The larynx (voice box) is located just below the oropharynx (throat) in the neck. The larynx contains the vocal cords, which produces sound when air is directed against them. The sound echoes through the pharynx, mouth, and nose to make a person's voice.
There are three main functions for the larynx: Voice production, Breathing and Swallowing. During breathing vocal cords open allowing air to flow into the trachea and the lung. With vice production the vocal cords come together allowing vibrations of its surface lining and hence sound production. During swallowing the larynx is elevated in the throat, the vocal cords close, the epiglottis (top part of the voice box) bend over the laryngeal inlet. All these help preventing aspiration into the lung.
Laryngeal cancer
Laryngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the larynx.
Most laryngeal cancers form in squamous cells, the thin, flat cells lining the inside of the larynx. These are called squamous cell cancer.
There are three main parts of the larynx:
- Supraglottis: The upper part of the larynx above the vocal cords, including the epiglottis.
- Glottis: The middle part of the larynx where the vocal cords are located.
- Subglottis: The lower part of the larynx between the vocal cords and the trachea (windpipe).
What causes larynx cancer?
Like most of squamous cell cancers of the head and neck region, use of tobacco products and drinking too much alcohol are the main risk factors for laryngeal cancer. Alcohol and tobacco products have synergistic affect on development of head and neck cancer.
What are the signs of laryngeal cancer?
These and other symptoms may be caused by laryngeal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:
- A sore throat or cough that does not go away.
- Trouble or pain when swallowing.
- Ear pain.
- A lump in the neck or throat.
- A change or hoarseness in the voice.
Examination by an Otolaryngologist-Head and Neck Surgeon is the most important diagnostic assessment for above symptoms. This examination includes a comprehensive and detailed assessment of neck, mouth, throat, larynx, ears and nose. A flexible laryngoscopy where a very thin fibro-optic tube is used to visualize the vocal cords may be used.
Diagnostic tests may include a CT scan (CAT scan) or MRI (magnetic resonance imaging), Barium swallow study and finally if a laryngeal tumor is seen or suspected a biopsy is done. The biopsy for vocal cord cancer is often done under general anesthesia. However, office based minimally invasive biopsies are available. With biopsy tissue is retrieved or examination under microscope by pathologist.
What are prognostic Factors for Laryngeal Cancer?
Prognosis (chance of recovery) depends on the following:
- The exact location and size of the tumor.
- The grade of the tumor.
- The patient's general health.
- Whether the patient continues to smoke and drink or not.
How one decides on treatment options for larynx cancer?
- The decision on appropriate treatment options for laryngeal cancer is complex taking into account many factors.
- The stage of the disease.
- The location and size of the tumor.
- Keeping the patient's ability to talk, eat, and breathe as normal as possible.
- Whether patient has new or recurrent cancer.
- Smoking tobacco and drinking alcohol decrease the effectiveness of treatment for laryngeal cancer. Patients with laryngeal cancer who continue to smoke and drink are less likely to be cured and more likely to develop a second tumor.
Laser Surgery for Vocal Cord Cancer
Vocal cord cancers often present with persistent hoarse voice at a fairly early stage. Prompt diagnosis may allow effective treatment of this condition with minimally invasive, through the mouth, microlaryngeal laser surgery. This surgery may often be performed as outpatient with rapid return to daily normal functioning.
How is laser surgery of vocal cords done?
Laser laryngeal surgery for vocal cords is done under general anesthesia through the mouth.
Vocal cords are examined under microscopic visualization with high magnification. This allows precision mapping of tumor. A laser beam coupled to the microscope is then used to make precise incisions to remove the tumor while maximally preserving the portions of the vocal cords and the voice box that are not involved by the tumor. During this type of surgery unlike the traditional open surgery, typically no tracheostomy is needed. It is often performed as outpatient surgery.
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