Laryngeal Cancer Treatment in Delhi, India

Laryngeal cancer is a type of cancer that originates in the tissues of the larynx, also known as the voice box. The larynx is located in the throat at the top of the windpipe (trachea) and contains the vocal cords. Laryngeal cancer typically begins in the cells lining the inside of the larynx and can spread to surrounding tissues if not treated. 

Like other types of cancer, laryngeal cancer occurs when cells in the larynx undergo genetic mutations that cause them to grow and divide uncontrollably. These abnormal cells can form a tumour in the larynx, which may interfere with breathing, swallowing, and speaking.

Laryngeal cancer is often categorised based on the specific area of the larynx where it originates. The main types of laryngeal cancer include:

• Glottic cancer: This type of cancer develops in the vocal cords (glottis), which are located at the centre of the larynx.
• Supraglottic cancer: Supraglottic cancer occurs in the upper portion of the larynx above the vocal cords.
• Subglottic cancer: Subglottic cancer is rare and begins in the area below the vocal cords, near the junction of the larynx and the windpipe.

The development of laryngeal cancer is typically attributed to a combination of genetic, environmental, and lifestyle factors. While the exact cause of laryngeal cancer is not always clear, certain risk factors increase the likelihood of developing the disease. Here are some common causes and risk factors associated with laryngeal/voice box cancer:

Tobacco Use

Smoking tobacco, whether through cigarettes, cigars, pipes, or smokeless tobacco (such as chewing tobacco), is the most significant risk factor for laryngeal cancer. The carcinogens in tobacco smoke can damage the cells lining the larynx, leading to cancerous growth.

Excessive Alcohol Consumption

Heavy alcohol consumption, especially when combined with tobacco use, significantly increases the risk of developing laryngeal cancer. Alcohol can irritate and damage the cells in the larynx, making them more susceptible to carcinogens.

Exposure to Certain Chemicals and Toxins

Occupational exposure to certain chemicals and toxins, such as asbestos, sulphuric acid fumes, nickel compounds, and wood dust, has been linked to an increased risk of laryngeal cancer. Individuals working in industries such as manufacturing, construction, and mining may be at higher risk.

Human Papillomavirus (HPV) Infection

Infection with certain strains of the human papillomavirus (HPV), particularly HPV-16, has been associated with an increased risk of laryngeal cancer. HPV-related laryngeal cancer often affects younger individuals and may have distinct characteristics compared to non-HPV-related cases.

Age and Gender

Laryngeal cancer is more common in older adults, with the risk increasing with age. Men are also at higher risk of developing laryngeal cancer than women, though the gender gap is narrowing, possibly due to changing smoking patterns among women.

Gastro-oesophageal Reflux Disease (GERD)

Chronic gastro-oesophageal reflux disease (GERD), characterised by frequent acid reflux, may irritate the lining of the larynx and increase the risk of developing laryngeal cancer, particularly in the supraglottic area.

Family History and Genetic Factors

A family history of laryngeal cancer or other head and neck cancers may indicate a genetic predisposition to the disease. Certain genetic mutations and inherited conditions, such as Fanconi anaemia, may also increase the risk of developing laryngeal cancer.

Laryngeal cancer can present with various symptoms, which may vary depending on the location and stage of the cancer. These include:

• Persistent Hoarseness or Changes in Voice: One of the most common early symptoms of laryngeal cancer is persistent hoarseness or changes in voice quality that do not improve over time. This hoarseness may be accompanied by roughness, raspiness, or a change in pitch.

• Sore Throat or Throat Pain: Persistent sore throat or throat pain, particularly if it worsens over time or is not alleviated by typical remedies, may be a symptom of laryngeal cancer.

• Difficulty Swallowing (Dysphagia): Difficulty swallowing, also known as dysphagia, may occur as a result of voice box cancer obstructing the normal passage of food and liquids through the throat. This symptom may become progressively worse as the cancer grows.

• Ear Pain: Pain in one or both ears that is not associated with an ear infection or other ear-related condition may be a sign of laryngeal cancer. This pain may radiate from the throat to the ears.

• Lump or Mass in the Neck or Throat: A palpable lump or mass in the neck or throat area may indicate the presence of a tumour in the larynx or nearby lymph nodes. This lump may be visible or felt as a swelling under the skin.

