Cancer of the Larynx

Symptoms

One of the commonest symptoms of laryngeal cancer is huskiness or hoarseness and therefore any long-term change in one’s voice should be investigated. Other symptoms are a change in the voice-pitch, the feeling of a lump in the throat, coughing, difficulty in breathing or swallowing and sometimes even ear-ache.

Diagnosis

The diagnosis is readily made by using a laryngeal mirror similar to that used by a dentist. At the same time, the presence of enlarged lymph nodes in the neck is looked for by the doctor. The malignant nature of the growth is confirmed by removing a sample of tissue for a biopsy.

Treatment

The treatment for a localised laryngeal growth is radiation therapy for which a six weeks’ course is usually given. During the latter half of the course, the patient will probably lose his or her voice, have a very sore throat and will find it difficult to swallow. But the voice returns and swallowing becomes easier within three to six weeks of completion of treatment. The results of radiation therapy for early carcinoma of the larynx are excellent.

For more advanced growth, surgery is sometimes used. There are two types of operation: the more limited one is called partial laryngectomy where only part of the larynx is removed, usually leaving a normal or only slightly hoarse voice. If it is necessary to remove all of the larynx, a total laryngectomy is performed and the upper air passage (trachea) is stitched to an opening in the skin (tracheostomy) so that air can pass through this to enter the lung. After operation the patient usually breathes through this opening rather than through the nose and mouth. Sometimes it is necessary also to remove enlarged lymph nodes in the neck called neck dissection. It is to these tissues and not to distant parts of the body that cancer of the larynx will spread.

After total laryngectomy the patient will have to learn to speak again by a technique known as oesophageal speech, which is produced by expelling swallowed air from the oesophagus. A great deal of training is necessary to acquire an oesophageal voice which will produce good quality speech and the method is best learned from a qualified speech therapist. There are mechanical devices, such as an artificial larynx, for those patients who are unable to learn the method. A mechanical larynx is a device that converts air motion into sound. It is held up to the hole in the neck that is left when the larynx is removed. Speech with this device is easy to understand but it has no normal inflections.

Although results of radiation treatment of early laryngeal cancer, a. already stated, are excellent, long-term cures after total laryngectomy for advanced growth are less good. All patients must attend for follow up examinations regularly, at first every three months and then a longer intervals.