Who Gets Laryngeal (Voice Box) Cancer?

Laryngeal cancer, also known as voice box cancer, is a type of head and neck cancer that affects your larynx (voice box.) It occurs when malignant (cancerous) cells develop in the tissue of your larynx.

Your larynx contains your glottis (vocal cords) that allow you to speak and make sounds with your voice. It also prevents food from entering your lungs and helps you breathe.

This disease can be treated with good outcomes. Knowing how this disease occurs and whether you're at risk can help you recognize symptoms when they occur. Finding laryngeal cancer early, before it grows and spreads, improves your chances of getting fully cured.

This article describes laryngeal cancer, where it occurs, symptoms, causes, and treatments. It also details what to expect from treatments and how to cope if you're living with this type of cancer.

Where Laryngeal Cancer Occurs in Throat

Laryngeal cancer appears in the tissue of the larynx. The larynx is part of your throat. It sits at the base of the tongue and trachea (windpipe).

Laryngeal cancer can form in one of three anatomical areas of your larynx:

• Supraglottis: The upper part of the larynx is found above your vocal cords, including the epiglottis. About 35% of laryngeal cancers develop here.
• Glottis: The mid-section of the larynx, which contains your vocal cords. This is where 60% of laryngeal cancers start, also known as vocal cord cancer.
• Subglottis: The lowest part of the larynx, found between the vocal cords but above the trachea (windpipe). Only about 5% of laryngeal cancers begin in this area.

While laryngeal cancer starts in one of these areas, it can sometimes overlap more than one area and make it difficult to determine where it originated. Laryngeal cancer can also metastasize (spread) to other organs such as your thyroid, your esophagus, the lymph nodes in your neck, and other parts of your body.

Why Do People Get Laryngeal Cancer?

All types of cancer develop from the uncontrolled growth of certain cells. Cancer forms due to changes (mutations) in a cell's DNA that make the cells grow and multiply abnormally. Instead of dying, mutated cells create new, abnormal cells. In some types of cancer, these group together to form a tissue mass called a tumor.

The causes of the cell changes that lead to laryngeal cancer are not fully understood but have been linked to the following:

• Human papillomavirus (HPV)
• Exposure to cancer-causing chemicals like those in tobacco smoke

Risk factors might increase your chances of having a disease. The two most important risk factors for laryngeal cancer include the following:

• Tobacco use: Smoking tobacco or marijuana, chewing tobacco, or exposure to secondhand smoke
• Alcohol use: Drinking more than one alcoholic beverage a day

Combining drinking and smoking multiplies your risk many times over. It makes you more likely to get laryngeal cancer or another head and neck cancer than people who don't have these risk factors.

Other factors contributing to the incidence of laryngeal cancer include the following:

• Sex, with men being 4 to 5 times more likely to be diagnosed with pharyngeal cancer than women (the terms for sex or gender from the cited sources are used).
• Age 65 or older
• Excess body weight
• Infection with HPV
• Gastroesophageal reflux disease (GERD)
• Repeated and intense workplace exposure to materials like wood dust, paint fumes, and certain chemicals used in the construction, textile, metalworking, and petroleum industries
• Certain genetic syndromes, including Fanconi anemia and dyskeratosis congenita

Symptoms: How Do You Know You Have Laryngeal Cancer?

Certain symptoms are common in people who have laryngeal cancer. Some larynx cancer symptoms affect how you feel, while others may cause subtle changes in your appearance. However, it's not possible to know you have this disease without a formal diagnosis from a healthcare provider.

Persistent voice hoarseness is one of the most common symptoms of laryngeal cancer. Hoarseness that persists for more than two weeks should be checked by a healthcare provider. Contact your healthcare provider if you have this problem or any of the following symptoms that can occur with laryngeal cancer:

• Constant sore throat that does not improve
• Painful swallowing
• Difficulty swallowing normally
• Ear pain
• Unexplained weight loss
• A lump or mass in the neck
• Trouble breathing

After Diagnosis: Laryngeal Cancer Treatment Plan

After a diagnosis of laryngeal cancer, your healthcare provider determines a treatment plan. The site and stage of laryngeal cancer you have at your diagnosis are significant factors in determining your treatment plan. Other factors that can affect the way your cancer is treated include your age, your general health, and your personal preferences.

Staging determines if and how much your laryngeal cancer has spread. Laryngeal cancer diagnosed at an early stage is easier to treat than when the cancer is in advanced stages.

