OVERVIEW

What is laryngeal cancer?

The larynx, located in the midline of the neck, is part of the upper respiratory tract. In addition to respiration, it performs vital physiological functions such as vocalization, swallowing, and protecting the respiratory tract. The larynx can be divided into the supraglottic, glottic, and subglottic regions based on the vocal cords, and laryngeal cancers in different locations exhibit distinct characteristics.

Malignant tumors occurring in the larynx are collectively referred to as laryngeal cancer, with 90% being squamous cell carcinoma. Other types include adenocarcinoma and sarcoma.

The exact cause of laryngeal cancer remains unclear, but it is currently believed to result from the combined effects of multiple carcinogenic factors, including smoking, alcohol consumption, human papillomavirus (HPV) infection, environmental pollution, radiation exposure, elevated androgen levels, and deficiencies in trace elements.

Symptoms of laryngeal cancer vary depending on the tumor's location and may include hoarseness, a sensation of a foreign body in the throat, throat pain, irritating dry cough, blood-streaked sputum, shortness of breath, and enlarged cervical lymph nodes.

Diagnosing laryngeal cancer involves not only reviewing medical history but also conducting a series of examinations, such as laryngoscopy, laryngeal CT scans, and histopathological examination of laryngeal lesions. Additionally, chest X-rays, abdominal ultrasounds, and bone scans may be performed to rule out lung, liver, or bone metastases, or PET/CT scans to exclude metastases in other parts of the body.

Treatment for laryngeal cancer includes surgery, radiation therapy, targeted therapy, and chemotherapy. The primary treatments are surgery and radiation therapy. Early-stage laryngeal cancer can often be treated with minimally invasive laser surgery or radiation therapy, while advanced cases require a combination of treatment modalities tailored to the individual patient.

SYMPTOMS

Can hoarseness directly diagnose laryngeal cancer?

Many diseases can cause hoarseness, including congenital voice disorders, inflammation, improper voice use, tumors, trauma, and neuromuscular disorders affecting the vocal cords. While laryngeal cancer can cause hoarseness, hoarseness does not necessarily indicate laryngeal cancer. However, prompt examination and diagnosis are still necessary.

What are the early symptoms of laryngeal cancer?

• Laryngeal cancer in the supraglottic region: Early symptoms mainly include a foreign body sensation in the throat and discomfort during swallowing, often misdiagnosed as pharyngitis.

• Laryngeal cancer in the glottic region: Early symptoms primarily manifest as hoarseness, sometimes misdiagnosed as vocal cord inflammation.

• Laryngeal cancer in the subglottic region: Early stages often show no obvious symptoms, leading to missed diagnoses. By the time symptoms appear, the tumor may already be locally advanced.

What are the manifestations of advanced laryngeal cancer?

In advanced stages, the tumor is larger and has a wider invasion range. In addition to early symptoms like hoarseness, throat discomfort, and sore throat, patients may experience coughing, bloody sputum, bad breath, and difficulty breathing. If lymph node metastasis occurs, neck lymph node enlargement may also be present.

CAUSES

Who is prone to laryngeal cancer?

Middle-aged and elderly men with long-term heavy smoking and alcohol consumption, a family history of malignant tumors, prolonged exposure to toxic chemicals or harmful air are high-risk factors for laryngeal cancer. Additionally, patients with papillomavirus infection (especially high-risk HPV16 and HPV18 infections), as well as adults with laryngeal papilloma, vocal cord leukoplakia, or erythroplakia, have a potential risk of malignant transformation. Individuals with these medical histories are also high-risk groups for laryngeal cancer.

Which diseases can develop into laryngeal cancer?

Some benign laryngeal diseases have a tendency to become malignant and may transform into laryngeal cancer under the influence of multiple factors, such as adult laryngeal papilloma, laryngeal leukoplakia, and laryngeal keratosis.

DIAGNOSIS

What tests should be done for laryngeal cancer?

If throat discomfort persists and medication is ineffective, you should visit an ENT department for a laryngeal examination. If necessary, further electronic laryngoscopy and spiral CT scans of the larynx may be required.

How is electronic laryngoscopy performed for laryngeal cancer? Is it dangerous or uncomfortable?

Electronic laryngoscopy involves inserting a fiber-optic tube with an electronic magnifier through the nasal cavity, passing through the nasopharynx and oropharynx to reach the larynx, allowing observation of lesions in the throat.

