What are the early signs of larynx cancer? Is larynx cancer curable?

Cancer of the Larynx

Man's ability to communicate verbally accounts in no small part for his achievements. The brain's control of the larynx and vocal cords makes this possible.

Surgical disorders of the larynx could not be diagnosed until the mechanics of instrumentation for looking at the area had been developed. These diagnostic tools, so ingeniously designed, permit the diagnosis to be made by examination and biopsy techniques that can be carried out through the mouth without having to make skin incisions.

In almost no other disease is such cooperation of multiple specialists required: the instrument maker, surgeon, radiotherapist, speech therapist and the diagnostician. Early diagnosis of larynx cancer permits complete preservation of this organ's sophisticated function.

What is a larynx? Where is it? What is its junction? 

The larynx, often referred to as the voice box, consists of the vocal cords and their bony cartilage supports together with ligaments and muscles. You can feel its front end as your Adam's apple. An additional function of the larynx is as the passageway for air going from the mouth to the lungs. It monitors the throat openings so that food will go one way and air the other, thus preventing choking on food going the wrong way.

What are the early symptoms of laryngeal disease? 

All diseases of the larynx share common symptoms. One can suspect a laryngeal disorder if there is hoarseness, change of voice quality and easy vocal f tigability. The voice changes are the most obvious symptom and include changes in pitch, resonance, clarity, inflection, strength and articulation.

How do you examine the larynx? Is it uncomfortable? 

In the office the larynx can be examined by reflecting the light from the doctor's head mirror onto a dental mirror that is held against the back of the patient's throat. By this indirect means the doctor can see down to the larynx. Ail patients gag somewhat while this is done. Sometimes the throat is anesthetized by a spray so that there is no sensation and the cough and gag reflexes are eliminated. Direct visualization of the larynx, which is a hospital procedure performed under local or general anesthesia, employs a special laryngoscope, which is arranged to push the back of the tongue out of the way while a light shines directly into the larynx. Both types of examination require experience for interpretation of an abnormality. In proper hands the examination carries virtually no risk.

How is the exact diagnosis pinpointed? 

Laryngeal diseases are recognized in the same way that, people are: from having seen the same type of thing before and knowing its name. However, no treatment should be considered until the biopsy tissue has been interpreted. It is most important that the biopsy be a piece of tissue taken from the primary diseased area.

Why do you also take X rays? 

Special X rays of the larynx can show parts of the area more clearly than can be seen by direct observation. X ray and laryngoscopy can supplement each other in visualizing all parts of this organ and its surrounding tissues.

When is there need for another biopsy?

 If the first biopsy report is inconclusive. The biopsy may not have been taken from exactly the right spot, or it may not have been deep enough. In either case it is best to repeat it.

What is a laryngeal polyp?

 It is a benign tumor, something like a wart, with a characteristic appearance. When completely excised, it should not come back. All polyps are examined microscopically to collaborate the diagnosis and to differentiate it from cancer. Most polyps can be removed through the laryngoscope. An incision is usually not required. Polyps should be removed for diagnosis and treatment.

What are singers nodules? 

They are nodularities occurring in the front part of the vocal cords. Their appearance is ordinarily quite characteristic. The phenomenon, which is not confined to singers, is caused by abuse of the voice. Voice rest and proper humidification are the usual treatments, but the nodules are sometimes large and require removal. A biopsy is performed if there is uncertainty about the diagnosis.

What determines the way in which cancer of the larynx is treated? 

Cancers of the larynx can be treated by various types of surgery (both radical and less radical). They can also be treated by radiation therapy with cobalt, with megavoltage, or with the betatron. The cancers are often treated by a combination of surgery and radiation. The method of treatment is determined by its microscopic characteristic, position and extent of local spread.

What causes cancer of the larynx? 

We don't know the specific cause of this cancer, but it appears to be associated with a high incidence of excessive use of tobacco and alcohol.

What is the treatment for cancer of the larynx? 

If the cancer is confined to the vocal cord, it can be successfully treated by radiation alone with a high percentage of cure. The voice is preserved. Six to eight weeks after this treatment the huskiness and hoarseness will disappear completely. The vast majority of patients in this early stage do well. In only 10 percent does the cancer remain. One caution is necessary: No patient who has had this radium treatment should later use , tobacco in any form. It irritates the throat lining and can cause harmful swelling and drying or even infection in the area that has been irradiated.

What happens to the speech after a partial removal of the larynx? 

The patient speaks in an acceptable fashion.

When does the entire larynx have to be removed? What happens then? 

Total laryngectomy is required if the tumor is too extensive for radiation or partial removal. The patient will require a permanent tracheotomy and will lose his normal voice. A tracheotomy is a surgically created opening in the throat part of the windpipe; a tube is inserted in this site through which the patient can breathe. The procedure is the only chance for survival with some forms of this cancer. More than 50 percent of those treated for this disease in its early stage can be expected to survive for at least five years. If the cancer is not present five years after operation, the patient is regarded as cured.

What will happen if I just refuse to have the operation? 

This would be an unwise decision because an advancing, spreading cancer in this area produces extremely uncomfortable symptoms. Untreated cancer of the larynx is a fatal disease.

How does the laryngectomized patient communicate? 

The major problem for the laryngectomee is to regain a useful voice. A well motivated patient can do it. However, he must have teeth or suitable dentures, and his hearing must be intact. About half of the laryngectomy patients can be taught to use esophageal speech effectively so that they can be understood by their family and can function in the community at large. Esophageal speech is produced by swallowing air and regurgitating it into the pharynx. The air column is modified into sounds by the mouth. Another 25 percent can be taught to substitute an electric larynx for esophageal speech. The final 25 percent can neither learn effective esophageal speech nor use of the electric larynx.

Surgical Treatment for Advanced Cancer of the Larynx

What is the electric larynx? 

This is a battery operated device that produces a sound when placed on a particular part of the throat. The patient learns to modify this sound with his throat and Ups to produce an acceptable voice.

What happens to the patient who can't develop a new voice? 

This can happen to the patient through no fault of his own. A local reaction in the skin and throat and drainage areas can preclude the use of the electric larynx. These patients have to carry a pad and pencil and communicate by writing. One should persist with speech therapy to avoid this limitation. It is the high price for survival.


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