• Persistent Cough or Coughing up Blood: A persistent cough that does not resolve with typical treatments or coughing up blood (hemoptysis) may be indicative of advanced laryngeal cancer, especially if accompanied by other symptoms.

• Unexplained Weight Loss: Significant and unexplained weight loss without changes in diet or physical activity may be a sign of advanced cancer, including laryngeal cancer. Cancer-related weight loss is often unintentional and may occur as a result of metabolic changes associated with the disease.
• Breathing Difficulties: In advanced stages of laryngeal cancer, individuals may experience difficulty breathing (dyspnoea) or noisy breathing (stridor) due to airway obstruction caused by the tumour.
• Fatigue and Weakness: Generalised fatigue, weakness, and a sense of overall decline in health may occur as a result of the body's response to cancer, including laryngeal cancer.

Diagnosing laryngeal cancer typically involves a combination of medical history assessment, physical examination, imaging tests, and biopsy procedures. Here's an overview of the diagnostic process for laryngeal cancer:

Medical History and Physical Examination

The diagnostic process often begins with a thorough medical history assessment, during which the healthcare provider asks about symptoms, risk factors (such as smoking and alcohol consumption), and any relevant medical conditions. A physical examination of the head and neck, including the larynx, may also be performed to evaluate for any signs of abnormality or swelling.

Imaging Tests

Imaging tests are commonly used to visualise the larynx and surrounding structures, assess the extent of the tumour, and determine if cancer has spread (metastasized) to nearby lymph nodes or distant organs. Common imaging tests for laryngeal cancer diagnosis include:

• Computed Tomography (CT) Scan: CT scans provide detailed cross-sectional images of the larynx and nearby structures, helping to identify the location, size, and extent of the tumour.

• Magnetic Resonance Imaging (MRI): MRI scans use magnetic fields and radio waves to produce high-resolution images of the larynx, providing detailed information about the tumour and its relationship to nearby tissues.

• Positron Emission Tomography (PET) Scan: PET scans use a radioactive tracer to detect areas of increased metabolic activity, helping to identify potential sites of cancer spread (metastasis) throughout the body.

Biopsy

A biopsy is the definitive diagnostic test for laryngeal cancer, as it involves removing a small sample of tissue from the suspicious lesion in the larynx and examining it under a microscope to look for cancerous cells. There are several types of biopsies that may be performed to diagnose laryngeal cancer:

• Direct Laryngoscopy and Biopsy: During a direct laryngoscopy, a thin, flexible tube with a camera (laryngoscope) is inserted through the mouth or nose to visualise the larynx. If an abnormal area is identified, a biopsy may be performed to obtain tissue samples.

• Fine Needle Aspiration (FNA) Biopsy: FNA biopsy involves using a thin needle to extract cells from a suspicious lump or lymph node in the neck for analysis under a microscope.

• Surgical Biopsy: In some cases, a surgical procedure may be necessary to obtain a tissue sample from the larynx for biopsy. This may involve removing part of the tumour (punch biopsy) or sampling tissue from the tumour (incisional biopsy) during surgery.

Pathology Evaluation

Following biopsy, the tissue samples are sent to a pathology laboratory, where they are examined by a pathologist under a microscope. The pathologist assesses the tissue for the presence of cancer cells, determines the type and grade of the cancer, and provides additional information about the tumour's characteristics, such as its size, extent of invasion, and presence of lymphovascular invasion.

Staging and Treatment Planning

Once a diagnosis is confirmed, further tests may be performed to stage the cancer and determine the most appropriate laryngeal cancer treatment approach. Staging helps classify the extent of the cancer and guides treatment decisions. Common staging tests for laryngeal cancer may include additional imaging studies, such as CT, MRI, or PET scans, as well as endoscopic examinations to evaluate the extent of tumour involvement and lymph node spread.

Laryngeal cancer staging is a crucial aspect of the diagnostic process, as it helps determine the extent of the cancer's spread and guides treatment decisions. The most commonly used staging system for laryngeal cancer is the TNM system, which categorises the cancer based on the size of the primary tumour (T), the involvement of nearby lymph nodes (N), and the presence of distant metastasis (M). Here's an overview of the stages of laryngeal cancer:

Stage 0

This stage, also known as carcinoma in situ, refers to cancer that is limited to the surface layer of cells lining the larynx and has not invaded deeper tissues.

