Understanding Laryngeal Cancer
The larynx, commonly known as the voice box, is a complex organ essential for speech, breathing, and swallowing. It contains the vocal cords and serves as an airway passage between the throat and lungs. Laryngeal cancer develops in the tissues of the larynx and can affect different areas:
Supraglottic cancer
Glottic cancer
Affects the middle portion of the larynx, including the vocal cords
Subglottic cancer
Affects the lower portion of the larynx, connecting to the trachea
Risk factors for laryngeal cancer include:
- Tobacco use (the most significant risk factor)
- Heavy alcohol consumption
- Combination of tobacco and alcohol (synergistic effect)
- Exposure to certain workplace chemicals
- Gastroesophageal reflux disease (GERD)
- Human papillomavirus (HPV) infection (less common than in other head and neck cancers)
Early symptoms may include:
- Persistent hoarseness or voice changes
- Sore throat or pain when swallowing
- Feeling of a lump in the throat
- Chronic cough
- Breathing difficulties
- Ear pain
- Unintentional weight loss
Early detection is crucial for successful treatment and voice preservation. At Premier Head and Neck Surgery, we emphasize the importance of prompt evaluation of any persistent voice changes or throat symptoms.
Diagnostic Approach
Accurate diagnosis and staging are essential for developing an effective treatment plan. Our comprehensive diagnostic approach includes:
- Detailed medical history and physical examination
- Laryngoscopy: Examination of the larynx using a flexible or rigid endoscope
- Videostroboscopy: Specialized examination that allows visualization of vocal cord vibration
- Biopsy of suspicious lesions for definitive diagnosis
- Imaging studies to assess the extent of the tumor and potential spread:
- CT scan
- MRI
- PET/CT scan for advanced cases
- Evaluation of lymph nodes in the neck for potential metastasis
This multifaceted approach allows us to determine the precise nature and extent of the cancer, guiding our treatment recommendations.
Surgical Approaches for Laryngeal Cancer
Surgery is a primary treatment option for laryngeal cancer. At Premier Head and Neck Surgery, we offer a range of surgical approaches tailored to the specific characteristics of each tumor, with a focus on preserving voice and swallowing function whenever possible:
Endoscopic Laser Surgery
- Minimally invasive approach using specialized lasers
- Performed through the mouth without external incisions
- Appropriate for early-stage cancers, particularly of the vocal cords
- Preserves surrounding healthy tissue and vocal function
- Shorter recovery time and fewer complications than open surgery
- May be combined with radiation therapy for optimal outcomes
Partial Laryngectomy
- Removal of part of the larynx while preserving voice function
- Several variations depending on tumor location:
-
- Supraglottic laryngectomy: Removes the upper portion of the larynx
- Vertical partial laryngectomy: Removes one vocal cord and adjacent structures
- Supracricoid laryngectomy: Removes most of the larynx while preserving some voice function
- Preserves natural breathing passage and some vocal function
- Requires intensive rehabilitation for optimal voice and swallowing outcomes
Total Laryngectomy
- Complete removal of the larynx
- Creates a permanent separation between the airway and the mouth/esophagus
- Results in a permanent tracheostoma (breathing hole in the neck)
- Loss of normal voice function, requiring alternative communication methods
- Reserved for advanced cancers or recurrences after other treatments
- May be combined with removal of surrounding structures if necessary
Neck Dissection
- Removal of lymph nodes in the neck
- Often performed in conjunction with laryngeal surgery for advanced cases
- May be:
-
- Selective: Removing specific groups of lymph nodes
- Modified radical: Preserving important structures while removing most lymph nodes
- Radical: Comprehensive removal of all lymph node groups (rarely necessary)
Voice Rehabilitation After Laryngeal Surgery
Voice rehabilitation is a critical component of recovery after laryngeal cancer surgery. At Premier Head and Neck Surgery, we work closely with specialized speech-language pathologists to provide comprehensive voice rehabilitation:
After Partial Laryngectomy
- Voice therapy to optimize remaining vocal function
- Techniques to improve breath support and vocal projection
- Swallowing therapy to address any difficulties
- Regular follow-up to monitor voice quality and function
After Total Laryngectomy
Several options for voice restoration are available:
- Tracheoesophageal Puncture (TEP) and Voice Prosthesis:
- Creation of a small passage between the trachea and esophagus
- Placement of a one-way valve that allows air to pass from the lungs to the esophagus
- Produces a more natural-sounding voice than other methods
- Requires good manual dexterity for maintenance
- Esophageal Speech:
- Learning to swallow air and release it in a controlled manner to create sound
- Requires no special equipment
- Takes significant practice to master
- Typically produces a lower-volume voice
- Electrolarynx:
- External electronic device held against the neck
- Produces vibrations that are shaped into speech by the mouth
- Immediate voice option after surgery
- Results in a mechanical-sounding voice
Multidisciplinary Treatment Approach
Radiation therapy
Chemotherapy
Often combined with radiation for organ preservation or advanced disease
Targeted therapy
Immunotherapy
Our team works closely with medical oncologists, radiation oncologists, speech pathologists, and other specialists to develop comprehensive treatment plans tailored to each patient’s specific needs, with a focus on both cancer control and quality of life.