The American Cancer Society predict that there will be 13,430 new cases and 3,620 deaths from laryngeal cancer in the United States, in 2016. They note that the number of cases is falling by 2 percent to 3 percent each year, probably because fewer people are smoking.
Cancer of the larynx is more likely in older adults, and it is rare in people under 40 years of age. Men are 4 times more likely than women to develop laryngeal cancers.
How does it start and spread?
Smoking is the number one risk factor for cancer of the larynx.
Cancer occurs when cells in the body, in this case, laryngeal cells, multiply and divide without control or order.
Normally, cells divide and multiply in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor.
The cancerous cells can invade nearby tissues and spread to other parts of the body. A benign tumor does not invade or spread.
The larynx is a short passageway, shaped like a triangle, that lies just below the pharynx in the neck. It is about 2 inches wide.
The larynx has three main parts:
- The supraglottis is the tissue above the glottis.
- The glottis is the middle part of the larynx, where the vocal cords are located.
- The subglottis is the tissue below the glottis. It connects to the trachea, which takes air to the lungs.
Cancer of the larynx can develop in any part of the larynx, but it normally begins in the glottis. The inner walls of the larynx are lined with cells called squamous cells, and most laryngeal cancers begin in these cells.
If cancer of the larynx spreads, the cancer cells often spread to nearby lymph nodes in the neck.
The cancer cells can also spread to the back of the tongue, other parts of the throat and neck, the lungs, and other parts of the body.
When this happens, and a tumor forms at the new site, it has the same kind of abnormal cells as the original tumor in the larynx, and it is called metastatic laryngeal cancer.
Symptoms of laryngeal cancer include:
- Persistent cough
- Sore throat
- An abnormal lump in the throat or neck
- Difficulty or pain when swallowing
- Frequent choking on food
- Difficult or noisy breathing
- Persistent ear pain or an unusual sensation in and around the skin of the ear
- Unplanned, significant weight loss
- Persistent bad breath.
Laryngeal cancer can be cured if it is diagnosed early. Just over 60 percent of people diagnosed with this type of cancer will survive for 5 years or more.
Smoking is the most important risk factor for laryngeal cancer. Death from laryngeal cancer is far higher among smokers than among nonsmokers. Passive smoking may also contribute.
Moderate or heavy consumption of alcohol is also a factor. The American Cancer Society suggests that one or more drinks a day, especially if combined with smoking, increases the risk of this type of cancer.
Other risk factors include low socioeconomic status, being male, and aged over 40 years, and a previous history of head or neck cancer. Cancer Research UK notes that acid reflux, human papillomavirus (HPV), exposure to certain chemicals and low immunity have been linked to laryngeal cancer.
Genetic and viral factors and nutritional deficiencies may also play a role.
Cancer of the throat may present as a palpable or visible lump on the outside of the neck. In this case, a biopsy will help make the diagnosis.
A laryngoscope is a small, lighted camera that allows a physician to look into the mouth and down the throat. It may be used if symptoms suggest a laryngeal or other head and neck tumor.
Fiber-optic nasal endoscopy involves a thin, flexible scope that is inserted into the nostril. It allows doctors to see the entire pharynx and larynx. This can be done in a clinic, under a local anesthetic.
Biopsy and pathological analysis of tumors or tissues that appear abnormal must be done to confirm the diagnosis of cancer.
If the lesion appears to be small and limited to one area, the surgeon may do an excisional biopsy, in an attempt to both completely remove the tumor and send it to pathology for review.
If laryngeal cancer is confirmed, doctors may order additional tests to find out if the cancer has spread to other parts of the body.
Treatment depends on the stage of the cancer.
Early-stage laryngeal cancer may be treated by surgery or radiation alone.
At the later stages, a patient may have either a combination of radiation and chemotherapy, or surgery followed by radiation.
Surgery will involve removing the cancerous tumor and nearby tissue, and may include a neck dissection in order to remove cancerous lymph nodes in the neck.
Surgeries for laryngeal cancer include endoscopic resection, partial laryngectomy, and total laryngectomy.
Depending on the type of surgery, the patient may have a temporary or permanent tracheostomy. This is a hole or stoma in the neck that allows for healing after surgery. Some patients will have a permanent stoma, through which they breathe. These patients will need an assistive device to allow them to speak.
Chemotherapy, radiation, and surgery are used to treat laryngeal cancer.
Radiation therapy is used to kill cancer cells and shrink tumors. External beam radiation therapy directs a beam of radiation at the tumor inside the neck from a source outside the body.
The beam burns everything in its path, so the skin, too, will be burned. This can be painful.
Chemotherapy uses drugs to kill cancer cells and to enhance and maximize the effects of radiation. It may be used to reduce the size of a large tumor before surgery, to improve the surgical and cosmetic outcomes.
The drugs are given as pills, or infused into the vein through a catheter. They enter the bloodstream and travel through the body, killing rapidly growing cells including both cancer cells and some healthy cells.
Laryngeal cancer is extremely rare in nonsmokers.
The best way to avoid cancer of the larynx is not to smoke or drink excessive amounts of alcohol, as both have been linked to the disease.