Stage I

This is considered a very good prognosis stage. The tumour is very small, typically no larger than 2 centimetres across. Importantly, the cancer at this stage hasn't spread beyond the larynx. 

Stage II

Stage II represents a slightly more advanced form of early-stage cancer. The tumour is larger than in stage 1, typically ranging between 2 and 4 centimetres. However, similar to stage I, the cancer remains confined to the larynx and hasn't spread to other areas.

The key distinction between stages 1 and 2 lies in the size of the tumour. While both are considered early-stage cancers, stage 2 presents with a larger tumour that might start impacting the voice due to its influence on vocal cord movement.

Stage III

The tumour is larger and may have spread to surrounding tissues in the larynx, such as the cartilage or vocal folds. It might also affect the movement of the vocal cords more significantly. In some cases, lymph nodes near the larynx may also be involved.

Stage IV

This is the most advanced stage. The tumour is large and has spread beyond the larynx to other parts of the neck, such as distant lymph nodes, or to other organs in the body, such as the lungs.

Staging helps the best oncologists in India to determine the most appropriate treatment approach, which may include surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy, or a combination of these modalities. Early detection and accurate staging are essential for achieving optimal outcomes and improving survival rates in individuals with laryngeal cancer.

The laryngeal cancer treatment depends on several factors, including the stage of the cancer, the location, and size of the tumour, the patient's overall health and preferences, and the presence of any other medical conditions. 

Surgery

Surgery may be recommended for early-stage voice box cancer or for tumours that are confined to the larynx and have not spread to other parts of the body. The type of surgery performed depends on the location and size of the tumour:

• Laser Surgery: This minimally invasive procedure uses a laser to remove the cancerous tissue from the larynx while preserving surrounding healthy tissue.
• Partial Laryngectomy: In this procedure, a portion of the larynx containing the tumour is removed, while the rest of the larynx is preserved. Depending on the extent of the surgery, voice function may be preserved or altered.
• Total Laryngectomy: In cases where the cancer involves the entire larynx or has not responded to other treatments, a total laryngectomy may be performed to remove the entire larynx. This procedure permanently alters speech and swallowing, requiring alternative methods of communication and swallowing rehabilitation.

Radiation Therapy

Radiation therapy uses high-energy beams to target and destroy cancer cells in the larynx. It may be used as the primary treatment for early-stage laryngeal cancer, or in combination with surgery or chemotherapy for more advanced cases. Radiation therapy may also be used to relieve symptoms and improve quality of life in patients with advanced or recurrent laryngeal cancer.

Chemotherapy

Chemotherapy involves the use of powerful drugs to kill cancer cells or stop them from growing and dividing. It may be used alone or in combination with surgery and/or radiation therapy for advanced or metastatic laryngeal cancer. Chemotherapy may also be given before surgery or radiation therapy to shrink the tumour and make it easier to remove.

Targeted Therapy

Targeted therapy drugs are designed to specifically target cancer cells by blocking specific pathways or molecules that are involved in the growth and spread of cancer. Targeted therapy may be used in combination with other treatments for advanced or recurrent laryngeal cancer, particularly in cases where traditional treatments have been ineffective.

Immunotherapy

Immunotherapy drugs help the body's immune system recognize and attack cancer cells. They may be used alone or in combination with other treatments for advanced or metastatic laryngeal cancer, particularly in cases where other treatments have not been effective. Immunotherapy has shown promising results in some patients with advanced laryngeal cancer.

Supportive Care

In addition to cancer-directed treatments, supportive care measures are an essential component of laryngeal cancer treatment. 

• Voice Rehabilitation: This therapy helps patients improve their voice function after treatment, especially if surgery has affected the vocal cords. Techniques include exercises to strengthen the vocal cords and learn new ways of speaking.
• Speech Prosthetic Devices: In cases where total laryngectomy is necessary, speech prosthetics can help patients regain the ability to speak. These devices work by directing air flow through a valve in the oesophagus, creating vibrations that can be used to produce sounds.

