Laryngeal Cancer Treatment and Prognosis

Most people who develop laryngeal cancer are long-time smokers.

Laryngeal Cancer
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Before the introduction of mass-produced cigarettes in the twentieth century, cancer of the larynx, or laryngeal cancer, was exceedingly rare. Europeans, however, were smoking tobacco as early as the sixteenth century, starting when it was first introduced to Europe by explorers returning from the New World.

Therefore, either there's something about cigarettes that made laryngeal cancer more prevalent after 1900, or more people were smoking tobacco after the mass-production of cigarettes.

(Mass production makes things cheaper and more affordable for everyone.) Most likely, some combination of these two factors has increased the frequency of laryngeal cancer during the past 100 years.

What Is Laryngeal Cancer?

Laryngeal cancer is cancer that affects the true vocal folds (vocal cords). The true vocal folds vibrate to produce sound and enable us to speak. In contrast, the false vocal folds lie above the true vocal folds and don't produce much sound other than guttaral (think throat singing). Instead, the false vocal folds are vestibular folds that protect the true vocal cords.

Laryngeal cancer can either directly sprout from the true vocal cords (glottic), or right above them (supraglottic) or below them (subglottic region).

The majority of laryngeal cancers are squamous cell cancers.

What Are the Risk Factors for Laryngeal Cancer?

Smoking is the most significant risk factor associated with laryngeal cancer.

In other words, most people who develop laryngeal cancer are long-time smokers.

Other risk factors for laryngeal cancer include the following:

  • alcohol use
  • HPV infection (with subtypes 16 and 18 the most dangerous)
  • toxic inhalation of asbestos
  • toxic inhalation of mustard gas
  • previous neck irradiation
  • nutritional deficiencies

    Smoking and alcohol misuse synergize to form a super-risk factor. Thus, people who drink and smoke a lot are much more likely to develop laryngeal cancer.

    Although experts suspect that gastroesophageal reflux disease (GERD) may also be a risk factor for laryngeal cancer, no direct research findings yet support this connection. However, people who have already been treated for laryngeal cancer and take medications to treat GERD, Iike PPIs, are less likely to get laryngeal cancer again (experience recurrence).

    According to the American Cancer Society, in 2016, there will be 13,543 new cases of laryngeal cancer diagnosed (10,550 men and 2880 women).

    Laryngeal Cancer Symptoms

    Laryngeal cancer most commonly first presents as hoarseness. Even the smallest change in the vocal cords can affect voice. Of note, supraglottic and subglottic laryngeal cancers—or those cancers above and below the vocal folds, respectively—present as hoarseness late because it takes time for these tumors to grow large enough to obstruct the passage of air through the true vocal folds.

    Thus, people with supraglottic and subglottic laryngeal cancers often present to a physician with more advanced disease.

    Here are some other possible symptoms of laryngeal cancer:

    • dysphagia (trouble eating)
    • throat pain
    • ear pain
    • aspiration
    • airway obstruction and compromise
    • male gender (about five times as many men develop laryngeal cancer)
    • older age (people in their 60s and 70s)

    Diagnosis of Laryngeal Cancer

    Once a physician suspects laryngeal cancer, she'll perform a full head and neck physical examination. Laryngeal cancer can be visualized in the office setting using laryngoscopy (think a mirror or endoscope). Imaging studies like CT and x-rays are useful when either detecting possible spread of the cancer to the lymph nodes and lungs or when looking for a source of metastases.

    Treatment and Prognosis of Laryngeal Cancer

    When treating laryngeal cancer, specialists do their best to preserve as much of the larynx and vocal folds as possible, so as to preserve voice and reduce disability. Laryngeal cancer is treated with surgery and radiation. Research out of Duke University suggests that chemotherapy is useful when treating advanced laryngeal cancer.

    Laryngeal cancer is treatable—especially if detected early—and five-year survival rates are good. In earliest stage (stage I) laryngeal cancer, more than 95 percent of people are alive five years after diagnosis. In late stage laryngeal cancer, 50 to 60 percent of people are alive five years after cancer.

    Unfortunately, despite improvements in surgical technique and expanded treatment options during the past 30 years, laryngeal cancer survival rates have not improved. However, morbidity has improved, with people receiving treatment for laryngeal cancer experiencing less symptoms and associated illness.

    The key to successful treatment for laryngeal cancer is early detection and treatment. If you are experiencing any symptoms suggestive of laryngeal cancer—most specifically hoarseness or changes in voice—please make an appointment to see your physician. You should be especially suspicious if you are a long-time smoker (and also misuse alcohol). Although the chance that any given person has laryngeal cancer and will need further work-up and treatment by a specialist (like an ENT surgeon or oncologist) is low, it's best to err on the side of caution.

    Selected Sources

    Concus AP, Tran TN, Sanfilippo NJ, DeLacure MD. Chapter 31. Malignant Laryngeal Lesions. In: Lalwani AK. eds. CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e. New York, NY: McGraw-Hill; 2012. Accessed February 28, 2016.

    Weinberger PM, Terris DJ. Otolaryngology: Head & Neck Surgery. In: Doherty GM. eds. CURRENT Diagnosis & Treatment: Surgery, 14e. New York, NY: McGraw-Hill; 2015. Accessed February 28, 2016.

    Article titled "Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer" by GT Wolf and co-authors published in NEJM in 1991.

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