Cancer of the Larynx

Each year, more than 12,000 people in the United States learn that they have cancer of the larynx.

The Larynx

The larynx, also called the voice box, is a 2-inch-long, tube-shaped organ in the neck. We use the larynx when we breathe, talk, or swallow.

The larynx is at the top of the windpipe (trachea). Its walls are made of cartilage. The large cartilage that forms the front of the larynx is sometimes called the Adam's apple. The vocal cords, two bands of muscle, form a "V" inside the larynx.

Each time we inhale (breathe in), air goes into our nose or mouth, then through the larynx, down the trachea, and into our lungs. When we exhale (breathe out), the air goes the other way. When we breathe, the vocal cords are relaxed, and air moves through the space between them without making any sound.

When we talk, the vocal cords tighten up and move closer together. Air from the lungs is forced between them and makes them vibrate, producing the sound of our voice. The tongue, lips, and teeth form this sound into words.

The esophagus, a tube that carries food from the mouth to the stomach, is just behind the trachea and the larynx. The openings of the esophagus and the larynx are very close together in the throat. When we swallow, a flap called the epiglottis moves down over the larynx to keep food out of the windpipe.

What Is Cancer?

Cancer is a group of more than 100 different diseases. They all affect the body's basic unit, the cell. Cancer occurs when cells become abnormal and divide without control or order.

Like all other organs of the body, the larynx is made up of cells. Normally, cells divide to produce more cells only when the body needs them. This orderly process helps keep us healthy.

If cells keep dividing when new cells are not needed, a mass of extra tissue forms. This mass of tissue, called a growth or tumor, can be benign or malignant.

Benign tumors are not cancer. They do not spread to other parts of the body and are seldom a threat to life. Benign tumors can usually be removed, but certain types may return.

Malignant tumors are cancer. They can invade and destroy nearby healthy tissues and organs. Cancer cells can also break away from the tumor and enter the bloodstream and the lymphatic system. That is how cancer spreads to other parts of the body. This spread is called metastasis.
Cancer of the larynx is also called laryngeal cancer. It can develop in any region of the larynx--the glottis (where the vocal cords are), the supraglottis (the area above the cords), or the subglottis (the area that connects the larynx to the trachea).

If the cancer spreads outside the larynx, it usually goes first to the lymph node (sometimes called lymph glands) in the neck. It can also spread to the back of the tongue, other parts of the throat and neck, the lungs, and sometimes other parts of the body.

Cancer that spreads is the same disease and has the same name as the original (primary) cancer. When cancer of the larynx spreads, it is called metastatic laryngeal cancer.

Symptoms

The symptoms of cancer of the larynx depend mainly on the size and location of the tumor. Most cancers of the larynx begin on the vocal cords. These tumors are seldom painful, but they almost always cause hoarseness or other changes in the voice. Tumors in the area above the vocal cords may cause a lump on the neck, a sore throat, or an earache. Tumors that begin in the area below the vocal cords are rare. They can make it hard to breathe, and breathing may be noisy.

A cough that doesn't go away or the feeling of a lump in the throat may also be warning signs of cancer of the larynx. As the tumor grows, it may cause pain, weight loss, bad breath, and frequent choking on food. In some cases, a tumor in the larynx can make it hard to swallow.

Any of these symptoms may be caused by cancer or by other, less serious problems. Only a doctor can tell for sure. People with symptoms like these usually see an ear, nose, and throat specialist (otolaryngologist).

Diagnosis

To find the cause of any of these symptoms, the doctor asks about the patient's medical history and does a complete physical exam. In addition to checking general signs of health, the doctor carefully feels the neck to check for lumps, swelling, tenderness, or other changes. The doctor can also look inside the larynx in two ways:

• Indirect laryngoscopy. The doctor looks down the throat with a small, long-handled mirror to check for abnormal areas and to see whether the vocal cords move as they should. This test is painless, but a local anesthetics may be sprayed in the throat to prevent gagging. This exam is done in the doctor's office.
• Direct laryngoscopy. The doctor inserts a lighted tube (laryngoscope) through the patient's nose or mouth. As the tube goes down the throat, the doctor can look at areas that cannot be seen with a simple mirror. A local anesthetic eases discomfort and prevents gagging. Patients may also be given a mild sedative to help them relax. Sometimes the doctor uses a general anesthetic to put the person to sleep. This exam may be done in a doctor's office, an outpatient clinic, or a hospital.
  

If the doctor sees abnormal areas, the patient will need to have a biopsy. A biopsy is the only sure way to know whether cancer is present. For a biopsy, the patient is given a local or general anesthetic, and the doctor removes tissue samples through a laryngoscope. A pathologist then examines the tissue under a microscope to check for cancer cells. If cancer is found, the pathologist can tell what type it is. Almost all cancers of the larynx are squamous cell carcinoma. This type of cancer begins in the flat, scale-like cells that line the epiglottis, vocal cords, and other parts of the larynx.

If the pathologist finds cancer, the patient's doctor needs to know the stage (extent) of the disease to plan the best treatment. To find out the size of the tumor and whether the cancer has spread, the doctor usually orders more tests, such as x-ray, a CT scan, and/or an MRI. During a CT scan, many x-rays are taken. A computer puts them together to create detailed pictures of areas inside the body. An MRI scan produces pictures using a huge magnet linked to a computer.

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