Laryngeal cancer and its treatments can lead to various complications, which may affect a person's quality of life and overall well-being. These complications can arise during or after treatment and may require ongoing management and support. Here are some common complications associated with laryngeal cancer:

Voice Changes and Swallowing Difficulties

Depending on the extent of surgery or radiation therapy, individuals may experience changes in their voice quality (dysphonia) or difficulty speaking (dysphonia). This can impact communication and may require speech therapy or alternative communication methods. Swallowing difficulties (dysphagia) can also occur, especially after surgery or radiation therapy involving the larynx, requiring swallowing rehabilitation and dietary modifications.

Respiratory Problems

Surgery or radiation therapy for laryngeal cancer can affect the airway and breathing function. Individuals may experience shortness of breath (dyspnoea), wheezing, or difficulty breathing (stridor) due to airway obstruction or narrowing. In severe cases, a tracheostomy (surgical opening in the windpipe) may be necessary to bypass the obstruction and maintain breathing. 

Nutritional Issues and Weight Loss

Swallowing difficulties and changes in taste perception may lead to reduced food intake, malnutrition, and unintentional weight loss. Adequate nutrition is essential for maintaining strength and supporting recovery from cancer treatment. Nutritional counselling, dietary modifications, and oral nutritional supplements may be recommended to address these issues. 

Lymphoedema

Removal of lymph nodes during surgery or radiation therapy can disrupt the normal flow of lymphatic fluid, leading to swelling (lymphoedema) in the neck or face. Lymphoedema can cause discomfort, restricted movement, and increased risk of infection. Manual lymphatic drainage, compression therapy, and exercises may help manage lymphoedema and improve symptoms.

Speech and Communication Issues

Individuals who undergo total laryngectomy may lose their ability to speak (aphonia) through the mouth, requiring alternative methods of communication such as electrolarynx devices, oesophageal speech, or tracheo-oesophageal puncture (TEP) speech. Learning to use these devices and techniques may take time and practice.

Although there's no guaranteed way to completely prevent laryngeal cancer, there are steps you can take to significantly reduce your risk. Here are some key strategies for laryngeal cancer prevention: 

Avoid Tobacco Use

Tobacco use, including smoking cigarettes, cigars, pipes, and using smokeless tobacco (such as chewing tobacco), is the most significant risk factor for laryngeal cancer. Quitting smoking and avoiding tobacco products can greatly reduce the risk of developing the disease. Supportive resources, such as smoking cessation programmes, counselling, and nicotine replacement therapies, can aid in tobacco cessation efforts.

Limit Alcohol Consumption

Heavy alcohol consumption is another major risk factor for laryngeal cancer, particularly when combined with tobacco use. Limiting alcohol intake or abstaining from alcohol altogether can lower the risk of developing the disease. For individuals who choose to drink alcohol, moderation is key—limiting intake to recommended guidelines can help reduce the risk of laryngeal cancer and other alcohol-related health conditions.

Maintain a Healthy Diet

Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help maintain overall health and reduce the risk of cancer, including laryngeal cancer. Aim to incorporate a variety of colourful fruits and vegetables into your diet, as they contain antioxidants and other nutrients that may help protect against cancer. Limiting consumption of processed and red meats, as well as foods high in salt and saturated fats, is also recommended.

Protect Against HPV Infection

Infection with certain strains of the human papillomavirus (HPV), particularly HPV-16, has been associated with an increased risk of laryngeal cancer. Practising safe sex and using condoms can reduce the risk of HPV transmission, thereby lowering the risk of HPV-related cancers, including laryngeal cancer. Additionally, HPV vaccination is available and recommended for adolescents and young adults to prevent HPV-related cancers.

Reduce Exposure to Occupational Hazards

Occupational exposure to certain chemicals and toxins, such as asbestos, sulphuric acid fumes, nickel compounds, and wood dust, has been linked to an increased risk of laryngeal cancer. Minimising exposure to these occupational hazards through proper workplace safety measures, such as ventilation systems, protective equipment, and adherence to safety protocols, can help reduce the risk of developing the disease.

Practise Good Oral Hygiene

Poor oral hygiene and chronic irritation of the throat may contribute to the development of laryngeal cancer. Practising good oral hygiene, including regular brushing and flossing, and seeking prompt treatment for any oral infections or irritations, can help maintain oral health and reduce the risk of laryngeal cancer.

