Facts and figures about laryngeal cancer
Accounts for approximately 1% of all new male cancer cases and 0.3% of new female cancer cases each year in the UK. Much higher incidence in men, male to female ratio of approximately 45:10. Age related, 25% of cases arising in the 75+years age group and 74% in those 60+ years.
Risk factors include smoking, heavy alcohol consumption (especially spirits), diet of high processed foods and lack of fruit and vegetables. Also, increased risk in those with gastro-oesophageal reflux disease, laryngeal dysplasia, organ transplant recipients, HPV and helicobacterpylori infections, HIV, first degree relative diagnosed with larynx cancer or occupational exposure to asbestos or rubber production chemicals.
Laryngeal cancer symptoms
- Hoarseness/ changes in voice.
- Pain/difficulty in swallowing (dysphagia).
- Persistent sore throat.
- Persistent coughing.
- Ear pain.
- Breathing difficulties.
- Weight loss.
- Swelling/lumps in the neck.
Diagnosis of laryngeal cancer
Investigations may include:
- Physical examination.
- Blood tests.
- Chest x-ray.
- Endoscopy – tissue samples may be taken from the affected area.
- Fine needle aspiration (FNA) - if there are any lumps/swelling in the neck which could indicate possible node involvement) a thin needle may be used to collect cells from the area for analysis.
- CT scan.
- PET-CT scan.
- MRI scan.
- Ultra sound scan.
Laryngeal cancer treatment
Depends on several factors:
- The position of the tumour/ mobility of the vocal cords.
- The stage of the cancer.
- General health.
Surgery may be used in early stage disease to remove a small tumour or part of the larynx (partial laryngectomy) and in very early stage it may be treated by laser surgery. If the tumour is above the vocal cords, the surgeon will try to avoid damaging them during the operation.
Post-operative radiotherapy may be advised if there is a risk of recurrence. During surgery neck some lymph nodes are likely to be removed for analysis and then the nodes may be removed on one or both sides (neck dissection).
If a partial laryngectomy is performed, the surgeon will aim to leave at least part of one vocal cord if possible to preserve some speech function. However, if the whole larynx is removed and possibly part of the pharynx, then it may be necessary to attach the trachea to a hole in the neck to enable the patient to breathe. This is a stoma (tracheostomy) which is permanent if a total laryngectomy is performed. Speech function will be lost and patients will be helped to learn new ways of ‘speaking’ and communicating.
Radiotherapy is often the first choice of treatment for cancer of the larynx, resulting in good outcomes for those with early stage laryngeal cancer. Also may be treatment of choice if the tumour is inoperable or the patient is not fit for surgery and has the advantage of larynx/pharynx preservation and therefore speech preservation.
Radiotherapy can be targeted very accurately to reduce dose to healthy tissue. Image guided radiotherapy (IGRT) also enables the radiotherapy to be precisely delivered to the intended area which reduces potential radiation dose to healthy tissues and allows the radiography team to monitor any changes in the patients shape. This is important as head and neck patients often lose weight during treatment which can affect the aligning of the radiotherapy treatment. In some cases, it may be necessary to make a new headshell and replan the patient’s radiotherapy treatment. It is important to achieve precise alignment for accuracy in delivering radiotherapy, therefore in most cases it is necessary for a ‘headshell’ to be produced.
This is achieved by using a specialised thermoplastic material which can be heated in warm water and then is laid over the patient’s face to form an accurately fitting customised shell which can then be used for the planning CT scan and for all the radiotherapy treatments. It is a painless procedure which is clearly explained by the radiographers prior to the procedure.
Radiotherapy may be given in combination with chemotherapy (chemoradiation), but the side effects can be quire severe, so patients need to be generally in good health to tolerate the treatment. Radiotherapy is sometimes used in advanced disease to relieve symptoms such as difficulty in breathing or swallowing by shrinking the tumour.
Chemotherapy may be used to shrink the tumour before surgery or radiotherapy or it may also be used in combination with radical radiotherapy (chemoradiation). Also, it may be advised if the tumour recurs after surgery or radiotherapy or in very advanced cases where it is likely to be palliative treatment aiming to control symptoms.
Cetuximab is a biological therapy referred to as a monoclonal antibody which acts by blocking areas on the surface of the cancer cells to restrict their growth. It is being used in combination with radiotherapy for locally advanced squamous cell carcinomas or an option for patients deemed unfit for chemoradiation. Also, trials are being conducted, researching the use of biological therapy with chemotherapy for tumours that have recurred or spread to other parts of the body.