Laryngeal cancer

How cancer develops

         

About laryngeal cancer

Laryngeal cancer is caused by an uncontrolled growth of cells in your larynx. About 2,300 people are diagnosed with laryngeal cancer each year in the UK. Most of these people are men over 40.

Your larynx sits at the entrance of your windpipe (trachea). It stops food entering your trachea and allows you to breathe. It also produces the sounds you make when you speak.

Types of laryngeal cancer

Nine out of 10 laryngeal cancers are squamous cell carcinomas. This type of laryngeal cancer starts in the flat, skin-like cells that cover the inside of your larynx. Other, rarer types of laryngeal cancers include the following.

  • Adenocarcinoma. This type starts in the gland cells scattered around the surface of your larynx.
  • Sarcomas. This type starts in connective tissues such as cartilage, muscle and nerves. Sarcomas of the larynx are extremely rare.

Symptoms of laryngeal cancer

A change in your voice or hoarseness is often the first sign of laryngeal cancer. If you have a hoarse voice for longer than three weeks, see your GP. Other symptoms of laryngeal cancer include:

  • pain or discomfort when you swallow – this can vary from feeling like there is a crumb stuck in your throat to being completely unable to swallow
  • a sensation of having a lump in your throat
  • an unexplained cough
  • restrictive and noisy breathing
  • unexplained weight loss

These symptoms aren't always caused by laryngeal cancer, but if you have them see your GP.

Causes of laryngeal cancer

The exact reasons why you may develop laryngeal cancer aren’t fully understood at present. But there are certain factors that make laryngeal cancer more likely, such as:

  • smoking
  • drinking alcohol excessively
  • human papilloma virus (HPV) infection
  • exposure to asbestos, formaldehyde, nickel or sulphuric acid – being regularly exposed to wood dust, paint fumes, soot or coal dust may also increase your risk
  • a weakened immune system – this includes people who have HIV/AIDS, or who are taking medicines that suppress the immune system

Diagnosis of laryngeal cancer

Your GP will ask about your symptoms and examine you. He or she may also ask about your medical history. You may be referred to a doctor who specialises in ENT (ear, nose and throat) conditions.

At the hospital, you will have tests to confirm a diagnosis. Your doctor will pass a narrow, flexible, tube-like telescopic camera into the back of your throat to see your larynx. The tube may be passed through your mouth (called laryngoscopy) or through your nose (called nasoendoscopy). The procedure may feel a bit uncomfortable, so your doctor may use a local anaesthetic spray.

Your doctor will take a biopsy. This is when a small sample of tissue is removed and sent to a laboratory for testing.

If you have laryngeal cancer, your doctor will recommend further tests to find out the size of your tumour and check whether the cancer has spread to other parts of your body. These tests may include X-ray, ultrasound, a CT scan or MRI scan. You may also have blood tests.

Treatment of laryngeal cancer

Your treatment will depend on the type of laryngeal cancer you have and how far it has spread. It will also depend on your age and general health. Your doctor will discuss your treatment options with you.

Surgery

Surgery (including the use of lasers) involves removing just the affected tissue. How much surgery is needed depends on how much tissue is affected. If the cancer is caught early, the cancerous cells may be destroyed using a laser, leaving your larynx intact. If the cancer is advanced, you may need to have part, or all, of your larynx removed. If you have all of your larynx removed, this is called a total laryngectomy.

Surgery is sometimes followed by chemotherapy or radiotherapy treatment to make sure all the cancer cells are destroyed.

Non-surgical treatments

Radiotherapy
A beam of radiation is targeted into the affected area. The aim of the treatment is to destroy cancer cells with minimal damage to the surrounding healthy tissue. Radiotherapy is often the first treatment option if the cancer affects only a small area of your larynx.

Chemotherapy
If you have a large laryngeal tumour, you may have chemotherapy before, or at the same time as, radiotherapy treatment. The medicines are usually injected into a vein but sometimes may be given as tablets.

Biological therapy
Your surgeon may treat you with manufactured monoclonal antibodies (cetuximab), in combination with radiotherapy. Cetuximab is a new treatment and is approved for use only in advanced squamous cell cancer of the head and neck. It blocks areas on the surface of cancer cells that can trigger growth.

Prevention of laryngeal cancer

Not smoking, eating a healthy, balanced diet, maintaining a healthy weight and drinking sensibly may help to protect against laryngeal cancer.

Will I be able to eat and drink normally after I've had treatment on my larynx?

Answer

It depends on the type of treatment you have had, but in general, treatment for laryngeal cancer is more likely to affect the way you breathe and speak than the way you eat and drink. You may find you have difficulty swallowing at first, but this should improve as you recover.

Explanation

Your larynx is part of your trachea (windpipe), so having treatment for laryngeal cancer is more likely to affect the way you breathe and speak and not the way you eat and drink. It’s possible you may have some problems with swallowing, but this will depend on the type of treatment you have had.

Radiotherapy treatment can give you a dry mouth and a sore throat for about two weeks. Eating softer foods can help. Having surgery will make swallowing difficult. If you have laser surgery, swallowing will become easier within a couple of days as the swelling improves.

If you have any concerns about how your treatment may affect your ability to eat or drink, talk to your doctor.

Will I be able to speak normally again if my larynx is removed?

Answer

If your larynx is removed, you won't be able to speak in the normal way. However, most people can learn how to make sounds and speak using a variety of different methods.

Explanation

If you need to have your larynx removed, your surgeon may fit a valve onto the opening made in your neck. This is called voice prosthesis. Pressing on the prosthesis with your thumb or finger when you breathe out will cause your oesophagus (the pipe that goes from your mouth to your stomach) to vibrate and make a sound. Your lips, tongue and cheeks also help to make sounds.

Other options include:

  • using an electronic device (electropharynx) to develop your voice
  • writing to communicate – electronic devices such as keypads are available

Having your larynx removed is a major operation and it can be distressing. Specialist doctors, nurses and speech therapists are experts in providing the care and support you need. A speech and language therapist will help you find the best ways to communicate. Ask your doctor about support groups you can join so you can meet people who have had similar experiences to you.

How would I breathe if I have my larynx removed?

Answer

If your larynx is removed, your surgeon will bring your windpipe (trachea) to the surface of your skin through a hole in your neck. You will no longer breathe through your mouth, but instead through the hole.

Explanation

If your larynx is removed, your trachea will no longer link to your mouth. Your surgeon will create a hole in your neck, called a laryngectomy stoma. This will be the opening for your trachea. Instead of taking air in through your mouth, it will pass directly into your lungs from the stoma in your neck.

You may need to use a stoma cover when you shower and special equipment if you go swimming to prevent water getting into your lungs. You may also need to use a stoma filter to protect against dust and dirt, and a heat and moisture exchanger (HME), which warms and moistens the air to prevent coughing.

Having your larynx removed is a major operation and it can be distressing. Specialist doctors, nurses and speech therapists are experts in providing the care and support you need. Ask your doctor about support groups you can join so you can meet people who have had similar experiences to you.