Larynx or voice box cancer
How common is it?
Cancers of the larynx (voice box) are the seventh most common cancer in Indian males. It also affects females but not as commonly. It is estimated that there are over 30,000 new cases of laryngeal cancer occurring in India each year.
What are the symptoms?
Some of the symptoms are change in voice quality or hoarseness, a feeling of having a lump in the throat, difficulty or pain swallowing, coughing when eating or drinking water, cough with blood in the sputum, a lump in the neck or difficulty breathing. Any of these symptoms lasting over two weeks need evaluation by a doctor.
What causes it?
The common causes are cigarette or beedi smoking, indoor air pollution, alcohol intake, and poor diet/nutrition. With the explosion of pollution because of vehicle exhaust and industrial smoke, it is expected that the incidence of laryngeal cancers will increase in time.
How do you diagnose it?
Evaluation of the larynx requires an endoscopy, which is a small camera to look at the voice box that is placed in either the mouth or the nose. Tumours of the hypopharynx (the junction between the voice box and the upper food pipe) may require an endoscopy of the food pipe and stomach to see. The diagnosis involves two parts. The first is a biopsy of the tumour (generally done under short general anaesthesia for visualization and biopsy), which determines which type of cancer you have. The second is imaging, either CT scan, MRI, PET or a chest X-ray in various combinations to determine the stage of the tumour and how far it has spread. Both of these will help determine what the best treatment plan is for you.
How do you treat it?
Rather than a single cancer, these are a diverse group of cancers. The way they are treated and how aggressive they are vary significantly. The goal of treatment in this group of cancers is organ preservation – treating the cancer while maintaining voice and swallowing. Most often this involves radiotherapy with or without chemotherapy. Very early vocal cord cancers are also treated well with laser surgery. However when tumours are advanced and there is destruction of the framework of the voice box (laryngeal cartilage), organ preservation is no longer as an option as voice and swallowing are already or soon to be irreversibly disrupted; in these patients surgical removal of the voice box is the best chance of cure along with restoration of swallowing and speech (through an electrolarynx or speech valve). This is also the most common treatment choice in laryngeal cancers that have recurred after treatment.
Is it curable?
Depending on the part of the larynx where the tumour arises, cure rates vary. Early vocal cord cancers have around 95% survival while early hypopharynx cancers have over 80% survival at 5 years. Advanced tumours have a 33-45% survival at 5 years. However each patient is different; it does not mean that patients with advanced disease do not survive. To maximize chances of survival, early diagnosis and appropriate and complete treatment from qualified specialists are of vital importance. Cancers that are early at presentation have the highest likelihood of being cured along with the least treatment-related impact on voice, swallowing, social functioning and other factors.
What does the road to recovery look like?
The extent of your treatment will determine how long it takes you to recover. Radiotherapy for an early tumour may take two weeks to recover from while a major surgery following by radiotherapy and chemotherapy may take months to completely recover from. It is important to think of your treatment as a marathon rather than a sprint, and take help from those around you, whether they are medical professionals, or friends and family. The team involved in your rehabilitation may include the speech and swallowing therapist, the dental team, the physical therapist and the pain specialists. Follow-up after treatment is crucial – this is to not only assess your recovery, but also to check for recurrence or to identify new tumours (this can happen in 5-15% of patients).