Laryngeal cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs, or voice box cancer, is a cancer that develops in the lower portion of the throat. In adults, the most common form of laryngeal cancer is squamous cell carcinomacancer arising from tissues that line organs, which is a cancer arising from the squamous cellsthe basic structural and functional unit of all living things that line the larynx. In children, the most common form of laryngeal cancer is a rhabdomyosarcoma, which is a type of sarcomacancer arising from bones and/or soft tissue that develops in muscles that are attached to bones.
The larynx/voice box is the entry point to the tracheathe tube that connects your voicebox (larynx) to the lungs, also known as a windpipe, and contains the vocal cords that allow us to speak. It consists of three main sections: the supraglottis, glottis and subglottis. The supraglottis is the top portion of the larynx, and provides a protective flap over the trachea that prevents foreign material, such as food, from entering the lungs. The middle portion, the glottis, contains the vocal cords that vibrate when air passes through and produces the voice. The bottom portion of the larynx is the subglottis, which provides passage to the trachea.
Laryngeal cancer is most commonly diagnosed in males, and is often diagnosed after the age of 55. However, anyone can get this disease.
Types of Laryngeal Cancer
There are several types of laryngeal cancer, which are categorised by the types of cells the cancer develops from.
Squamous Cell Carcinoma (SCC)
Squamous cell carcinomas (SCCs) are the most common form of laryngeal cancer in adults, and develops from the squamous cells that line the larynx. SCCs of the larynx can be aggressive, but can have a good prognosisto predict how a disease/condition may progress and what the outcome might be. These tumours can be subcategorised into the part of the larynx they develop in.
Supraglottic Squamous Cell Carcinoma
Supraglottic SCCs are a less common subtype of laryngeal SCCs, and develop in the top portion of the larynx (supraglottis). Tumours that develop here (as well as their treatment) can adversely affect speech, swallowing, and/or breathing abilities. These cancers can be aggressive, are likely to metastasise early (notably to lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid in the cervical spine), and may not have as good of a prognosis as other types of laryngeal SCCs.
A very rare variant of SCC, called basaloid SCC (BSCC), has a predilection to develop in the supraglottis. BSCC is very aggressive, and is often associated with a less favourable prognosis than other subtypes.
Glottic Squamous Cell Carcinoma
Glottic SCCs are the most common subtype of laryngeal SCCs that develop in the middle portion of the larynx (glottis). Tumours that develop here (as well as their treatment) can adversely affect speech, swallowing, and/or breathing abilities. Unlike supraglottic SCCs, glottic SCCs rarely metastasise due to the poor lymphatic drainage in this area. Glottic SCCs can be less aggressive, and can have a good prognosis.
Subglottic Squamous Cell Carcinoma
Subglottic SCCs are the rarest subtype of laryngeal SCCs that develop in the bottom portion of the larynx (subglottis). Tumours that develop here often produce minimal (if any) symptoms, often leading to a delayed diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and an advancedat a late stage, far along stage of disease at diagnosis. These cancers can be aggressive, are likely to metastasise early (notably to nearby lymph nodes), and may not have as good of a prognosis as other types of laryngeal SCCs.
Transglottic Squamous Cell Carcinoma
Transglottic SCCs are the rarest subtype of laryngeal cancers, and occur when the tumoura tissue mass that forms from groups of unhealthy cells is in two portions of the larynx. This type of cancer always involves the glottis, and can also affect either the supraglottis or subglottis. There has been limited research done into the aggressiveness and prognosis of this subtype.
Minor Salivary Gland Cancer
Salivary glands are responsible for the production of saliva, which is a fluid that aids in digestion, prevents your mouth from becoming too dry and supports healthy teeth. Humans have three pairs of major salivary glands behind the jaw, as well as several minor salivary glands found in the lips, cheeks, mouth, and throat. The minor salivary glands in the throat are found under the lining of the larynx and hypopharynx.
For more information on salivary gland cancers, please refer to the Rare Cancers Australia Salivary Gland Cancers page.
Laryngeal Papillomas
Laryngeal papillomas are the most common type of laryngeal tumour in children, and are often benignnot cancerous, can grow but will not spread to other body parts. They are generally considered low gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells tumours, as they often develop slowly and rarely metastasise. Laryngeal papillomas often have a good prognosis.
Sarcomas
Laryngeal sarcomas are a less common type of laryngeal cancer that develops from the soft connective tissues that help give the larynx its shape. These cancers can be aggressive and can metastasise, however they can have a good prognosis. Types of sarcomas associated with laryngeal cancer include:
Rare types of Laryngeal Cancer
These types of laryngeal cancer are very rare:
- Basloid squamous cell carcinomas (BSCCs) (a rare variant of SCCs).
- Lymphomas.
- Melanomas (mucosal).
- Neuroendocrine tumours.
- Plasmacytomas.
- Sarcomatoid carcinoma (a tumour that has parts of both carcinomas and sarcomas).
- Verrucous carcinomas (a rare variant of SCCs).
Treatment
If laryngeal cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodes.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health. In adult patients, your tumour will be staged and graded to help determine the best treatment option for you. There is currently no standard staging system for children with laryngeal cancer.
The treatment options for adults and children with laryngeal cancer are similar. These options may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Laser therapya procedure that uses an infrared laser to raise the temperature of the tumour to shrink and damage cancer cells.
- Laryngectomycomplete or partial removal of the larynx.
- Thyroidectomycomplete or partial removal of the thyroid gland.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Targeted therapymedication that targets specific molecular features of cancer cells.
- Immunotherapya treatment that uses a person's immune system to fight cancer.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
- Smoking tobacco.
- Drinking alcohol.
- Infectiona condition where harmful pathogens, such as bacteria, viruses or parasites, have entered the body with the human papillomavirus (HPV).
- Exposure to hazardous chemicals.
- Having a weakened immune system.
- Having a family history of laryngeal cancer.
Not everyone with these riskthe possibility that something bad will happen factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
Potential symptoms of laryngeal cancers include:
- Changes in the voice, such as an unusual hoarseness.
- Persistent sore throat.
- Difficulty and/or painful swallowing.
- Persistent cough.
- Dyspneadifficulty breathing, shortness of breath.
- Unexplained weight loss.
- Pain in the ear.
Not everyone with the symptoms above will have cancer, but see your GP if you are concerned.
Diagnosis
If your doctor suspects you have laryngeal cancer, they may order the following tests to confirm the diagnosis and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- PET (positron emission tomography) scana type of medical imaging that uses radioactive tracers to create detailed images of the body.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Exploratory surgeryan exploratory surgical procedure used for conditions that cannot be confirmed by scans and tests alone, potentially including:
- Endoscopya procedure that involves inserting a long, flexible tube with a light and small camera (endoscope) into the body to view internal organs.
- Laryngoscopy/Microlaryngoscopyexamination of the larynx with a small, flexible instrument known as a laryngoscope.
- Biopsyremoval of a section of tissue to analyse for cancer cells.