IV. Oncological diseases

1. Laryngeal cancer

The larynx is located in the neck at the top of the windpipe (trachea) and is used when we talk, swallow and breathe. It's also called the voice box and is made up of cartilage - the large cartilage in the front is often called the Adam's apple. Inside the larynx are the vocal cords.

The larynx is made up of three main parts:

• The supraglottis - the tissue at the top of the larynx.

• The glottis - the middle part of the larynx where the vocal cords are located.

• The subglottis - the tissue at the bottom of the larynx that connects the larynx to the windpipe.

Cancer of the larynx, or laryngeal cancer, can develop in any of these parts, but most commonly develops on the vocal cords.

The precise causes of laryngeal cancer aren't known. However, it's more common:

• on the vocal cords

• in men

• between the ages of 55 and 65

• in smokers

• in those who drink alcohol heavily.

Symptoms:

The symptoms of laryngeal cancer depend on where the cancer develops. Since it most often develops on the vocal cords, hoarseness or other changes in the voice are common.

Other symptoms that may occur when cancer develops above or below the vocal cords, or if it spreads from the vocal cords, include:

• a persistent sore throat

• ear pain

• noisy breathing

• difficulty swallowing

• difficulty breathing

• a lump in the neck

• painful swallowing

• a feeling of a lump in the throat

• a persistent cough.

If the cancer spreads outside the larynx, the lymph glands in the neck may become enlarged.

Diagnosis:

If laryngeal cancer is suspected, the throat with be examined with a small long-handled mirror or a fibre-optic light called a laryngoscope. If abnormal areas are seen, a biopsy will be taken under local or general anaesthetic. This is the only way of accurately diagnosing laryngeal cancer.

If cancer is detected, x-rays, a CT scan (or CAT scan) or magnetic resonance scan (MRI) may be used to establish the size of the tumour and whether the cancer has spread.

Treatment:

Treatment of laryngeal cancer may involve:

• Radiotherapy - when high-energy x-rays are used to kill cancer cells.

• Surgery - this may involve the removal of a vocal cord, the supraglottis, part of the larynx or the entire larynx (laryngectomy). Lymph glands may also be removed. For early laryngeal cancers, laser therapy may be used.

• Chemotherapy - when drugs are used to kill cancer cells.

A team of experts is involved in caring for a person with laryngeal cancer. This team may include an ear, nose and throat (ENT) specialist; a cancer specialist; a radiotherapy specialist; a specialist cancer nurse; a dietician; a dentist and a speech therapist.

Following treatment, a person may need specialist help and advice with talking and breathing, especially if the whole larynx has been removed. Helping someone speak may involve using the oesophagus (gullet) to speak, or using a special electronic device that generates sound.

Emotional help and support is also often needed following diagnosis and treatment.