Understanding voice box cancer: Risk Factors, Symptoms, Diagnosis & Treatment

 Voice box cancer, also known as Laryngeal cancer, is a type of throat cancer that forms in the tissues of the larynx. It is a part of the throat between the base of the tongue and the trachea. The larynx contains vocal cords that help phonate, breathe, and swallow. Voice box cancer can occur in any part of the larynx; hence, it is essential to understand the risk factors, symptoms, diagnosis, and treatment to detect and treat the disease early.

Risk Factors

There are various risk factors associated with voice box cancer. Below are a few significant ones that should not be ignored –

• Smoking cigarettes or using tobacco prducts can be one of the most significant risk factors for voice box cancer. Around 80- 90% of voice box/laryngeal cancer occur due to smoking.
• Excessive consumption of alcohol is another significant risk factor which can increase the risk of voice box /laryngeal cancer/ laryngopharyngeal cancer.
• Gender is also a risk factor, as men tend to develop this type of cancer four times more likely than women due to higher smoking/drinking habits.
• Voice box/Laryngeal cancer is most common among people aged 55 and above.
• People who work in specific occupations, such as construction workers, metalworkers, and firefighters, may have a higher risk of developing voice box/laryngeal cancer when exposed to sulfuric acid mist, nickel, wood dust, asbestos, or manufacturing mustard gas.

Symptoms

The symptoms of voice box/laryngeal cancer can differ depending on the affected area and stage of the tumor. Some common symptoms include:

• Hoarseness or change in voice persisting for more than 2-3 weeks.
• Cough and sore throat that is persistent.
• Difficulties in breathing or high-pitched wheezing noise when breathing.
• Pain or difficulty in swallowing
• Swelling or a lump in the neck

Diagnosis

This type of cancer cannot be traced without an expert’s intervention. Hence if a person experience any of the symptoms mentioned above, it is necessary to consult an ENT surgeon or a Head and neck surgeon at the earliest. These patients require physical examination of the neck along with endoscopic laryngeal examination using a rigid or fibreoptic laryngoscope mounted with a video camera. Further, a few tests such as radiological imaging, including MRI or CT scan, can be advised to assess the extent of disease and status of lymph nodes and possible spread. Biopsy is required to confirm the diagnosis.

Treatment

The treatment of voice box/laryngeal cancer depends on the tumour's location, size of the tumor, stage of the disease, the patient's ability to talk, eat & breathe as normally as possible, age, gender, & general health of the patient. Below are a few treatment options that are successful in most cases:

• Laser Surgery- Selected patients of early-stage laryngeal cancer may benefit from this laryngeal preserving surgical approach. Patient can go to his work or start routine activities in few days’ time.
• Partial Laryngectomy: This is another voice preserving surgical approach for slightly bigger tumor who is not a candidate for laser surgery and doesn’t want to go for long course of radiation.
• Total Laryngectomy – A common type of treatment for advanced stages of laryngeal cancer wherein the head and neck oncosurgeon removes the cancer-affected tissues along with whole of voice box and the affected lymph nodes from the neck. Patient will lose voice after total laryngectomy so to rehabilitate voice, patient requires tracheoesophageal prosthesis at the same sitting or in the follow up period. With the help of TEP, patient is able to speak.
• Radiation therapy – Radiation therapy is standard of care for treating laryngeal cancer. In early stages, radical radiation alone is sufficient. In advanced stages, radiation is used concurrently with chemotherapy or can be used as adjuvant therapy after surgery.
• Chemotherapy – A treatment that uses drugs to control the growth of cancer cells by killing or stopping them from spreading. Chemotherapy is used concurrently in combination with radiation therapy as an organ preserving approach in case of advanced tumor or can be used as neoadjuvant therapy or in palliative settings to mitigate the symptoms of metastatic disease.
• Immunotherapy – A treatment involves using immunotherapeutic drugs to stimulate the patient's immune system to fight this disease. In selected patients of metastatic disease, immunotherapy may be useful in controlling the disease and prolonging life with better quality of life.

Understanding the risk factors, symptoms, diagnosis, and treatments can help in early detection and successful treatment. People must seek medical attention at the earliest if they experience the mentioned symptoms for more than 2-3 weeks duration. Quitting smoking or any other forms of tobacco use, or alcohol use is must for prevention and management of laryngeal cancer. Healthy lifestyle, balanced diet and exercises or physical activity may reduce overall cancer risk in long run.

 By - Dr. Rajeev Sharan, H.O.D & Sr. Consultant - Head & Neck Cancer and Thyroid Surgery, HCG EKO Cancer Centre