The precise cause of laryngeal cancer is unknown; clinical data, however, suggest that this neoplasm is strongly related to several factors, including for example smoking and alcohol abuse.
Laryngeal cancer presents with various symptoms; among the latter, the most common are: hoarse voice, persistent sore throat and cough, pain when swallowing and a feeling of lump in the throat.
For a correct diagnosis of laryngeal cancer, a biopsy is needed.
Treatment depends mainly on the stage and site of the tumor; possible treatments include: radiotherapy, chemotherapy, surgery and targeted therapy.
What is the Larynx: a brief review
The larynx is an unequal internal organ of tubular shape, located at the level of the neck.
Between the pharynx (superiorly) and trachea (inferiorly), it is made up of different cartilage, muscle and ligament structures.
Seat of the vocal cords, the larynx performs three fundamental functions:
- It channels the air towards the trachea (thus participating in the respiratory function).
- It allows phonation (thanks to the vocal cords).
- Thanks to a cartilage valve called the epiglottis, it prevents food that is about to be swallowed from entering the trachea and obstructing the airways.
Externally, the larynx can be placed in correspondence with the so-called Adam's apple (anterior protrusion of the neck more evident in men than in women).
constituting the larynx.Laryngeal cancer is an example of throat cancer, on a par with pharyngeal cancer and palatine tonsil cancer.
Laryngeal cancer is also known as laryngeal cancer or laryngeal cancer.
Epidemiology
According to the most recent statistics, in an advanced country such as the United States, the annual incidence of laryngeal cancer is equal to 5 cases per 100,000 people considered; this means that, again in the United States, they develop the cancer in question annually. more than 12,000 individuals.
Like all cancers of the throat, laryngeal cancer most frequently affects people of advanced age (especially those over 60) and men (the male: female ratio is 4: 1).
, by the DNA of one of the cells that make up the organ concerned (the larynx, in this case). These mutations, in fact, are responsible for the phenomenon of uncontrolled proliferation that characterizes the formation and growth of malignant tumors.In spite of the numerous researches on the subject, doctors have not yet identified the precise causes of the aforementioned genetic mutations; however, they are pretty sure that factors such as:
- The smoke;
- The abuse of alcoholic substances;
- Human Papillomavirus infection;
- A diet low in fruit and vegetables;
- The advanced age;
- Continuous exposure, usually for work reasons, to dust or fumes containing toxic substances (eg: asbestos, coal, wood dust, sulfuric acid fumes, nickel, formaldehyde);
- Fanconi's anemia, a genetic disease that alters the DNA repair system;
- Familiarity for Throat Cancers.
Did you know that ...
According to some studies, smokers are 20 times more likely to die from laryngeal cancer than non-smokers.
Histological Types of Laryngeal Cancer
There are various histological types of laryngeal cancer.
In most cases, laryngeal cancer is a squamous carcinoma, ie it derives from the uncontrolled proliferation of a squamous cell constituting the superficial epithelium of the larynx; more rarely, it is a sarcoma, adenocarcinoma or lymphoma.
All throat cancers are, in most cases, examples of squamous carcinoma.
Possible locations of Laryngeal Cancer
The larynx is ideally divided into three overlapping sections: the supraglottis (upper section), the glottis (middle section) and the subglottis (lower section).
Laryngeal cancer can be located in each of the three sections that ideally divide the larynx; however, statistics say that it prefers the glottis (glottic tumor or cancer), while it only rarely affects the supraglottis (tumor or supraglottic cancer) and subglottis (tumor or subglottic cancer).
Glottic cancer, supraglottic cancer, and subglottic cancer are three subtypes of throat cancer.
Who Is Most at Risk of Laryngeal Cancer?
Based on clinical data and epidemiological statistics, they are most at risk of laryngeal cancer:
- Smokers and those who chew tobacco;
- Those who have excluded fresh fruit and vegetables from their diet during their life, preferring processed foods;
- Those who habitually consume large quantities of alcohol;
- Who, in spite of himself, has exposed himself to asbestos;
- Anyone with a family history of throat cancer.
In some cases, to the aforementioned symptoms, it also adds:
- Respiratory difficulties;
- The emission of a high-pitched wheezing sound when breathing;
- Halitosis;
- Cough with blood (hemoptysis);
- Swelling in the neck
- Weight loss.
The intensity and exact symptomatology of a laryngeal tumor depends on the location of the neoplastic mass and its size; this explains why it is not possible to precisely define the symptomatological picture of the pathology.
When to see a doctor?
If symptoms such as hoarse voice, pain when swallowing, sore throat and cough persist for more than two weeks, without hint of improvement, it is advisable to contact your doctor and make an appointment to find out more about the situation.
Complications
If not subjected to adequate and timely treatment, tongue cancer can spread some of its malignant cells to the rest of the body, affecting nearby and distant lymph nodes as well as some organs (including the liver).
