Laryngeal cancer may also be called
cancer of the larynx or
laryngeal carcinoma. Most laryngeal cancers are
squamous cell carcinomaIn medicine, squamous cell carcinoma is a form of cancer of the carcinoma type that may occur in many different organs, including the skin, lips, mouth, esophagus, urinary bladder, prostate, lungs, vagina, and cervix...
s, reflecting their origin from the squamous cells which form the majority of the laryngeal
epitheliumIn biology and medicine, an epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body. Many glands are also formed from epithelial tissue...
.
CancerCancer is a class of diseases in which a group of cells display uncontrolled growth , invasion , and sometimes metastasis...
can develop in any part of the
larynxThe larynx , colloquially known as the voicebox, is an organ in the neck of mammals involved in protection of the trachea and sound production...
, but the cure rate is affected by the location of the tumor. For the purposes of tumour
stagingThe stage of a cancer is a descriptor of how much the cancer has spread. The stage often takes into account the size of a tumor, how deeply it has penetrated, whether it has invaded adjacent organs, how many lymph nodes it has metastasized to , and whether it has spread to distant organs...
, the larynx is divided into three anatomical regions: the
glottisThe glottis is defined as the combination of the vocal folds and the space in between the folds .-Function:As the vocal folds vibrate, the resulting vibration produces a "buzzing" quality to the speech, called voice or voicing or pronunciation.Sound production involving only the glottis is called...
(true vocal cords, anterior and posterior commissures); the supraglottis (
epiglottisThe epiglottis is a flap of elastic cartilage tissue covered with a mucus membrane, attached to the root of the tongue. It projects obliquely upwards behind the tongue and the hyoid bone...
, arytenoids and aryepiglottic folds, and false cords); and the subglottis.
Most laryngeal cancers originate in the
glottisThe glottis is defined as the combination of the vocal folds and the space in between the folds .-Function:As the vocal folds vibrate, the resulting vibration produces a "buzzing" quality to the speech, called voice or voicing or pronunciation.Sound production involving only the glottis is called...
.
Laryngeal cancer may also be called
cancer of the larynx or
laryngeal carcinoma. Most laryngeal cancers are
squamous cell carcinomaIn medicine, squamous cell carcinoma is a form of cancer of the carcinoma type that may occur in many different organs, including the skin, lips, mouth, esophagus, urinary bladder, prostate, lungs, vagina, and cervix...
s, reflecting their origin from the squamous cells which form the majority of the laryngeal
epitheliumIn biology and medicine, an epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body. Many glands are also formed from epithelial tissue...
.
CancerCancer is a class of diseases in which a group of cells display uncontrolled growth , invasion , and sometimes metastasis...
can develop in any part of the
larynxThe larynx , colloquially known as the voicebox, is an organ in the neck of mammals involved in protection of the trachea and sound production...
, but the cure rate is affected by the location of the tumor. For the purposes of tumour
stagingThe stage of a cancer is a descriptor of how much the cancer has spread. The stage often takes into account the size of a tumor, how deeply it has penetrated, whether it has invaded adjacent organs, how many lymph nodes it has metastasized to , and whether it has spread to distant organs...
, the larynx is divided into three anatomical regions: the
glottisThe glottis is defined as the combination of the vocal folds and the space in between the folds .-Function:As the vocal folds vibrate, the resulting vibration produces a "buzzing" quality to the speech, called voice or voicing or pronunciation.Sound production involving only the glottis is called...
(true vocal cords, anterior and posterior commissures); the supraglottis (
epiglottisThe epiglottis is a flap of elastic cartilage tissue covered with a mucus membrane, attached to the root of the tongue. It projects obliquely upwards behind the tongue and the hyoid bone...
, arytenoids and aryepiglottic folds, and false cords); and the subglottis.
Most laryngeal cancers originate in the
glottisThe glottis is defined as the combination of the vocal folds and the space in between the folds .-Function:As the vocal folds vibrate, the resulting vibration produces a "buzzing" quality to the speech, called voice or voicing or pronunciation.Sound production involving only the glottis is called...
. Supraglottic cancers are less common, and subglottic tumours are least frequent.
