryngologist. A large majority of recurrences are found in the first two years after treatment.
  • Following the active treatment phase many patients also require the services of dietitians, physiotherapists and speech language pathologists.
  • Excellent oral hygiene must be maintained. Detailed information about the effects of radiation on teeth is available in the Head and Neck Cancer Management Guidelines.
  • Life after Cancer focuses on the issues that cancer survivors can face.
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SOURCE: Larynx ( )
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