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Laryngeal Cancer

What is this condition?

Laryngeal cancer is cancer of the larynx - the "voice box." It is nine times more common in males than in females and usually strikes between ages 50 and 65.

Intrinsic laryngeal cancer, which originates in a pair of folds called the true vocal cords, rarely spreads because underlying connective tissues lack lymph nodes. Extrinsic laryngeal cancer, which originates outside these structures, tends to spread early.

Laryngeal cancer is classified according to its location:

  • supraglottic (false vocal cords)
  • glottic (true vocal cords)
  • subglottic (downward extension from the vocal cords).

What causes it?

Major factors that can lead to laryngeal cancer include smoking and alcoholism. Minor factors include chronic inhalation of noxious fumes and familial tendency.

What are its symptoms?

In intrinsic laryngeal cancer, the primary and earliest symptom is hoarseness that lasts more than 3 weeks. In extrinsic cancer, it's a lump in the throat or pain or burning in the throat when drinking citrus juice or hot liquid.

If the disease spreads to other sites, the person may have trouble swallowing, shortness of breath or difficulty breathing, a cough, enlarged lymph nodes in the neck, and pain radiating to the ear.

How is it diagnosed?

Anyone who is hoarse for more than 2 weeks should have laryngoscopy, a procedure in which the doctor directly visualizes the larynx after inserting an instrument called an endoscope.

Firm diagnosis also requires xeroradiography (a special X-ray technique), biopsy, laryngeal tomography (an X-ray showing a detailed cross-section of the larynx), a computed tomography scan (commonly called a CAT scan), or laryngography (an X-ray of the larynx after instillation of a radiopaque substance). These studies define the tumor borders. To detect cancer spread, the doctor will take chest X-rays.

How is it treated?

Early tumors are treated with surgery or radiation; advanced tumors with surgery, radiation, and chemotherapy. Surgical procedures vary with tumor size.

Drugs used in chemotherapy may include methotrexate, cisplatin, bleomycin, fluorouracil, and vincristine.

The treatment goal is to eliminate the cancer and preserve speech. If speech can't be preserved, the person may receive a special speech or prosthetic device. (Surgical techniques to construct a new voice box are still experimental.)

What can a person with laryngeal cancer do?

  • If you're scheduled for a partial or total laryngectomy, the doctor or nurse will help you choose a temporary nonspeaking communication method (such as writing) before surgery. Be aware that right after the operation, you'll breathe through your neck and won't be able to speak. You also won't be able to smell, blow your nose, whistle, gargle, sip, or suck on a straw.
  • After a partial laryngectomy, you won't be permitted to use your voice at all until the doctor allows it (usually 2 to 3 days after surgery). Then you'll be told to whisper until healing is complete.
  • After a total laryngectomy, speech rehabilitation may help you to speak again. For support, contact the International Association of Laryngectomees.
  • After radical neck dissection, you can do special exercises to strengthen your neck, arm, and shoulder muscles.

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