HEALTH - CANCER OF THE LARYNX (THROAT CANCER) SYMPTOMS
What is Cancer of the Larnx?
Cancer of the larynx also may be called laryngeal cancer. It can develop in any part of the larynx. Most cancers of the larynx begin in the glottis. The inner walls of the larynx are lined with cells called squamous cells. Almost all laryngeal cancers begin in these cells. These cancers are called squamous cell carcinomas. Throat cancer is cancer of the vocal cords, voice box (larynx), or other areas of the throat.
The larynx is an organ at the front of your neck. It is also called the voice box. It is about 2 inches long and 2 inches wide. It is above the windpipe (trachea). Below and behind the larynx is the esophagus. The larynx has two bands of muscle that form the vocal cords. The cartilage at the front of the larynx is sometimes called the Adam's apple.
The larynx plays a role in breathing, swallowing, and talking. The larynx acts like a valve over the windpipe. The valve opens and closes to allow breathing, swallowing, and speaking:
- Breathing: When you breathe, the vocal cords relax and open. When you hold your breath, the vocal cords shut tightly.
- Swallowing: The larynx protects the windpipe. When you swallow, a flap called the epiglottis covers the opening of your larynx to keep food out of your lungs. The food passes through the esophagus on its way from your mouth to your stomach.
- Talking: The larynx produces the sound of your voice. When you talk, your vocal cords tighten and move closer together. Air from your lungs is forced between them and makes them vibrate. This makes the sound of your voice. Your tongue, lips, and teeth form this sound into words.
If cancer of the larynx spreads (metastasizes), 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, the new tumor has the same kind of abnormal cells as the primary tumor in the larynx. For example, if cancer of the larynx spreads to the lungs, the cancer cells in the lungs are actually laryngeal cancer cells. The disease is called metastatic cancer of the larynx, not lung cancer. It is treated as cancer of the larynx, not lung cancer. Doctors sometimes call the new tumor "distant" disease.
Health: Types of Cancer of the Larynx (Throat - Cancer)
Throat cancer is a general term that applies to cancer that develops in the throat (pharyngeal cancer) or in the voice box (laryngeal cancer). The throat and the voice box are closely connected, with the voice box sitting just below the throat. More specific terms to describe the types of throat cancer include:
- Nasopharyngeal cancer begins in the nasopharynx — the part of your throat just behind your nose.
- Oropharyngeal cancer begins in the oropharynx — the part of your throat that is right behind your mouth.
- Hypopharyngeal cancer (laryngopharyngeal cancer) begins in the hypopharynx (laryngopharynx) — the lower part of your throat, just above your esophagus and windpipe.
- Glottic cancer begins in the vocal cords.
- Supraglottic cancer begins in the upper portion of the larynx and includes cancer that affects the epiglottis, which is a piece of cartilage that blocks food from going into your windpipe.
- Subglottic cancer begins in the lower portion of your voice box, below your vocal cords.
NATURAL CANCER TREATMENT
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Health: Risk Factors of Cancer of the Larynx (Throat - Cancer)
No one knows the exact causes of cancer of the larynx. Doctors cannot explain why one person gets this disease and another does not. We do know that cancer is not contagious. You cannot "catch" cancer from another person.
People with certain risk factors are more likely to get cancer of the larynx. A risk factor is anything that increases your chance of developing this disease.
Studies have found the following risk factors:
- Age. Cancer of the larynx occurs most often in people over the age of 55.
- Gender. Men are four times more likely than women to get cancer of the larynx.
- Race. African Americans are more likely than whites to be diagnosed with cancer of the larynx.
- Smoking. Smokers are far more likely than nonsmokers to get cancer of the larynx. The health risk is even higher for smokers who drink alcohol heavily. People who stop smoking can greatly decrease their risk of cancer of the larynx, as well as cancer of the lung, mouth, pancreas, bladder, and esophagus. Also, quitting smoking reduces the chance that someone with cancer of the larynx will get a second cancer in the head and neck region. (Cancer of the larynx is part of a group of cancers called head and neck cancers.)
- Alcohol. People who drink alcohol are more likely to develop laryngeal cancer than people who don't drink. The health risk increases with the amount of alcohol that is consumed. The health risk also increases if the person drinks alcohol and also smokes tobacco.
