Laryngeal and Hypopharyngeal Cancer (Voice Box)

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Laryngeal and Hypopharyngeal Cancer (Voice Box)

Your voice box (larynx) is at the top of your windpipe (trachea) and is important for speaking, breathing and swallowing.

There are three parts to your larynx:

  • Supraglottis - Upper part, above your vocal cords
  • Glottis - Middle part, including your vocal cords
  • Subglottis - Lower part, below your vocal cords

The hypopharynx is at the top of your food pipe or oesophagus, and it lies to the sides of and behind your larynx. It helps direct food into your oesophagus instead of your larynx.

Cancer can form in one or more of these areas, most often in the squamous cells.

  • Laryngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the larynx.
  • Use of tobacco products and drinking too much alcohol are major risk factors for these cancers.
Signs and symptoms of laryngeal cancer are as follows
  • A sore throat or cough persistent for more than 3 weeks
  • Pain or difficulty when swallowing
  • Ear pain
  • A lump or mass in the neck or throat
  • A change or hoarseness in the voice more than 2 to 3 weeks
  • Blood tinged sputum on coughing
Signs and symptoms of Hypopharyngeal cancer are as follows:
  • Difficulty in swallowing especially for solids initially
  • Gradual loss of weight
  • Pain in throat
  • Lump or mass in neck
  • Hoarseness or change in voice for more than 2 to 3 weeks
  • Blood on coughing
The following investigations are done for diagnosis and staging:
  • Physical examination of the throat and neck -
    Clinical examination of oral cavity and neck is very important. A history of the patient’s health habits and past illnesses and medical treatments will also be taken.
  • Biopsy - A small sample of the tumour tissue is taken and sent for evaluation by pathologist under a microscope to establish the diagnosis of cancer . The sample of tissue may be removed during one of the following procedures:
    • Laryngoscopy -
      A procedure in which the doctor checks the larynx (voice box) with a flexible or rigid endoscope to check for abnormal areas. A laryngoscope is a thin, tube-like instrument with a light and a lens for viewing the inside of the throat and voice box. A biopsy is not usually possible in office setting or a clinic. Most commonly patients will be given complete anaesthesia for thorough examination using the rigid direct laryngoscope and then a biopsy sample is taken from the tumour site.
  • CT scan - A contrast enhanced CT scan of head and neck region with thin cuts in larynx region is classically used to check for the extent of the tumour.
  • PET-CT scan - In advanced stage III and IV tumours, a PET-CT scan is usually recommended to check for spread of cancer to other parts of the body.
Prognosis depends on the following:
  • The stage of the disease
  • The location and size of the tumour
  • The grade of the tumour
  • The patient's age, gender, and general health
Treatment options depend on the following:
  • The stage of the disease
  • The location and size of the tumour
  • Keeping the patient's ability to talk, eat, and breathe as normal as possible
  • Whether the cancer has come back (recurred)

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 tumour. After treatment for laryngeal cancer, frequent and careful follow-up is important.

Laryngeal Cancer Surgery

The following surgical procedures are used for the treatment of laryngeal cancer:

  • Cordectomy: Surgery to remove the vocal cords only.
  • Supraglottic laryngectomy: Surgery to remove the supraglottis only.
  • Hemilaryngectomy: Surgery to remove half of the larynx (voice box). A hemilaryngectomy saves the voice.
  • Partial laryngectomy: Surgery to remove part of the larynx (voice box). A partial laryngectomy helps keep the patient's ability to talk.
  • Total laryngectomy: Surgery to remove the whole larynx. The wind pipe of trachea is brought out from the front of the neck, this is called a tracheostoma. Patient will breathe through this stoma
  • Thyroidectomy: The removal of all or part of the thyroid gland.
Laser surgery:

A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumour in the larynx. Laser is especially useful in early stage vocal cord cancer (Glottic Cancer).