Cancer, laryngeal (larynx)

Page last reviewed: 13/07/2011

Laryngeal cancer (cancer of the larynx) is a rare type of cancer which can cause hoarseness of the voice and swelling of the throat.

The larynx

The larynx, also known as the voice box, is a tube-like structure found at the entrance of the trachea (windpipe). The lump you can see at the front of your throat, commonly known as the Adam's apple, is your larynx.

The larynx has three main functions:

  • it helps channel oxygen into the trachea when you breathe,
  • it acts like a valve, closing off the trachea when you swallow to prevent food or liquid entering the airways, and
  • it contains two membranes (the vocal cords) which vibrate as air passes through them, producing the sound of your voice.

How common is laryngeal cancer?

Laryngeal cancer is rare. An estimated 145 new cases occur in Ireland each year and approximately four out of five cases are in men.

The condition mostly affects older people. The average age for the onset of symptoms is 60.

Alcohol and tobacco use are the two biggest contributing factors to getting laryngeal cancer. The risk is particularly high if you drink and smoke heavily. It is estimated that 75% of all cases are caused by alcohol or tobacco use.

Recent evidence shows the human papilloma virus (HPV) may also be responsible for some cases of laryngeal cancer, particularly in younger people.

Outlook

As with most cancers, the outlook for laryngeal cancer is mainly determined by what stage the cancer has reached when it is diagnosed.

If the cancer is in its early stages and has not spread outside the larynx, the chance of being completely cured is relatively high. Laryngeal cancer can be treated with a combination of surgery, radiotherapy, chemotherapy and a medicine called cetuximab.

Health professionals use a four-stage system to describe how far laryngeal cancer has progressed (see the section above on Treatment). An estimated 80% of people with stage one or two laryngeal cancer will live for at least five years after being diagnosed, and many people live much longer.

If the cancer has spread from the larynx to other parts of the body (metastasis), the outlook is not so good and a cure may not be possible. About 60% of people with stage three laryngeal cancer live for at least five years after diagnosis. This figure is about 25% for people with stage four cancer.

Lungs

The lungs are a pair of organs in the chest which control breathing. They remove carbon dioxide from the blood and replace it with oxygen.

 

Page last reviewed: 13/07/2011

As most cases of laryngeal cancer develop near the vocal cords, the initial symptom is often a noticeable change in the sound of your voice. For example, your voice may be unusually hoarse or husky.

Other symptoms include:

  • pain when swallowing or difficulty swallowing,
  • sore throat,
  • ear pain,
  • a lump in the neck,
  • persistent coughing,
  • unexplained weight loss, and
  • difficulty breathing.

When to seek medical advice

See your GP if you have any of the symptoms above and they have lasted for more than three weeks.

As these symptoms are the same as those for many other conditions, it is unlikely that they are caused by cancer. But it is a good idea to rule out more serious causes of your symptoms by going to your GP.

 

Page last reviewed: 13/07/2011

How does cancer begin?

Cancer begins with a change in the structure of DNA. DNA provides our cells with a basic set of instructions such as when to grow and reproduce.

A change in its structure (called a genetic mutation) can alter these instructions and cause the cells to reproduce uncontrollably. This produces a lump of tissue known as a tumour.

How does cancer spread?

Left untreated, cancer can quickly grow and spread to other parts of the body. Cancer usually spreads through the lymphatic system. This is a series of glands (or nodes) located throughout the body, similar to the blood circulation system.

Lymph glands produce many specialised cells which your immune system needs to help fight infection.

Once the cancer reaches the lymphatic system, it can spread to any other part of your body, including your bones, blood and organs.

Alcohol and tobacco

Evidence shows that alcohol and tobacco are the two biggest risk factors for laryngeal cancer.

It is thought that alcohol and tobacco contain chemicals which affect the normal working of the cells of the larynx, triggering mutations which can lead to cancer. Drinking alcohol and smoking carry individual risks but, if you do both, the risks are greatly increased.

Research has shown that if you smoke 40 cigarettes a day but do not drink alcohol, you are five times more likely to develop laryngeal cancer (as well as other cancers of the head and neck, such as cancer of the mouth) than someone who does not drink or smoke.

In the same way, if you do not smoke but drink the equivalent of 30 pints of beer a week, your risk of getting laryngeal cancer is also five times that of someone who does not drink or smoke.

But if you smoke more than 40 cigarettes a day and drink an average of 30 pints a week, you are 38 times more likely to develop laryngeal cancer than someone who does not drink or smoke.

Diet

There is evidence to suggest that a diet high in red meat, processed food and fried food can increase your risk of developing laryngeal cancer.

Occupational exposure

Having a job where you are exposed to high levels of certain substances may increase your risk of developing laryngeal cancer. These substances include:

  • paint fumes,
  • coal dust,
  • wood dust,
  • diesel fumes,
  • nickel,
  • formaldehyde (a chemical used in a wide range of industrial processes, such as paint manufacturing and cosmetics), and
  • isopropyl alcohol (often used as a cleaning solvent).

