Introduction

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Introduction

Cancer of the larynx is also Larynx Cancer called laryngeal cancer. It can develop in any region of the larynx, for example 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).

This is how the Larynx looks from above. It's what the doctor can see with a mirror.

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If the cancer spreads outside the larynx, it usually goes first to the lymph nodes Cancer of the larynx (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. When cancer of the larynx spreads, it is called metastatic laryngeal cancer. 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.

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 examination. In addition to checking the 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 (laryngeal mirror) to check for abnormal areas and to see whether the vocal cords move as they should. This test is painless, but a local anesthetic 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 anesthesia, 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 carcinomas. 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-rays, a CT (or CAT) 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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