Laryngeal Cancer

Symptoms

Symptoms of laryngeal cancer include:

• Hoarseness or other change in the voice
• Difficulty swallowing or breathing
• Persistent sore throat
• Ear pain
• Lump in the neck

Having one or more of the symptoms listed above does not necessarily mean you have laryngeal cancer. However, it is important to discuss any symptoms with your doctor, since they may indicate other health problems.

Risk Factors

People who smoke, especially in combination with alcohol consumption, are at the most at risk for developing laryngeal cancer.

Other risk factors include:

Gender: men are up to five times more likely to get cancer of the larynx than women, and black men have the highest risk.

Age: most cases occur over the age of 65.

Exposure to certain chemicals: including nickel, asbestos and sulfuric acid fumes.

Diagnosis

Depending on the tumor location, some larynx cancers are found early. Cancer that forms on the vocal cords (not above or below) is often diagnosed early because of the hoarseness caused.

Staging

(Source: American Cancer Society)

Staging is the process of finding out how far the cancer has spread. This is very important because the type of treatment and the outlook for recovery depend on the stage of the cancer.

The staging system most often used for laryngeal cancer is the TNM staging system, also known as the American Joint Committee on Cancer (AJCC) system.

This system gives three key pieces of information:

• T stands for tumor (how far it has spread within the larynx or hypopharynx and to nearby tissues)
• N describes whether the cancer has spread to lymph nodes
• M stands for spread (metastasis) to distant organs

All of this information is combined to arrive at a stage. After stage 0 (which is carcinoma in situ or cancer that has not grown beyond the lining layer of cells), stages are labeled using Roman numerals from I through IV (1-4). The smaller the number, the less the cancer has spread. A higher number, for example, stage IV, means a more serious stage of the disease.

For early stage laryngeal cancers (stages I-II), patients respond equally well to surgery or radiation treatment. For intermediate stage cancers (stages II-III), a combination of radiation and chemotherapy or radiation and surgery provide the best opportunity to preserve the larynx. Depending on the location and size of the tumor, some patients may undergo radiation or surgery alone.

Surgery

Surgery may involve partial or total removal of the larynx (laryngectomy), portions of the subglottis or supraglottis or removal of just the vocal cords (cordectomy). In some patients, the thyroid gland may also be removed. Partial laryngectomy allows surgeons to preserve speech. At M. D. Anderson, two procedures are used to preserve normal function:

Transoral Laser Microsurgery (TLM) uses a flexible, hollow-core fiber to transmit CO₂ laser energy, enabling surgeons to reach otherwise inaccessible areas and to perform a 360-degree resection around tumors in ways that were previously not possible.

Supracricoid Partial Laryngectomy: the supraglottis, vocal cords and thyroid cartilage are removed, while sparing other structures needed to swallow and produce speech.

While advanced techniques are helping preserve normal function, patients who have had their entire larynx or vocal cords removed will lose the ability to speak or breathe normally. There are several options to restore speech:

• A special valve implanted between the trachea and esophagus (food pipe), which eliminates the need for an electrolarynx
• Using a handheld vibrating device (electrolarynx) to produce sounds and words
• Intensive speech therapy to learn how to use the esophagus for speaking

Other Treatments

Chemotherapy drugs can be used to shrink the tumor before surgery or to kill lingering cancer cells after surgery and/or radiation treatment. A combination of chemotherapy and radiation may be used as a primary treatment for patients with larger tumors or those who cannot tolerate surgery.

Survivorship

Laryngeal cancer patients are strongly urged not to smoke or drink alcohol both during and after cancer treatment. Drinking and smoking can make treatments less successful, as well as greatly increasing the chances for recurrence.

Regular follow-up and screening is vital due to the high risk of cancer returning to the larynx or other areas in the head and neck region. Patients may have to see their doctor every two months for the first two years after treatment, since 80-90% of new cancers occur within the first three years.

Cancer is a journey that no one needs to take alone. There are many forms of support to help you through every stage: diagnosis, treatment and survivorship. Whether you meet with other cancer survivors like yourself, use complementary therapies or individual coping mechanisms, support is available. Listed below are just some of the ways to find help...and hope.

Learn more about patient and family support programs

Support Groups

Getting together with other cancer patients in a support group is a valuable coping tool. Support groups are usually focused on a single disease or topic, such as breast cancer survivors or people coping with life-changing side effects from their cancer or cancer therapy. These groups allow participants to meet others like themselves and seek strength from each other. Most major cities and cancer hospitals offer support groups that meet weekly or monthly. There are also dozens of online support web sites or message boards for those who may not have access to a traditional meeting. 

Find a support group

Complementary Therapies

Complementary therapies are used in conjunction with cancer treatment, in an effort to reduce treatment side effects, ease depression and anxiety and help cancer patients take their mind off the negative aspects of their situation. Complementary therapies may include mind-body exercises like yoga, tai chi and Qi gong; visualization or guided imagery; using art or music as therapy and self-expression and traditional Eastern medicine such as acupuncture. 

Find complementary therapies at M. D. Anderson

Physical Activity

Staying physically active as much as possible during cancer treatment has many positive benefits. Physical activity stimulates the release of endorphins, a hormone that helps elevate mood, as well as decreasing feelings of fatigue.

Exercises for cancer patients can range from simple stretches done in the bed or chair, to more active pursuits such as walking or light gardening work. However, it’s important not to push yourself too hard. Check with your doctor before attempting any physical activity to make sure you are up to it.

Journaling/Blogging

Many people find it helpful to keep a journal of their cancer treatment experience. It may be as simple as recording symptoms and side effects into a notebook, or may include personal emotions and opinions about what they may be going through. Journals can be private, like a diary, or shared with loved ones and even strangers. 

Increasingly, people are turning to the Internet to share their cancer journey with the world at large and to seek out others with similar experiences. Many cancer patients have begun their own web log, or “blog” to publicize their battle with cancer. Twitter, a mini-blogging technology that limits posts to 140 characters, has also proven to be a helpful tool for cancer patients to keep friends updated and reach out to others.