What is Laryngeal (Larynx) Cancer?

What is Laryngeal (Larynx) Cancer?

The larynx is the organ located in the neck area that separates the food and the trachea. Since it contains the vocal cords, sound production is also done here. The larynx, which is an important part of the respiratory tract, prevents food from entering the windpipe during swallowing.

Malignant mass diseases that occur in the larynx area are called laryngeal cancer. Since the larynx is called larynx in medical language, it is also called larynx cancer. Larynx cancers generally occur in the glottis region, where the trachea and vocal cords are located.

The incidence of laryngeal cancer is increasing in parallel with the increase in the consumption of cigarettes and tobacco products worldwide. It stands out as the most common type of cancer among head and neck cancers.

What are The Causes of Laryngeal Cancer?

There are risk factors that may cause the development of laryngeal cancer.

• Tobacco and Alcohol Use:

Alcohol and tobacco use are among the most important risk factors that increase the risk of laryngeal cancer. The risk factor increases as the amount of tobacco and alcohol use and the years of use increase.

People who smoke more than 25 cigarettes a day or have smoked for more than 30 years are approximately 40 times more likely to develop throat cancer than non-smokers.

Likewise, those who use alcohol regularly and for a long time are at 3 times more risk than those who do not drink alcohol. The majority of head and neck cancers, including laryngeal cancer, are caused by smoking.

Do not smoke or smoke tobacco products. People who are constantly exposed to smoke also increase the risk of throat cancer.

• Gender:

Men’s risk of throat cancer is 4-5 times higher than women. However, the prevalence of smoking among women in recent years causes laryngeal cancer to be more common in women.

• Genetic Factors:

People with a family history of head and neck cancer or laryngeal cancer have a higher risk of developing laryngeal cancer than those without.

• Age:

As with many types of cancer, advancing age is among the most important risk factors for laryngeal cancer. Larynx cancer is rare under the age of 40.

• Nutrition Style:

People who consume excessive amounts of red meat, processed foods or fried foods have a higher risk of developing laryngeal cancer. There are also studies showing that a diet deficient in vitamins A and E is a cause of laryngeal cancer. Eating a diet rich in fresh fruits and vegetables, known as the Mediterranean diet, and getting enough vitamins A and E can reduce the risk of laryngeal cancer.

• HPV Virus:

There are scientific studies showing that the HPV (Human papillomavirus infection) virus, which is mostly sexually transmitted and causes genital warts, cervical and vagina cancer in women, can cause laryngeal cancer. HPV is a common infection and can go away on its own without causing any problems for most people.

• Exposure to Harmful Substances:

Long-term exposure to some harmful or chemical substances resulting from work may cause laryngeal cancer.

• Sawdust
• Soot or coal dust
• Paint fumes
• Formaldehyde used in many industries such as paint production and cosmetic products
• Nickel
• Isopropyl alcohol used as cleaning solvent
• Sulfuric acid fog
• Asbestos
• Poor oral hygiene and reflux disease can also cause laryngeal cancer.

What are The Symptoms of Laryngeal Cancer?

Symptoms of laryngeal cancer can often be mild in the early stages of the disease and may resemble other health problems. However, in later stages, symptoms may become more pronounced. Symptoms of throat cancer may include:

• Hoarseness or Voice Changes:

One of the most common symptoms is prolonged hoarseness. There may be changes in voice quality due to tumors in the vocal cords.

• Sore Throat or Difficulty Swallowing:

There may be constant pain in the throat or a feeling of difficulty swallowing. Difficulty may be experienced, especially when swallowing solid foods.

• Cough and Spitting Blood:

Chronic or bloody cough is a symptom of laryngeal cancer. Coughing and coughing up blood may also occur.

• Shortness of Breath:

Throat cancer can narrow the airway, causing difficulty breathing.

• Neck Swelling:

Lymph nodes around the larynx may swell as they try to prevent cancer cells from spreading. For this reason, swelling or lumps may be noticed in the neck.

• Lesions in the Mouth or Tongue:

In some cases, cancer cells may form lesions inside the mouth or on the tongue.

• Earache:

Advanced throat cancer can sometimes cause ear pain.

What are The Types of Laryngeal Cancer?

