Laryngeal cancer is a type of cancer that affects the larynx (voice box). The larynx is a tube about 5cm long in adults. It is located in the neck, above the trachea (the windpipe), and in front of the esophagus (the food pipe). One-third of all head and neck cancers are laryngeal cancer, which may be a significant cause of morbidity and mortality. In the USA, 13,000 new cases of laryngeal cancer are reported each year, the majority of which are squamous cell carcinoma. Patients with a considerable history of smoking are more likely to be diagnosed with laryngeal cancer. It can occur at various subsites of the larynx such as supraglottic, glottic, and subglottic with different manifestations or symptomatic presentation, patterns of spread, and therapeutic approaches. 

Laryngeal cancer occurs when a tumor grows in the larynx or on the vocal cords. It is a rare type of head and neck cancer.

Symptoms

The symptoms of laryngeal cancer can vary, but they often include:

• Hoarseness: One of the most typical early signs of laryngeal cancer is persistent hoarseness (a change in voice quality that lasts longer than two weeks).

• Chronic or persistent sore throat or throat pain.

• Difficulty in swallowing.

• Shortness of breath.

• Noisy breathing

• Unexplained weight loss

• Blood on coughing (hemoptysis), may be a symptom in later stages.

• Lump or mass in the throat and neck

• Ongoing fatigue and weakness

• Persistent ear pain

• Bad breath (termed as halitosis).

Diagnosis

Laryngeal cancer may be diagnosed using various tests such as laryngoscopy, nasendoscopy, imaging, bone scan, barium swallow, and histopathological examination.

Medical history and physical examination

A patient’s complete medical history is recorded, including details about their symptoms, tobacco and alcohol use, contact with asbestos or sulphuric acid at work, and the presence of any co-morbidities. During physical examination, lymph nodes, neck, inside of the mouth (including the cheeks and lips), back of the throat, nose, and ears are examined for any lumps or swelling, growths, or abnormalities.

Laryngoscopy

The most common method for directly visualizing the larynx is through a procedure called laryngoscopy. Laryngoscopy can be performed using a flexible or rigid endoscope, and it allows the examination of the vocal cords and surrounding tissues for tumor invasion, to check sub-sites such as anterior commissure, subglottis, laryngeal ventricle, and pyriform sinus, and to perform biopsies.

Nasendoscopy

A nasendoscopy is a test to examine the larynx, pharynx, and nose from the inside. Typically, a nasendoscopy is performed at an outpatient facility.

Imaging

• Computerized tomography (CT) and magnetic resonance imaging (MRI): CT scan and MRI are utilized to stage primary laryngeal cancer, except for tiny superficial carcinomas. Both tests can provide information on the primary tumor volume, cartilage involvement, invasion of the pre-epiglottic region, and extension and/or invasion outside the larynx.

• PET-CT (Positron Emission Tomography-Computed Tomography): PET-CT scans can help determine if the cancer has spread to other parts of the body (metastasis).

• Ultrasonography: Ultrasonography is a sensitive technique for identifying neck and metastatic involvement. Large reactive lymph nodes cannot be reliably distinguished from metastatic ones by ultrasonography.

Bone scan

To do a bone scan, a small amount of low-level radioactive material is injected into the blood, where it primarily gathers in aberrant bone tissue. A bone scan can assist in determining whether a malignancy has metastasized to the bones.

Barium swallow

If there is a swallowing issue, barium swallow may be performed. The patient consumes a barium liquid to cover the walls of the throat and esophagus (swallowing tube) and then a series of x-rays of the throat and esophagus are taken to check for any abnormalities.

Histopathological examination

Laryngeal cancer requires a biopsy, which entails the removal of a small tissue sample for evaluation under a microscope, to provide a conclusive diagnosis. Using specialized tools, the biopsy may be completed during laryngoscopy. The tissue sample will be histopathologically examined to confirm the presence of cancer, the type, and grade of cancer.

Additional Tests

Additional tests may be performed, including blood tests (complete blood count, liver and kidney function tests), pulmonary function tests, nutrition and speech tests, and hearing tests to evaluate the patient's general health condition.

Management

The choice of treatment depends on the type, stage, grade, and spread of laryngeal cancer, and the general health of the patient. One or more of the following treatment methods may be utilized based on the patient's requirements.

Surgery

For early laryngeal cancer, surgery may be preferred as it can remove the tumor while preserving the larynx. Surgical procedures include:

• Cordectomy: Removal of a portion of the vocal cords.

• Partial Laryngectomy: Removal of a part of the larynx.

• Total Laryngectomy: Removal of the entire larynx, which involves creating a hole in the neck to breathe.

• Thyroidectomy: Removal of the entire or part of the thyroid gland.

• Supraglottic laryngectomy: Removal of the supraglottis (the upper part of your larynx).

• Laser surgery: Removal of the tumor in a bloodless procedure using a laser beam.

Radiation therapy

High-intensity radiation is used in radiotherapy to kill cancer cells. Intensity-modulated radiation therapy (IMRT) is a specific form of radiation therapy commonly utilized for laryngeal cancer. It may be used as the main course of treatment, in conjunction with surgery, and chemotherapy.

Chemotherapy

Chemotherapeutic drugs are used to either kill or slow the growth of cancer cells. For advanced laryngeal cancer, it is frequently combined with radiation therapy (chemoradiation). In circumstances where surgery or radiation are not the options, chemotherapy can be used. For laryngeal cancer, cisplatin, fluorouracil, paclitaxel (Taxol), docetaxel (Taxotere), capecitabine (Xeloda), carboplatin (Paraplatin), and methotrexate are the preferred drugs.

Targeted Therapy

Targeted therapy is designed to specifically target cancer cells and the pathways that support their growth. The targeted therapy like cetuximab (Erbitux) may be utilized in some cases of laryngeal cancer.

Immunotherapy

Pembrolizumab and nivolumab are the immunotherapeutics used for patients with laryngeal cancer. Immunotherapy works by stimulating the body's immune system to recognize and attack cancer cells.

Voice Rehabilitation

For patients who have undergone surgery that affects their ability to speak, voice rehabilitation and speech therapy may be recommended to improve voice quality (acoustic and perceptual qualities), patient perceptions, and communication.

Early detection through regular check-ups and prompt treatment are pivotal in the battle against laryngeal cancer. With advances in medical science and a proactive approach to healthcare, there is hope for better outcomes and improved quality of life for patients with this challenging condition.