Cancer of the larynx (voice box), often causing persistent hoarseness
- Most common after the age of 50
- Four times more common in males
- Smoking and alcohol abuse are risk factors
- Genetics is not a significant factor
Cancer of the larynx is rare in the UK, accounting for only about 1 in every 100 cases of cancer. It usually occurs after the age of 50 and is four times more common in men than women. In about 6 in 10 cases, cancer develops on the vocal cords; in the remainder, it begins above or below the cords. If the cancer is on the cords, symptoms develop early, allowing prompt diagnosis and treatment. If cancer develops elsewhere in the larynx, it is more likely to be fatal.
The cause of laryngeal cancer is not known, but it is commonly associated with smoking and alcohol abuse. Without treatment, it may spread to lymph nodes in the neck and eventually to other areas.
What are the symptoms?
If a tumour develops on the vocal cords, the first noticeable symptom is hoarseness. If the tumour is not detected, it may spread above and below the vocal cords, causing symptoms such as:
Difficulty in breathing.
Difficult and painful swallowing.
These symptoms may also occur if cancer develops above or below the vocal cords, although often these tumours do not produce symptoms at first. Tumours developing anywhere in the larynx may spread to the lymph nodes in the neck, causing them to become enlarged.
How is it diagnosed?
Your doctor will examine your throat (see Mirror laryngoscopy). If cancer is suspected, you will have a further examination known as direct laryngoscopy. In this procedure, which is usually carried out under general anaesthesia, a tissue sample is removed. If the lymph nodes in the neck are enlarged, fine needle aspiration may be performed, in which a tissue sample is taken from a lymph node using a needle attached to a syringe. You may also have CT scanning or MRI to see how far the cancer has spread.
What is the treatment?
Treatment will depend on how far the cancer has spread. You may be offered radiotherapy, and you will possibly be given surgery. If surgery to remove the entire larynx is necessary, you will need a permanent laryngectomy, in which a hole (stoma) is made in the windpipe (trachea) to maintain an airway for breathing. You may need a similar procedure called a tracheostomy temporarily while you are undergoing radiotherapy, but it can be reversed when treatment is completed.
If the larynx has to be removed, normal speech will no longer be possible. However, several techniques have been developed that allow speech without a larynx. A speech therapist (see Speech therapy) may teach you to speak using your oesophagus, or a small device known as a tracheo-oesophageal valve may be fitted to help you to speak. Alternatively, you may be taught to speak using a hand-held electromechanical device that generates sounds.
In more than 9 in 10 cases in which the tumour develops on the vocal cords and is detected and treated early, treatment is successful. The chances of a cure are reduced if the cancer originates elsewhere in the larynx because symptoms appear later and the cancer may have already spread. In these cases, treatment may be given only to relieve symptoms, and survival rates are much lower.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
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