Head and Neck Cancer

Home » Head and Neck Cancer » Laryngeal Cancer

Questions to Ask Your Doctor About Your Cancer
(Free Handout)

Laryngeal Cancer

Laryngeal cancers often afflict middle-aged and older men who have a history of smoking and alcohol consumption. The disease tends to affect men, with about 10,000 of the estimated 13,000 new cases diagnosed annually being men. African Americans have a significantly higher incidence of laryngeal cancer than Caucasians. Risk factors in the development of laryngeal cancer include voice abuse and chronic laryngitis, dietary factors, chronic gastric reflux and exposure to wood dust, mustard gas, asbestos and ionizing radiation, and smoking.

The larynx consists of three subsites:

• the glottis or true vocal cords;
• the supraglottis, consisting of the false vocal cords, the epiglottis and the aryepiglottic folds; and
• the subglottis, consisting of the area bounded by the under-edge of true vocal cords and the top of the cricoid cartilage.

More than 95% of all primary laryngeal cancers are squamous cell carcinomas, with the remainder being sarcomas, adenocarcinomas, neuroendocrine tumors and, rarely, metastasis from renal cell, breast, lung, prostate and gastrointestinal cancers. Cellular characteristics tend to vary by site, with supraglottic cancers tending to show more aggressive local behavior, while true vocal cord cancers tend to be less aggressive locally and well differentiated.

Lesions of the supraglottis most often begin on the epiglottis, although some are seen on the false vocal cords and the aryepiglottic folds. These tumors almost never destroy the thyroid cartilage. They frequently metastasize to the lymph nodes, however, with from 25% to 50% of patients presenting clinically positive nodes (nodes that test positively for the presence of cancer cells).

Diagnostically, lesions in the supraglottic region tend to produce no early symptoms. When symptoms do occur, they may be subtle, such as ear pain, itchiness or scratchiness when swallowing or a change in tolerance for hot and cold foods. Hoarseness and a tendency to aspirate (cough up) liquids are usually signs of advanced disease.

Lesions of the glottis are the most common laryngeal cancers in the United States. Most tend to be well differentiated. Due to the scarcity of lymphatic channels in the area, metastasis to lymph nodes tends not to occur in early-stage (T1, T2) lesions. Cancers of the glottis are often detected early because they typically produce a change in the patient's voice. Experts often recommend that any patient who experiences a voice change that does not go away completely within one month should undergo an examination by an ENT (ear, nose and throat) physician.

Lastly, lesions of the subglottic region are unusual, making up only about 10% of all laryngeal cancers. These cancers tend to be undifferentiated and grow by infiltration, unrestricted by natural tissue barriers. Unfortunately, these tumors tend to be relatively asymptomatic and therefore are often far advanced before they can be diagnosed.

Staging
See Staging for general staging rules. Supraglottic, glottic and subglottic tumors are staged separately as follows:

Supraglottic Tumors

TX	Primary tumor cannot be assessed
T0	No existence of primary tumor
Tis	Carcinoma in situ
T1	Tumor confined to site of origin with normal mobility of vocal cords.
T2	Tumor involves adjacent supraglottic site(s) or glottis without fixation of vocal cords.
T3	Tumor limited to larynx with fixation of extension to involve postcricoid area, medial wall of pyriform sinus, or preepiglottic space.
T4	Massive tumor extending beyond larynx to involve oropharynx, soft tissues of neck, or destruction of thyroid cartilage.

Glottic Tumors

TX	Primary tumor cannot be assessed
T0	No existence of primary tumor
Tis	Carcinoma in situ
T1	Tumor confined to vocal cord(s) with normal mobility.
T2	Supraglottic or subglottic extension of tumor with normal or impaired cord mobility.
T3	Tumor confined to the larynx with cord fixation.
T4	Massive tumor with thyroid cartilage destruction or extension beyond the confines of the larynx.

