Laryngeal cancer

A tumor is an abnormal growth of certain cells that are part of a tissue or organ. Within tumors, we distinguish those that are generally indolent, without worsening the prognosis and are called benign, and those with more uncontrolled and aggressive growth, which worsens the patient's prognosis and is called malignant. The latter are the substrate of the great syndrome that we know as cancer.

Laryngeal cancer involves a type of malignant tumor that affects the cells of the larynx, which is the structure where the vocal cords reside and communicates with the pharynx above and with the trachea below.

Laryngeal cancer is common in Mediterranean Europe, where it represents 3% of cancers in men and 0.2% in women. It is the most common among head and neck tumors, representing 30-40% of them.

It is a type of cancer common in men between 45 and 70 years, presenting its maximum incidence around 60 years of age. Generally, the microscopic study of the cells usually corresponds to the squamous cell carcinoma type (90%).

How is it produced?

Tobacco is the essential carcinogenic agent, being related to various factors such as chronic burn, local irritative effect or alterations on the vascular network. The other major carcinogen is alcohol. Thus, the two most relevant factors favoring laryngeal cancer are tobacco and alcohol, especially if they are associated.

The disproportion of cases between men and women has been attributed to higher consumption of tobacco and alcohol by men. However, today women smoke more than men and a substantial increase in this type of cancer in women has not been shown, so far.

Other factors that may be involved in the appearance of this cancer, although they are difficult to prove and that can be discussed, are the contact with various chemicals derived on many occasions from exposure in the workplace (mainly in the textile and chemical industry), genetic factors, some viruses (Papillomavirus or herpes virus) as possible tumor-enhancing agents, vitamin deficiencies or gastroesophageal reflux .

It is thought that the adequate consumption of fruits rich in vitamins could act as a protector, although it is more debated.

Laryngeal cancer is classified according to the location of the tumor within the larynx into:

• Tumors of supraglottic location, that is, above the glottis, which is where the vocal cords are found
• Glottic localization tumors.
• Tumors of subglottic location, below the glottis.

There is another classification by stages (TNM) that depends on the size of the tumor, the adenopathies or nodes it affects, and the metastasis or extension to other organs such as the lung or liver.

Symptoms: tickling in the throat

The clinical signs that can lead to suspicion of laryngeal cancer are swallowing disorders (dysphagia) and breathing difficulties (dyspnea). The symptoms will depend on the location in which the tumor develops.

In the case of supraglottic tumors, more frequent in Latin countries, the symptoms are very nonspecific and generally appear later. You can start with tingling sensation and mild itchy discomfort, feeling of having something in the throat constantly, irritating cough or dysphagia. Glottic tumors mainly affect the voice or dysphonia. It is a symptom of early appearance, which allows a diagnosis in the initial stages. Subglottic tumors usually present with difficulties in breathing or dyspnea. Symptoms take time to appear, which means that the diagnosis may be in an advanced stage. The extensions of the tumor between the three areas of the larynx mean that the symptoms can often be mixed.

In the event that the tumor spreads to the lower part of the pharynx (throat) there may be difficulty swallowing food or even pain when swallowing (odynophagia). Difficulties in breathing, due to the possible occlusion of the airways by the tumor, can appear both by location and by size. May affect lymph nodes or adenopathies of the neck, especially in the case of supraglottic tumors. They appear as masses in the neck area. The appearance of these nodes affects treatment and prognosis. The incidence of other organ involvement, such as the lung, bone or liver, is difficult to establish, although it is very low.

Diagnosis

The diagnosis begins with an exhaustive questioning of the symptoms and associated risk factors that the patient presents, as well as a correct physical examination, where an increase in cervical volume may be revealed by enlarged nodes.

Exploration of the larynx can be performed using mirror laryngoscopy, rigid endoscopes with 70º or 90º angles, or flexible nasofibroendoscope. Given the existence of suspicious lesions, it is mandatory to take a biopsy, with local anesthesia or with general anesthesia if necessary, to study the cells of the lesion under the microscope and be able to make an exact diagnosis.

Imaging tests such as CT (scanner) or nuclear magnetic are of great importance to assess the extent of the tumor and make the decision for treatment.

Treatment

The treatment and prognosis of laryngeal cancer depend on the evolutionary stage in which it is found. Regional (lymphadenopathy) or distant (other organs) metastases cloud the prognosis. The curative treatment modalities at present are the surgery, radiotherapy and the association of both.

There is another therapeutic weapon, chemotherapy, which can be very useful in certain tumors to help in curative treatment. It is also used as a palliative treatment in tumors that cannot be treated with surgery and / or radiotherapy.

The surgery aims to remove the tumor and contiguous areas likely to be affected. In many cases, the neck lymph nodes are emptied in the same surgical time. The surgical technique will depend on the size and tumor location. Functional techniques can be performed, by external surgery or by endoscopic laser surgery (depending on the characteristics of the tumor), preserving laryngeal functions, but on other occasions it is necessary to perform radical techniques in which laryngeal functions are not preserved, leaving a permanent tracheostoma (opening in the throat) through which the patient must breathe.

Radiation therapy can be curative in some tumors. It can be used as a single treatment or associated with surgery and / or chemotherapy.

The decision of the type of treatment is based on the location and stage of the tumor.

Precautionary measures

In general, preventive measures are aimed at alcohol and inflexible, since they are the main risk factors for laryngeal cancer.

A diet rich in vitamins, with fruits and vegetables seems to have a beneficial effect in preventing the appearance of this tumor.