Laryngeal Cancer

Laryngeal cancers are the most common cancers of the upper aerodigestive tract, affecting men more than women and in the older age group.

Where exactly is the larynx?

The larynx opens into the trachea (windpipe).

It divided into 3 main parts:

1. Supraglottis, the part above the vocal chords
2. Glottis, the area of the vocal chords
3. Subglottis, the part below the vocal chords leading into the trachea

What are the main functions of the larynx?

The larynx is responsible for:

1. Maintaining an open airway (breathing)
2. Voice production
3. Preventing aspiration (preventing food particles from accidentally entering the windpipe)
4. Protecting the lungs from harmful or irritative substances

What are the symptoms of laryngeal cancers?

Patients complain of:

1. Voice hoarseness
2. Shortness of breath
3. Recurrent lung infection due to aspiration
4. Blood stained sputum
5. Difficulty swallowing
6. Lump in the neck (which usually indicates a spread of the cancer to the lymph nodes)
7. Persistent throat pain or earache

What are the risk factors?

Risk factors include:

1. Smoking
2. Heavy alcohol consumption
3. Human papillomavirus infection
4. Low dietary fibre or diets rich in preserved meats and fats
5. Exposure to industrial fumes or reagents such as paint, asbestos, diesel, gasoline fumes
6. Chronic laryngopharyngeal reflux

How do we work-up and diagnose laryngeal cancers?

A thorough head and neck examination is performed which includes examination of the oral cavity, the neck and a nasoendoscopy. A panendoscopy and biopsy under general anaesthesia is done in the operating theatre for tissue diagnosis. A fine needle aspiration cytology is also performed of any neck node. Either a computed tomography scan or magnetic resonance imaging (CT or MRI) is done to evaluate the extent of the laryngeal lesion and possible neck node involvement. If the biopsy confirmed the diagnosis of cancer, a CT scan of the thorax and liver is done as part of the staging work-up, looking for distant spread to the lungs or the liver.

How do we treat laryngeal cancers?

All patients will be discussed at the multidisciplinary tumour board where the best recommended treatment options will be detailed. Treatment modality depends on:

1. Age and general health of the patient
2. Extent of the laryngeal lesion infiltration
3. Stage of the cancer
4. Preservation of voice
5. Patient’s expectations and preferences

For early stage disease, single modality treatment is considered either with radiotherapy or surgery of the primary laryngeal lesion and the associated nodes in the neck. For more advanced stages, multi-modality treatment is needed, either a combination of chemoradiotherapy or surgery with postoperative radiotherapy, with or without chemotherapy.

Even after completion of treatment of cancer, patients often have to undergo months of rehabilitation due to altered speech and swallowing. Hence, intensive speech and swallowing therapy as well as a regular dietician review is to be expected by our patients.