Laryngeal carcinoma
Overview
Laryngeal cancer may also be called cancer of the larynx or laryngeal carcinoma. Most laryngeal cancers are squamous cell carcinomas, reflecting their origin from the squamous cells which form the majority of the laryngeal epithelium. Cancer can develop in any part of the larynx, but the cure rate is affected by the location of the tumor. For the purposes of tumour staging, the larynx is divided into three anatomical regions: the glottis (true vocal cords, anterior and posterior commissures); the supraglottis (epiglottis, arytenoids and aryepiglottic folds, and false cords); and the subglottis.
Symptoms
The symptoms of laryngeal cancer depend on the size and location of the tumor. Symptoms may include the following:[1] * Hoarseness or other voice changes * A lump in the neck * A sore throat or feeling that something is stuck in the throat * Persistent cough * Stridor * Bad breath * Earache
Causes
There is no single cause of laryngeal cancer. It is likely that several factors combine to cause it. Not all of these factors are known, but research is going on continually into possible causes. Smoking and heavy drinking of alcohol (especially spirits) greatly increase the risk of developing laryngeal cancer. Drug abuse/addiction, such as cocaine and methamphetamine, when snorted, greatly increases the risk as well. Laryngeal cancer occurs mainly in middle-aged and older people, but it can occur in younger people who started smoking at an early age. It is more common in men than in women.
Diagnosis
Diagnosis is made by the doctor on the basis of a careful medical history, physical examination, and special investigations which may include a chest x-ray, 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 fossa are palpated to feel for cervical adenopathy, other masses, and laryngeal crepitus. The oral cavity and oropharynx 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 nostril, is used to clearly visualise the entire pharynx and larynx. Nasal endoscopy is a quick and easy procedure performed in clinic. Local anaesthetic spray may be used.
Treatment
Specific treatment depends on the location, type, and stage of the tumour. Treatment may involve surgery, radiotherapy, or chemotherapy, alone or in combination. This is a specialised area which requires the coordinated expertise of dedicated ear, nose and throat (ENT) surgeons (otolaryngologists) and oncologists.