Laryngeal cancer may spread by direct extension to adjacent structures, by
metastasisMetastasis , or metastatic disease, sometimes abbreviated mets, is the spread of a disease from one organ or part to another non-adjacent organ or part...
to regional cervical
lymph nodeA lymph node is an organ consisting of many types of cells, and is a part of the lymphatic system. Lymph nodes are found all through the body, and act as filters or traps for foreign particles. They contain white blood cells that use oxygen to process. Thus they are important in the proper...
s, or more distantly, through the blood stream. Distant metastates to the
lungThe lung or pulmonary system is the essential respiration organ in air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located in the chest on either side of the heart...
are most common.
Risk factors
Smoking is the most important risk factor for laryngeal cancer. Death from laryngeal cancer is 20 times more likely for heaviest smokers than for nonsmokers. Heavy chronic consumption of
alcoholIn chemistry, an alcohol is any organic compound in which a hydroxyl group is bound to a carbon atom of an alkyl or substituted alkyl group. An important group of acohols is formed by the simple acyclic alcohols, the general formula for which is C
nH
2n+1OH...
, particularly alcoholic spirits, is also significant. When combined, these two factors appear to have a synergistic effect.
Some other quoted risk factors are likely, in part, to be related to prolonged alcohol and tobacco consumption. These include low socioeconomic status, male sex, and age greater than 55 years.
People with a history of head and neck cancer are known to be at higher risk (about 25%) of developing a second cancer of the head, neck, or lung. This is mainly because in a significant proportion of these patients, the aerodigestive tract and lung
epitheliumIn biology and medicine, an epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body. Many glands are also formed from epithelial tissue...
have been exposed chronically to the carcinogenic effects of alcohol and
tobaccoTobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as an organic pesticide, and in the form of nicotine tartrate it is used in some medicines. In consumption it most commonly appears in the forms of smoking, chewing, snuffing, or...
. In this situation, a field change effect may occur, where the epithelial tissues start to become diffusely dysplastic with a reduced threshold for malignant change. This risk may be reduced by quitting alcohol and tobacco.
Symptoms
The symptoms of laryngeal cancer depend on the size and location of the tumor. Symptoms may include the following:
- Hoarseness or other voice changes
- A lump in the neck
- A sore throat
Sore Throat were a British crust punk / grindcore band, formed in Yorkshire in 1987. They are known for being one of the earliest exponents of the grindcore subgenre known as "noisecore", as well launching the careers of several prominent members of the British metal community.-Biography:Sore...
or feeling that something is stuck in the throat
- Persistent cough
A cough , in medicine, is a sudden and often repetitively occurring defense reflex which helps to clear the large breathing passages from excess secretions, irritants, foreign particles and microbes...
- Stridor
Stridor is a high pitched sound resulting from turbulent air flow in the upper airway. It is primarily inspiratory. It can be indicative of serious airway obstruction from severe conditions such as epiglottitis, a foreign body lodged in the airway, or a laryngeal tumor. Stridor is indicative of a...
- Bad breath
- Ear ache ("referred")
Incidence
5 in 100,000 (12,500 new cases per year) in USA. The American Cancer Society estimates that 9,510 men and women (7,700 men and 1,810 women) will be diagnosed with and 3,740 men and women will die of laryngeal cancer in 2006.
Laryngeal cancer is listed as a "rare disease" by the Office of Rare Diseases (ORD) of the
National Institutes of HealthThe National Institutes of Health is an agency of the United States Department of Health and Human Services and is the primary agency of the United States government responsible for biomedical and health-related research. It consists of 27 separate institutes and centers which includes the Office...
(NIH). This means that laryngeal cancer affects fewer than 200,000 people in the U.S.
Each year, about 2,200 people in the U.K. are diagnosed with laryngeal cancer.
Diagnosis
Diagnosis is made by the doctor on the basis of a
medical historyThe medical history or anamnesis of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information , with the aim of obtaining information useful in formulating a diagnosis and providing...
,
physical examinationPhysical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
, and special investigations which may include a
chest x-rayIn medicine, a chest radiograph, commonly called a chest x-ray , is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures...
,
CTComputed tomography is a medical imaging method employing tomography created by computer processing. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation.CT...
or MRI scans, and tissue biopsy. The examination of the larynx requires some expertise, which may require specialist referral.