• Nasopharynx Cancer (Starts in the back of the throat):

The nasopharynx is the upper part of the pharynx and the part behind the nose. Cancer occurring in this section is called nasopharyngeal cancer. It is a rare type of cancer.

• Oropharyngeal Cancer (Starts just behind the mouth):

The oropharyngeal is the part just behind your throat and mouth that contains the tonsils. Cancer occurring in this part is called oropharyngeal cancer.

• Hypopharyngeal Cancer:

It is a type of cancer that occurs in the hypopharynx, which is located in the lower part of your throat, above the esophagus and trachea.

• Glottic Cancer (Starts in the vocal cords):

Vocal cords are located in the part of the larynx called the glottic. Your voice is formed in this part. Cancer occurring in this section is called glottic cancer.

• Supraglottic Cancer (Starts above the vocal cords):

The area above the vocal cords, known as the upper larynx, is called supraglottic, and the cancer that occurs in this part is called supraglottic cancer. Because cancer occurs in the upper larynx area, it can affect the epiglottis, a cartilage that prevents the food we eat from entering the windpipe. It covers approximately 35% of all throat cancers.

• Subglottic Cancer (Starts under the vocal cords):

The area below the vocal cords, called the lower larynx, is called subglottic. Cancer occurring in this region is called subglottic cancer. It covers approximately 5% of all laryngeal cancers.

What Are The Grades Of Laryngeal Cancer?

The degree of laryngeal cancer is related to the appearance of cancerous cells. It is generally divided into two groups: low-grade and high-grade laryngeal cancer.

• Low Grade Larynx Cancer:

Cancer cells look similar to the cells from which they originate.

Low-grade throat cancer cells usually grow slowly and are less likely to spread.

• High Grade Larynx Cancer:

The differentiation in cancer cells is high. High-grade throat cancer cells tend to multiply faster and are more likely to spread than low-grade cancer cells.

What are The Stages of Laryngeal Cancer?

Larynx cancer is a type of cancer that has stages:

Stage 1:

Cancer cells are only in the inner lining of the larynx.

Stage 2:

The small tumor moves outside the larynx.

Stage 3:

The larger tumor grows into the inner part of the thyroid gland or the upper part of the larynx. It may also affect one of the vocal cords.

Stage 4:

The tumor may spread to the esophagus, trachea or thyroid gland. It is the last phase.

How Is Laryngeal Cancer Diagnosed?

If you suspect laryngeal cancer and have had hoarseness for more than 3 weeks, you can be examined by an ear, nose and throat doctor for initial diagnosis and treatment.

Your doctor will first perform a physical examination to examine the inside of the neck. Your doctor may also need imaging tests such as biopsy and PET-CT (tomography) to make a correct diagnosis.

Tests used to diagnose throat cancer include:

• Physical Examination:

Your doctor will ask about your symptoms and activities that may increase the risk of throat cancer. He or she will also perform a physical exam to check for any abnormal symptoms, such as a sore in your mouth or swollen lymph nodes in your neck. Laryngoscopy: Your doctor may use a laryngoscope to examine your throat in more detail. A laryngoscope is an instrument that helps view the back of the throat, consisting of a thin lighted tube and a lens.

• Pharyngoscopy:

Your doctor performs this test to diagnose oropharyngeal cancer. No special preparation is required for pharyngoscopy. Your doctor will use a disposable wooden or plastic spatula to press your tongue. After pressing pharyngoscopy uses a 5-10mm mirror to examine your mouth.

• Computed Tomography (CT) Scan:

CT scan test is a medical imaging method used in the diagnosis of many diseases, especially cancer. Your doctor may use this test to diagnose oropharyngeal cancer.

• Magnetic Resonance Imaging (MRI) Scan:

Radio waves, powerful magnets and a computer are used to create detailed images of your throat.

• Positron Emission Tomography (PET) Scan:

In cancer patients, a pet scan is performed to determine the tumor and to check whether the cancer has spread. A three-dimensional image of the shooting area is taken.

• Endoscopic Biopsy:

Your doctor may perform endoscopy to obtain tissue samples. Endoscopy is a procedure used to view the esophagus, stomach and intestines, and to take tissue samples if necessary, with the help of an instrument with a small illuminated camera at the tip.