- A personal history of head and neck cancer. Almost one in four people who have had head and neck cancer will develop a second primary head and neck cancer.
- Occupation. Workers exposed to sulfuric acid mist or nickel have an increased risk of laryngeal cancer. Also, working with asbestos can increase the risk of this disease. Asbestos workers should follow work and safety rules to avoid inhaling asbestos fibers.
Other studies suggest that having certain viruses or a diet low in vitamin A may increase the chance of getting cancer of the larynx. Another risk factor is having gastroesophageal reflux disease (GERD), which causes stomach acid to flow up into the esophagus.
Most people who have these risk factors do not get cancer of the larynx. If you are concerned about your chance of getting cancer of the larynx, you should discuss this concern with your health care provider. Your health care provider may suggest ways to reduce your risk and can plan an appropriate schedule for checkups.
Health: Symptoms of Cancer of the Larynx (Throat - Cancer)
People with larynx cancer may experience the following symptoms. Sometimes, people with larynx cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical health condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor or health care provider.
- Hoarseness or change in voice (often an early symptom) that does not go away within two weeks
- An enlarged lymph node or a lump in the neck
- Airway obstruction, difficulty breathing, and noisy breathing
- Persistent sore throat, or a feeling that something is caught in the throat
- Persistent difficulty in swallowing
- Ear pain
- Chronic bad breath
- Choking
- Unexplained weight loss
- Fatigue
People who notice any of these symptoms should talk with a doctor and/or dentist, especially if the symptoms are persistent or get worse. When detected early, larynx cancer can often be treated successfully while preserving the function of the larynx and/or hypopharynx.
Because many of these symptoms can also be caused by other noncancerous health conditions, it is always important to receive regular health and dental screenings, especially for those who routinely drink alcohol or use tobacco products or have used them in the past.
Health: Diagnosis of Cancer of the Larynx (Throat - Cancer)
In addition to a physical examination, the following tests may be used to diagnose laryngeal and hypopharyngeal cancer:
Physical examination. The doctor will feel for any lumps in the neck, lip, gums, and cheek. The doctor will inspect the nose, mouth, throat, and tongue for abnormalities and often use a mirror for a clearer view of these structures. Though there is no specific blood test that detects laryngeal or hypopharyngeal cancer, several tests, including blood and urine tests, may be done to determine the diagnosis and establish the extent of the disease.
Laryngoscopy. This test can be performed in three ways. In an
indirect laryngoscopy, the doctor sprays the throat with a local
anesthetic to numb the area and prevent gagging and then uses a small,
long handled mirror to see the vocal folds. In a fiberoptic
laryngoscopy, the doctor inserts a lighted tube through the person’s
nose or mouth and down the throat to view the larynx and hypopharynx.
In a direct laryngoscopy, done in an operating room, the person receives a sedative or general anesthetic. The doctor then views the larynx and hypopharynx using an instrument called a laryngoscope. A sample of tissue for a biopsy (see below) is often taken during a direct laryngoscopy. Frequently, the doctor will recommend a triple endoscopy, a procedure done under general anesthesia to examine the ear, nose, and throat area, as well as the trachea and the bronchus located next to the lung and the esophagus.
Videostroboscopy. This fiberoptic video technique is used so the doctor can see the larynx. It is performed in the same way as the indirect laryngoscopy. It is used to view the vocal folds and can detect motion abnormalities and other changes, including changes in vibration. Videostroboscopy helps to determine the location and size of a tumor, as well as how the tumor has affected the function of the larynx and hypopharynx.
Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The type of biopsy performed will depend on the location of the cancer. In a fine needle aspiration biopsy, cells are withdrawn using a thin needle inserted directly into the tumor. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).
The following imaging tests may be used to determine if the cancer has metastasized:
X-ray. An x-ray is a picture of the inside of the body. For
instance, a chest x-ray can help doctors determine if the cancer has
spread to the lungs. Sometimes, the patient will be asked to swallow
barium, which coats the mouth and throat, to enhance the image on the
x-ray (called a barium swallow). A barium swallow is used to identify
abnormalities along the throat and esophagus.
A special type of barium swallow, called a modified barium swallow, may be needed to evaluate difficulties with swallowing. A dentist may take extensive x-rays of the teeth, mandible (jawbone), and maxilla (upper jaw), including a panorex (panoramic view). Any signs of cancer may be followed with a computed tomography scan.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of soft tissue, such as the tonsils and the base of the tongue.
Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. This test can detect the spread of cancer to the liver or the lymph nodes in the neck (cervical lymph nodes).
Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is injected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark. In head and neck cancer, bone scans are recommended if there are signs of bone metastasis.
Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images.
Health: Staging of Cancer of the Larynx (Throat - Cancer)
Staging is a way of describing cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body.
Stage 0: Describes a carcinoma in situ (Tis), with no spread to lymph nodes (N0) or distant metastasis (M0).
Stage I: Describes a small tumor (T1), with no spread to lymph nodes (N0) and no distant metastasis (M0).
Stage II: Describes a tumor with some spread to nearby areas (T2), but has not spread to lymph nodes (N0) or to distant parts of the body (M0).
Stage III: Describes any larger tumor (T3), with no spread to regional lymph nodes (N0) or metastasis (M0), or a smaller tumor (T1, T2) that has spread to regional lymph nodes (N1) but has no sign of distant metastasis (M0).
Stage IVA: Describes any invasive tumor (T4a), with either no lymph node involvement (N0) or spread to only a single same-sided lymph node (N1), but no metastasis (M0). It is also used for any tumor (any T) with more significant spread to the lymph nodes (N2), but no metastasis (M0).
Stage IVB: Describes any cancer (any T) with extensive spread to lymph nodes (T3), but no metastasis (M0).
Stage IVC: Indicates there is evidence of distant spread.
Tumor grade. Doctors also describe a
primary tumor by its grade, which is determined by using a microscope
to examine tissue from a tumor. The doctor compares the tumor tissue
with normal tissue. Normal tissue contains many different types of
cells grouped together, which is called differentiated. Tissue from
tumors usually has cells that look more alike, called poorly
differentiated. Generally, the more differentiated the tissue, the
better the prognosis. GX: Indicates the grade cannot be evaluated. G1: Indicates the cells look more like normal tissue (well differentiated). G2: The cells are only moderately differentiated. G3: The cells don’t resemble normal tissue (poorly differentiated).
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Natural Alternative Treatment Options: CANCER FREE
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Health: Conventional Treatment of Cancer of the Larynx (Throat - Cancer)
Cancer of the larynx may be treated with radiation therapy, surgery, or chemotherapy. Some patients have a combination of therapies.
Radiation therapy (also called radiotherapy) uses high-energy x-rays to kill cancer cells. The rays are aimed at the tumor and the tissue around it. Radiation therapy is local therapy. It affects cells only in the treated area. Treatments are usually given 5 days a week for 5 to 8 weeks.
Laryngeal cancer may be treated with radiation therapy alone or in combination with surgery or chemotherapy:
- Radiation therapy alone: Radiation therapy is used alone for small tumors or for patients who cannot have surgery.
- Radiation therapy combined with surgery: Radiation therapy may be used to shrink a large tumor before surgery or to destroy cancer cells that may remain in the area after surgery. If a tumor grows back after surgery, it is often treated with radiation.
- Radiation therapy combined with chemotherapy: Radiation therapy may be used before, during, or after chemotherapy.
After radiation therapy, some people need feeding tubes placed into the abdomen. The feeding tube is usually temporary.
Surgery is an operation in which a doctor removes the cancer using a scalpel or laser while the patient is asleep. When patients need surgery, the type of operation depends mainly on the size and exact location of the tumor.
There are several types of laryngectomy (surgery to remove part or all of the larynx):
- Total laryngectomy: The surgeon removes the entire larynx.
- Partial laryngectomy (hemilaryngectomy): The surgeon removes part of the larynx.
- Supraglottic laryngectomy: The surgeon takes out the supraglottis, the top part of the larynx.
- Cordectomy: The surgeon removes one or both vocal cords.
Sometimes the surgeon also removes the lymph nodes in the neck. This is called lymph node dissection. The surgeon also may remove the thyroid.
During surgery for cancer of the larynx, the surgeon may need to make a stoma. (This surgery is called a tracheostomy.) The stoma is a new airway through an opening in the front of the neck. Air enters and leaves the windpipe (trachea) and lungs through this opening. A tracheostomy tube, also called a trach ("trake") tube, keeps the new airway open. For many patients, the stoma is temporary. It is needed only until the patient recovers from surgery. More information about stomas can be found in the "Living with a Stoma" section.
