Definition

Laryngeal carcinoma, also known as laryngeal cancer, is a type of neck cancer that begins to develop in the larynx organ. The larynx, also known as the voice box, is part of the throat that connects to the trachea (part of the respiratory tract branching into the lungs). The larynx plays a crucial role in aiding the processes of breathing, swallowing, and speaking.

Cancer occurs when certain cells in the body begin to grow uncontrollably and start to attack and damage the human body. Cancer, or carcinoma, is malignant. In laryngeal carcinoma, these cancer cells originate in the larynx. If laryngeal cancer spreads to other tissues, it often reaches the lymph nodes in the neck and other nearby organs, such as the tongue, lungs, etc.

Causes

The exact cause of laryngeal carcinoma is not known. In laryngeal carcinoma, there are changes in the larynx cells, although it is not clear why this occurs. All cancer cells start with changes in the DNA or genetic material of the cell. DNA functions to provide our cells with a set of basic instructions, such as when to grow and reproduce.

Changes in DNA can alter the instructions that control cell growth, meaning cells continue to grow instead of stopping when they should. This leads to uncontrolled cell growth, resulting in the growth of tissues that eventually develop into cancer cells. Changes in DNA in laryngeal cells are often caused by smoking habits and can also be caused by:

• Excessive alcohol consumption
• Poor nutrition
• Exposure to the Human Papillomavirus virus
• Disorders of the immune system
• Exposure to hazardous substances in the workplace, such as asbestos
• Certain genetic diseases, such as Fanconi anemia inherited genetically from parent to child

Risk Factor

Smoking and alcohol consumption

Smoking or using other tobacco products significantly increases the risk of laryngeal carcinoma. Alcohol consumption, especially in large amounts, can also increase the risk of laryngeal carcinoma. Alcohol consumption and tobacco use together can further increase the risk.

Age

Laryngeal carcinoma occurs more often in people aged 55 and older.

Gender

Men are more likely to develop this cancer, perhaps because heavy smoking and alcohol consumption are more common in men.

History of head and neck cancer

About one in four (25%) people who have had head and neck cancer are at risk of getting it again.

Exposure to substances

People exposed to certain substances in the workplace have a higher risk. These substances include sulfuric acid, wood dust, nickel, asbestos, or combustion residues.

Family history

People who have parents, brothers, sisters, or children diagnosed with laryngeal carcinoma are more likely to develop laryngeal carcinoma than those without a family history.

Human Papillomavirus (HPV) virus

Human Papillomavirus (HPV) is a group of viruses that attack the skin and mucous membranes lining several parts of the body, such as those in the cervix, anus, mouth, and throat. This virus often spreads through sexual contact, including oral sex. It is estimated that this virus may contribute to changes that occur in laryngeal cells.

Symptoms

The main symptoms of laryngeal carcinoma are having a hoarse voice for more than 3 weeks, which may be accompanied by other symptoms such as:

• Changes in voice, such as persistent hoarseness
• Pain when swallowing or difficulty swallowing
• Lump or swelling in the neck
• Persistent cough or difficulty breathing
• Sore throat or persistent ear pain
• Wheezing or high-pitched squeaking sounds heard when breathing
• In severe cases, difficulty breathing may occur
• Unplanned and significant weight loss
• Persistent foul breath

Diagnosis

In diagnosing laryngeal carcinoma, the doctor will start by conducting an interview to ask about the symptoms you are experiencing, possible risk factors, your lifestyle and social habits that may contribute to the onset of laryngeal carcinoma, and other medical history. Next, the doctor will perform a physical examination to find signs of possible cancer or other diseases. The doctor will pay close attention to your head and neck, looking for abnormal areas on the outside and inside of your mouth or throat and assessing swollen lymph nodes in your neck.

After the initial examination, you will likely need further tests to confirm the diagnosis. Some supportive examinations that the doctor may recommend include:

• Laryngoscopy

There are two types of laryngoscopy examinations, namely direct laryngoscopy and indirect laryngoscopy. In indirect laryngoscopy, the doctor will use a small mirror placed at the back of the mouth, above the throat, to view the condition of the larynx through the mirror. In direct laryngoscopy, the doctor will use a thin tube with a camera at the end called an endoscope inserted into your throat to examine the larynx.

• Imaging scans

CT or MRI scans can provide detailed body images. Chest X-rays can help determine if cancer cells have spread to the lungs.

• PET scan

During a PET scan, a small dose of radioactive substance will be injected into your bloodstream. This substance will mark abnormal areas of the body where cancer cells are present. The PET scan machine can create a 3D image of the energy emitted by this substance.

• Biopsy

This examination is usually done to confirm cancer cells in the larynx. In a biopsy examination, the doctor will remove a small piece of abnormal tissue in the larynx to be examined under a microscope.

Management

Treatment options for laryngeal carcinoma include:

• Radiation therapy uses high-energy radiation to kill cancer cells. Radiation targets only cancer cells to minimize damage to surrounding healthy tissue.
• Chemotherapy, using specific drugs to kill or slow the growth of cancer cells. People often receive chemotherapy intravenously (through the bloodstream). Chemotherapy can cause some side effects during treatment.
• Immunotherapy uses and modifies your body's immune system, your natural body defenses, to help fight cancer. Immunotherapy is also called biological therapy.
• Surgery is an option for early-stage laryngeal carcinoma. Surgery can remove cancer cells while preserving the structure of the larynx (and the ability to speak and swallow). For advanced-stage cancer, surgeons often need to perform a laryngectomy, a surgical procedure to remove the larynx entirely.

You may receive more than one treatment option. For example, in some cases, chemotherapy or radiation therapy may be given after surgery to completely destroy any remaining cancer cells.

Complications

Laryngeal carcinoma can interfere with and damage your voice. If left untreated, this disease can spread to other parts of the body. When it spreads, laryngeal carcinoma often reaches the lymph nodes around the neck. These cells can also spread to the back of the tongue, other parts of the throat and neck, lungs, and other parts of the body.

Prevention

There is no known way to prevent the onset of laryngeal carcinoma. Steps you can take to reduce your risk include:

• If you smoke, reduce or quit tobacco use in all forms.
• If you drink alcohol, begin to limit or avoid alcohol consumption.
• Use appropriate protective equipment if exposed to asbestos or other toxic substances in the workplace.
• Eat healthy foods, including foods high in antioxidants.

When to See a Doctor?

Consult with a doctor if you experience symptoms of laryngeal carcinoma, especially if you have hoarseness for more than 3 weeks. The doctor will help identify the cause of your symptoms and provide appropriate guidance and treatment.