Surgical Treatment of Laryngeal Cancer

Endoscopic (Partial Larynx Removal) Resection (Endoscopic Laser Surgery)

• It is a surgical method mostly suitable for patients with early stage laryngeal cancer and locally advanced laryngeal cancer.
• Since endoscopic resection surgery, popularly known as intraoral laser surgery, is performed through the mouth, no incisions are made.
• Since laser is used during the procedure, bleeding is less.
• The procedure is performed in the operating room under general anesthesia.
• Necessary surgical instruments and laser are passed through the tube placed from the mouth to the vocal cords. During the operation performed under a microscope, the surgeon sees the cancerous tumor clearly.
• Depending on the condition of the tumor, the surgeon may cut a part of it with a laser or completely destroy it with a laser using high energy.
• Before endoscopic laser surgery, it should be determined whether the patient is suitable for this surgery. Since laser surgery is performed through the mouth, the patient’s teeth and throat structure must be suitable for this procedure.
• Hospitalization period after oral laser surgery may vary depending on the location and size of the tumor.
• Swelling that occurs after endoscopic laser surgery, which is usually performed on large tumors, may cause breathing or feeding problems.
• Intraoral laser surgery generally does not cause permanent problems with speech and swallowing. Speech restrictions may be imposed for a few days after the surgery. Working with a speech therapist can yield positive results for long-lasting speech problems.

Laryngeal Cancer Laryngectomy Surgery

• Depending on the size and location of the tumor, the cancer-affected part or all of the larynx is surgically removed.
• Surgeries in which only part of the larynx is removed, called partial laryngectomy, can be performed by making a small incision in the neck, or can be performed through the mouth without making an incision.
• In partial laryngectomy surgeries, a small hole is opened in the neck so that the patient can breathe. This hole usually closes after surgery.
• After partial laryngectomy surgeries, speech problems may occur temporarily.
• However, speaking and breathing problems are generally not observed after the recovery process.
• In total laryngectomy surgeries, in which the entire larynx is removed, the trachea is connected to the hole opened in the throat in order to breathe.
•  In total laryngectomy, that is, surgeries in which the entire larynx is removed, the hole opened in the throat is permanent.
• After total laryngectomy operations, the patient loses his voice.
• The patient can communicate with voice prostheses produced as speech devices or voice devices.
• After total laryngectomy surgeries, in addition to voice problems, problems such as swallowing, taste and smell may also be observed.

Neck Dissection Surgery

This surgery is performed if throat cancer has spread to the lymph nodes in the neck. For this reason, some or all of the lymph nodes can be removed during surgery. It may also be necessary to remove muscle, nerves and adjacent tissues. It is not a suitable surgical technique for every patient and the reason for this is its side effects. Some side effects such as numbness in the ear and loss of movement in the lower lip may occur.

Laryngeal Cancer Radiation Treatment

Radiation therapy uses high-energy rays from sources such as X-rays and protons to cause cancer cells to die.

In this type of treatment, rays are transmitted from a large machine outside your body.

However, it is also delivered through small radioactive seeds that can be placed inside your body, right next to the area where the cancer occurs.

Radiation therapy may be the only treatment needed for laryngeal cancer in the early stages.

For tumors in more advanced stages, radiation therapy can often be combined with chemotherapy or surgery.

However, for those with end-stage laryngeal cancer, radiation therapy may be used to reduce signs and symptoms and make the patient more comfortable.

Laryngeal Cancer Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy is often used in combination with radiotherapy to treat throat cancers. Some chemotherapy drugs make cancer cells more sensitive to radiation therapy. However, combining chemotherapy and radiotherapy increases the side effects of both treatments. Talk to your doctor about the side effects you are likely to experience and whether combination treatments may provide benefits beyond these effects.

Targeted Therapy:

Targeted therapy uses drugs to kill cancer cells without harming healthy cells.

This treatment focuses on proteins found in cancer cells that support cell growth and proliferation.

The drugs used kill cancer cells. And this slows down their growth.

Targeted therapy is mainly favored in oropharyngeal and hypopharyngeal types of cancer.

Although there is a cure for laryngeal cancer, laryngeal cancer that is not diagnosed early can cause permanent and significant damage.

Therefore, if you have symptoms of laryngeal cancer, it is very important that you are examined by a healthcare professional without delay for early diagnosis and treatment.