After surgery, some people may need a temporary feeding tube.
This picture shows the pathways for air and food after a total laryngectomy.
The stoma is the new opening into the trachea.
Chemotherapy is the use of drugs to kill cancer cells. Your doctor may suggest one drug or a combination of drugs. The drugs for cancer of the larynx are usually given by injection into the bloodstream. The drugs enter the bloodstream and travel throughout the body.
Chemotherapy is used to treat laryngeal cancer in several ways:
- Before surgery or radiation therapy: In some cases, drugs are given to try to shrink a large tumor before surgery or radiation therapy.
- After surgery or radiation therapy: Chemotherapy may be used after surgery or radiation therapy to kill any cancer cells that may be left. It also may be used for cancers that have spread.
- Instead of surgery: Chemotherapy may be used with radiation therapy instead of surgery. The larynx is not removed and the voice is spared.
Chemotherapy may be given in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a hospital stay may be needed.
Targeted drugs therapy treat throat cancer by altering specific aspects of cancer cells that fuel their growth. Cetuximab (Erbitux) is one targeted therapy approved for treating throat cancer in certain situations. Cetuximab stops the action of a protein that's found in many types of healthy cells, but is more prevalent in certain types of throat cancer cells.
Other targeted drugs are being studied in clinical trials. Targeted
drugs can be used in combination with chemotherapy or radiation
therapy.
Health: Side Effects of Treatment of Cancer of the Larynx (Throat - Cancer)
Cancer treatments are very powerful. Treatments that remove or destroy cancer cells are likely to damage healthy cells, too. That's why treatments often cause side effects. This section describes some of the side effects of each kind of treatment.
Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and how they can be managed. It may help to know that although some side effects may not go away completely, most of them become less troubling.
It may also help to talk with other patients. A social worker, nurse, or other member of the medical team can set up a visit with someone who has had the same treatment.
The NCI provides helpful booklets about cancer treatments and coping with side effects, such as Radiation Therapy and You and Eating Hints for Cancer Patients. See the "National Cancer Institute Information Resources" and "National Cancer Institute Booklets" sections for other sources of information about side effects.
People treated with radiation therapy may have some or all of these side effects:
- Dry mouth. Drinking lots of fluids can help. Some patients find artificial saliva helpful. It comes in a spray or squeeze bottle.
- Sore throat or mouth. Your health care provider may suggest special rinses to numb your throat and mouth and help relieve the soreness.
- Delayed healing after dental care. Many doctors recommend having a dental exam and any needed dental work before radiation therapy.
- Tooth decay. Good mouth care can help keep your teeth and gum healthy and can help you feel better. If it's hard to floss or brush your teeth in the usual way, you can try using gauze, a soft toothbrush, or a toothbrush that has a spongy tip instead of bristles. A mouthwash made with diluted peroxide, salt water, baking soda, or a combination can keep your mouth fresh and help protect your teeth from decay. It may also be helpful to use fluoride toothpaste or rinse.
- Changes in sense of taste and smell. During radiation therapy, food may taste or smell different.
- Fatigue. During radiation therapy, you may become very tired, especially in the later weeks of treatment. Resting is important, but doctors usually advise their patients to stay as active as they can.
- Changes in voice quality. Your voice may be weak at the end of the day. It may also be affected by changes in the weather. Voice changes and the feeling of a lump in your throat may come from swelling in the larynx caused by the radiation. The doctor may suggest medicine to reduce this swelling.
- Skin changes in treated area. The skin in the treated area may become red or dry. Good skin care is important at this time. Try to expose this area to the air but protect it from the sun. Avoid wearing clothes that rub, and do not shave the treated area. You should not put anything on your skin before radiation treatments. Also, you should never use lotion or cream without your doctor's advice.
Surgery
People who have surgery may have any of these side effects:
- Pain. You may be uncomfortable for the first few days after surgery. However, medicine can usually control the pain. You should feel free to discuss pain relief with the doctor or nurse.
- Low energy. It is common to feel tired or weak after surgery. The length of time it takes to recover from an operation is different for each patient.
