Voice box (larynx) cancer
This section contains information on the following:
1. Presentation
2. Diagnosis
3. Risk factors
4. Treatment
5. What happens to my voice?
6. Outcome
7. Prevention
1. How does cancer of the voice box present?
It usually presents as a change in voice (hoarseness). It can also cause a painful sore or a feeling of lump inside the throat. While usually these symptoms are caused by a simple viral or bacterial throat infection and should not be cause for alarm, persistence beyond 2 weeks calls for urgent specialist attention. Rarely, it can cause a lump in the neck.
2. How do I find out if I have cancer?
In the first instance, a thorough clinical examination, including an out-patient fiberoptic endoscopy under local anesthesia, needs to be performed. If suspicion is high, a thorough endoscopic examination is performed under general anesthesia and any suspicious lesion is biopsied. A contrast CT is also done to stage the disease.
3. Why does it occur?
Tobacco exposure in the form of smoking, chewing etc and heavy alcohol intake are known risk factors. Some nutritional deficiencies may also play a role. In some patients, there are no obvious risk factors.
4. How is it treated?
A variety of treatment options are available for voice box cancer, depending on tumor site, stage and patient preference. For early stage tumors, surgery or radiotherapy may be sufficient. Surgery can be performed entirely endoscopically using the microscope and CO2 laser to achieve complete tumor removal (see ). For advanced stage tumors, combined treatment is essential. This involves either open surgical removal of the tumor, along with lymph nodes in the neck, followed by radiotherapy (with or without additional chemotherapy), or primary chemoradiation treatment (organ preservation) followed by planned or salvage (for recurrence) surgery. These tricky and complex decisions need to be taken as a team that comprises the surgeon, radiotherapist, medical oncologist, pathologist, radiologist, speech therapist, dietician and counsellor, and of course most importantly, you.
5. Will I lose my voice?
This is the most important question that would spring to your mind. The good news is, with the currently available state-of –the-art treatment and rehabilitation techniques, it is possible to preserve existing voice, improve it to almost normal, or at least make speech understandable in the vast majority of patients. What type of treatment is given also influences voice outcomes. Therefore, treatment decisions for voice box cancers are mostly underpinned by the desire to preserve or improve existing voice. Treatment goals that aim for cure must be balanced against the desire to be able to speak following treatment.
These decisions are therefore complex, depending on tumor site and stage and your expectations. As mentioned before, smaller tumors can be treated with surgery or radiation with equally good results. Radiation can preserve or even improve voice, especially for small tumors that involve the vocal cord. However, radiation causes burning throat pain and dry mouth which can persist for several years. If the tumor does not involve the vocal cords, then endoscopic CO2 laser resection is an attractive option, as this is associated with excellent cure rates, can be repeated if necessary, preserves voice and avoids the side-effects of radiation. For bigger tumors that have not fixed or destroyed the voice box, organ preservation treatment with chemoradiation can be attempted. Sometimes, even though the voice box and throat structures have been preserved, chemoradiation may cause severe scarring and result in a poor voice, dependence on tracheostomy tube for breathing (via a hole in the neck) and inability to swallow normal diet. For these reasons, removal of the voice box (total laryngectomy) is often preferred, as this generally achieves better cure rates and excellent swallowing outcomes. With various speech prostheses, which re-direct air from the lungs to the throat via a small hole in the neck, voice can be rehabilitated to an understandable level even in patients who lose their voice box.
These complex issues mean that no single treatment would suit all patients. You must carefully discuss the pros and cons of all available treatment options with your specialist before choosing the treatment modality.
6. What are my chances of cure?
Stage of the tumor is currently accepted as the most important factor that determines cure. Early stage tumors in general have an excellent outcome. Advanced stage tumors that are fully treated with combined strategies also have good potential for cure. In addition, lots of other data that are available in the biopsy/pathology report also help predict the outcome.
7. How can I prevent voice box cancer?
Quitting smoking and moderating alcohol intake are the two most important preventive steps. Maintaining a healthy lifestyle with good intake of fruits and vegetables and regular exercise is recommended. Attending screening camps, especially if you use tobacco, would also help pick up very early/suspicious lesions.