Since electronic laryngoscopes are reused, although strictly sterilized, there is a minimal risk of cross-infection of infectious diseases. Additionally, it may cause damage, bleeding, or even choking in the upper respiratory mucosa, but the likelihood is low. Necessary examinations should not be refused due to fear of potential risks.

The procedure may irritate the nasal and throat mucosa, causing discomfort. Most patients can tolerate it after topical anesthesia with tetracaine.

Besides laryngeal cancer, what else could a laryngeal mass be?

Apart from laryngeal cancer, a laryngeal mass may result from inflammation, trauma, benign tumors, or congenital conditions, such as vocal cord polyps, Reinke's edema, laryngeal tuberculosis, laryngeal granulomas, laryngeal papillomas, or laryngeal hemangiomas.

How is laryngeal cancer diagnosed?

The definitive diagnosis of laryngeal cancer relies on a biopsy, where a portion of the mass or cells is extracted for histopathological examination. In addition to identifying the pathological type, the malignancy grade should also be determined to guide treatment planning.

TREATMENT

Which department should laryngeal cancer patients visit?

Oncology, otolaryngology (ENT), or head and neck surgery.

What are the treatment options for laryngeal cancer? Are there any specific drugs?

Treatment methods for laryngeal cancer mainly include surgical resection, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. The specific treatment plan depends on the patient's tumor condition and overall health, and is ultimately determined through multidisciplinary discussions involving ENT-head and neck surgery, radiology, pathology, radiation oncology, and oncology departments.

Currently, there is no specific drug that can cure laryngeal cancer. However, some patients may prolong survival with targeted drugs (e.g., cetuximab).

What surgical methods are available for laryngeal cancer?

There are various surgical approaches for laryngeal cancer, and the specific procedure depends on the tumor's location and extent. Options include CO2 laser microsurgery under suspension laryngoscopy, laryngofissure with cordectomy, coronal laryngectomy, vertical hemilaryngectomy, horizontal hemilaryngectomy, 3/4 laryngectomy, subtotal laryngectomy, and total laryngectomy.

Can laryngeal cancer be treated without surgery?

Besides surgery, laryngeal cancer can also be treated with radiation therapy, combined radiotherapy and chemotherapy, or molecular targeted therapy, depending on the individual case.

How should early-stage laryngeal cancer be treated?

Common treatments for early-stage laryngeal cancer include CO2 laser microsurgery under suspension laryngoscopy. This procedure is minimally invasive, with short operation time, minimal bleeding, fewer complications, and faster recovery. Voice function recovery is good, though it may not fully restore pre-surgery vocal quality. Patients with high vocal demands may also consider radiation therapy.

Radiation therapy is another option for early-stage laryngeal cancer, with comparable efficacy to surgery.

How is CO2 laser microsurgery under suspension laryngoscopy performed?

This is a minimally invasive procedure. Under general anesthesia, a laryngoscope is inserted through the mouth to expose the larynx, and a CO2 laser is used to remove the tumor. The surgery is brief, causes minimal bleeding, and leaves no external neck incision, making it a common treatment for early-stage laryngeal cancer.

What is the treatment outcome for early-stage laryngeal cancer?

Early-stage laryngeal cancer has a favorable prognosis, with over 80% of patients surviving more than five years after surgery or radiation therapy alone. Post-treatment laryngeal function recovery is also generally good.

How should advanced laryngeal cancer be treated?

Advanced laryngeal cancer often requires a combination of two or more treatments, such as surgery, radiation therapy, targeted therapy, and chemotherapy. Single-modality treatment is less effective.

What evaluations or tests are needed before laryngeal cancer surgery?

Preoperative assessment includes evaluating the patient's overall health to ensure they can tolerate surgery. Tests may include blood work (e.g., complete blood count, liver/kidney function, coagulation, electrolytes), electrocardiogram, chest X-ray, and abdominal ultrasound to rule out heart, lung, or liver diseases. Patients over 60 may also need echocardiography and pulmonary function tests.

Additionally, laryngoscopy and neck CT scans are performed to assess the tumor, and a biopsy is taken to confirm malignancy.

What type of anesthesia is used for laryngeal cancer surgery?

