Unlocking the Mystery of Laryngeal Cancer: From the Beginning to Recovery

By Dr. Shama Shetty, Consultant ENT and Head and Neck Oncology, SPARSH Hospital, Yelahanka, Bengaluru

Getting to Know Your Voice’s Guardian

Let’s talk about the larynx – our voice’s defender, tucked in our neck, making sure we can talk, breathe, and swallow easily. But what if the dark clouds of laryngeal carcinoma disturb this balance? There are a few things you must know if any situation arises like this.

Larynx has three parts – the upper supraglottis, the middle glottis, and the lower subglottis. Laryngeal cancer? It’s a tricky character, with glottic cancer stealing the spotlight at 50%, supraglottic at 45%, and subglottic playing a mysterious role at 5%.
Predominantly observed in individuals aged 40-70 years, it exhibits a higher prevalence among males, with an increasing incidence in females attributed to rising smoking rates. 

The Culprits: Un the Risk factors

In the mysterious tale of laryngeal cancer, risk factors play a vital role. Tobacco, the main troublemaker, poses a significant threat, especially for cigarette smokers. Excessive alcohol consumption, encounters with workplace toxins like asbestos, paint, plastic radiation, and a history of acid reflux, and the plot thickens. Exploring these risk factors is crucial in developing preventive strategies and raising awareness

Early Detection: A Vital Component of Recovery 

Understanding the subtle indicators of laryngeal carcinoma is crucial for early identification. Supraglottic cancer might start with feeling of a foreign object in the throat, throat pain, difficulty swallowing or neck swelling. Glottic involvement can present with hoarseness whereas Subglottic cancers present with stridor. Additional presentations might include a lingering cough, and referred ear pain. Recognizing these signs and seeking prompt medical attention can significantly impact the success of treatment.

Diagnosis: Why Precision Matters 

In the diagnostic theatre, precision steals the spotlight. CT scans, MRIs, and laryngoscopies take centre stage. An Examination Under Anesthesia is like an encore for a comprehensive diagnosis. A biopsy performed on suspicious lesions confirms the presence of cancer. Speech and Swallowing Evaluation is imperative to gauge the impact of laryngeal cancer and its treatment on essential functions such as eating, speaking, and swallowing. Each of these diagnostic elements plays a crucial role in both diagnosing and developing a tailored treatment plan. 

Precision in Treatment: Tailoring Approaches to Individuals 

Recent strides in medical research has shattered the one-size-fits-all approach. Personalized treatments, like bespoke suits, consider the cancer stage, location, patients general health and their preferences. A multidisciplinary team including oncologists, radiologists, speech therapists, nutritionists, and mental health professionals is essential to maximize cure and provide good quality of life.

Early stage cancers-  a single modality treatment with Transoral Microscopic Laser Resection (TOLR), radiotherapy or partial laryngectomy are the options. The choice depends on the patient’s general condition, performance status, profession, and the expertise of the surgeon. Intermediate-stage cancers, where laryngeal function is still preserved, often undergo organ preservation chemoradiotherapy. If the patient is unfit for chemoradiotherapy, surgery is considered. In advanced cancers, total laryngectomy, involving the removal of the entire voice box, is performed, followed by adjuvant treatment and postoperative voice rehabilitation. 

Neck dissection (removal of lymph nodes around the tumor) is contingent on the subsite and stage of the tumor.

Regular follow-ups and supportive care are crucial components to enhance the patient’s overall well-being throughout the treatment journey.

Life After Cancer: The Rehabilitation Journey

Surviving laryngeal cancer extends beyond overcoming the disease; it involves reclaiming life post-treatment. Rehabilitation programs, which encompass speech therapy and swallowing exercises, are crucial in assisting individuals in regaining their voice and adjusting to any changes in their communication and swallowing abilities. Psychological support also plays an integral role in addressing challenges that may arise during the recovery process.

Voice rehabilitation methods include Esophageal speech, Electro larynx, TEP (Tracheo-oesophageal puncture) with voice prosthesis. Each method has its own set of advantages and disadvantages, with TEP prosthesis offering the best speech compared to the others. Speech and language pathologists play a pivotal role in guiding and supporting individuals through the voice rehabilitation process.

Raising Awareness: A Collective Responsibility

Understanding the nuances of laryngeal cancer becomes a powerful tool. The more informed individuals are, the better equipped they are to take charge of their health. From educating the public about risk factors, symptoms, promoting regular screenings to embracing innovative treatments and rehabilitation, a holistic approach ensures that individuals facing this diagnosis can navigate the complexities with resilience and hope.