Seek Regular Medical Check-ups

Regular medical check-ups and screenings are important for early detection of laryngeal cancer and other health conditions. Individuals at increased risk due to factors such as tobacco and alcohol use, occupational exposures, or history of HPV infection should undergo routine screenings as recommended by their healthcare provider. Early detection allows for timely intervention and improved voice box cancer treatment outcomes.

Can laryngeal cancer affect the thyroid gland?

Laryngeal cancer originates in the tissues of the larynx (voice box) and typically does not directly affect the thyroid gland. However, in advanced cases where the cancer has spread locally, it may involve nearby structures such as the thyroid gland. Treatment for laryngeal cancer may sometimes involve surgery that affects the surrounding tissues, including the thyroid gland.

Can voice changes indicate laryngeal cancer?

Yes, voice changes, such as persistent hoarseness or changes in voice quality, can be early signs of laryngeal cancer. The larynx is responsible for producing sound and controlling vocal cord movement, so any abnormalities in this area, including the presence of a tumour, can affect voice function. If you experience persistent voice changes, it's essential to consult a healthcare professional for further evaluation.

How is laryngeal cancer different from throat cancer?

Laryngeal cancer specifically refers to cancer that originates in the tissues of the larynx (voice box), whereas throat cancer is a broader term that may encompass cancers occurring in various parts of the throat, including the pharynx (throat) and larynx. Laryngeal cancer specifically affects the vocal cords and surrounding structures within the larynx, while throat cancer may involve different areas of the throat, such as the tonsils, base of the tongue, or back of the throat.

What is the survival rate for laryngeal cancer?

The survival rate for laryngeal cancer depends on various factors, including the stage of the cancer at diagnosis, the specific characteristics of the tumour, and the effectiveness of treatment. Generally, the overall five-year survival rate for laryngeal cancer is around 60% to 70%. However, survival rates can vary widely based on individual circumstances, and early detection and prompt treatment can significantly improve outcomes.

Can laryngeal cancer affect breathing?

Yes, laryngeal cancer can affect breathing, particularly in advanced cases where the tumour obstructs the airway or impairs the function of the larynx. Symptoms such as shortness of breath, noisy breathing (stridor), or difficulty breathing may occur if the cancer obstructs the flow of air through the larynx. Voice box cancer treatment aims to alleviate such symptoms and restore normal breathing function.

Can laryngeal cancer be treated with laser therapy?

Yes, laser therapy, also known as laser microsurgery, is a minimally invasive voice box cancer treatment option. It involves using a laser beam to precisely remove cancerous tissue from the larynx while preserving surrounding healthy tissue. Laser therapy may be used for early-stage laryngeal cancer or for tumours located in accessible areas of the larynx. It offers advantages such as quicker recovery, reduced postoperative complications, and preservation of voice function.

What is dysphagia, and how is it managed in patients with laryngeal cancer?

Dysphagia refers to difficulty swallowing, which can occur in individuals with laryngeal cancer due to the location and size of the tumour or as a side effect of treatment such as surgery or radiation therapy. Management of dysphagia in patients with laryngeal cancer may involve dietary modifications, swallowing exercises, speech therapy, and interventions to improve swallowing function. In some cases, a feeding tube may be temporarily or permanently required to ensure adequate nutrition and hydration.

Can laryngeal cancer recur after treatment?

Yes, laryngeal cancer can recur (come back) after initial treatment. The risk of recurrence depends on various factors, including the stage of the cancer, the effectiveness of the initial treatment, and individual risk factors. Regular follow-up appointments and surveillance are essential for monitoring for recurrence and managing any signs or symptoms promptly.

Is it possible to regain voice function after total laryngectomy?

Yes, individuals who undergo total laryngectomy (removal of the entire larynx) can regain voice function through alternative methods such as electrolarynx devices, oesophageal speech, or tracheo-oesophageal puncture (TEP) speech. These methods involve using different mechanisms to produce speech without the vocal cords. Speech therapy and rehabilitation can help individuals learn and adapt to these alternative communication methods.

Reviewed By Dr. Sowrabh Kumar Arora, Senior Director - Surgical Oncology (Head & Neck) Cancer Care / Oncology on 18 June 2024.