Page last reviewed: 13/07/2011

Before diagnosing laryngeal cancer, your GP will ask you about your symptoms and recent medical history. They will probably check the inside and outside of your throat for any abnormalities, such as lumps and swellings.

Your GP may arrange for a blood test to rule out other possible causes of your symptoms, such as infection.

If laryngeal cancer is suspected, you will probably be referred to the ear, nose and throat (ENT) department of your local hospital for further testing.

Nasoendoscope

A nasoendoscope is a medical instrument which consists of a small tube with a light attached to one end. The tube can be threaded through one of your nostrils and passed into the back of your throat, allowing hospital staff to get a clearer view of your larynx.

The procedure is not painful but can sometimes feel a little uncomfortable, so an anaesthetic spray is often used to numb your nose and throat.

Biopsy

During a biopsy, a small sample of suspected cancerous tissue is removed and sent to a laboratory to check for cancerous cells.

It is usually possible to perform a biopsy at the same time as using the nasoendoscope or panendoscope. Small instruments are passed down the tube and used to remove a tissue sample.

Alternatively, if you have a noticeable lump in your neck, a needle can be used to draw out a sample of tissue. This is known as fine needle aspiration (FNA).

Further testing

If the biopsy results show that you have cancer and there is a risk it may have spread, you will probably be referred for further testing to assess how widespread the cancer is.

These tests may include X-rays, computerised tomography (CT) scans and magnetic resonance imaging (MRI) scans.

Glossary

Tissue
Body tissue consists of groups of cells which perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Biopsy
A biopsy involves taking a small sample of tissue from the body so it can be examined.
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local anaesthetic) or to put a patient to sleep (general anaesthetic) during surgery.
Local anaesthetic
A local anaesthetic is a drug injected by needle or applied as a cream which causes loss of feeling in a specific area of the body.

Page last reviewed: 13/07/2011

Cancer treatment team

Laryngeal cancer is treated by multi-disciplinary teams.

An MDT is made up of a number of different specialists . If you have laryngeal cancer, you may see some or all of these people as part of your treatment.

It can be difficult to decide which treatment is best for you. Your cancer team will make recommendations, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may want to write a list of questions to ask the specialist. For example, you may want to find out what the advantages and disadvantages are of particular treatments.

Staging

Health professionals use a four-stage system to describe how far laryngeal cancer has advanced. The four stages are:

  • Stage 1. The cancer is contained in the top layers of tissue that cover the larynx. The vocal cords are usually unaffected.
  • Stage 2. The cancer has spread deeper into the larynx, affecting the normal working of the vocal cords and making the voice hoarse. Nearby lymph nodes are unaffected.
  • Stage 3. The cancer has spread throughout the larynx and one of the vocal cords is no longer able to move, resulting in loss of voice. Small lymph nodes near the larynx may also contain cancerous cells.
  • Stage 4. The cancer has spread beyond the larynx and into the larger lymph nodes. In very advanced cases, the cancer can also spread to another part of the body, usually the lungs.

In early stage-one laryngeal cancer, it may be possible to remove the cancer using radiotherapy alone. Later stage-one and stage-two cancer will probably require a combination of surgery and radiotherapy.

In stages three and four, more extensive surgery may be required. Radiotherapy and chemotherapy will probably be used. In particularly severe cases, the entire larynx may have to be removed.

Radiotherapy

Radiotherapy uses controlled doses of high-energy radiation to destroy cancerous cells. It can be used as a primary treatment in early-stage laryngeal cancer. It is also often used as a secondary treatment before or after surgery to stop cancerous cells returning.

The energy beams used during radiotherapy have to be precisely targeted on to the larynx. To ensure the beams are directed at exactly the right area, a special plastic mask will be made to hold your head in the right position. During your first visit to the radiotherapist, a mould of your face will be taken to make the mask.

Radiotherapy is usually given in short daily sessions from Monday to Friday, with a break from treatment at the weekend. As well as killing cancerous cells, radiotherapy can affect healthy tissue and has a number of side effects, including:

  • sore, red skin (like sunburn),
  • mouth ulcers,
  • sore mouth and throat,
  • dry mouth,
  • loss of taste,
  • loss of appetite,
  • tiredness, and
  • nausea.

Your MDT will monitor any side effects and, where possible, provide treatment for them. For example, protective gels can be used to treat mouth ulcers and medicines can help if you have a dry mouth.

Radiotherapy can sometimes cause the tissues of the throat to become inflamed. If the inflammation is severe, it can cause breathing difficulties. If you experience breathing difficulties, contact your MDT as soon as possible.

Most side effects should pass after your radiotherapy has been completed, although symptoms such as tiredness and dry mouth can last for several months after treatment.

See Useful links for more information on radiotherapy.

Surgery

There are four types of surgery which are used to treat laryngeal cancer:

  • laser surgery,
  • partial laryngectomy, and
  • total laryngectomy.

Endoscopic resection

Endoscopic resection can be used to treat stage-one and stage-two laryngeal cancer. The surgeon uses an endoscope, which is a small flexible tube with a light and a camera on one end. Tiny surgical instruments can also be passed down through the endoscope.