Cancer staging in the United States uses the American Joint Committees on Cancer's TNM system, which involves the following factors:

• Size and tumor number (T)
• Lymph node involvement (N)
• If and to what extent the laryngeal cancer has metastasized (M)

Treatment of laryngeal cancer typically involves the following approaches based on the disease stage, as follows.

Stage 0 Laryngeal Cancer

Stage 0 laryngeal cancers involve small, noninvasive tumors. At this stage, laryngeal cancer can usually be cured with one of the following:

• Endoscopic surgery: This surgery uses a small rigid or flexible tube, called an endoscope, with a tiny camera and light at the end. The endoscope and special instruments are passed done your throat to find the tumor.
• Radiation therapy: Radiation therapy uses powerful high-energy X-rays to stop the growth or kill cancer cells from outside your body.

Stages 1 and 2 Laryngeal Cancers

Stages 1 and 2 laryngeal cancers are confined to the larynx. Laryngeal cancers at this stage may have spread to the vocal cords and affected their normal movement. Laryngeal cancer at this stage can usually be treated without the removal of your entire voice box. Treatment for these cancers usually involves :

• Radiation therapy (alone or with surgery)
• Surgery

The surgical techniques that may be used include;

• Partial laryngectomy: The surgical removal of the affected area of your larynx while leaving as much intact as possible so you keep your ability to talk
• Hemilaryngectomy: Surgery to remove one side of the larynx
• Supraglottic laryngectomy: The surgical removal of your larynx above your vocal cords
• Cordectomy: The surgical removal of one or both vocal cords

Stages 3 and 4 Laryngeal Cancers

Stages 3 and 4 laryngeal cancers involve laryngeal cancer that has spread to the voice box. Cancers at this stage have a high risk of spreading to nearby lymph nodes in your neck.

These cancers may or may not involve other areas of the throat or neck, like your thyroid gland or esophagus (the tube that connects your mouth and stomach). As these cancers advance, they may spread to other areas of your body.

Treatment for laryngeal cancers at this stage involves the following:

• Chemoradiation: A combination of radiation therapy and chemotherapy (the intravenous administration of drugs to kill or stop the growth of cancer cells) used before or after surgery
• Surgery

Surgery may involve one or more of the following techniques:

• Total laryngectomy: The surgical removal of your entire larynx
• Lymph node dissection: The surgical removal of the affected lymph nodes near the site of the malignancy
• Thyroidectomy: Surgical removal of the thyroid gland if the cancer spreads into this organ

Other Treatments

Depending on your disease stage and other factors regarding your response to traditional therapies, one of the following treatments may also be advised for laryngeal cancer:

• Targeted drug therapy: Targeted drug therapies focus on the specific molecular pathways involved in the abnormal growth of laryngeal cancer cells to hinder their progression.
• Immunotherapy: Immunotherapy helps your body's immune system find and attack laryngeal cancer cells. It uses natural or manufactured materials to target, boost, or restore the function of your immune system.

How Successful Is Laryngeal Cancer Treatment?

The success of laryngeal cancer treatment depends on many factors, such as the stage of your cancer when treatment began. Smoking and/or continued alcohol use can interfere with the best outcomes.

Early diagnosis and treatment are important to successful disease outcomes. Early stage laryngeal cancer treated with radiotherapy or surgery has a high cure rate.

On average, the five-year relative survival rate for laryngeal cancer is 80%. This means that people with laryngeal cancer are about 80% as likely to live for five years after diagnosis than people who don't have this disease.

Since these numbers are based on people diagnosed and treated at least five years earlier, people diagnosed from here on out are likely to have a better prognosis because treatments have improved during that time.

Side Effects of Laryngeal Cancer Treatment

Side effects of laryngeal cancer treatment can vary by person. The most common side effects include the following.

Radiation therapy:

• Skin problems ranging from redness to blistering and peeling
• Dry mouth
• Mouth sores
• Trouble swallowing
• Worsening of hoarseness
  
• Changes in your sense of taste
• Tiredness
• Possible breathing trouble from swelling
  
• Hearing problems

Chemotherapy:

• Nausea and vomiting
• Loss of appetite or weight loss
• Mouth sores
• Diarrhea
• Hair loss
• Nail changes
• Skin changes
• Ringing in the ears
• An increased chance of infection
• Easy bruising due to a low blood platelet count
• Fatigue

Surgery:

• Blood clots
• Infections
• Anesthesia complications
• Pneumonia
• Loss of the ability to speak
• Gradual narrowing of the throat or voice box, making it hard to breathe
• Difficulty swallowing possibly requiring a feeding tube

Immunotherapy:

• Fatigue
• Cough
• Nausea
• Diarrhea
• Skin rash
• Loss of appetite
• Joint pain
• Itching
• Infusion reaction (a hypersensitivity reaction to the drug)
• Autoimmune reaction (immune system reaction that attacks normal parts of your body)

Targeted therapy:

• Headache
• Fatigue
• Diarrhea
• Problems with breathing
• Low blood pressure

Self-Care With Laryngeal Cancer

Self-care is an important aspect of maintaining your overall well-being. It can also make a significant difference in managing your physical and mental health while dealing with laryngeal cancer.