The physical exam includes a systematic examination of the whole patient to assess general health and to look for signs of associated conditions and metastatic disease. The neck and
supraclavicular fossaThe Supraclavicular fossa is an indentation immediately above the clavicle.In terminologia anatomica, it is divided into fossa supraclavicularis major and fossa supraclavicularis minor-External links:*...
are palpated to feel for cervical adenopathy, other masses, and laryngeal crepitus. The oral cavity and
oropharynxThe Oropharynx reaches from the Uvula to the level of the hyoid bone.It opens anteriorly, through the isthmus faucium, into the mouth, while in its lateral wall, between the two palatine arches, is the palatine tonsil....
are examined under direct vision. The larynx may be examined by indirect laryngoscopy using a small angled mirror with a long handle (akin to a dentist's mirror) and a strong light. Indirect laryngoscopy can be highly effective, but requires skill and practice for consistent results. For this reason, many specialist clinics now use fibre-optic nasal endoscopy where a thin and flexible endoscope, inserted through the
nostrilA nostril is one of the two channels of the nose, from the point where they bifurcate to the external opening. In birds and mammals, they contain branched bones or cartilages called turbinates, whose function is to warm air on inhalation and remove moisture on exhalation...
, is used to clearly visualise the entire
pharynxThe pharynx is the part of the neck and throat situated immediately posterior to the mouth and nasal cavity, and cranial, or superior, to the esophagus, larynx, and trachea.-Functions:...
and larynx. Nasal endoscopy is a quick and easy procedure performed in clinic. Local anaesthetic spray may be used.
If there is a suspicion of cancer,
biopsyA biopsy is a medical test involving the removal of cells or tissues for examination. It is the removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
is performed, usually under
general anaestheticA general anaesthetic drug is an anaesthetic drug that brings about a reversible loss of consciousness...
. This provides histological proof of cancer type and grade. If the
lesionA lesion is any abnormal tissue found on or in an organism, usually damaged by disease or trauma. Lesion is derived from the Latin word laesio which means injury.-Causes of lesions:...
appears to be small and well localised, the surgeon may undertake excision biopsy, where an attempt is made to completely remove the tumour at the time of first biopsy. In this situation, the pathologist will not only be able to confirm the diagnosis, but can also comment on the completeness of excision, i.e., whether the tumour has been completely removed. A full endoscopic examination of the larynx,
tracheaThe trachea, or windpipe, is a tube that connects to the pharynx or larynx, allowing the passage of air to the lungs. It is lined with pseudostratified ciliated columnar epithelium cells with mucosal goblet cells which produce mucus...
, and
esophagusThe esophagus or oesophagus , sometimes known as the gullet, is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. The word esophagus is derived from the Latin œsophagus, which derives from the Greek word oisophagos , lit...
is often performed at the time of biopsy.
For small glottic tumours further imaging may be unnecessary. In most cases, tumour staging is completed by scanning the head and neck region to assess the local extent of the tumour and any pathologically enlarged cervical
lymph nodeA lymph node is an organ consisting of many types of cells, and is a part of the lymphatic system. Lymph nodes are found all through the body, and act as filters or traps for foreign particles. They contain white blood cells that use oxygen to process. Thus they are important in the proper...
s.
The final management plan will depend on the site, stage (tumour size, nodal spread, distant
metastasisMetastasis , or metastatic disease, sometimes abbreviated mets, is the spread of a disease from one organ or part to another non-adjacent organ or part...
), and histological type. The overall health and wishes of the patient must also be taken into account.
Treatment
Specific treatment depends on the location, type, and stage of the tumour. Treatment may involve
surgerySurgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason...
, radiotherapy, or
chemotherapyChemotherapy, in its most general sense, is the treatment of disease by chemicals especially by killing micro-organisms or cancerous cells. In popular usage, it refers to antineoplastic drugs used to treat cancer or the combination of these drugs into a cytotoxic standardized treatment regimen...
, alone or in combination. This is a specialised area which requires the coordinated expertise of ear, nose and throat (ENT) surgeons (otolaryngologists) and oncologists.
External links