Larynx Cancer - Definition, Causes, Risk Factors, Symptoms and Treatment

Laryngeal Cancer

The larynx, which protects the trachea during swallowing, allows air to reach the lungs and produces sound through vocal cords, is the region where the respiratory and digestive system are separated. Laryngeal cancer between head and neck cancers occurs in the region where there are vocal cords between the root of the throat and the trachea. Larynx or laryngeal cancer, also known as laryngeal cancer, is one of the most common cancers of head and neck cancer.

Anatomy of The Larynx

Anatomy of the larynx

The larynx is an anatomical structure consisting of cartilage, membrane, ligament and musculoskeletal, located in the midline and anterior part of the neck, extending between the tongue root and trachea, with the task of breathing, swallowing, and most importantly, the formation of sound during speech.

On both sides of the larynx, there are large vascular structures on our neck. 4-6 in adults. The larynx located at the level of the vertebrae is located slightly higher in childhood and in women.

The larynx contains a total of 9 cartilage structures, including 3 pairs and 3 single vertebrae. These:

- Thyroid Cartilage
- Cricoid Cartilage
- Epiglottis
- One pair of Arytenoid Cartilage
- A pair of Corniculate Cartilage
- A pair of Cuneiform Cartilage

Apart from these, there are various membranes, ligaments and muscle groups that form the larynx skeleton.

The larynx is divided into 3 parts:

1. Upper part (Supraglottis):

Epiglottis, arytenoid cartilages and ariepiglottic folds and false vocal cords (sections on vocal cords)

2. Middle section (Glottis):

This is the section where the vocal cords are. True vocal cords consist of anterior and posterior commissures.

3. Subglotttis:

It is the larynx section under the vocal cords.

What is Larynx Cancer?

The inner surface of the larynx is mostly covered with squamous epithelial cells (squamous cells). Laryngeal cancers are of the type called assı Squamous Cell Carcinoma (SCC]) assı which is mostly caused by this epithelium. Since the lymph circulation of the vocal cords, the most common cancer in the larynx region, is very poor, the chance of cancers limited to vocal cords is less than 10% and the success of treatment is very high.

59% of laryngeal cancers occur in the glottic region, 40% in the supraglottic region, and 1% in the subglottic region.

Laryngeal cancer is primarily spread to the lymph nodes in the neck lymphatic way; rarely spreads to distant tissues. This ratio is about 1-4%. In advanced laryngeal cancers, the probability of spreading to distant tissues increases. Distant metastasis is most common to the lung.

Causes of Laryngeal Cancer

Smoking is the most important risk factor for laryngeal cancer. The risk of death from laryngeal cancer is 20 times higher in patients who smoke heavily compared to nonsmokers. Chronic alcohol consumption is another important risk factor. When alcohol and cigarettes are combined, these two factors appear to have a synergistic effect.

Patients with a history of head and neck cancer are at greater risk of developing head, neck, lung, or second cancer (approximately 25%). In a significant proportion of these patients, the respiratory and lung epithelium were simultaneously exposed to chronic carcinogenic effects of alcohol and tobacco.

Tobacco and alcohol use: Alcohol and tobacco use are among the most important risk factors that increase the risk of laryngeal cancer. The amount of use of tobacco and alcohol and the higher the year of use, the higher the risk factor. Those who smoke more than 25 cigarettes per day or who have been smoking for more than 30 years are approximately 40 times more likely to develop laryngeal cancer than non-smokers. Likewise, regular alcohol users have been at risk 3 times more than non-alcohol users for a long time. The vast majority of head and neck cancers, including larynx cancer, are caused by smoking. Do not use cigarettes or tobacco products and people who are constantly exposed to smoke also have an increased risk of having laryngeal cancer.

Gender: Men have a 4-5 times greater risk of having larynx cancer than women. However, in recent years, widespread use of cigarette smoking among women causes laryngeal cancer to be common in women.

Genetic factors: People with a family history of head and neck cancer or laryngeal cancer are more likely to develop laryngeal cancer than those who do not.

Age: As in many types of cancer, advanced age is one of the most important risk factors for laryngeal cancer. Laryngeal cancer is rare under 40 years of age.

Diets of diet: Red meat, processed food or fried foods are more likely to develop laryngeal cancer. There are also studies showing that undernutrition of vitamin A and E is the cause of laryngeal cancer. Fresh fruits and vegetables, known as the Mediterranean diet, are predominantly nourished by taking adequate amounts of vitamins A and E to reduce the risk of larynx cancer.

Laryngopharyngeal reflux, which has gained popularity in recent years, is also among the risk factors. The use of cigarettes with alcohol has a synergistic effect, particularly in the development of supraglottic cancer. Although less associated; low socioeconomic status, male gender and age above 55 are other risk factors.

