Laryngeal and Hypopharyngeal Cancer

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Laryngeal and Hypopharyngeal Cancer

Larynx (Voice Box)

The larynx, commonly known as the voice box, is a tube-shaped organ located in the throat. It plays a key role in breathing, speaking, and swallowing. During respiration, the larynx acts like a valve, allowing air to flow from the throat to the lungs. When we speak, the vocal cords within the larynx vibrate to produce sound. The larynx also prevents food from entering the airway by closing the vocal folds and epiglottis during swallowing.

The larynx has three main sections:

1. Glottis: The part containing the vocal folds.

2. Supraglottis: The area above the vocal folds.

3. Subglottis: The part below the vocal folds that connects the larynx to the windpipe.

Hypopharynx

The hypopharynx is located just below the throat and surrounds the larynx. Cancer in this area can occur anywhere in the larynx or hypopharynx. About 95% of these cancers are squamous cell carcinomas. Laryngeal and hypopharyngeal cancers are significant types of head and neck cancers.

Statistics

In the United States, laryngeal cancer is the most common head and neck cancer. Approximately 12,380 people are diagnosed with laryngeal cancer annually, while hypopharyngeal cancer affects about 2,000 to 4,000 people per year.

Survival Rates

The five-year survival rate for laryngeal cancer is about 61%, while for hypopharyngeal cancer, it is 37%.

Risk Factors

Certain risk factors can increase the chances of developing laryngeal or hypopharyngeal cancer, although having these factors doesn’t necessarily mean a person will get cancer. The two main risk factors include:

1. Tobacco Use:

• Approximately 85% of head and neck cancers are related to tobacco use in various forms (cigarettes, cigars, chewing tobacco, etc.). Secondhand smoke and marijuana use also increase the risk.

2. Alcohol:

• Heavy alcohol consumption increases the risk of these cancers. The risk is especially high for people who use both alcohol and tobacco.

Additional Risk Factors:

Gender: Men are 4 to 5 times more likely than women to develop these cancers.

Age: Although it can occur in younger people, the risk is higher for those over 55.

Occupational Hazards: Exposure to asbestos, paint, wood dust, and certain chemicals increases the risk.

Nutritional Deficiency: A diet low in vitamins A and E may contribute to the development of these cancers.

Human Papillomavirus (HPV): Infection with HPV, especially through sexual contact, can lead to these cancers.

Prevention

The best way to prevent laryngeal and hypopharyngeal cancers is to stop using tobacco and alcohol. Vaccination against HPV (such as Gardasil) can prevent cancers caused by the virus.

Symptoms

Common symptoms of laryngeal or hypopharyngeal cancer include:

• Persistent changes in the voice lasting more than two weeks

• A lump in the neck or swollen lymph nodes

• Breathing difficulties

• Noisy breathing

• Constant throat discomfort

• Difficulty swallowing

• Ear pain

• Persistent bad breath

• Unexplained weight loss

• Fatigue

Diagnosis

1. Physical Examination:

• The doctor will feel the neck for lumps and check the throat for any visible abnormalities.

2. Laryngoscopy:

• There are three main types:

Indirect Laryngoscopy: A small mirror at the end of a tool is used to view the vocal folds.

Fiber Optic Laryngoscopy: A lighted scope is inserted through the nose or mouth to examine the vocal cords.

Direct Laryngoscopy: Performed under anesthesia, a laryngoscope is used to examine the area, and a biopsy may be taken.

3. Videostroboscopy:

• A fiber optic video technique that shows detailed motion abnormalities and vocal fold vibrations.

4. Biopsy:

• A small sample of tissue is taken from the suspicious area to be examined under a microscope to confirm if cancer is present.

5. Biomarker Testing:

• Molecular tests to detect specific genes or proteins in the cancer cells.

6. Imaging:

CT Scan, MRI, PET-CT, Bone Scan, Ultrasound, and X-rays may all be used to determine the extent of the cancer and its spread.

Treatment

Treatment for laryngeal and hypopharyngeal cancer depends on the stage of cancer and whether preserving the function of the larynx is possible. The three main types of treatment are surgery, radiation therapy, and chemotherapy.

1. Preserving Laryngeal Function:

• The primary goal is to treat the cancer while maintaining the function of the larynx. In early-stage cancers (T1 or T2), surgery or radiation can preserve laryngeal function. For T3 cancers, a combination of chemotherapy and radiation may be used. In advanced stages (T4), the entire larynx may need to be removed.

2. Radiation Therapy:

• High-energy radiation is used to destroy cancer cells. It can be given as a primary treatment, after surgery, or alongside chemotherapy (chemoradiation). Patients are advised to see a dentist before radiation to ensure no infections or damaged teeth are present. Side effects of radiation therapy include changes to the skin, dry mouth, nausea, fatigue, difficulty swallowing, voice changes, and loss of taste.

3. Surgery:

• Various surgical procedures are performed depending on the extent of the cancer:

Partial Laryngectomy: Only part of the larynx is removed, preserving the voice.

Total Laryngectomy: The entire larynx is removed, and a stoma (an opening) is created in the neck for breathing. The patient will not be able to speak after this surgery.

Laryngopharyngectomy: The larynx and part or all of the pharynx are removed. The pharynx may need reconstruction, and the patient will have difficulty swallowing.

Neck Dissection: If cancer has spread to the lymph nodes in the neck, these may also be removed.

4. Chemotherapy:

• Drugs are used to kill cancer cells. Chemotherapy can be given before surgery (neoadjuvant therapy) or in combination with radiation (chemoradiation). Side effects include nausea, vomiting, hair loss, loss of appetite, and fatigue.

5. Targeted Therapy:

• These drugs target specific proteins or genes in cancer cells. Cetuximab (Erbitux) may be used with radiation for advanced cancers or with chemotherapy.

6. Immunotherapy:

• Drugs such as Nivolumab (Opdivo) and Pembrolizumab (Keytruda) help the body’s immune system fight cancer.

Follow-Up Care

After treatment, regular follow-up is essential to monitor for recurrence and manage any side effects. This includes routine physical exams, blood tests, and imaging tests to ensure the cancer does not return.

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