The process that sees any malignant tumor disseminating its own cells into the rest of the organism takes the name of metastatic process or more simply metastasis (N.B: this term also identifies the cells that are the protagonists of dissemination).
Very often, at the conclusion of the aforementioned investigations and once the diagnosis is definitive, doctors also indicate the execution of a CT scan, a magnetic resonance imaging (MRI) and / or a PET scan.
Physical examination and anamnesis
The physical examination is the diagnostic investigation that allows the doctor to personally ascertain the symptoms and signs complained of by the patient.
The anamnesis, on the other hand, is the collection of all data relating to the patient, such as age, general health, lifestyle, family history, etc., which can be very useful in establishing probable reasons for the present condition.
Physical examination and medical history are important in the detection of laryngeal cancer, but do not allow a definitive diagnosis; for the latter, endoscopic examinations and biopsy are necessarily required.
Laryngoscopy
Laryngoscopy is an instrumental examination which, through the use of a probe, allows an "inspection from the inside" of the throat and larynx.
Laryngoscopy allows to identify any anomalies, including tumors, present in the anatomical sectors observed.
In "performing laryngoscopy, the doctor uses an instrument called a laryngoscope; the laryngoscope is a probe equipped with a camera and connected to a monitor, which can be conducted up to the larynx through the mouth or through the nasal cavities.
Biopsy
Tumor biopsy consists of taking and subsequent laboratory analysis of a sample of cells belonging to a tumor or suspected tumor.
Tumor biopsy allows not only to confirm the diagnosis of laryngeal cancer, but also to establish an "important feature of the tumor: staging.
What is the staging of a malignant tumor?
The staging of a malignant tumor includes all the information, collected during the biopsy, concerning the size of the tumor mass, its infiltrating power and its metastasizing capacity.
For a malignant tumor such as that of the larynx, the staging can be divided into 4 levels of increasing severity, levels which are called stages and which are identified with the first 4 Roman numerals. There are, therefore, stage I (less severe), stage II (medium-mild severity), stage III (medium-severe severity) and stage IV (the most severe).
CT, MRI and PET
Through CT (Computed Axial Tomography), Nuclear Magnetic Resonance (MRI) and PET (Positron Emission Tomography), the doctor can assess whether laryngeal cancer has spread to neighboring lymph nodes and other organs of the body (e.g. liver or lungs).
CT and PET provide exposure to a minimal dose of harmful ionizing radiation.
Radiotherapy represents the treatment of choice for less severe laryngeal tumors (therefore not very extensive and confined to well-defined areas), but it can also represent a valid support to surgery in cases of severe neoplasms (adjuvant radiotherapy).
Unfortunately, radiation therapy is not free from side effects.
Laryngeal Cancer Surgery
When practicable, surgery is perhaps the best therapeutic approach for removing a laryngeal tumor.
Currently, there are various types of surgery for the removal of a laryngeal tumor, including:
- Endoscopic resection. It is reserved for small and limited area laryngeal tumors.
Endoscopic resection is so called, because the removal takes place using an endoscope, which is used as a guide-tool for the removal of the tumor mass. - Partial laryngectomy. It consists in the removal of the section of the larynx affected by the tumor mass.
This surgical approach is reserved for laryngeal tumors limited to one area, the size of which is not particularly large.
At the end of the partial laryngectomy, the patient's voice may be permanently impaired. - Total laryngectomy. It consists in the removal of the entire larynx.
This solution is reserved for large laryngeal tumors.
After the total laryngectomy, there is a tracheostomy (to breathe) and a vocal rehabilitation course (to be able to speak again).
Finally, it should be noted that total laryngectomy is often combined with the removal of the lymph nodes in the neck, which makes the whole procedure even more invasive.
As reported above, "on the contrary, surgery is not free from risks and complications, so before its application, the treating physician thoroughly evaluates the risks and benefits of a possible intervention.
Chemotherapy for Laryngeal Cancer
Chemotherapy is the administration of drugs capable of killing all rapidly growing cells, including cancer cells.
In the presence of laryngeal cancer, chemotherapy can be used as:
- Treatment prior to future radiotherapy or future tumor removal surgery (neoadjuvant chemotherapy);
- Palliative treatment in case of very extensive and non-removable neoplasms;
- Treatment of relapses.
Like radiotherapy, chemotherapy also has several side effects.
Targeted Therapy for Laryngeal Cancer
Targeted therapy for laryngeal cancer is based on the use of an anticancer drug called Cetuximab, which acts specifically against cancer cells.
Several scientific researches have shown that Cetuximab can be combined with chemotherapy and / or radiotherapy.
The advice of doctors
Doctors strongly advise to avoid / stop smoking and drinking alcohol, as tobacco and alcohol (especially the former) slow down the healing of surgical wounds, negatively influence therapy (i.e. the effects are reduced), favor the appearance of others tumors (or relapses) and, finally, make chemotherapy and other anticancer drugs less tolerable.
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