There is no sure way to protect yourself from throat cancer.

• However, reducing tobacco and alcohol consumption,
• Getting the HPV vaccine,
• and adopting healthy eating habits can significantly reduce your risk of throat cancer.

If you have had throat cancer, your throat cancer may come back after treatment. For this reason, it is very important not to neglect your health check-ups after treatment.

Immunotherapy:

Immunotherapy is a form of treatment used to stimulate the body’s immune system to fight cancer cells. In throat cancer, immunotherapy can be used in addition to other treatments in some patients.

Post-Treatment Rehabilitation

Cancer treatment often causes complications that may require working with specialist doctors to regain the ability to swallow, eat solid foods, and speak.

During and after throat cancer treatment, you may need rehabilitation for:

• Care of tracheostomy in cases where it is opened,
• Eating problems,
• Difficulty in swallowing,
• Stiffness and pain felt in the neck,
• Speech problems.

Frequently Asked Questions About Laryngeal Cancer

Is Throat Cancer Fatal?

There are high numbers of deaths every year from laryngeal cancer, which is one of the most common cancers of the head and neck region in the world. Men have a higher risk of death than women. However, cancers diagnosed at an early stage are almost certainly curable.

Where Does Throat Cancer Metastasize (Spread)?

Larynx cancer first spreads to neighboring tissues. In advanced stages, it can also spread to distant organs.

  The places where laryngeal cancer spreads are;

• Larynx Length
• Soft Tissues in the Neck
• Vocal Cords
• Thyroid Gland
• Language Base
• Tongue And Neck Muscles
• Pharynx
• Windpipe (Trachea)
• Esophagus
• Lymph Nodes
• Lung, Liver and bones.

Will I Be Able to Speak After Laryngeal Cancer Surgery?

Vocal cords can be preserved in partial laryngeal cancer surgeries. Although there may be difficulty in speaking immediately after these surgeries in which the vocal cords are preserved, the voice can return to its normal state after a while.

However, after the surgery in which the entire larynx is removed, the patient loses his voice.

After these surgeries, different speech techniques or devices can be used depending on the patient’s condition. Speech can be accomplished by moving air down the esophagus and then returning the air to the mouth. This is called esophageal speech.

For this, you can work with voice therapists.

It is possible for the patient to make sounds by holding a small device called an electronic larynx towards the neck.

The patient can be enabled to speak with voice prostheses, also known as voice microphones.

What Should be Considered in Nutrition in Laryngeal Cancer?

In order to minimize the side effects of cancer treatment and avoid health problems due to weight loss, it is beneficial to include some nutritional sources in the diet:

1. Protein:

Protein, which plays a role in repairing tissues, strengthening the immune system and providing energy to the body, has an important place in the nutrition of cancer patients.
Cancer patients need more protein than healthy individuals.
When sufficient protein intake is not achieved, muscle breakdown and loss of strength and resistance occur.
As the immune system weakens, we become vulnerable to diseases.

Larynx cancer patients’ daily diet:

• Egg,
• Chicken,
• Legumes,
• Red meat,
• Yoghurt and cheese

It should include protein-rich foods such as:

If you have insufficient protein intake due to nutritional difficulties, you can receive medical nutrition support with the advice of a doctor or dietician.

2. Carbs:

Another source of macronutrients that the body needs daily are carbohydrates. Carbohydrates meet a large part of the body’s daily energy needs. It is beneficial for cancer patients to include carbohydrate-rich foods such as bread, rice, pasta, potatoes and grains in their meals in order to improve their quality of life and find the energy they need for treatment.

3. Oil:

Another energy source of the body is fat. In order for cancer treatment and the recovery process to proceed as expected, healthy fats should be included in the daily diet.

Even if you were on any diet before your throat cancer diagnosis, you can be careful to consume enough foods containing fat.

Remember;

Cancer patients may need higher calories daily than healthy individuals.

In order to avoid malnutrition due to nutritional problems, you can apply for medical nutrition support that provides resistance and energy to your body, with the advice of your doctor.

4. Vitamins and Minerals:

Cancer patients are recommended to consume fresh vegetables and fruits to get the vitamins and minerals they need. You can consume 3 portions of vegetables and 2 portions of fruit daily as main and snack meals.