During an endoscopic resection, the surgeon will guide the endoscope into your larynx. The camera relays images to a screen in the operating theatre, allowing the surgeon to view your larynx in detail. The surgeon will remove any cancerous cells, using either a laser or surgical instruments.

An endoscopic resection is carried out under general anaesthetic and does not cause any long-lasting side effects. However, you may experience some soreness in your mouth and throat for a few weeks afterwards.

Partial laryngectomy

A partial laryngectomy is usually used to treat stage-three laryngeal cancer. The operation involves surgically removing the affected part of your larynx. Some of your vocal cords will be retained so you will still be able to talk, but your voice may be quite hoarse or weakened.

While your larynx is healing it may not be able to carry out its job of helping you breathe. If this is the case, the surgeon will create a temporary hole in your neck which is attached to a tube you can breathe through. This is known as a temporary tracheostomy.

Once your larynx has healed, the tube can be removed and the hole will heal. There may be a small amount of scarring.

Total laryngectomy

A total laryngectomy is usually used to treat advanced stage-three or stage-four laryngeal cancer. The operation involves removing your entire larynx. Nearby lymph nodes may also need to be removed if the cancer has spread to them.

As your vocal cords will be removed, you will not be able to speak in the usual way. There are several ways to help restore your speech. See the Complications section, above, for more information about vocal restoration.

If you have a total laryngectomy, you will also need a permanent tracheostomy. The tube will usually be removed after a few weeks, leaving the hole (stoma).

You will be given training on how to keep the stoma clean. Having a permanent tracheostomy can seem disturbing and frightening at first, but most people get used to the stoma after a few months.

Chemotherapy

Chemotherapy is often used in combination with radiotherapy before you have surgery to treat advanced laryngeal cancer. Chemotherapy uses powerful cancer-killing medicines to damage the DNA of the cancerous cells and stop them reproducing.

Chemotherapy can often be used to shrink a tumour, which means it is not necessary to remove your entire larynx during surgery.

The medicines used in chemotherapy can sometimes damage healthy tissue as well as the cancerous tissue. Unfortunately, side effects are common.

Side effects of chemotherapy can include:

  • nausea,
  • vomiting,
  • hair loss,
  • sore mouth,
  • mouth ulcers, and
  • tiredness.

These side effects should stop once the treatment has finished. Chemotherapy can also weaken your immune system, making you more vulnerable to infection.

See Useful links for more information on chemotherapy.

Glossary

Radiotherapy
Radiation therapy uses X-rays to treat disease, especially cancer.
Lungs

The lungs are a pair of organs in the chest which control breathing. They remove carbon dioxide from the blood and replace it with oxygen.

Useful Links

An MDT can include:

  • a surgeon,
  • a clinical oncologist (specialist in the non-surgical treatment of cancer),
  • a pathologist (specialist in diseased tissue),
  • a radiologist,
  • a plastic surgeon,
  • a dentist,
  • a dietitian,
  • a social worker,
  • a speech and language therapist, and
  • a specialist cancer nurse, who will usually be the first point of contact between you and the rest of the team.

Page last reviewed: 13/07/2011

Tobacco

Using tobacco products increases your chances of developing laryngeal cancer, lung cancer and bladder cancer. Tobacco comes in many forms, including:

  • cigarettes,
  • pipe tobacco,
  • cigars,
  • cigarillos,
  • snuff (powdered tobacco designed to be snorted through the nose), and
  • chewing tobacco.

Quitting smoking (or other tobacco products) has both short-term and long-term health benefits. For example, if you manage to go without smoking for 10 years, your risk of developing laryngeal cancer and other oral cancers will be the same as somebody who has never smoked.

The National Smokers Quitline offers advice and encouragement to help you quit smoking. Call 1850 201 203 or visit the HSEQuit website, www.quit.ie.

Your GP or pharmacist can give you help and advice about giving up smoking.

Alcohol

Staying within the recommended guidelines for alcohol consumption will reduce your risk of developing laryngeal cancer and liver cancer.

The recommended maximum daily alcohol consumption is three to four units for men and two to three units for women. A unit of alcohol is equal to half a pint of normal strength lager, a small glass of wine or a single measure of spirits.

If you are worried about your drinking and find it difficult to reduce your alcohol consumption, see http://www.yourdrinking.ie/.

Or call the national helpline for people with alcohol problems, on 1800 459 459.

Diet

Research shows that eating a diet high in fresh vegetables (particularly tomatoes), citrus fruits (oranges, grapefruits and lemons), olive oil and fish oil can help reduce your risk of getting laryngeal cancer. This is sometimes called a 'Mediterranean-style' diet.

Eating five portions a day of a variety of fruit and vegetables will also help prevent oral cancer, as well as other types of cancer.

Fruit and vegetables contain chemicals called antioxidants, which are thought to help protect cells from becoming damaged. Leafy vegetables, such as lettuce, spinach and cabbage, are thought to provide the most protection against cancer.

Your diet should also be low in fat and high in starchy foods (carbohydrates), such as wholemeal bread, cereals and potatoes.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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