- Swelling in the throat. For a few days after surgery, you won't be able to eat, drink, or swallow. At first, you will receive fluid through an intravenous (IV) tube placed into your arm. Within a day or two, you will get fluids and nutrition through a feeding tube (put in place during surgery) that goes through your nose and throat into your stomach. When the swelling goes away and the area begins to heal, the feeding tube will be removed. Swallowing may be difficult at first, and you may need the help of a nurse or speech pathologist. Soon you will be eating your regular diet. If you need a feeding tube for longer than one week, you may get a tube that goes directly into the abdomen. Most patients slowly return to eating solid foods by mouth, but for a very few patients, the feeding tube may be permanent.
- Increased mucus production. After the operation, the lungs and windpipe produce a lot of mucus, also called sputum. To remove it, the nurse applies gentle suction by placing a small plastic tube in the stoma. You will learn to cough and suction mucus through the stoma without the nurse's help.
- Numbness, stiffness, or weakness. After a laryngectomy, parts of the neck and throat may be numb because nerves have been cut. Also, the shoulder, neck, and arm may be weak and stiff. You may need physical therapy to improve your strength and flexibility after surgery.
- Changes in physical appearance. Your neck will be somewhat smaller, and it will have scars. Some patients find it helpful to wear clothing that covers the neck area.
- Tracheostomy. Patients who have surgery will have a stoma. With most supraglottic and partial laryngectomies, the stoma is temporary. After a short recovery period, the tube can be removed, and the stoma closes up. You should then be able to breathe and talk in the usual way. In some people, however, the voice may be hoarse or weak.
After a total laryngectomy, the stoma is permanent. If you have a total
laryngectomy, you will need to learn to speak in a new way.
Chemotherapy
The side effects of chemotherapy depend mainly on the specific drugs and
the dose. In general, anticancer drugs affect cells that divide rapidly:
- Blood cells: These cells fight infection, help your blood to clot, and carry oxygen to all parts of your body. If your blood cells are affected, you are more likely to get infections, may bruise or bleed easily, and may feel very weak and tired.
- Cells in hair roots: Chemotherapy can lead to hair loss, but hair will grow back. However, the new hair may be different in color and texture.
- Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Many of these side effects can be controlled with new or improved drugs.
Nutrition
Some people who have had treatment for cancer of the larynx may lose
their interest in food. Soreness and changes in smell and taste may make
eating difficult. Yet good nutrition is important. Eating well means getting
enough calories and protein to prevent weight loss, regain strength, and
rebuild healthy tissues.
If eating is difficult because your mouth is dry from radiation therapy, you may want to try soft, bland foods moistened with sauces or gravies. Thick soups, puddings, and milkshakes often are easier to swallow. The nurse and the dietitian will help you choose the right foods.
After surgery or radiation therapy, some people need feeding tubes placed into the abdomen. Most people slowly return to a regular diet. Learning to swallow again may take some practice with the help of a nurse or speech pathologist. Some people find liquids easier to swallow; others do better with solid foods. You will find what works best for you.
Health: Prevention for Cancer of the Larynx (Throat - Cancer)
Although there's no proven way to prevent throat cancer from occurring, by taking these following steps of prevention can reduce your risk of throat cancer:
- Stop smoking or don't start smoking. If you smoke, quit. If you don't smoke, don't start. Quitting smoking can be very difficult, so get some help. Your doctor can discuss the benefits and risks of the many stop smoking strategies, such as medication, nicotine replacement products and counseling.
- Drink alcohol only in moderation, if at all. For women and older adults, this means one drink a day. For men, moderate drinking means no more than two drinks a day.
- Choose a healthy diet full of fruits and vegetables. The vitamins and antioxidants in fruits and vegetables may reduce your risk of throat cancer. Eat a variety of colorful fruits and vegetables.
- Use caution around chemicals. When working with chemicals, whether on the job or around your house, carefully follow the directions. Avoid breathing hazardous chemical fumes. Properly ventilate the room where you're working and wear a mask over your nose and mouth.
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Disclaimer: This information is not presented by a medical practitioner. Therefore any content of this site is strictly intended for educational and informational purpose only. Any access to this site is strictly on a voluntary basis and at the sole discretion of the user. No content of this site is intended as a substitute for medical advice, diagnosis or treatment, nor constitute the practice of any medical profession or health care provider. The information provided on this site is here to educate visitors on health issues that may affect their lives. Otherwise, always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. And never disregard professional medical advice or delay in seeking it because of something you have read.
Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
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