HPV virus: Human Papilloma Virus (HPV), a sexually transmitted virus, has been reported as an increasing risk factor for oral and laryngeal cancers. It is emphasized that HPV may be the most common cause of oral and laryngeal cancer risk factors in the next 20 years. Since this virus may play a role in head and neck cancers, it is argued that HPV vaccine against uterine cancer should be given in boys. There are scientific studies showing that HPV virus, which is mostly sexually transmitted and causes cancer of genital warts, cervix and vagina in women, can cause laryngeal cancer. HPV is a common infection and can be passed on to most people without causing any problems.

Exposure to harmful substances: Exposure to certain harmful or chemical substances caused by the profession for a long time can cause laryngeal cancer.

Soot or coal dust
Paint Smoke
Formaldehyde used in many industries such as paint production and cosmetics
Isiopropyl alcohol used as cleaning solvent
Sulfuric acid fog
Poor oral hygiene and reflux disease can also cause laryngeal cancer.

Laryngeal Cancer Symptoms

Symptoms of laryngeal cancer vary according to tumor size and location. These symptoms include:

- Hoarseness or other voice changes (if the hoarseness lasts more than 2-3 weeks, a ENT specialist should be consulted)
- Having painless swelling with increasing neck size
- Sore throat or sore throat
- Persistent cough
- Shortness of breath
- Bad breath smell.
- Earache

The main symptom of larynx cancer is hoarseness. This finding is especially valid for vocal cord cancer. However, in cancers above the vocal cord, difficulty in swallowing, pain in the ear, and foreign body sensation in the throat are in the foreground. In large ulcerated tumors, blood may also come from the mouth.

Laryngeal Cancer Diagnosis

The diagnosis of laryngeal cancer is made after endoscopic laryngeal examination and chest x-ray, CT or MRI scans and tissue biopsy after questioning the patient's complaints.

Imaging methods other than endoscopic examination of the larynx are performed for a systematic examination in order to screen for metastatic disease and simultaneous second primary cancer disease. If cancer is suspected, biopsy is usually performed under general anesthesia. Pathological examination of the biopsy provides histological detection of the type and degree of cancer.

If the lesion is small and well localized (for example, a few millimeters of cancer area confined to only one vocal cord), lesion excision can be performed for both diagnostic and therapeutic purposes. In this case, the pathologist will inform both the confirmation of the diagnosis and the tumor-free margin. Further imaging modalities may be unnecessary in small vocal cord tumors. In most cases, the tumor is completed by staging the head and neck for staging purposes.

Larynx cancer video (endoscopic larynx examination, video)

Rigid (rigid) and flexible (soft or bendable) endoscopes are used in the diagnosis of laryngeal cancer. When you click on the video image on the side, a flexible endoscopic examination shows a tumoral lesion with white and irregular areas filling the larynx of a patient ...

Treatment of Laryngeal Cancer

Treatment of Laryngeal Cancer

As a result of all evaluations, tumor size, spread to lymph nodes, distant metastasis status and treatment type are determined according to histologic type of tumor. General health status and patient wishes should also be taken into account.

Specific treatment depends on the location, type and stage of the tumor. Treatment alone or in combination may include surgery, radiotherapy or chemotherapy. Determining which of these treatment methods is appropriate for the patient arises from the coordination of ear, nose and throat specialists and oncologists.

In the surgical treatment of glandular cancers, total laryngectomy was performed by removing the entire larynx and opening a permanent tracheostomy in the neck region; There are many different types of surgery, ranging from partial laryngectomy to the specific area of ​​the larynx.

In cases with tumors limited to vocal cords, removal of the vocal cords (cordectomy), removal of tumor tissue by laser (laser cordectomy) or radiotherapy alone can be performed.

Neck dissection is also performed in order to clean the lymphoid tissues of the neck in case the lymph nodes that are spread to the cancer are detected or the probability of spiking to the lymph nodes in the neck region is high.

After surgery, radiotherapy and chemotherapy can be applied according to the number of lymph nodes spread by the cancer in the neck, cancer spreading out of the lymph node, whether there is cancer spread to the laryngeal cartilage.

Laryngeal Cancer Surgery (Total Laryngectomy, Partial Laryngectomy Operations)

Throat (larynx) cancer treatment, which is an increasing type of cancer especially in smoking societies, consists of surgery, radiotherapy and chemotherapy options planned separately for each patient. Especially in early stage vocal cord cancers, cordectomy is the smallest surgical intervention among laryngeal cancer surgeries. Different types of surgery (laryngectomy operations) have been defined according to the size and location of the area affected by cancer in the larynx. The operation in which the entire larynx is removed and permanent tracheostomy is opened in the neck region is called "Total Laryngectomy Surgery" and operations where certain parts of the larynx are preserved and partial resection are called "Partial Laryngectomy Surgery".

In addition, radiotherapy and chemotherapy treatments have been defined according to the presence or absence of metastasis of the cancer to the lymph nodes of the neck, and the presence of neck dissection and splitting to the distant organ (distant metastasis) and removal of the tumor.

Imaging methods are used for systemic screening in a patient with laryngeal cancer. Most of these patients are also at risk of other cancers of the head and neck region and other organ cancers because they smoke and / or drink alcohol.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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