Self-care involves paying attention to your needs and strengthening your physical and emotional reserves as you deal with the overwhelming challenges of laryngeal cancer. Research indicates that regular self-care care can reduce the effects of anxiety, stress, and sleep problems.

If you're new to the aspect of self-care, try these strategies to find what works for you:

• Carve out daily quiet time for your body and mind.
• Try aromatherapy.
• Schedule time for movement or light exercise daily, with the approval of your healthcare provider.
• Start a journal.
• Make time for hobbies, reading, walking, baking, or other practices or activities that make you feel fulfilled.
  
• Prioritize quality sleep.
• Get a massage.
• Prioritize your time instead of over-committing.

Getting Your Voice Back With Laryngeal Cancer

If your voice box was removed as part of your treatment for laryngeal cancer, there are several options for restoring your voice after a laryngectomy. Voice restoration is usually handled after you have completed all treatments for your disease. It usually requires the help of speech therapy to master this new way of talking.

Options for voice restoration include tracheoesophageal voice prosthesis, electrolarynx, and esophageal speech.

Tracheoesophageal Voice Prosthesis

It involves the surgical insertion of a prosthesis in the upper part of your trachea, where it is connected to your esophagus. It uses a one-way valve to let air from your lungs pass from your trachea and into the esophagus. This allows the esophagus to vibrate as your new voice box.

Though it takes guidance and practice to use, a tracheoesophageal voice prosthesis can usually help you achieve the best voice quality compared to other voice restoration methods.

Electrolarynx

Another voice restoration option is an electrolarynx, also known as an artificial larynx. It is a small, battery-operated device that produces a voice with an electronic quality that is typically well-understood.

When you want to speak, you place it on your neck under your chin. To speak, you push a button that transfers vibrations through your skin to your throat. You shape the sounds by using your mouth, tongue, teeth, and lips.

Esophageal Speech

Esophageal speech does not require any devices. It can be understood, though it creates a rough, hoarse sound.

Esophageal speech involves learning to push air with your mouth into the esophagus and back out again. This causes your esophagus to vibrate and make a sound that is shaped into words by your mouth, lips, tongue, and teeth.

Recurrent Laryngeal Cancer After Treatment

It is common for laryngeal cancer to recur after treatment. When this happens, it typically recurs locally in your larynx. If this occurs, it typically happens within two to three years after treatment.

There is a 20.5% overall risk of recurrence with laryngeal cancer. Having the following characteristics may contribute to a higher risk of recurrence:

• Supraglottic cancer
• T2 and T3 size tumors
• Younger age

Research indicates that the majority (71%) of laryngeal cancer that recurs involves the location of the primary tumor.

Support for Advanced Laryngeal Cancer

Coping with advanced laryngeal cancer involves more than medical care. In addition to meeting your physical needs, it's important to identify and meet your emotional and mental health needs to support your well-being.

Accept the help of family and friends who are willing to lighten your load. Whether it's helping with meal preparation, driving you to medical appointments, or doing everyday errands, allow yourself to let others help so you can focus your energies on healing.

If you feel overwhelmed, talk to your healthcare provider about getting a palliative care support visit. This involves meeting with a team of specialists, including a social worker, a nurse, and a healthcare provider, who can address the full range of concerns involved in your cancer treatment.

Some of the most valuable support can come from others who understand what you are experiencing. You can find this in an online or local cancer support group. Some options for support groups include the following organizations:

• CancerCare
• The Cancer Survivors Network

Summary

Laryngeal cancer can be a challenging disease. When caught and treated early, it can be easily cured. However, if caught in later stages, tumor growth may require the removal of your voice box to protect your health.

You have the highest risk of getting this disease if you smoke or use tobacco products. Heavy drinking also increases your risk. Doing both raises your risk greatly.

Symptoms of a hoarse voice, coughing, and trouble swallowing should not be ignored. Getting an early diagnosis can improve your chances of having the best outcomes.