Subglottic Tumors

TX	Primary tumor cannot be assessed
T0	No existence of primary tumor
Tis	Carcinoma in situ
T1	Tumor confined to the subglottal area.
T2	Tumor extension to vocal cords with normal or impaired cord mobility.
T3	Tumor confined to the larynx with cord fixation.
T4	Massive tumor with cartilage destruction or extension beyond confines of larynx, or both.

Treatment

Supraglottis
For all lesions in this region, whether the neck is clinically negative or positive, some form of therapy should be delivered to the neck(s) due to the high probability of occult (undetectable) or overt involvement of the lymph nodes.

For early stage lesions, either surgery or radiation therapy is acceptable. With small lesions, it may be necessary to choose between radiation therapy and a surgical procedure called supraglottic laryngectomy, which preserves vocal and swallowing functions. If the surgery is performed first, but fails to eliminate all traces of cancer or prevent its spread (local failure), the situation may still be salvaged by means of radiation therapy. However, if radiation is utilized first, local failure must often be salvaged by a total laryngectomy (surgical removal of the larynx), which means the loss of normal vocal and swallowing functions.

In more advanced stages, surgery (total laryngectomy) is preferred over radiation alone, due to the decreasing rate of local control afforded by radiation for large lesions. Nevertheless, medical advances over the years involving the combined modality treatment of lesions with chemotherapy and radiation have made it possible, in some cases, to preserve the larynx of patients afflicted with advanced-stage cancers.

Glottis
Carcinoma in situ of the true vocal cord is high curable by several different methods, such as microexcision, laser vaporization or radiation therapy. The procedure of choice for carcinoma in situ generally is surgery, due to the ease with which the surgical procedure can be done. In more advanced cancers of the glottis (T1, T2), partial laryngectomy or radiation therapy can achieve very good local control rates. For more advanced lesions (T3), surgery is usually the treatment of choice, although in selected cases an attempt may be made at organ preservation.

As with supraglottic tumors, the treatment consists of induction chemotherapy, followed by radiation therapy for those who responded to chemotherapy. With advanced (T4) lesions, there are several different ways to approach the treatment plan. Discussion with a physician is imperative and should be initiated and maintained throughout the treatment regimen.

Factors to take into account when devising a treatment plan for T4 tumors are:

• presence or absence of bulky disease in the neck, and
• extent (size, depth of penetration) of primary tumor.

Strategies may range from induction chemotherapy with radiation therapy, for those whose tumors respond favorably to chemotherapy, to surgical resection.

Subglottis
Despite the availability of modern combination therapy, the overall cure rate for these tumors is poor, due the advanced stage at which they are often found. Some experts recommend that patients with such tumors consider volunteering for treatment in a clinical protocol study.

Head and Neck Cancer Resources

	Questions to Ask Your Doctor About Your Cancer The more knowledge you have, the easier it is to make decisions about your cancer treatment. Print this free handout to take with you on your next office visit.	Advertising Disclaimer
	Join Our Head and Neck Cancer Forum Do you have a question, want to share medical advice, or just need to discuss your situation with someone else having a similar experience? The healthchannels forum is a resource for everyone to share and discuss their health and medical needs with others.
	Living with...Share your story Do you have a personal health story that you would like to share with others? As a source of free patient education, our goal is to provide our users with trustworthy information and support from others. That's why we've started our "Living with..." sections.
	Our "Living With..." support pages are a place to share experiences about living with a certain condition, disease, disorder, or illness and for loved ones of those dealing with health-related issues. Many people, especially when newly diagnosed, find comfort in knowing that others are having a similar experience. Help others by sharing your story. View stories already submitted. In honor of National Cancer Survivors Day on June 1, 2008, we asked you to share your stories about surviving cancer. Read the inspiring stories we received or share your survival story and help others in the fight against cancer.
Advertising Disclaimer To quickly access health information from your website's browser, download Healthcommunities.com's healthchannels toolbar. Advertising Disclaimer