General anesthesia with endotracheal intubation is typically used. A breathing tube is inserted into the trachea and connected to a ventilator, while medications render the patient unconscious. The tube is removed after surgery, and the patient is awakened.

Which laryngeal cancer patients are no longer candidates for surgery?

Surgery is no longer meaningful if the cancer has metastasized to distant organs (e.g., lungs, liver, bones), as complete tumor removal is impossible. Multidisciplinary palliative treatment should be considered instead.

What is multidisciplinary treatment for laryngeal cancer?

Multidisciplinary treatment (MDT) involves experts from ENT-head and neck surgery, radiology, pathology, radiation oncology, and oncology collaborating to create a personalized treatment plan. This may include surgery, radiation, targeted therapy, chemotherapy, or a combination.

What is the treatment outcome for advanced laryngeal cancer?

Advanced laryngeal cancer has a poor prognosis, with a 5-year survival rate of about 50–60%. Most deaths result from uncontrolled primary tumors or recurrence.

What happens if laryngeal cancer is left untreated?

Laryngeal cancer is a malignant tumor. Without treatment, it grows rapidly, causing hoarseness, coughing, and bloody sputum. It may obstruct the airway (leading to suffocation), cause fatal hemorrhage from tumor necrosis, or lead to multi-organ failure due to cancer cachexia.

Can laryngeal cancer recur after treatment? What should be done?

Laryngeal cancer is malignant, so even early-stage cases may recur. Regular follow-ups are crucial to detect and treat recurrences early.

DIET & LIFESTYLE

Can you still speak after laryngeal cancer surgery?

There are many types of laryngeal cancer surgeries. Most patients who undergo partial laryngectomy can still speak, while those who undergo total laryngectomy lose their ability to vocalize and speak.

How can total laryngectomy patients communicate if they cannot speak? What methods can help produce sound?

After total laryngectomy, the vocal function of the larynx is lost. Patients can learn esophageal speech through training, but not all patients can master this method. Additionally, they can use external electronic larynx devices, tracheoesophageal voice prostheses, or voice buttons to assist in sound production.

How does laryngeal cancer surgery affect daily life?

The impact of laryngeal cancer surgery on daily life varies depending on the extent of resection. Short-term postoperative complications may include wound bleeding or infection, while long-term effects may involve hoarseness, breathy voice, coughing, excessive phlegm, choking, difficulty eating, altered breathing pathways, loss of smell, changes in appearance due to a tracheostoma, or breathing difficulties caused by laryngeal or tracheal stenosis. Further treatment may be needed if the tumor recurs.

What details should family members pay attention to when caring for a patient after laryngeal cancer surgery?

After laryngeal cancer surgery, most patients can regain self-sufficiency and engage in light physical activities after a period of recovery, eliminating the need for dedicated family care. However, some patients may experience hoarseness or even lose their ability to speak, which can affect their confidence in social interactions and lead to frustration, irritability, or depression. Family members should provide timely emotional support, communication, and, if necessary, seek help from a psychologist.

Can laryngeal cancer patients still work?

Early and mid-stage laryngeal cancer patients have a chance of being cured with standardized treatment. After recovery, they can return to work, but heavy physical labor is not recommended.

What dietary precautions should laryngeal cancer patients take?

Laryngeal cancer patients should maintain a light diet, avoid greasy foods, and ensure adequate intake of protein, vitamins, and trace elements to achieve balanced nutrition and enhance immunity.

They should consume more fresh fruits and vegetables.

Fried, grilled, pickled, or overly hot foods should be avoided.

What lifestyle precautions should laryngeal cancer patients follow?

Laryngeal cancer patients should quit smoking and alcohol, avoid spicy foods, prevent excessive fatigue, maintain a positive mood and healthy habits, and engage in appropriate exercise to boost immunity.

PREVENTION

Can Laryngeal Cancer Be Prevented?

The exact cause of laryngeal cancer is not yet fully understood, so complete prevention is not possible.

However, excessive smoking and alcohol consumption should be avoided, as well as exposure to radiation and harmful substances. Patients with chronic laryngitis should avoid long-term consumption of irritating foods, and those with benign laryngeal lesions prone to malignancy should seek early treatment to remove the lesions.

When symptoms related to laryngeal cancer appear, especially in middle-aged and elderly male patients, prompt medical examination is essential to achieve early detection, diagnosis, and treatment.