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Laryngeal cancer

Published by Bupa's health information team, May 2008.

This factsheet is for people who have laryngeal (larynx) cancer, or who would like information about it.

In the UK, about 1,800 men and 375 women are diagnosed with laryngeal cancer each year. Less than one in every 100 cancers diagnosed is laryngeal cancer. It's more common in people over 55 but it can occur in younger people.

• Animation - How cancer develops
• About laryngeal cancer
• Symptoms
• Causes
• Diagnosis
• Treatment
• Help and support
• Further information
• Questions and answers
• Related topics
• Sources

How cancer develops

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About laryngeal cancer

A laryngeal tumour is a lump created by an abnormal and uncontrolled growth of cells. It can be either malignant (cancerous) or benign.

Cancerous tumours can grow through your larynx and spread to other parts of your body (through the bloodstream or the lymph system) where they may grow and form secondary tumours. This spread of cancer is called a metastasis.

Benign tumours don't spread to other parts of the body.

The larynx

Your larynx is a 5cm (2 inch) tube which is at the top of the windpipe (trachea) and in front of the oesophagus (food pipe) in your neck. It's also called the voicebox and "Adam's apple". The larynx produces the sounds you make when you speak, stops food entering the windpipe and allows you to breathe.

The types of laryngeal cancer are named according to where they are in your larynx such as cancer of the glottis or supraglottis. Glottis tumours are the most common. The larynx has three areas:

• supraglottis - the area above the vocal cords
• glottis - the area around the vocal cords
• subglottis - the area below the vocal cords, which goes into the windpipe

Types of laryngeal cancer

There are several types of laryngeal cancer. Squamous cell laryngeal cancer is the most common and causes 95 out of 100 laryngeal cancers. It starts in the squamous cells which cover most of the areas of the larynx. Other types of laryngeal cancer include adenocarcinoma which starts in the gland cells which produce mucus. Sarcoma laryngeal cancer starts in the connective tissues such as muscle, cartilage and nerves. This type of cancer is very rare.

Symptoms

The most common symptom of laryngeal cancer is a hoarse voice. If you have had a hoarse voice for longer than four weeks, you should visit your GP and ask if you can be referred to a doctor who specialises in conditions that affect the ear, nose and throat. You may not have hoarseness. Other symptoms can include:

• a lump in the neck or throat
• pain or discomfort when swallowing
• feeling breathless
• coughing
• bad breath (halitosis)
• unexplained weight loss
• earache
• sore throat

Many of these are common symptoms for minor or mild conditions and don't usually mean you have cancer. For example, a lump in the neck or throat may be due to enlarged glands which have swollen because of a mild viral infection.

Although not necessarily a result of laryngeal cancer, if you have these symptoms you should visit your GP.

Causes

The causes of laryngeal cancer aren't fully understood at present. But there are certain factors that make laryngeal cancer more likely, including those listed below.

• Smoking - chemicals in cigarettes can cause cancer.
• Drinking alcohol excessively (particularly spirits).
• Human papilloma virus - if you have papillomas or papilloma growths on your larynx you may have an increased risk of laryngeal cancer later in life.
• There is currently limited evidence that diet plays a part in the development of laryngeal cancer, but a diet high in fruit and vegetables and low in fat may help reduce the risk.
• Environmental factors including chemicals such as asbestos, formaldehyde, nickel and sulphuric acid can also increase the risk of developing laryngeal cancer.

Diagnosis

Your GP will ask you about your symptoms and will examine you. He or she may arrange further tests or refer you to an ENT specialist for further tests. An ENT specialist specialises in conditions that affect the ear, nose and throat. Tests may include the following.

• Blood tests - which will be sent to a laboratory for testing.
• A mirror may be used to look at the back of your throat. This is called an indirect laryngoscopy.
• A nasoendoscopy is a narrow, flexible, tube-like telescopic camera called an endoscope which is passed through your nose to check your larynx.
• A biopsy may be taken. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing.
• A chest X-ray may be taken.
• An MRI (magnetic resonance imaging) scan uses magnets and radiowaves to produce two- and three-dimensional pictures of the inside of the body.
• An ultrasound scan uses high frequency sound waves to produce an image of the body and may be used to help your doctor take a biopsy.
• A CT (computerised tomography) scan uses X-rays to build up a three-dimensional picture of the body.
• Other tests may also be done so your doctor can look at your airways or larynx.

The results of the tests will determine your course of treatment.

Treatment

The treatment for laryngeal cancer depends on the type, stage and grade of cancer that you may have.

Treatment focuses on radiotherapy in the first instance, then chemotherapy and surgical laser therapy. Surgery (open) is used if the cancer is more advanced. Treatment aims to avoid removal of the larynx (laryngectomy).

Radiotherapy

This uses radiation to destroy cancer cells. This treatment is usually used for laryngeal cancer which hasn't spread outside the larynx and the lymph nodes near the larynx.

Chemotherapy medicines

Medicines to attack cancer cells are given to some people with certain types of cancer. For laryngeal cancer, chemotherapy medicines such as cisplatin and fluorouracil are given via a drip. You may be given chemotherapy medicines at the same time as radiotherapy.

Surgical laser treatment

This is when a light is used to destroy the cancer tumour. The laser cuts out the abnormal cancer cells and aims to leave as much of the larynx as possible. For this you will need an anesthetic.

Surgery

The cancer may be removed using open surgery if it's advanced. This treatment is only suggested if it's essential to cure you.

This may mean that part (partial laryngectomy) or all (total laryngectomy) of your larynx, and some of the lymph nodes near it, may need to be removed. After a partial laryngectomy you will speak with a hoarse voice. If you have a total laryngectomy you won't be able to speak or breathe as you used to. A stoma (opening) will be made in your neck and you will breathe this way.

If you have a total laryngectomy you will need support to help you find an alternative way of communicating. A voice prothesis, electropharynx or oesophageal speech can all be used to produce a voice. It depends which is the best option for you. Alternatively, you may prefer to write or type. Ask your doctor, nurse or a speech and language therapist for advice.

Clinical trials

Sometimes you may be able to be involved in clinical trials to help treat laryngeal cancer. You can discuss this with your doctor.

Cetuximab and erlotinib are monoclonal antibodies used to treat laryngeal cancer. These medicines can recognise certain cancer cells and stop them multiplying or make the cancer cells more sensitive to radiotherapy or chemotherapy. These treatments are mainly available as part of a clinical trial.

Help and support

Being diagnosed with cancer can be distressing for you and your family. Specialist cancer doctors and nurses are experts in providing the care and support you need. There may also be support groups so you can meet people who may have similar experiences to you. Ask your doctor for advice.

Further information

• Macmillan Cancer Support
  0808 800 1234
  www.macmillan.org.uk

Related topics

• Chemotherapy
• CT scan
• MRI scan
• Radiotherapy

Sources

• Diagnosis and management of head and neck cancer. Scottish Intercollegiate Guidelines Network (SIGN). October 2006. www.sign.ac.uk
• Improving outcomes in head and neck cancers. National Institute of Health and Clinical Excellence (NICE) November 2004: 17-22. www.nice.org.uk
• Laryngeal cancer. Macmillan Cancer Support. www.macmillan.org.uk, accessed 19 November 2007
• Laryngeal cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 19 November 2007
• Souhami R, TJ, Cancer and its management. 5th ed. Oxford: Blackwell, 2005:155-158
• UK Laryngeal (larynx) cancer incidence statistics. Cancer Research UK. http://info.cancerresearchuk.org, accessed 19 November 2007

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: May 2008